Murat Yılmaz

Prevalence of scoliosis and cost-effectiveness of screening in schools in Turkey

The study was intended determine the prevalence of scoliosis and to assess the cost-effectiveness of a school screening program for scoliosis in Turkey. A total of 4259 children (2057 females and 2022 males aged 10-14 years old) were screened. Thirty-nine children had a positive forward bending test. The prevalence of scoliosis was 25 per 1000 in the screened population. The ratio of girls to boys with scoliosis was 2.5:1. A minor curve was detected in 72.7% of children with scoliosis (Cobb angle of 10-20 degrees), and a major curve was found in 27.3% (Cobb angle >20 degrees). The cost of screening was found to be 47 cents per child, but the cost per case of scoliosis was determined to be

A comparison between three irrigation methods in the debridement of contaminated bovine cancellous bone and the effect of duration of irrigation on the efficiency of debridement

236.81. School screening for scoliosis seems to be cost-effective in Turkey.

Comparison of the efficiency of different antibiotic irrigation solutions in decontamination of allografts contaminated with Staphylococcus aureus.

OBJECTIVES Irrigation and debridement constitute an important part of treatment of open fractures. We investigated the efficiency of different irrigation methods and durations in cleansing contaminated bovine femur cancellous bone samples and the extent of tissue damage associated with irrigation. METHODS A total of 72 samples of 4x4x1 cm size were obtained from fresh frozen bovine distal femoral cancellous bone. The top surface of the samples were sawed to a 2-mm depth to create four squares equal in size. All the samples were contaminated with construction sand using the same method and were then randomized to three irrigation groups (bulb syringe irrigation, high-pressure pulsatile lavage, and low-pressure pulsatile lavage), each consisting of 24 samples. The duration of irrigation was set as 3, 6, or 9 minutes for every eight samples of each group. After the irrigation procedure, the images were transferred to a computer screen with a video-microscope camera and the number of sand particles on the samples were counted and irrigation-related macroscopic bone damage was assessed. RESULTS The lowest number of sand particles was found on the samples irrigated by high-pressure pulsatile lavage (p<0.001). The duration of irrigation did not affect the efficiency of cleansing in all the groups (p>0.05). The least irrigation-related bone damage was observed in samples irrigated by low-pressure pulsatile lavage for 3 minutes (p<0.01). The amount of bone damage was similar in all groups after irrigations beyond 3 minutes (p>0.05). CONCLUSION Our findings showed that the most efficient method of cleansing contaminated bone samples was high-pressure pulsatile lavage and that prolonged irrigations did not enhance the efficiency of the irrigation method; however, high-pressure irrigation of 3 minute duration resulted in the greatest bone damage.

Short-term Results of Robinson Type 2B2 Clavicular Fractures Treated Conservatively or Surgically

OBJECTIVE The purpose of this study was to investigate the local antibacterial efficacy of saline, rifampicin, gentamicin, high-concentration fusidic acid and low-concentration fusidic acid in the decontamination of allografts contaminated with Staphylococcus aureus. METHODS Fifty-five sterile, fresh-frozen femoral heads obtained from the bone bank were contaminated with methicillin-sensitive ATCC 25923 Staphylococcus aureus. Samples were divided into groups and debrided with high-pressure (80 psi) pulse lavage using a saline, rifampicin irrigation solution (50 mg/l), gentamicin irrigation solution (50 mg/l) and low- (50 mg/l) or high-concentration (500 mg/l) fusidic acid irrigation solution for 30 seconds from a distance of 10 cm. After irrigation, allografts were incubated in the culture and developed colonies were counted. Mean±standard deviation (min-max) values were calculated. The differences between the four irrigation groups were evaluated using the Kruskal-Wallis variance analysis and groups were compared two at a time using the post-hoc Mann-Whitney U test. RESULTS No colonization was detected with the exception of one allograft in the rifampicin irrigation group. The gentamicin irrigation group had similar results as the high-concentration fusidic acid irrigation group and both results were superior to those of the saline and low-concentration fusidic acid irrigation groups (p=0.010 and 0.004, respectively). The low- and high-concentration fusidic acid irrigation groups were similar and were not shown to have superior results than saline irrigation group. CONCLUSION Rifampicin irrigation solution was the most effective in the decontamination of allografts previously contaminated with Staphylococcus aureus. Gentamicin, high-concentration fusidic acid, low-concentration fusidic and saline irrigation solutions may also be used respectively, according to their effectiveness.

Diyabetik ayak yaraları ve klinik deneyimimiz

The most frequently treated injuries, representing approximately 82% of all clavicular fractures, involve the midshaft clavicle. Historically, most acute displaced midshaft clavicular fractures were treated nonsurgically. However, the outcomes of nonsurgical treatment have recently been thought to be not as good as expected in the past, and the trend is to treat these fractures surgically. The goal of this study was to evaluate the short-term clinical outcomes of Robinson type 2B2 clavicular fractures treated conservatively vs with locked plate fixation. Among 59 patients included in the study, 30 patients (mean age, 45±13.7 years; range, 30-62 years) treated conservatively were designated as group A, and 29 patients (mean age, 38.8±11.1 years; range, 20-60 years) treated with locked plate fixation were designated as group B. All patients were evaluated using Oxford and Constant scoring systems at final follow-up. Mean follow-up was 18 months (range, 12-24 months). In group A, mean Constant score was 70.5±15.1 (range, 98-43) and mean Oxford score was 46.6±1.3 (range, 49-44) at final follow-up. In group B, mean Constant score was 89.2±8 (range, 100-77) and mean Oxford score was 46.5±1.2 (range, 48-44) at final follow-up. Callus was detected radiographically in both groups at 6-week follow-up. Patients in groups A and B started active range-of-motion exercises at weeks 6 and 3 after treatment, respectively. Locked plate fixation of Robinson type 2B2 clavicular fractures can be the first treatment option because of good clinical results, low complication rates, and good cosmesis.

Comparison of Short Term Results of Type IIB2 Middle Third Clavicular Fractures Treated with Figure of Eight Bandage and Locked Plate Fixation.

Diabetic foot lesions and clinical experience Objective: Although some diabetic foot undergone amputation because of progressive wound others heal without complication. This study evaluates the risk factors for amputation of diabetic foot. Material and Methods: This study include 104 patients (77 males, 27 females; mean age 62.3 years; range 23 to 90 years) who had diabetic foot ulcers and treated between 2008 and 2011. Data on age and sex, type and time of diabetes, complications and treatment type were recorded. Results: 36.5% of patients had no any antidiabetic medicine. The frequencies of diabetes related complications in descending order were as follows; 44.2% retinopathy, 16.3% polyneuropathy, 11.5% nephropathy, 3.8% Charcot joint. According to Wagner Classification most of the patients (n=100) stages found in two to four. Total 82 patients undergone surgical treatment. Conclusion: We consider that multidisciplinary treatment strategy in which orthoapedic surgeons have an important and special mission decreases amputation rate in diabetic foot.

Basit ve kompleks dirsek çıkıklarının tedavi sonuçlarının değerlendirilmesi

Objectives: Most acute displaced midshaft clavicular fractures conventionally have been treated nonoperatively with the expectation of a high probability of fracture union, good functional outcomes, and a high level of patient satisfaction . However, the outcome of nonoperative treatment is not as favorable as once thought and there has been a growing trend to treat these fractures surgically We aimed to evaluate and compare the short term results of conservative treatment and locked plate fixation in the treatment of type IIB2 clavicula fractures according to Robinson classification in this study. Methods: Thirty eight patients with type IIB2 clavicula fractures according to Robinson classification were retrospectively reviewed. 20 patients who were treated conservatively were enrolled as group A and 18 patients who were operated with locked plate and screws were enrolled as group B. All patients were evaluated with Constant and Oxford scores in their last follow up control. For the patients that were treated conservatively (Group A) figure of eight bandage were applied for six week. Patients (Group B) were operated under general anesthesia in the beach chair position. A straight incision was made over the fracture line. Butterfly or free fragments in comminuted fractures were fixed to the main fragment with a lag screw in 3 patients before fracture reduction and plate fixation. Fracture reduction was performed with taking care of minimal periosteal stripping. After reduction of the main fragments, titanium alloy, locked anatomic compression plate were applied on the superior surface of the clavicle. A minimum of six cortexes were fixed with 3.5 mm locked cortical screws on the medial and lateral sides of the fracture. We did not need any Auto- or allografts during the surgery. Statistical analysis was performed between the scores of two groups. Conservative and surgical treated groups Oxford scores and Constant scores had normal distribution. For this reason Students t test, and Non-parametric version of Student’s t test Mann Whitney U test were performed. 95% confidence interval and p <0.05 was considered significant as statistically. Results: Mean follow up period is 18 months (12-24 months). At the last follow-up, mean Constant score is 79.5 (98-43) and mean Oxford score was 46.35(49-44) for group A. In group B mean Constant score is 89.3(100-77) and mean Oxford score is 46,6(48-44) at the last follow-up. There were no patients who require any revision surgery in group B. Bone healing was detected in all fractures radiologically in both groups. There was no statistically significant difference between Oxford scores of the two groups (p=0,570). There was statistically significant difference between Constant scores of the two groups whereas results of Group B were better than group A (p=0,013) Surgical treatment with locked plate fixation in type IIB2 clavicle fractures according to Robinson Classification, can be the first treatment choice with better cosmetics, lower complication rate, and better outcomes. Conclusion: Surgical treatment with locked plate fixation in type IIB2 clavicle fractures according to Robinson Classification, can be the first treatment choice with better cosmetics, lower complication rate, and better outcomes.

Glove perforation time and frequency in total hip arthroplasty procedures

Amac: Basit ve kompleks akut dirsek cikikli olgularin tedavi sonuclari incelendi. Hastalar ve Yontemler : Akut dirsek cikikli 28 olgu calismaya alindi. Olgularin ortalama yasi 30,2 idi. Tum olgular acil serviste teshis konulmasini takiben cikiklari redukte edilerek cikigin basit ve kompleks olmasina gore tedavisi planlandi. Olgularin takibinde klinik olarak Mayo dirsek performans skoru kullanildi. Ayrica tum olgular radyolojik olarak heterotropik ossifikasyon, dejeneratif artirit olup olmamasina gore degerlendirildi. Bulgular: Yaralanma mekanizmasi 26 hastada yuksekten dusme, 2 hastada ise arac disi trafik kazasiydi. Olgular 17’si posterior, 10 olgu posterolateral ve 1 olguda da posteromedial cikik idi. Olgularin %35,7’si izole basit cikik, %64,3’u ise ek patolojiler olan kompleks dirsek cikiklari idi. 4 olguda gec donemde posttravmatik artrit bulgulari, 9 olguda gec donem ektopik kemik gelisimi saptandi. Klinik olarak hastalarimizin %82,1’i mukemmel sonuc, %18’i iyi sonuc aldi. Sonuc: Basit dirsek cikiklarinda prognoz iyi iken, kompleks dirsek cikiklarinda eklem sertligi, heterotrofik ossifikasyon ve posttravmatik artirit gibi komplikasyonlar ortaya cikmaktadir. Radius basi kiriklari mumkun oldugunca redukte edilerek dirsek stabilitesi saglanmali ve radius basi rezeksiyonu yapilmamalidir. Reduksiyon sonrasi dirsek immobilizasyonu uc haftayi gecmemeli, asiri germe egzersizleri verilmemelidir.