Savas Guner

Review of Van earthquakes form an orthopaedic perspective: a multicentre retrospective study

PurposeThis is a descriptive analysis, of victims of Turkey’s October 23, 2011 and November 21, 2011 Van earthquakes. The goal of this study is investigated the injury profile of the both earthquakes in relation to musculoskeletal trauma.MethodsWe retrospectively reviewed medical records of 3,965 patients admitted to in seven hospitals. A large share of these injuries were soft tissue injuries, followed by fractures, crush injuries, crush syndromes, nerve injuries, vascular injuries, compartment syndrome and joint dislocations. A total of 73 crush injuries were diagnosed and 31 of them were developed compartment syndrome.ResultsThe patients with closed undisplaced fractures were treated with casting braces. For closed unstable fractures with good skin and soft-tissue conditions, open reduction and internal fixation was performed. All patients with open fracture had an external fixator applied after adequate debridement. Thirty one of 40 patients with compartment syndrome were treated by fasciotomy. For twelve of them, amputation was necessary. The most common procedure performed was debridement, followed by open reduction and internal fixation and closed reduction-casting, respectively.ConclusionsThe results of this study may provide the basis for future development of strategy to optimise attempts at rescue and plan treatment of survivors with musculoskeletal injuries after earthquakes.

Analyzing the Effects of Platelet Gel on Knee Osteoarthritis in the Rat Model

Platelet gel (PG) includes concentrated dose of growth factors which plays role in physiological processes of healing. The goal of this study is to evaluate repairing effects of intra-articular injection of PG use in a rat model of knee osteoarthritis (OA). A total of 20 rats were randomly distributed into a PG group and a control group. Both the groups were induced OA in knee joints with intra-articular formaline injection. The rats in the PG group and the control group were injected in the knee joint with PG and 0.9% NaCl solution, respectively. Two weeks after last injections, all rats were sacrificed by ether asphyxiation. Tissue samples were obtained from the knee joints and were examined histopathologically. No statistically significant differences were found between the groups regarding cartilage healing (P > .05). We were unable to determine any beneficial or harmful effects of PG on joint cartilage healing in OA.

Effectiveness of Local Tenoxicam Versus Corticosteroid Injection for Plantar Fasciitis Treatment

Plantar fasciitis is one of the most common causes of foot pain in adults. In this prospective study, the outcomes of local tenoxicam injection and corticosteroid therapy for the treatment of plantar fasciitis were compared. Patients were randomly assigned to either the tenoxicam or corticosteroid group. The tenoxicam group (n=31) was treated using a local injection of 1 mL of tenoxicam (20 mg/2 mL) and 1 mL of 2% lidocaine, whereas the steroid group (n=30) was treated with a local 1-mL injection containing 40 mg of methylprednisolone acetate and 1 mL of 2% lidocaine. Clinical evaluations, which were performed before the injection and 6 and 12 months after the injection, consisted of patient-assessed pain using a visual analog scale. In addition, patient satisfaction was measured using the Roles and Maudsley score. Comparison of pre- and posttreatment visual analog scale scores demonstrated a statistically significant difference in both groups (P<.05). Furthermore, no significant difference was found between the steroid and tenoxicam groups in terms of visual analog scale scores measured 12 months after injection (P>.05). The tenoxicam injection was not significantly more effective than the corticosteroid injection. However, both methods were effective and successful in treating patients with plantar fasciitis. Tenoxicam therapy appears to provide pain relief, but its effectiveness in the long term should be explored in additional studies.

Mitchell’s Osteotomy With Mini-Plate and Screw Fixation for Hallux Valgus

Background: The aim of this study was to evaluate the use of mini-plate and screw fixation to stabilize the first metatarsal osteotomy in patients undergoing Mitchell bunionectomy, with the outcomes of interest being radiological alignment and the time to bony union. Methods: We used mini-plates and screws in 43 feet of 25 patients to avoid cast immobilization and prevent osteotomy displacement. The mean age at operation was 45.4 ± 13.4 years (range, 17.0-65.0 years). The mean follow-up was 16.9 ± 3.6 months (range, 12.0-30.0 months). The hallux valgus angles, intermetatarsal angles, and American Orthopaedic Foot and Ankle Society (AOFAS) forefoot scores were evaluated preoperatively and at postoperative month 12. Results: The mean preoperative value for the hallux valgus angle was 35.9 ± 4.4 degrees (range, 26.0-45.0 degrees) and for the intermetatarsal angle was 12.1 ± 1.4 degrees (range, 10.0-15.0 degrees). The mean postoperative value for the hallux valgus angle was 16.0 ± 2.12 degrees (range, 12.0-20.0 degrees) and for the intermetatarsal angle was 7.7 ± 1.2 degrees (range, 5.0-10.0 degrees). The mean AOFAS score was 50.5 ± 12.8 points (range, 30.1-76.0 points) preoperatively and 75.9 ± 11.3 points (range, 43.3-92.3 points) at postoperative month 12. Improvement of range of motion of the metatarsophalangeal joint, pain relief, and satisfactory alignment of the first ray were achieved in 41 feet (95.3%). Conclusions: We recommend this fixation for Mitchell’s bunionectomy because it provided stable fixation without the need for casting. Level of Evidence: Level IV, retrospective case series.

Biepicondylar fracture presenting with elbow dislocation: a case report

IntroductionBiepicondylar fracture of the elbow is very rare, and to date there have only been three reports of this injury and its treatment in the English scientific literature. This case report evaluates the surgical internal fixation of a biepicondylar fracture of the elbow with an associated dislocation.Case presentationWe report the case of a 15-year-old Turkish girl with a biepicondylar fracture dislocation of the left elbow. Open reduction and an internal fixation operation were applied. There were no complications.ConclusionIn these injuries, open reduction and internal fixation appear to be a good method to restore elbow stability and function.

Hip Dislocation and Physis Separation Related to the Delayed Diagnosis of Septic Arthritis - Case Re

Mehmet Ata Gokalp1, Mehmet Fethi Ceylan2, Savas Guner2, Ugur Turktas2, Levent Ediz3 1Baskale Devlet Hastanesi Ortopedi ve Travmatoloji Servisi, 2Ortopedi ve Travmatoloji AD Yuzuncu Yil Universitesi Tip Fakultesi, 3Fizik Tedavi ve Rehabilitasyon AD Yuzuncu Yil Universitesi Tip Fakultesi, Van, Turkiye Hip Dislocation and Physis Separation Related to the Delayed Diagnosis of Septic Arthritis Case Report

Removal of metallic foreign bodies embedded in soft tissues by stereotaxic approach

BACKGROUND A trial fibrillation (AF) is the most common cardiac arrhythmia and increases the risk of stroke and death. Patients with hypertensive have an increased risk of developing atrial fibrillation. RDW (Red blood cell distribution width) levels are elevated in cardiovascular disorders including heart failure, stable coronary disease, acute coronary syndrome, slow coronary flow and stroke. OBJECTIVE To investigate the relation between RDW and AF in patients with hypertensive. METHOD We retrospectively examined 126 consecutive hypertensive patients (63 hypertensive patients with AF and 63 hypertensive patients without AF matched with age and sex. RESULTS The mean age of the study population was 71,09± 8,50 (af group) and 70,97±8,24 (non-af group) years. RDW level was different among patients with atrial fibrillation and without atrial fibrillation.(15,13±1,58 and 14,05±1,15 p<001). Logistic regression analysis showed that RDW and left atrial dimension were only independently risk factory associated with atrial fibrillation. (Rdw odds ratio:1,846 CI; 1,221-2,793 p<0,05). Roc curve analyses were applied to determine the cut-off point. Cut-off point was at 14,195 and Sensitive, specificity was %71,4, %56 respectively. CONCLUSION RDW levels were higher in hypertensive patients with atrial fibrillation. An increased RDW level in the patient with hypertension may alert physician on developing or presence of atrial fibrillation.

A Modified Rotation Flap Design: The S‐Flap

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The outcomes of acetabular fractures treated surgically and factors affecting the result

DOI: 10.4328/JCAM.5124 Received: 03.06.2017 Accepted: 21.12.2017 Published Online: 30.12.2017 Printed: 01.03.2018 J Clin Anal Med 2018;9(2): 93-6 Corresponding Author: Mehmet Ata Gökalp, Department of Orthopedics and Traumatology, Yüzüncü Yıl University, Medical Faculty, Van, Turkey. T.: +905055037613 E-Mail: doktorata@hotmail.com Abstract Aim: The aim of this study was to evaluate the radiological and clinical outcomes of surgically treated acetabular fractures. Material and Method: A total of 30 patients with acetabular fracture who had presented to the Orthopedics and Traumatology Department of Yüzüncü Yıl University Medical Faculty between January 2009 and December 2013 and undergoing surgery were included in the study. The number of males was 25 (83.3%), and the number of females was 5 (16.7%). The ages of the patients varied between 18 and 68 (mean: 40) years. The indications for surgery were: more than 3 mms of dislocation in one of the three X-Rays obtained (antero-posterior, obturator oblique and iliac oblique), intra-articular piece of the fracture and posterior instability. Results: 20 (66.7%) and 10 (33.7%) patients had acetabular fractures in the right and left hips, respectively. The most common cause of trauma was falling from a height. According to the classification of Letournel, 18 patients (60%) had complex and 12 patients (40%) had simple fractures. 13 patients (43.5%) had additional traumatic hip dislocation. Following the surgical intervention, 13 patients (43.3%) had anatomical reduction and 4 (13.3%) had poor reduction. The patients were followed-up for a mean duration of 28 months. According to the radiological criteria of Matta, 13 patients (43.3%) had excellent, 11 (36.6%) had good, 4 (13.3%) had moderate, and 2 (6.6%) had poor outcomes. According to the clinical recovery criteria of Merle d’Aubigne and Postel, 7 patients (23.3%) had very good, 15 (50%) had good, 4 (13.3%) had moderate, and 4 (13.3%) had poor outcomes. Discussion: It was concluded that the quality of reduction affected the clinical and radiological outcomes, and that this effect depended on the simple or complex nature of the fracture. Successful and satisfactory results may be obtained by selecting the correct incision method for the fracture type, advanced surgical experience and careful post-operative patient follow-up.

Effectiveness of etofenamate for treatment of knee osteoarthritis: a randomized controlled trial.

The intramuscular application of etofenamate in the treatment of knee osteoarthritis was not observed in the existing English language literature. The objectives of this study were to compare the efficacy of etofenamate versus hyaluronic acid (HA) in reducing joint pain and functional improvement for mild to moderate knee osteoarthritis. The patients were randomly divided into etofenamate (n=29) and HA (n=30) groups. Intramuscular etofenamate injection was administered as a series of seven intramuscular injections at intervals of 1 day. Intra-articular HA injection was administered as a series of three intra-articular injections at intervals of 1 week. Clinical evaluation was made before the first injection and again both 6 and 12 months after the last injection. The evaluation consisted of patient-assessed pain on a visual analog scale (VAS) and on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Statistical significance was found for the etofenamate group when comparing preinjection with 12 months postinjection VAS scores (P<0.05). Statistical significance was also found for the HA group when comparing preinjection with 12 months postinjection VAS and WOMAC scores (P<0.05). However, there was no significant difference between the etofenamate and HA groups in terms of VAS or WOMAC scores measured at 12 months after injection (P>0.05). Results from this study indicated that, etofenamate treatment was not significantly more effective than HA treatment. However, both methods were effective and successful in treating knee osteoarthritis.