İbrahim Gökhan Duman

Reinforcement of the Flexor Tendon Repair Using Human Amniotic Membrane

BACKGROUND Human amniotic membrane is used to prevent peritendinous adhesions after tendon injuries. This study compares the mechanical properties of modified Kessler repairs and modified Kessler repairs strengthened using multiple layers of human amniotic membrane. METHODS Twenty flexor digitorum profundus tendons of sheep forelimbs were sutured by the two-strand modified Kessler technique (group A) and by the two-strand modified Kessler repair reinforced with multiple layers of human amniotic membrane (group B). To assess the mechanical performance of the repairs, tendons were subjected to a linear noncyclic load-to-failure test using a material testing machine. Outcome measures included ultimate forces and the mode of failure. RESULTS The mean ± SD value of the failure strength was 34.6 ± 1.64 N for group A and 50.6 ± 5.60 N for group B. The reinforced repair provided a significantly higher ultimate load compared with the nonreinforced group (P < .001). All of the specimens failed due to suture breakage at the repair site. CONCLUSIONS The results of this study show that the modified Kessler repair can be reinforced effectively with human amniotic membrane.

The comparison of macroscopic and histologic healing of side-to-side (SS) tenorrhaphy technique and primer tendon repair in a rabbit model

IntroductionThe side-to-side (SS) tenorrhaphy technique has been used in tendon transfer surgery. The mechanical properties of SS tendon suture have been studied previously. However, the histo-pathological healing of the SS tenorrhaphy of the tendons is unknown. The aim of this study was to assess the gross and histological effects of SS tenorrhaphy in a rabbit model.Materials and methodsTwenty New Zealand rabbits were used. The extensor hallucis longus and tibialis anterior tendon were sewed SS at the level distal to the ankle joint. The patellar tendon (PT) at the same side was used as control group. A unilateral midline incision was made and repaired with a single suture. The animals were killed at the 12th week postoperatively. The histological sections were obtained from the side of surgery from each group. Each sample was stained with hematoxylene and eosin (H&E). Gross and microscopic healing was compared between the two groups.ResultsGross examination of the control group showed complete healing with a thin peri-tendinous sheath formation around the suture site, whereas in the study group, a thick peri-tendinous sheath was formed around the area of the tendon–tendon anastomosis. In the control group, at the 12th week after surgery, the healing was almost completed in all samples. In the study group, a thick fibro vascular sheath has formed around the side of anastomosis. In all specimens few inter-digitations were observed between the tendons;however, the trough was still present.ConclusionThe result of the current study showed that histological healing and union of SS tenorrhaphy differ from that in primary tendon injury and healing. Further studies are required to clarify the healing stages at the tenorrhaphy site.

Five cases of early dissociation between the bipolar hip endoprosthesis cup components; either spontaneously or during reduction maneuvers

Bipolar hemiarthroplasty is frequently used in the treatment of intracapsular hip fractures. Dissociation of the bipolar components can happen during the hip dislocation, the reduction maneuvers, or spontaneously without any dislocation. Here we report early dissociation between bipolar components in two cases during the attempt of closed reduction maneuvers and three cases with spontaneous dissociation without any trauma. To prevent or minimize this complication; the reduction of dislocated hips must be achieved very gently under general anesthesia with fluoroscopic control. During the initial operation the surgeons must be sure that the bipolar components are locked to each other and after final reduction, especially in osteoarthritic acetabulums, that the cup position is not in varus position.

NADİR GÖRÜLEN BİR BENİGN YUMUŞAK DOKU TÜMÖRÜ; ELASTOFİBROMA DORSİ

Elastofibroma dorsi is a rare benign tumor which arises from fibrous tissue. Usually it is located under the bottom corner of scapula and attached to the periost of thorax wall. It may not lead to clinical complain in 50% of patients. Most of the time it is presented with swelling, back pain, shoulder pain and sound of sliding on back. The lesion is usually more common in women over the age of 55, as well as single-sided involvement is present in 90% of cases. MRI is the most important radiological evaluation method in the diagnosis of elastofibroma dorsi. Treatment of elastofibroma dorsi is total removal of the mass

Our results of surgical treatment of supracondylar humeral fractures in children

Amac: Cocuklarda humerus alt uc kiriklari, on kol kiriklarindan sonra ikinci en sik gorulen kiriklardir. Bu calismanin amaci, klinigimizde cerrahi olarak tedavi edilen cocuk suprakondiler humerus kiriklarinda uygulanan tedavi yontemimizi degerlendirmek ve literaturle karsilastirmaktir.Yontemler: 2006 ve 2011 yillari arasinda klinigimizde tedavi edilen 54 suprakondiler kirikli hasta degerlendirmeye alindi. Calismada hastalarin demografik verileri, kirigin olus nedenleri, kirik tipleri, eslik eden yaralanmalar, postoperatif komplikasyonlar, radyolojik parametreler, kozmetik ve fonksiyonel sonuclar degerlendirildi.Bulgular: 38 erkek (%70,4) ve 16 kiz hasta calismaya dahil edildi. Ortalama yas 5,51 olarak bulundu. Hastanede ortalama yatis suresinin 2,29 gun yine ortalama takip suresinin ise 140 hafta oldugu goruldu. Iyatrojenik damar ve sinir yaralanmasina rastlanmadi. Bir hastada civi dibi enfeksiyonu diger bir hastada ise heterotopik ossifikasyon saptandi. Flynn kriterlerine gore fonksiyonel sonuclar %90, 7 mukemmel, %9,3 iyi; kozmetik sonuclar ise %90, 7 mukemmel, %5,6 iyi, %1,9 orta, %1,9 kotu olarak bulundu. Sonuc: Cocuklarda suprakondiler humerus kiriklarinda hastanede yatis suresi, norovaskuler komplikasyonlar, fonksiyonel ve kozmetik sonuclar goz onune alindiginda posterior yaklasim ile medial ve lateralden capraz K-teli ile tespitin guvenli ve etkin bir yontem oldugu goruldu

Akut akromioklaviküler eklem çıkıklarında endobutton ile tesbit yöntemi

Objective: Acromioclavicular (AC) joint dislocation is a common injury frequently affecting young athletes. The aim of this study is to evaluate postoperative functional results in cases diagnosed with acute AC joint dislocation stabilized with endobutton system. Methods: This fixation procedure has been applied on 10 patients. Indications of the technique included: a grade V AC joint dislocation (7 patients), and grade III AC joint dislocation (3 patient) according to Rockwood classification. The coracoclavicular (CC) interval and AC joint were reduced using two endobuttons. One endobutton was fitted on the clavicle and the second was placed at the undersurface of the coracoid. Outcomes were assessed with the Constant shoulder score and visual analog pain scale. Results: All the patients had powerful intraoperative fixa tion. Immediately after surgery, and 6 weeks, and 1 year postoperative radiographs showed adequate reduction of the CC distance and the AC joint. The mean Constant shoulder score was 89 (88–92) in the injured shoulder and 90 (88–93) in the uninjured shoulder. There was no statically significant difference between the injured and normal shoulder in terms of Constant shoulder score and there was no complication during the process. Conclusion: This technique is a safe and effective method for providing fixation for the AC joint.

Rotator manşet yırtığı tamirinde mini açık yaklaşımla tek-sıra sütür-ankor tekniğinin klinik ve radyolojik sonuçları

Amac: Tam kat Rotator manset yirtigi (RMY) tamirinde mini-acik yaklasimla tek sira anchor tekniginin klinik sonuclarini ve yeniden yirtik oranini degerlendirmeyi amacladik Yontemler: Tam kat RMY lezyonu tanili hastalar calismaya dâhil edildi. Mini acik yaklasimla tek sira anchor teknigi ile tamir yapildi. Hastalarin ortalama takip suresi 9,8 ay idi Hastalarin ameliyat oncesi ve sonrasi fonksiyonel ve klinik durumlari UCLA (University of California at Los Angeles) ve Constant skorlamasi ile degerlendirildi. Hastalarin son kontrollerinde yeniden yirtik olup olmadigi MRG (Magnetik rezonans goruntuleme) ile degerlendirildi Bulgular: Yirmi uc hasta (13 erkek, 10 kadin) calismaya dahil edildi. Ortalama yas 52 (18-68 yas) idi. Ameliyat oncesi ortalama UCLA skoru 11.7, Constant skoru 26.83 olarak bulundu. Ameliyat sonrasinda ise sirasiyla 29.91, 82.04 yukseldigi goruldu. Her iki skorlamadaki artis istatistiksel olarak anlamli idi (p

FEMUR BAŞI OSTEONEKROZU: VAKUM DRENLİ VE VAKUM DRENSİZ KOR DEKOMPRESYON SONUÇLARI

Objectives: The aim of this study is to compare the clinical outcomes of the femoral head osteonecrosis treatead with core decompression (CD) combined with a suction drain into the core tract versus simple CD. Materials and Methods: Thirtynine osteonecrotic hips in 25 patients were divided into 2 groups. Patients in group 1 (19 hips) were treated with CD, and those in group 2 (20 hips) received suction drain into the core tract after CD. Outcome between the 2 groups were compared clinically. Clinical assessments included assessment Harris hip score (HHS). Difference in HHS between the two groups were calculated using the Mann-Whitney U test. Results: At the end 6 months, patients compared with HHS. No significant differences were found between the two groups, but there was significant statical difference within the groups. Conclusions: Treatment of the early stage of osteonecrosis of the femoral head with CD improved the HHS but combined with the a suction drain into the core tract after CD seems to be not better than simple CD.

TÜRKİYEDE TIP FAKÜLTELERİNDE ve EĞİTİM KURUMLARINDA ASİSTAN OLMAK

Aim: This study aimed to compare the training programs, the infra-structure and social resources of the postgraduate training orthopedic residences in the newly established medical faculties or teaching institutes to that of the older faculties. Materyal and method: A new application form was used in this study to evaluate and determine the problem facing the residents regarding their teachers, teaching program, problems and social resources in orthopedic training programs in the newly established medical faculties or teaching institutes the residents. The form was converted into electronically applicable form and send to participants.Up to the data that obtained from TOTBID, assuming that 951 orthopedics assistants were present and α = 0,05,the sample size must have been at least 196 with 95% confidence bounds. The institutes were classified into older (established before 1980), medium and new (established after 2001). Findings:Up to the information obtained from TOTBID the datas of August 2010 revealed that 20.75% of 122 orthopedics and travmatology assistants whom gave education after graduation responsed. postgraduate teaching is not satisfactory in the newly established institutes. Results: The accreditation of the postgraduate training institutes is a most. All institutes most apply the training programs approved by Turkish orthopedic and trauma teaching institute (TOTEK). Electronic residents evaluation report, visiting institutes, central exam, regular feedback from doctors who completed the orthopedic training , teaching certificates and recertification are among the important goals to be achieved by these institutes

ARTROSKOPİK ÖN ÇAPRAZ BAĞ REKONSTRÜKSİYONUNDA ENDOBUTTON CL VE ASANSÖR SİSTEMLİ ZİPLOOP TEKNİKLERİNİN KLİNİK KARŞILAŞTIRILMASI

Aim: The objective of this study is to compare the results of the surgically treated patients, having anterior cruciate ligament rupture (ACL), by applying Endobutton-CL and Lift Systemed Ziploop technique. Methods: arthroscopically ACL rupture reconstruction patients