Gokhan Maralcan

A new syndrome of microtia with mixed type hearing loss, renal agenesis, and multiple skeletal anomalies

We report on a 17‐year‐old man who presented with unreported combination of right sided microtia and preauricular skin tag with conductive hearing loss, unilateral renal agenesis, partial syndactyly of forth and fifth metacarpals, multiple tarsal coalitions, absent toe, and hypoplastic tibia and fibula. Radiological and clinical findings did not match with the previously described syndromes with the type of anomalies seen in the case. We propose that this represents a new syndrome.

The use of a proximal femoral nail as a hip prosthesis: A biomechanical analysis of a newly designed implant

Complication rates of hip fractures after proximal femoral nail are not rare. In such fractures, treatment invariably comprises the extraction of proximal femoral nail and the introduction of a different hip prosthesis. To solve this problem, we aimed to develop a new implant, the modular nail prosthesis, which combines an intramedullary nail with a hip prosthesis. The aim of this study was to determine the effect of stress load distribution on the stem using finite element analysis under laboratory conditions. For this, the shortest stem of 175 mm was chosen. In addition, six proximal femoral nail–hip prosthesis combinations were produced and tested with a biomechanical test device and passed 2300-N load bearing. According to the test results, our newly developed modular nail prosthesis can be converted to hip prosthesis securely.

VARUS DİZİLİM BOZUKLUĞU VE PRİMER OSTEOARTROZLU DİZLERDE TOTAL DİZ PROTEZİ SONRASI PROKSİMAL TİBİOFİBULAR KAYNAKLI AĞRI HASTA MUTSUZLUĞUNA NEDEN Mİ

AMAC: Ileri evre gonartrozlarda proksimal tibiafibular eklem (PTFE) ile tibiofemoral eklem (TFE) arasindaki klinik iliski daha once gosterilmemistir. Bu retrospektif calismanin amaci son evre gonartrozu olup diz protezi uygulanan genu varum deformiteli hastalarda PTFE’in klinik degerlendirmesidir. GEREC VE YONTEM: Ileri evre osteoartrozu olup diz protezi uygulanan genu varum deformiteli hastalar degerlendirmeye alindi. PTFE’in klinik muayene bulgulari ile PTFE tipi, hamstring gerginligi, ve lateral eklem araligi (LEA) hassasiyeti arasindaki iliski ki-kare testi kullanilarak arastirildi. Ayrica tanimlayici istatistikte kullanildi. BULGULAR: Calisma grubu (5 erkek ve 49 kadin; ortalama yas 62.7 yil; 46-81 arasinda) elli dort hastadan olus- maktadir. 30 hastanin (%55.6) her iki dizi ameliyat edildi. Ortalama takip suresi 21.6 ay (12-49 ay). PTFE hassasiyeti, hamstring gerginligi ve LEA hassasiyeti sirasiyla alti (%7.1), dort (%4.8), ve alti (%7.1) dizde tespit edildi. Alti dizde (%7.1) horizontal tip PTFE varken, yetmis sekiz dizde (%92.9) oblik tip PTFE vardi. Oblik tip PTFE olan dizlerde PTFE hassasiyeti (ki-kare testi, p=0.000) , LEA hassasiyeti (ki-kare testi, p=0.000), hamstring gerginligi (ki-kare testi, p=0.000) tespit edildi. SONUC: Varus dizilim kusuru olan ileri evre dejeneratif eklem hastaligi nedeniyle diz protezi yapilan hastalarda, PTFE’in ameliyat sonrasi lateral diz agrisinin kaynagi olmadigi ortaya konmustur. Bununla birlikte oblik tip PTFE bu dizlerde potansiyel agri kaynagi olabilecegi dusunulebilir

Comparison of two different suture-passing techniques with different suture materials and thicknesses: Biomechanical study of flexor tendons for yield points, gap formation and early post-operative status -

Objective: The purpose of this study was to evaluate the biomechanical characteristics of two different suture-passing techniques with different suture materials and thicknesses and assess whether they could with stand passive and/or active mobilization in the very early post-operative period. Materials and Method: 192 flexor digitorum profundus communis tendons of similar diameters were obtained from sheep front limbs. Each tendon was transected completely at a point 6 cm from the distal end and each repaired by one of the following suture materials: polyester suture (Ethilon 3.0 and 4.0 (Ethicon, U.S.)) and polypropylene monofilament (Polypropylene 3.0 and 4.0 (Ethicon, U.S.)). The repair of the tendons was performed through employing two different techniques with each suture material - the Bunnel and Modified Kessler. The primary outcome measures for each repair combination was suture material, suture-passing type and suture thickness. Regarding post-operative early motion, the yield point differences between the suture materials and techniques were compared. Results: There was a statistically significant difference between suture materials used for the repair. Tendons repaired with Ethibond needed significantly greater amounts of force for rupture compared with tendons repaired with Polypropylene. There was a statistically significant difference between Ethibond and Prolene for all study groups. Conclusion: The yield points with higher forces is expected to be preferred, but their thicknesses can be 3-0 or 4-0. Oblique suture passing should be preferred rather than longitudinal passing. Obviously, suture strengthening methods, like epitendineous running sutures and core sutures, should be used. Without these measures, even passive wrist motion can result in gap formation at the repair site. The results of this study showed that tensile properties of the repaired vary considerably with differences in suture material and design.

Prevention of web creep using a new frame after synpolydactyly surgery.

The main goal in syndactyly surgery is to create a normal web space; however, it is difficult to achieve the best clinical results in older and complex cases with bony fusions and joint deformities requiring osteotomies. In these complex cases, proper postoperative wound care is difficult to achieve due to the web contractures and deformities. In our report, we introduce a new technique using a frame that we called the “Hittite Sun,” which helps in proper wound management to reduce wound healing problems that lead to web creep. Between 2002 and 2006, this frame was used in operations for 46 webs, and the results were compared with those of 30 operated webs in which conventional wound management technique was used. It was found that significantly lower complication rate and lesser web creep formation was seen in these patients, which were managed using the frame, compared with the cases with conventional wound care. The frame was found to be effective for prevention of severe web creep especially in complex synpolydactyly surgery.

Talonavicular Joint Approach to the Talar Body : A Cadaver Study

Background: Lesions of the talar dome or tumors within the talar body may require an open approach with medial or lateral malleolar osteotomies. The aim of this study was to evaluate the possibility and feasibility of a new minimally invasive approach without osteotomy, using the talonavicular joint (TJ) as the entry portal for lesions of the talar body. Materials and Methods: Nine cadaveric feet were used for this study. Using the TJ and a 5-mm skin incision we aimed to reach the superolateral, superomedial, inferolateral and inferomedial corners of the talar body under fluoroscopy. A 2-mm Kirshner wire and a 4-mm cannulated drill bit were used to reach the desired target area and an angled curette was used for curettage after reaching the target. The proximity of vascular structures to the entry portal was noted. The talar and navicular joint surfaces were checked for any damage. The articular areas of the talar heads and the defect areas were measured. Results: All 4 targets and even the posterior talus could be reached by this approach. The nearest neurovascular structures were the saphenous vein and the saphenous nerve. The navicular cartilage was not damaged in any specimen. The talar defect area corresponded to only 3.3% of the talar head cartilaginous area. Conclusion: The TJ approach can be used to reach lesions in all regions of the talar body without the need for an osteotomy. A mini-incision may be used to retract the saphenous nerve and vein. Damage to the talar head cartilage is minimal with this approach which requires no special equipments. Clinical Relevance: This study shows that talar dome lesions can be reached with a minimally invasive method.

Spinal Anestezi Sırasında Ortaya Çıkan Hipokalsemik Kriz

34 yasinda bayan hastada anterior krusiat ligamanin parsiyel rupturu ve lateral meniskus anterior ve medial meniskus posterior boynuzunda evre 2 dejenerasyon saptanmasi uzerine artroskopi planlandi. Lateral dekubit pozisyonda lumbal 3-4 araligindan girilerek 1.3 ml %0.5 hiperbarik bupivakain+ 0.2 ml 10 mg meperidin verildi. Duysal blok seviyesinin torakal 10 oldugu saptandiktan sonra operasyona baslandi. Operasyonun 110. dakikasinda hasta dudaklarinda ve ellerinde uyusmadan sikayet etmeye basladi. Hemen arkasindan hastanin ellerinde ebe eli (Trosseau bulgusu) gelisti. 10 mEq magnezyum, 20 mEq kalsiyum yavas infuzyonla intravenoz olarak verildi. Arteriyel kan gazinda dekompanze solunumsal alkaloz ve iyonize kalsiyum 0.83 mEq/l olarak geldi. Hastamizda organik bir hipokalsemi nedeni bulunamadi. Hastamizda solunumsal alkalozun neden oldugu hipokalsemi krizi dusunuldu. Sonuc olarak bu hastalarda sedasyon uygulanmalidir

The efficacy of intra-articular tenoxicam in the treatment of knee osteoarthritis

AbstractOsteoarthritis (OA) of the knee is a degenerative disorder that can cause pain and functional limitation. Intra-articular injections have become very popular in recent years. The efficacy of intraarticular tenoxicam injections in knee OA was investigated in this study. Eighty patients with knee (OA) were included in this study and were randomly assigned to two groups. Analgesics (paracetamol), hot-packs and exercise therapy were applied to both groups. Additionally, patients in Group 1 were treated with an intra-articular tenoxicam injection. Pain, functional capacity and disability parameters were evaluated. Pain was assessed by a visual analogue scale (VAS); functional capacity was assessed by Lequesne-Samson index (OA index); and the disability was evaluated by Health Assessment Quastionnaire (HAQ). After 6 months, statistically significant improvement in VAS and OA index was observed only in the tenoxicam group. Also, HAQ scores decreased significantly in Group 1.