Barış Yılmaz

Injuries associated with motorcycle accidents

OBJECTIVES In recent years, there has been a significant increase in motorcycle accidents in parallel with the increasing number of motorcyclists. Data on motorcycle accidents/injuries are relatively limited in Turkey. This study sought to determine the injury profile of patients involved in motorcycle accidents. METHODS This retrospective study included 212 patients (204 males, 8 females; mean age 36+/-16 years; range 2 to 79 years) who were hospitalized for injuries caused by motorcycle accidents. Data on age and sex, injury patterns, length of hospitalization were recorded. Injuries were grouped according to localization. RESULTS The frequencies of injuries in descending order were as follows: musculoskeletal system injuries (n=106, 50%), skull injuries (n=103, 48.6%), maxillofacial injuries (n=38, 17.9%), thoracic (n=15, 7.1%), vertebral (n=10, 4.7%), and abdominal (n=6, 2.8%) injuries. Multiple fractures in upper and lower extremities were seen in 17 (8%) and 43 (20.3%) patients, respectively. The most frequent extremity injuries were tibia-fibula fractures (17.9%) followed by shoulder injuries (11.3%). Both extremity and skull injuries were seen in 23 patients (10.9%). The mean hospital stay was 12.2+/-16.8 days (range 1 to 150 days). Eight patients required intensive care for a mean of seven days. As a complication, one patient (0.5%) with olecranon and tibial plateau fractures developed pulmonary embolism. Motorcycle accidents resulted in mortality in nine patients (4.3%). CONCLUSION Since motorcycle accidents are preventable or associated risks for injuries are reducible, risk factors for our country should be determined, necessary laws and restrictive regulations should be put into practice, and educational programs should be implemented.

Serum and knee synovial fluid matrixmetalloproteinase-13 and tumor necrosis factor-alpha levels in patients with late stage osteoarthritis

Objective To compare the levels of MMP-13 and TNF-α in late stage osteoarthritis, define their predominant pathways and investigate their correlation with McMaster Universities Arthritis Index scores. Patients and methods A total of 42 patients (mean age 64 ± 8.8) with grade 3 and grade 4 knee osteoarthritis according to Kellegren- Lawrence criteria and who were scheduled for total knee arthroplasty were enrolled in the study. TNF-alpha and MMP-13 levels were measured preoperatively from venous blood samples and intraoperatively from knee synovial fluid via ELISA. Preoperative and 1 month postoperative knee functions were assessed by McMaster Universities Arthritis Index. Results Grade 4 synovial fluid MMP-13 (4.76 ± 5.82) was elevated compared to grade 3 (3.95 ± 4.45) (p = 0.438), whereas grade 3 serum MMP-13 (1.128 ± 0.308) was found elevated compared to grade 4 (1.038 ± 0.204) (p = 0.430). Grade 4 serum TNF-α (0.253 ± 0.277) was elevated compared to grade 3 (0.206 ± 0.219) whereas grade 3 synovial fluid TNF-α (0.129 ± 0.052) was elevated compared to grade 4 (0.118 ± 0.014). Positive correlation was observed between synovial fluid MMP-13 levels and postoperative WOMAC scores. Mean serum TNF-α level (0.226 ± 0.246 pg/ml) was found higher compared to synovial level (0.124 ± 1.59), synovial MMP-13 level (4.31 ± 1.24) was found higher compared to serum level (1.089 ± 1.519). Conclusion Despite the systemic increase in TNF-α levels concordant with osteoarthritis grade, MMP-13 levels are elevated via local manner with a significant correlation with WOMAC scores. Level of evidence Level IV, Diagnostic study.

Major Extremity Injuries Associated with Farmyard Accidents

Background. The aim of the study is to analyze the major agricultural injuries related to the extremities. Patients. We evaluated a 3-year period including 41 patients. Data on age, sex, injury patterns, anatomical localizations, injury season, length of stay in the hospital, and infections were evaluated, and the patients were examined with SF-36 in the follow-up period. Results. Hand was the most commonly injured part (n: 9) followed by the distal part of the lower limb (cruris) (n: 7) and foot (n: 7). Mean time between trauma and emergency-department arrival was 115 minutes (60–360). Mean length of stay was 24 days (4–150), and mean number of operations during hospitalization was 2.4 (1–30). Deep wound infection was seen in 8 patients. Seasonal distribution for accidents was even for spring and fall (27% each), high for summer (36%), and less for winter (10%). Conclusions. Distal parts of the elbow and knee were affected more frequently. Due to the high microbiological load and high incidence of crush-type injuries, repetitive debridements and long duration of hospital stay were needed. Attention should be paid in the harvesting times to the farmyard injuries. Due to the seasonal variation, more resources should be allocated to treat the increasing incidence of injury over the period from spring to fall.

Ten-year follow-up results of posterior instrumentation without fusion for traumatic thoracic and lumbar spine fractures

BACKGROUND This retrospective study aims to present and evaluate the long follow-up results of posterior instrumentation without fusion in patients with traumatic thoracic and lumbar fractures. METHODS 45 patients were operated. The mean follow-up period was 147.6 months. Sagittal plane kyphosis (SPK) and anterior wedge angle (AWA) were evaluated in preoperative and follow-up. RESULTS SPK and AWA improved significantly in the early postoperative. However, the correction was lost in the 10-year follow-up. The loss of correction was statistically significant in SPK and AWA. CONCLUSION Posterior instrumentation without fusion is still among the most useful in treatment of traumatic thoracolumbar fractures.

Open Reduction and Internal Fixation of the Isolated Tibial Lateral Plateau Posterior Fracture Using Direct Posterior Split Gastrocnemius Approach

Open reduction and internal fixation of the isolated tibial lateral plateau posterior fractures using direct posterior split gastrocnemius approach is a safe and effective method.

Brucellosis Suspicion is the Most Important Criterion for Diagnosis Particularly in Endemic Regions.

Introduction: Brucellosis is a zoonotic infectious disease that remains endemic in developing countries. The purpose of this study is to emphasize the need for considering brucellosis as a diagnosis, since this disease has a high risk of complications among young patients when not treated appropriately. Methodology: A total of 88 brucellosis cases with blood cultures that were positive for the pathogen were evaluated retrospectively in this study. Results: The patients included 33 males (37.5%) and 55 females (62.5%) with a median age of 8.9 years (range: 5-14 years). A total of 43.1% (n=38) of the cases included occupational exposure to animals as a possible infection source. The consumption of raw milk products, especially cheese, was present in 52.2% (n=46) of the cases. Clinically, 55 of the cases were acute (62.5%), 23 of the cases were subacute (26.2%) and 10 of the cases were chronic (11.3%). The distribution of the joint pain complaints was as follows: 62.5% (n=55) of patients reported hip pain, 22.7% (n=20) of patients reported knee pain, 11.4% (n=10) of patients reported lumbar-back pain and 3.4% (n=3) of patients reported pain in other joints. A total of 59.1% (n=52) of the cases had been examined by another doctor at least once and mistreated. Conclusion: Complication rates and the rate of chronic infection increase with delayed diagnosis, and clinical doubt is the most important criterion for diagnosis, particularly in endemic regions.

Impact of Alprazolam on Comorbid Pain and Knee Functions in Total Knee Arthroplasty Patients Diagnosed with Anxiety and Depression.

Purpose: Studies report 19-33% postoperative moderate-severe pain and dissatisfaction in uncomplicated total knee arthroplasty (TKA), even after 1 year. High rates of undiagnosed depression and anxiety may have a strong impact on these unfavourable outcomes. Here we aimed to investigate the efficacy of alprazolam on postoperative analgesic use and knee functions. Methods: Seventy-six patients with a mean age of 65 ± 9.3 years (range 46-80) diagnosed with mild-moderate anxiety or depression according to the Hamilton anxiety scale (HAS) and Beck Depression Inventory (BDI) that underwent TKA were evaluated in the study. Group 1 patients were subjected to alprazolam treatment in addition to an analgesic/antiinflammatory drug, whereas Group 2 consisted of patients receiving only the standard postoperative pain management protocol. Visual analog scale (VAS) and postoperative analgesic use (g/day) were calculated to evaluate the magnitude of pain experienced. Preoperative and postoperative knee functions were assessed from the patients’ Knee Society Score and Knee Society Functional Score records. Results: A positive correlation was found between the preoperative HAS, BDI, and total postoperative analgesic use in both groups. Although the decrease in VAS was significant in both groups, postoperative analgesic need (4.25 ± 0.30 g) in Group 1 was less compared to Group 2 (4.81 ± 0.41 g) (p=0.01). The mean change in postoperative (1 month) Knee Society Score and Knee Society Functional Score were also significantly improved in Group1 compared to Group 2. Conclusion: Alprazolam can reduce postoperative analgesic use and improve knee functions by reducing the pain threshold, and enhancing overall mood via its antidepressive and anxiolytic properties in patients undergoing TKA diagnosed with mild-moderate anxiety/depression.

Ankle arthroplasty in a patient with bleeding diathesis and the mid-term clinical outcome of the case

Purpose The purpose of this report was to present the case of a patient with bleeding diathesis on whom we performed ankle arthroplasty for the first time. Materials and methods A 29-year old male patient with bleeding diathesis, who had been treated and followed up over a long period, underwent ankle arthroplasty because of osteoarthritis of the ankle. The patient was prepared for surgery by the haematology department in accordance with the guidelines for surgical preparation, diagnosis and management of haemophilia. After ankle arthroplasty was performed, the preoperative and two-year postoperative clinical outcomes were evaluated using a subjective foot score and Maryland foot score. Results Preoperative factor VIII levels were raised to the target level of haemostasis prior to the surgical procedure. The factor VIII levels were maintained within the normal range up to postoperative day 14. The subjective foot score of the patient was 40 preoperatively and 85 postoperatively, whereas their Maryland foot scores were 33 preoperatively and 90 postoperatively. Both scoring systems indicate an excellent clinical outcome. Conclusion As observed, the early and mid-term functional outcomes are promising for patients with bleeding diathesis who undergo ankle arthroplasty.

Lunatum excision and scaphocapitate arthrodesis in Kienböck’s disease

Purpose: The aim of this study was to compare functional results before and after lunatum excision and scaphocapitate arthrodesis (SCA) using an angular stable circular plate in patients with Lichtman’s stage IIIB Kienböck’s disease. Methods: The study included nine patients (six females and three males) with a mean age of 33.2 ± 11 years (range: 18–54 years). Clinical and radiological assessment before and after surgery included wrist extension and flexion, range of motion and grip strength, visual analogue scale (VAS) score to assess pain, modified Mayo wrist scores, and measurements of the scapholunate (SL) angle and modified carpal height ratio. Results: The mean follow-up period was 17.33 ± 4.69 months (range: 12–24 months), mean operation time was 56.67 ± 12.5 min (range: 45–75 min) and mean hospitalization time was 3.44 ± 1.13 days (range: 2–6 days). Preoperative mean wrist extension was 23.89° ± 4.17°, mean wrist flexion was 32.22° ± 5.07°, mean grip strength compared to the healthy side was 34% (range: 28–37%) and mean VAS score was 7.6 (range: 7–8). Modified Mayo wrist scores were poor in all of the nine patients. Post-operative mean wrist extension was 27.78° ± 4.41°, mean wrist flexion was 40.56° ± 4.64°, mean grip strength compared to the healthy side was 71% (range: 63–81%) and mean VAS score was recorded as 1.4 (range: 1–2). Modified Mayo wrist scores were good in five and moderate in four patients. No patients had non-union or additional surgery. Conclusion: Lunatum excision and SCA using angular stable circular plate fixation provide pain relief with acceptable preservation of the range of motion.

Evaluation of patella alta using MRI measurements in adolescents

Purpose: To determine whether or not there were any differences in the measurement techniques used by orthopedic and radiology specialists in the evaluation of magnetic resonance (MR) images for the diagnosis of patella alta in adolescents. Materials and Methods: Evaluations were performed by three orthopedic specialists (Group I) and three radiology specialists (Group II) regarding the presence of patella alta in 40 adolescents cases using the Insall–Salvati, Caton–Deschamps, Blackburne–Peel, and modified Insall–Salvati indices on MR images obtained to diagnose patellar instability. Results: The Fleiss Kappa conformity levels for Insall–Salvati, Caton–Deschamps, Blackburne–Peel, and modified Insall–Salvati measurements were 0.531, 0.559, 0.246, and 0.272, respectively, in Group I, and 0.699, 0.346, 0.516, and 0.394, respectively, in Group II. Conclusion: The radiology specialists were found to have greater conformity in the evaluation of all patella alta indices, which was probably due to their greater familiarity with radiological measurements than that of the orthopedic specialists.