Baran Sarikaya

Injury of the infrapatellar branch of the saphenous nerve due to hamstring graft harvest: A prospective comparative study of two different incisions

Purpose: Sensory disturbance around the surgical incision due to injury of the infrapatellar branch of the saphenous nerve can be seen in the anterior cruciate ligament reconstruction. In this research, we aimed to compare the incidence, extent of sensory loss, its clinical effect, and natural course caused by two different skin incisions used for hamstring graft harvest. Methods: Vertical incision for 36 patients and oblique incision for 42 patients used for graft harvest were included in this study. Sensory loss areas were documented at 6th week, 3rd month and 6th month. Pin prick examination is used to detect the change in sensation. Digital photographs of hypaesthesia were taken and analysed by computer for area detection. The length of incision and subjective complain of sensory loss were also noted. Results: At 6th month, 77% (28/36) of the vertical incisions were associated with persistent sensory loss when compared to the oblique incision (45%, 19/42). The measured area of hypaesthesia was significantly higher in vertical incision (42.4 ± 22.3 cm2) than that in oblique incision (9.3 ± 15.3 cm2) at 6th month. The area of hypaesthesia gradually shrunk in size from distal to proximal in direction. Also, subjective cutaneous anaesthesia was higher in vertical incision (15/36, 41%) than oblique incision (6/41, 14%) at 6th month. Conclusion: Oblique incision with less risk of nerve damage is better for graft harvesting. Area of hypaesthesia gradually reduces with time and even recover totally. As a possible complication, nerve injury and its benign prognosis should be explained to the patient before surgery.

Endoscopically Assisted Resection of a Rare Mass: Intra-Articular Osteochondroma of Shoulder Originated from Scapula

Osteochondromas are the most common benign bone tumors which are mostly seen in the metaphysis of distal femur, proximal tibia, and proximal humerus. As arising from flat bones such as scapula is a rare case, intra-articular osteochondroma is also rare. When the literature is searched it appeared that the scapula and shoulder joint are an uncommon site for osteochondroma. We present a case in which a patient had an osteochondroma placed in shoulder joint and originated from scapula which is a rare situation determined in the literature.

A Surgical Opinion in a 36-Week Pregnant with Tibia Fracture: Intramedullary Nailing

The operative treatment of tibial fractures in late pregnancy is a controversial issue that is rarely discussed in the literature. Here we present a case of a tibial diaphyseal fracture in a woman that was 36 weeks pregnant, which was treated with intramedullary nails under noninvasive foetal monitoring with cardiotocography. The patient underwent a successful surgery, and no harm or adverse events to either the mother or the foetus were reported during or after the procedure. Following surgery, the mother had a comfortable pregnancy and a normal spontaneous vaginal delivery with a healthy newborn.

İzole Tip 2 Slap Lezyonu Nedeniyle Artroskopik Tamir Uygulanan Hastaların Kısa Dönem Klinik Sonuçlarının Değerlendirilmesi

Amac: Bu calismada, izole tip 2 superiorlabrumanteriorposterior (SLAP) lezyonu nedeniyle artroskopik SLAP tamiri uygulanan hastalarinkisa donem kliniksonuclarinin degerlendirilmesi amaclandi. Yontemler: Konservatif tedaviye cevap vermeyenve izole tip 2 SLAPlezyonu olan hastalar retrospektif olarak degerlendirildi. Hastalar klinik olarak Constant-Murleyskorlama sistemive vizuel analog skala (VAS) sistemine gore degerlendirildi. Ameliyattan once ve son takiptehastalarin aktif ve pasifeklem hareket acikliklari olculdu. Bulgular:Toplam 19 hasta degerlendirildi. Hastalarin 15’ierkek 4’u ise kadindi. Ortalama yas31.5(23-45)olarak tespit edildi. Ortalama takip suresi 16.8ay (8-26) idi. Ameliyat oncesi Constant-Murleyskorlari ortalama57 (40-71 )iken; son takipte ortalama 81 ( 66- 98) olarak saptandi. VAS degerleri ameliyat oncesi7 (6-9) iken;son takipte 2 (0- 5) olarak tespit edildi. Her iki skorlama sisteminde de ameliyat oncesi doneme kiyasla son takiplerde istatistiksel olarakanlamli degisiklikler saptandi (p < 0.001). Sonuc:Izole tip 2 SLAPlezyonu nedeniyle artroskopik SLAP tamiri uygulananhastalarda,kisa donemde klinik acidan tatmin edici sonuclar elde edilebilmektedir.

Biomechanical Evaluation of a Novel Apatite-Wollastonite Ceramic Cage Design for Lumbar Interbody Fusion: A Finite Element Model Study

Objectives Cage design and material properties play a crucial role in the long-term results, since interbody fusions using intervertebral cages have become one of the basic procedures in spinal surgery. Our aim is to design a novel Apatite-Wollastonite interbody fusion cage and evaluate its biomechanical behavior in silico in a segmental spinal model. Materials and Methods Mechanical properties for the Apatite-Wollastonite bioceramic cages were obtained by fitting finite element results to the experimental compression behavior of a cage prototype. The prototype was made from hydroxyapatite, pseudowollastonite, and frit by sintering. The elastic modulus of the material was found to be 32 GPa. Three intact lumbar vertebral segments were modelled with the ANSYS 12.0.1 software and this model was modified to simulate a Posterior Lumbar Interbody Fusion. Four cage designs in different geometries were analyzed in silico under axial loading, flexion, extension, and lateral bending. Results The K2 design had the best overall biomechanical performance for the loads considered. Maximum cage stress recorded was 36.7 MPa in compression after a flexion load, which was within the biomechanical limits of the cage. Conclusion Biomechanical analyses suggest that K2 bioceramic cage is an optimal design and reveals essential material properties for a stable interbody fusion.

Comparision of the expandable nail with locked nail in the treatment of closed diaphyseal fractures of femur

Background: Expandable nails achieve stability only by hydraulic expansion; therefore suggest less radiation exposure and operation time. In this study, we aimed to compare the results of expandable femoral nails with locked intramedullary nails in the treatment of diaphyseal fractures of femur. Materials and Methods: Isolated closed AO = Arbeitsgemeinschaft für Osteosynthesefragen type 32.A or 32.B unilateral femoral shaft fractures operated with expandable or locked nail were evaluated retrospectively. We match patients who undergone expandable nail fixation with patients of the same-sex, age, and fracture type who undergone locked nailing. A match was done for 31 expandable nail. At follow up, healing was assessed radiologically and clinically. Outcome measures included duration of hospital stay, time taken to achieve bony union, and participation in full activities. Results: The average duration of surgery in the expandable group was 60.9 min and in the locked group was 82.4 min. In the expandable group, the average clinical healing time was 15.5 weeks and radiographic healing time was 21.7 weeks. In the locked IMN group, the average clinical healing time was 18.4 weeks and the average radiographic healing time was 24.1 weeks. We observed seven (22.6%) non-union in expandable group and four (12.9%) non-union in locked group. In the expandable group, type of the fracture was AO 32.B in all of the non-union patients. We achieved union in all of non-unions of the locked group only with dynamization. In the expandable IMN group, five (16.1%) patients required major surgery, in the locked group none of the patients required major surgery. Conclusion: Non-union rate of the expandable nail is higher than that of the locked nail for femoral diaphyseal fractures. It may be a treatment option in simple fractures like AO 32.A and in patients where rapid fixation is demanded. It has advantages of reduced operative time and less radiation exposure in comparison with reported series of conventional nails.

Evaluation of short-term clinical outcomes of subacromial impingement patients with performed arthroscopic subacromial decompression -

Aim: In this study, it was aimed to evaluate short-term clinical outcomes of arthroscopic subacromial decompression procedure which was performed on patients who had subacromial impingement syndrome and did not respond to conservative treatment. Materials Methods: Patients who did not have any shoulder disorder including rotator cuff rupture or capsulolabral pathologies, but subacromial impingement syndrome were evaluated retrospectively. The patients were evaluated clinically according to the Constant-Murley scoring system and visual analog scale (VAS). Active and passive ranges of motion of the joint of the patients were evaluated both preoperatively and at the final follow-up. Results: A total of 64 patients were evaluated. Of the patients; 22 were male and 42 were female and 54 (29-77) was determined to be the mean age. Mean follow-up duration was 17.4 months (7-25 months). The preoperative mean Constant-Murley score was 52 (36-79), whereas it was determined to be a mean of 79 (48-98) at the final follow-up. VAS was determined to be 7.2 (5-9) preoperatively, whereas it was determined to be 2 (0-5) at the final follow-up. Statistically significant differences were determined for both scoring systems at the final follow-up compared with the preoperative period (p

The early radiological effects of Dega and Pemberton osteotomies on hip development in children aged 4–8 years with developmental dysplasia of the hip

We aimed to investigate the early radiological effects of Dega and Pemberton iliac osteotomies that were performed in patients aged 4–8 years with developmental dysplasia of the hip on development of hip joint. Dega osteotomy or Pemberton osteotomy was performed in 76 hips of 58 patients because of developmental dysplasia of the hip between September 2011 and June 2015 and were evaluated retrospectively. Of a total of 76 hips, Pemberton osteotomy was performed on 39 (19 unilateral) and Dega osteotomy was performed on 37 (21 unilateral). In all hips, the acetabular index, acetabular depth ratio, centre-edge angle of Wiberg, and Reimer’s index values were recorded preoperatively and at the final follow-up. We measured the surface areas of the femoral head ossific nucleus in patients with unilateral dysplastic hips and compared results before both osteotomy procedures and at the final follow-up. There were no statistically significant differences between the groups in terms of the acetabular index and acetabular depth ratio values (P>0.05) preoperatively and at the final follow-up, but the mean centre-edge angle of Wiberg and Reimer’s index values showed significant statistical differences in favor of the Dega procedure (P<0.05). There was a statistically significant difference in favor of the Pemberton procedure when the mean ratio of the surface area of the femoral head ossific nucleus on the dysplastic side in relation to the normal side was compared preoperatively (P=0.042) and at the final follow-up (P=0.027) in unilateral hips. Although Dega and Pemberton osteotomies produce satisfactory radiological outcomes at early stages in children aged 4–8 years with developmental dysplasia of the hip, a higher rate in the surface area of the femoral head ossific nucleus was observed in the Pemberton osteotomy group, which also had a lower mean age than the Dega osteotomy group.

Anatomical single bundle anterior cruciate ligament reconstruction with three portal technique /Üçlü portal teknik ile anatomik tek bant ön çapraz bağ rekonstrüksiyonu

Objective: Anatomic reconstruction of anterior cruciate ligament is becoming more important as the knee anatomy and biomechanics are being understood much more. In order to place femoral tunnel at its original point, it should be drilled from another porta which is more medial instead of from tibial tunnel. In this article we aimed to present clinical and radiologic results of ACL reconstructions that we placed femoral tunnel from a third anteromedial portal. Material and methods: The study included 43 patients (four female, 39 males; mean age 29.3 years; range 18 to 42) with ACL injury. ACL reconstruction was performed to all of the patients with the three portal anatomic single bundle technique using hamstring autograft. Preoperative and postoperative clinical evaluation was done by Lysholm knee score, Tegner activity score, International Knee Documentation Committee (IKDC) score. Anteroposterior instability evaluation was done by anterior drawer and pivot shift tests. Results: According to IKDC score, preoperatively 22 patients were D (51%) and 21 were C (49%) and postoperatively 33 were A (%76), 10 were B (%23) and 1 was C (%2). Preoperative mean Lysholm knee score was 54,87 (45-66) and increased to 89,86 (59-99) at the last control. Tegner activity score was 4,70 preoperatively and 5,22 postoperatively. Conclusion: In ACL reconstruction, restoring knee biomechanics is possible by placing graft near normal anatomy. As defined for this purpose, three portal technique can place tibial and femoral tunnel as anatomic as possible. This technique is an applicable technique with good results.