Sürdürülebilir Kalkınma Amaçları
Yayınlar
- ReviewYalnız künye2023Dopesick: Dealers, Doctors, and the Drug Company that Addicted America
Yapici, Furkan; Gur, Volkan; Sari, Ilker Fatih; Karakose, Resit; Tardus, Ismail; Ucpunar, Hanifi
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2023Which Treatment Method Is Better in the Treatment of Chronic Plantar Fasciitis: Corticosteroid Injection, Extracorporeal Shock Wave Therapy, or Radiofrequency Thermal Lesioning?
Yapici, Furkan; Gur, Volkan; Sari, Ilker Fatih; Karakose, Resit; Tardus, Ismail; Ucpunar, Hanifi
Background: Chronic plantar fasciitis (CPF) is a common disease that has various treatment options. This study aimed to compare the effectiveness of three of these options: corticosteroid injection (CSI), extracorporeal shock wave therapy (ESWT), and radiofrequency thermal lesioning (RTL). Methods: The records of 229 patients treated with CSI (n = 81), ESWT (n = 76), or RTL (n = 72) were retrospectively analyzed. Visual analog scale scores, patient satisfaction– related success rates, repeated treatment rates, and initial treatment change rates were compared. Results: Mean ± SD follow-up was 19.0 ± 4.5 months. Baseline clinical characteristics, mean visual analog scale scores (before treatment and at months 3, 6, and 12), patient satisfaction and success rates (at months 6 and 12), and repeated treatment and initial treatment change rates were similar between treatment groups. No complications were observed after the treatments. Conclusions: All three options—CSI, ESWT, and RTL—were found to be safe and effective in treating CPF, with similar outcomes up to 1 year. Use of CSIs is advantageous because it is more accessible than the other treatments. Similarly, the noninvasive nature of ESWT is glaring among other minimally invasive options. Therefore, the first-line treatment modality of CPF can be CSI or ESWT, depending on the patient’s and physician’s joint preference; RTL treatment should be tried in patients who do not respond to these treatments.
RDL Kalıcı Kaydıİncele - ArticleYayıncıda açık erişim2022Comparison of Contemporary Surgical Indications for Revision Total Knee Arthroplasty between 2005-2011 and 2012-2017 in a Referral Center
Ucpunar, Hanifi; Camurcu, Yalkin; Buyuk, Abdul Fettah; Aydin, Abdurrahman; Tas, Suleyman Kasim; Sahin, Vedat
Background: Different causative factors for revision total knee arthroplasty (TKA) surgeries are elucidated in the arthroplasty registry data of different countries and the patient records at tertiary care centers. We aimed to determine the changes in the causes for revision TKAs before and after 2011 (The year that the Musculoskeletal Infection Society proposed a new definition for periprosthetic joint infection) and the changes in the demographics of patients who underwent revision TKAs during the same time intervals. Methods: Patients who underwent revision TKAs between 2004 and 2017 were evaluated. A total of 291 patients operated before (period 1, n = 139) and after (period 2, n = 152) 2011 were included, while 53 patients with inconclusive diagnoses were excluded. The demographic data of patients and the causes for revision TKAs were collected and compared between the two periods. Results: Infection was the most common cause of revision TKAs during periods 1 (58%) and 2 (48%). Aseptic loosening (46%) and infection (37%) were the 2 most common causes for late revisions during period 2. Aseptic loosening almost doubled during period 2 compared with that in period 1. Age, sex, and body mass index distribution in patients were similar across both the periods. Conclusion: Although the incidence of aseptic loosening has significantly increased since 2011, infection is still the most common cause for revision knee arthroplasty surgery.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2022For intramedullary nailing of femoral shaft fractures, talon fixation is helpful to cope with the troublesome distal locking, but conventional distal locking with screws offers a more stable construct: Talon femoral nail versus conventional femoral nail; [Femur şaft kırıklarının intramedüller çivilenmesinde, talon fiksasyonu zahmetli distal kilitlemeyle başa çıkmada yararlıdır, ancak vidalarla konvansiyonel distal kilitleme daha stabil bir yapı sunar: Talon femoral çiviye karşı konvansiyonel femoral çivi]
Yapici, Furkan; Gur, Volkan; Onac, Osman; Alpay, Yakup; Tardus, Ismail; Ucpunar, Hanifi; Camurcu, Yalkin
BACKGROUND: A novel-design femoral nail (FN) with distal talon deployment (Talon-FN) has emerged in the market to cope with problematic distal locking. We aimed to compare the radiological and functional outcomes of the Talon-FN with a conventional FN (Con-FN) for the treatment of femoral shaft fracture (FSFs). METHODS: This retrospective study included 85 patients (57 men, 28 women; mean age: 46.8±23.9 years) with FSFs (AO types 32-A and B) who were treated with FNs (Talon-FN: 41, Con-FN: 44) during October 2014–2018. Knee injury and Osteoarthritis Outcome Score Physical Function Shortform, Hip injury and Osteoarthritis Outcome Score Physical Function Shortform, Short musculoskeletal function assessment bother and dysfunction indexes were used for functional assessment. RESULTS: The mean follow-up time was 25.8±6.7 months. The complication rates were 19.6% and 20.5% for Talon-FN and Con-FN, respectively (p=0.92). Malunion was the most common complication for each FN type (Talon-FN: 9.8%, Con-FN: 9.1%). All of the Talon-FN group’s malunions were axial (shortening and malrotation) and happened gradually. In contrast, the Con-FN group’s malu-nions were angular (varus and valgus) and caused by initial malreduction. The Talon-FN group’s two patients with shortening (4.9%) had AO 32-B type fractures, and the other two with malrotation (4.9%) had AO 32-A3 type fractures, all of four fractures were localized distal to the femoral isthmus. The post-operative functional outcomes were similar between the groups (all p>0.05). The mean op-eration/fluoroscopy time and the mean blood loss were lower in the Talon-FN group, while the mean union time was shorter in the Con-FN group (all p<0.01). No nonunion was noted in either group. The reoperation rates were similar at approximately 5% (p=0.95). CONCLUSION: Our study results revealed that the Talon-FN shortens the operation/fluoroscopy time and decreases the intra-operative blood loss with similar functional outcomes. However, the Con-FN seems to offer a more stable construct against axial malunion with a shorter bone union time. The Talon-FN should not be used in FSFs distal to the femoral isthmus with certain types of fractures prone to shortening and malrotation.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2022Functional and radiological comparison of three cephalomedullary nails with different designs used in the treatment of unstable intertrochanteric femur fractures of elderly; [Yaşlılarda instabil intertrokanterik femur kırıklarının tedavisinde kullanılan dizaynları farklı üç sefalomedüller çivinin fonksiyonel ve radyolojik açıdan karşılaştırılması]
Yapici, Furkan; Ucpunar, Hanifi; Gur, Volkan; Onac, Osman; Alpay, Yakup; Karakose, Reşit; Camurcu, Yalkin
BACKGROUND: The aim of this study to compare three cephalomedullary nails (CMNs) with different designs in terms of complica-tion, reoperation, implant failure, mortality rates, and functional outcomes in the treatment of unstable intertrochanteric fractures (UIFs). METHODS: This retrospective study included patients with UIFs (AO/OTA type 31-A2 and 31-A3) who were treated with one of these CMNs (74 patients with Talon-PFN, 70 patients with PFN-III, and 69 patients with Intertan) between October 2014 and October 2018. RESULTS: A total of 213 patients (122 females and 91 males) with a mean age of 81.0±9.3 years have participated in this study. The mean follow-up time was 26.1±6.3 months. Malfixation was the most common complication and the most common reason of reop-eration for each type of CMN. Complication and reoperation rates, post-operative functional status, mean union times, and overall mortality rates were similar between groups. Mean operation/fluoroscopy time and mean blood loss were low in the Talon-PFN group, whereas the highest means of these parameters were in the PFN-III group. There were six (8.2%) implant failures in the Talon-PFN group and one (1.5%) in PFN-III group. No implant failure was seen in the Intertan group. The highest rate (58.6%) of anatomic reduction was detected in PFN-III group. CONCLUSION: Our study results showed that each implant type had its own advantages and disadvantages in the treatment of UIFs with similar functional and reoperation outcomes. Intertan was advantageous with its absence of implant failures. Talon-PFN decreased the operation/fluoroscopy time and intraoperative blood loss but had the highest implant failure rate. There was a need for more anatomic reduction to centralize two separate parallel lag screws in the femoral neck in PFN-III group, and that costs operation/fluo-roscopy time and blood loss. Malfixation, which was the most common cause of complications and reoperations, should be avoided.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2022Open double-button technique is superior to hook plate in the treatment of acute Rockwood Type III/V acromioclavicular dislocations; [Akut Rockwood Tip III/V akromiyoklaviküler çıkıkların tedavisinde açık çift düğme tekniği kancalı plaktan üstündür]
Yapici, Furkan; Ucpunar, Hanifi; Gur, Volkan; Sevencan, Ahmet; Kizilay, Yusuf Onur; Karakose, Resit; Camurcu, Yalkin
BACKGROUND: The aim of this study is to compare open double-button (DB) and hook plate (HP) techniques in the treatment of acromioclavicular joint dislocation (ACJD) in terms of clinical and radiological outcomes and to determine which method is superior. METHODS: This retrospective comparative study included patients with ACJDs (Rockwood Type III/V) who were treated with one of these implants (22 patients with HP, 21 patients with DB) between June 2014 and February 2018. RESULTS: A total of 43 patients (39 men and 4 women) with a mean age of 41.8±17.4 years have participated in this study. The mean follow-up time was 20.6±7.5 months. Mean times of fluoroscopy, operation, and return to work were shorter in the DB group. Complication rates were 23.8% and 54.6%, reoperation rates (including mandatory implant removals [IR]) were 4.8% and 77.3%, mean constant scores were 92.1±3.4 and 88.3±4.2, and mean Visual Analog Scale scores were 0.8±1.0 and 1.5±1.0 for the DB and HP groups, respectively. IR was the main reason for reoperations in the HP group, whereas the DB group’s only reoperation was caused by a coracoid cutout (due to coracoid tunnel malposition) leading to redislocation. AC joint arthritis (36.4%) and subacromial osteolysis (31.9%) were com-monly encountered in the HP group. The most frequent complication of the DB group was malreduction (initial undercorrection) (9.6%). CONCLUSION: DB was superior to HP in functional outcome, post-operative pain, complication and reoperation rates, operation and fluoroscopy times, and time to return to work. Besides, reoperation (for IR) was needed in most of the HP patients. Therefore, the open DB technique should be preferential to the HP procedure.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2021Foot orthoses use for pediatric flexible flatfoot: comparative evaluation of quality of life for children and parents
Camurcu, Yalkin; Ucpunar, Hanifi; Karakose, Resit; Ozcan, Seckin; Sahin, Vedat
This study aimed to comparatively evaluate the quality of life scores of patients with pediatric flexible flatfoot (PFF) according to the use of foot orthoses. We also aimed to compare quality of life scores of children and their parents. Nonobese children aged between 5 and 10 years old who were diagnosed as PFF according to physical and radiological examinations were included in this cross-sectional comparative study. All children and their parents completed the Turkish translation of Oxford ankle foot questionnaire (OxAFQ) which contains four domains (physical, school and play, emotional, and footwear). Patients were grouped according to the use of foot orthoses (group I: no foot orthoses group and group II: foot orthoses group). Comparison of OxAFQ scores demonstrated no significant differences between the two groups. However, the mean emotional scores of parents were significantly lower in group II (P= 0.007). In group I, the mean emotional score of children was significantly lower compared to their parents’ scores (P= 0.001). In group II, the mean physical score of children was significantly lower compared to their parents’ scores (P= 0.003). According to our results, we observed no significant difference in terms of quality of life scores between children using foot orthoses and not using foot orthoses. However, we observed significantly lower emotional scores in parents whose children were using foot orthoses. We recommend that physicians should be aware of low physical scores in children with PFF and should inform parents about this situation rather than considering foot orthoses to relieve parents’ concern about foot deformity.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2020Monoblock polyethylene radial head prosthesis for the treatment of unreconstructable acute radial head fractures with a minimum 1-year follow-up: A retrospective case series
Ucpunar, Hanifi; Camurcu, Yalkin; Altay, Ridvan; Duman, Serda; Cobden, Adem; Sofu, Hakan
Background:Radial head arthroplasty is an alternative treatment for complex radial head fractures that are not appropriate for fixation. No study to date has reported the outcomes of monoblock ultrahigh molecular weight polyethylene (UHMW-PE) radial head prosthesis (RHP) for the treatment of radial head fracture. We aimed to evaluate the functional and radiographic outcomes of patients with unreconstructable acute radial head fractures treated with a monoblock UHMW-PE RHP.Methods:Patients who underwent UHMW-PE RHP placement for the treatment of radial head fracture were included in this retrospective case series. Patients who did not complete follow-up were excluded. Primary outcome measurements were the Mayo Elbow Performance Score (MEPS) and the Disabilities of Arm, Shoulder, and Hand (DASH) score. The latest follow-up physical examination and radiographs were evaluated for loosening, subluxation, and dislocation. Postoperative complications and need for further surgery were noted.Results:Eleven patients (four female and seven male patients) with a mean follow-up of 18.5 mo were evaluated. The mean MEPS was 79.5 (range, 65-100) at 3 mo postoperatively and 85.9 (range, 75-100) at the latest follow-up. The mean DASH score was 10.8 (range, 3-20) at 3 mo postoperatively and 8.7 (0-20) at the latest follow-up. No complications were encountered during follow-up.Conclusions:Radial head arthroplasty with a monoblock UHMW-PE RHP is safe and effective at short-term follow-up for treating acute unreconstructable radial head fractures with satisfactory functional and radiographic outcomes.Level of Evidence:Level IV.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2020Arthroscopic Treatment of Acute Septic Arthritis of the Hip Joint in Pediatric Patients Aged 10 Years or Younger
Duman, Serda; Camurcu, Yalkin; Ucpunar, Hanifi; Çöbden, Adem; Karahan, Nazım; Sofu, Hakan
Purpose: To present the results of arthroscopic treatment of acute septic arthritis of the hip joint in children aged 10 years or younger. Methods: Patients with a minimum follow-up period of 2 years who underwent arthroscopic treatment (anterolateral and medial subadductor 2-portal approach) of acute septic arthritis of the hip joint between January 2014 and January 2017 were included in this retrospective case-series study. The exclusion criteria included fungal infection, late presentation (≥5 days after the onset of the symptoms), presence of concomitant osteomyelitis, osseous pathologic conditions on radiography suggesting osteomyelitis, immunocompromised condition, history of surgery or infection surgery from the affected extremity, immobility owing to neuromuscular pathologic conditions, and identification of inflammatory or reactive arthritis during follow-up. The diagnosis of septic arthritis was confirmed according to the Waldvogel criteria. Clinical outcomes were assessed according to the Bennett score and Harris Hip Score. Results: We evaluated 15 hips in 15 patients (6 female and 9 male patients) with a mean age of 5.2 years (range, 2-10 years) in this study. The mean hospital stay was 4.2 days (range, 3-7 days), and the mean antibiotic-use period was 34 days (range, 26-45 days). The most causative pathogen was Staphylococcus aureus (40%) (including methicillin-sensitive S aureus) and was isolated and cultured in all patients. All patients had full range of motion of the hip joint. All of the Bennett scores were excellent; the mean Harris Hip Score was 96.3 (range, 92.5-100) after a minimum follow-up period of 24 months (mean, 26.1 ± 3.2 months; range, 24-35 months). No patient needed additional surgical intervention. No degenerative changes or avascular necrosis developed. Conclusions: According to our results, arthroscopic treatment is an effective choice for the treatment of acute septic arthritis of the hip joint in children aged 10 years or younger. Level of Evidence: Level IV, retrospective case series.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2020Evaluation of the association between plantar fasciitis and hallux valgus
Cobden, Adem; Camurcu, Yalkin; Sofu, Hakan; Ucpunar, Hanifi; Duman, Serda; Kocabiyik, Ahmet
Background: The windlass mechanism, first described by John Hicks in 1954, defines the anatomical and biomechanical relationship between the hallux and the plantar fascia. Hallux valgus (HV) and plantar fasciitis are the most common foot disorders, and, to date, no study has evaluated the relationship between these disorders. The purpose of this study was to determine the incidence of and factors associated with plantar fasciitis in patients with HV deformity. Methods: In this prospective observational study, 486 patients with HV were divided into three groups according to stage of HV deformity. Patient sex, age, and body mass index were recorded. Presence of accompanying plantar fascii ti s and heel spur was investigated by physical and radiographic examination. First metatarsophalangeal joint dorsiflexion of the affected side was measured. Patients with or without plantar fasciitis were also compared to evaluate factors associated with plantar fasciitis. Results: Mean age and body mass index of the patients were significantly different among the three HV groups. The incidence of plantar fasciitis and heel spur significantly increased in correlation with the severity of HV deformity. Increased age and HV stage and decreased first metatarsophalangeal joint dorsiflexion were significantly associated with presence of plantar fasciitis in HV. Conclusions: In this study, the incidence of plantar fasciitis was significantly increased in correlation with the severity of HV deformity. Significant association was found between plantar fasciitis and HV, which are anatomically and biomechanically related to each other by the windlass mechanism.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2020Clinical outcomes of iatrogenic complex clubfoot treated with modified Ponseti method
Duman, Serda; Camurcu, Yalkin; Cobden, Adem; Ucpunar, Hanifi; Karahan, Nazim; Bursali, Aysegul
Introduction: There are not enough studies demonstrating the results of the modified Ponseti method on iatrogenic complex clubfoot that occurs due to errors during the application of the method for treating idiopathic clubfoot. The present study aimed to present the treatment results of the modified method reported by Ponseti for treating feet that became complex solely due to errors during casting. Methods: Patients with the confirmed diagnosis of iatrogenic complex clubfoot were according to initial physicians’ report and photographs were included in this retrospective case series study. Patients with congenital atypical feet, incomplete medical records, and accompanying pathologies were excluded from the study. Patients’ clinical data and clinical scores were recorded at the initial visit and at the latest follow-up. Results: There were 21 children (15 boys and 8 girls) with 32 complex clubfeet. Initial correction was achieved in all children, with an average of five serial casts (range 3 to 6 casts). At the last follow-up, ISGCF score of 25 feet (78.1%) was excellent and seven feet (21.9) was good. Conclusion: According to the results acquired from this study, an iatrogenic complex clubfoot can be successfully treated using the modified Ponseti method.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2020Clinical and radiological outcomes of patients treated with the talon distalfix proximal femoral nail for intertrochanteric femur fractures
Yapici, Furkan; Ucpunar, Hanifi; Camurcu, Yalkin; Emirhan, Necati; Tanoglu, Oguzhan; Tardus, Ismail
Background: The Talon™ DistalFix™ Proximal Femoral Nail (Talon-PFN) is a new proximal femoral intramedullary nail designed for the treatment of intertrochanteric femoral fractures. This study aimed to report the clinical and radiological outcomes of patients treated using a proximal femoral intramedullary nail with a novel design. Methods: Patients with either stable or unstable (AO/OTA type 31-A1, 2, 3) intertrochanteric fractures who were treated with the Talon-PFN between October 2014 and January 2018 in our department participated in this retrospective study. Patients’ demographics, clinical characteristics, and functional and radiographical outcomes were evaluated. Results: A total of 110 patients (65 females, 45 males) with a mean age of 80.6 ± 9.1 years participated in this study. The mean follow-up time was 24 ± 13.4 months. The overall mortality rate during follow-up was 50.48%. The most common perioperative complications were a malposition of the femoral neck screw and talon cutout, both of which occurred in 17 patients (15.5%). The most common complications observed during follow-up were a lesser trochanter nonunion/malunion in 34 patients (30.9%), valgus malunion in 18 patients 16.4%), lateral screw migration in four patients (3.6%), and varus malunion in 15 patients (13.7%). A late screw cutout through the femoral head was seen in four patients (3.6%). At least one complication was detected in 53 patients (48.2%). However, revision surgery was performed in only six of these cases (5.5%). Conclusion: According to the results obtained in this study, the Talon-PFN, which has similar clinical and radiological outcomes compared to other proximal femoral intramedullary nail designs according to the reported studies, can be a suitable alternative in the treatment of intertrochanteric fractures.
RDL Kalıcı Kaydıİncele - ArticleYayıncıda açık erişim2020Does radial extracorporeal shockwave therapy impair hearing function in patients with plantar fasciitis?
Cobden, Serap; Cobden, Adem; Camurcu, Yalkin; Duman, Serda; Ucpunar, Hanifi; Dagistan, Hakan
Background: Radial extracorporeal shock wave therapy (r-ESWT) is commonly used for the treatment of chronic plantar fasciitis. Previously in the urology literature, some studies reported hearing impairment after extracorporeal shock wave lithotripsy. However, there is no study that evaluates the possible side effects of r-ESWT on the hearing function of patients. The aim of this study was to investigate the effects of r-ESWT on the pure tone audiometry of the patients on whom r-ESWT was applied for chronic plantar fasciitis. Material and Methods: Patients with the diagnosis of plantar fasciitis who were treated with r-ESWT were included in this prospective case-control study. Before and after the r-ESWT application, all patients were consulted to our otolaryngology department for pure tone audiometric examination to detect any hearing impairment before and after the treatment. A control group was also constructed that consisted of patients who were admitted to our department for any complaint. Results: A total of 67 patients participated in the study. Radial ESWT group consisted of 47 patients (39 female, 8 male) with the mean age of 44.1 years. The control group consisted of 20 patients (12 female, 8 male) with the mean age of 36.9 years. We observed a 20-dB threshold shift at 8000Hz in 1 patient who had no clinical symptom. This patient had no threshold shift at the 1-month control audiometric measurement. Conclusion: According to the results acquired from this study, we can consider that r-ESWT treatment in patients with chronic plantar fasciitis has no markedly detrimental effect on the hearing function.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2020Does Adductor Tenotomy Need During Closed Reduction Have a Prognostic Value in the Treatment of Developmental Dysplasia of the Hip Between 6 and 12 Months of Age? “Adductor Tenotomy in the Treatment of Developmental Dysplasia’’
Ucpunar, Hanifi; Mert, Muhammed; Camurcu, Yalkin; Sofu, Hakan; Yildirim, Timur; Bayhan, Avni Ilhan
Background: Adductor tenotomy is needed for clinically complex hips with soft-tissue contractures. It may be proposed that the patients who need adductor tenotomy during closed reduction would have poorer prognosis than the ones without need for adductor tenotomy. The main purposes were to compare the normalization of acetabular index angle (AI), to determine the incidence of femoral head avascular necrosis (AVN), and to predict the need for any secondary surgical intervention between the patients who need adductor tenotomy and those who do not during closed reduction for developmental dysplasia of the hip. Materials and Methods: The study group consisted of 65 hips treated between 6 and 12 months of age. The mean age at the time of surgery was 8.1 ± 1.4 (6–12) months and the mean follow-up was 4.2 ± 1.5 years. Improvement of AI, rate and severity of AVN, and need for secondary surgery with its predictors were evaluated. Results: Adductor tenotomy was performed in 22 hips (Group 1), but not in 43 hips (Group 2). Normalization of the AI was − 14.8° ± 3.5° versus − 14.3° ± 3.2°. The overall incidence of AVN was 18.4%. The rate of secondary surgical intervention was higher in Group 1 (63.1% versus 36.9%) (p = 0.014). Conclusions: No significant difference was detected regarding the improvement of AI as well as the incidence of AVN between the groups. The need for adductor tenotomy during closed reduction was one of the main predictors of the possible secondary surgery.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2020Clinical and Magnetic Resonance Imaging Outcomes of Microfracture Plus Chitosan/Blood Implant vs Microfracture for Osteochondral Lesions of the Talus
Camurcu, Yalkin; Ucpunar, Hanifi; Yapici, Furkan; Karakose, Resit; Ozcan, Seckin; Cobden, Adem; Duman, Serda; Sofu, Hakan
Background: The aim of this study was to compare the clinical and magnetic resonance imaging (MRI) outcomes of arthroscopic microfracture (MF) plus chitosan-glycerol phosphate/blood implant and MF alone for the treatment of the osteochondral lesions of the talus (OCLTs). Methods: Patients who underwent either MF plus chitosan (group 1, n = 32) or MF alone (group 2, n = 31) between 2015 and 2019 in 2 separate time periods were retrospectively analyzed. Visual analog scale (VAS) score and American Orthopaedic Foot & Ankle Society (AOFAS) score were used for clinical evaluation. The magnetic resonance observation of cartilage repair tissue (MOCART) system was used for MRI evaluation. The mean follow-up time was 32 ± 13 months (range, 12-61 months). Results: Postoperatively, we detected significant improvements in both groups in terms of VAS and AOFAS scores. However, we observed no statistically significant difference between groups in terms of clinical scores, except the mean VAS function score, which was significantly higher in group 1 (P =.022). According to MOCART scale, complete repair with the filling of the chondral defect and intactness of the surface of the repair tissue were more common in group 1. However, these parameters did not significantly differ between groups (P =.257 and.242, respectively). Conclusion: Arthroscopic MF plus chitosan glycerol phosphate/blood implant did not result in better clinical and MRI outcomes compared with MF alone in the treatment of OCLTs. Level of Evidence: Level III, retrospective comparative study.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2019The incidence and interrelationship of concomitant anomalies in congenital scoliosis
Sevencan, Ahmet; Misir, Abdulhamit; Ucpunar, Hanifi; Balioglu, Mehmet Bulent; Gur, Volkan; Akinci, Suayip
AIM: To report the incidence and interrelationship of concomitant anomalies in congenital scoliosis (CS) patients. MATERIAL and METHODS: Whole-spine computed tomography and magnetic resonance imaging (MRI) examination, echocardiography, and renal ultrasonography (USG) evaluations of 231 patients with CS were reviewed. Additionally, intraspinal pathologies and structural cardiac and renal anomalies were recorded. RESULTS: The incidence of intraspinal pathology was 53.7%. Echocardiography was performed in 140 of 231 patients, and congenital heart disease was detected in 38 patients. Renal USG was performed in 133 of 231 patients, and a renal disease was detected in 37 patients. In 133 patients, spinal MRI, echocardiography, and renal USG were performed. In 22 of 67 (32.8%) patients with an intraspinal anomaly, an additional cardiac anomaly was detected. In 27 of 67 (40.3%) patients with an intraspinal anomaly, an additional renal anomaly was detected. In 47.3% of patients with a cardiac anomaly, an additional renal anomaly was detected. In 15 of 133 patients (11.2%) intraspinal, cardiac, and renal anomalies were identified. CONCLUSION: Surgeons should evaluate additional anomalies in CS if patients report having a congenital anomaly. Because cardiac and renal anomalies increase intra- and postoperative complication risks, a careful and comprehensive preoperative evaluation is needed.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2019The incidence of biphalangeal fifth toe: Comparison of normal population and patients with foot deformity
Ucpunar, Hanifi; Camurcu, Yalkın; Ozcan, Cagri; Buyuk, Abdul Fettah; Tas, Suleyman Kasim; Cobden, Adem
Background: Pedal biphalangism, which was also defined as symphalangism, is seen at a frequency that cannot be ignored; however, no study can be found in the literature evaluating biphalangism in normal population in comparison to those who have foot disorders. The aim of this study was to evaluate the incidence of the pedal fifth toe symphalangism in normal population and in patients with foot deformity including hallux valgus, pes planus, pes cavus, and pes equinovarus. We hypothesized that pedal fifth toe symphalangism may be a predisposing factor or an accompanying structural variation for foot deformity. Materials: Patients admitted to the emergency department of our center in October and November 2016 were defined as the control group, and patients with the diagnosis of hallux valgus, pes planus, pes cavus, and pes equinovarus treated between 2011 and 2016 in our department were defined as the foot deformity group. Individuals who had anteroposterior, oblique, and lateral radiographs of foot were included in the study. Results: One thousand and four patients participated in the cross-sectional observational study. Biphalangeal fifth toe was found in 328 of 1004 (32.7%) patients. In foot deformity group (n = 672), 222 patients (33%) had biphalangeal fifth toe. In the control group, 106 (31.9%) of the 332 patients had biphalangeal fifth toe. There was no statistically significant difference in the incidence of biphalangeal fifth toe between the two groups (p = 0.72). Conclusions: According to the results of this study, biphalangeal fifth toe is a common pedal anatomical variant seen approximately in one-third of the population who have either foot deformity or not. This information may be valuable for podiatrist undertaking the conservative or surgical treatment of fifth toe-related disorders.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2019Should orthopedic surgeons consider reducing the negative effects of Outerbridge grade 2 patellofemoral chondral lesion on early postoperative recovery during anterior cruciate ligament reconstruction
Sofu, Hakan; Camurcu, Yalkin; Issin, Ahmet; Ucpunar, Hanifi; Ozcan, Seckin; Duman, Serda
Purpose: The purpose of this study was to comparatively evaluate the effectiveness of intra-articular PRP and HA injections applied as the treatment of Outerbridge grade 2 chondral lesions in patellofemoral joint during arthroscopic ACL reconstruction. Methods: The clinical and radiographic data of 61 patients between 18 and 45 years of age were evaluated. The patients were separated into three groups. Hyaluronic acid injection was applied in 22 knees (Group 1), PRP injection was applied in 18 knees (Group 2), and 21 knees did not have any specific treatment except ACL reconstruction (Group 3). All patients were followed clinically at least for 12 months. Clinical examination of the operated knee, visual analogue scale (VAS) score, Lysholm knee score, and Tegner activity scale were the outcome measures. Routine X-ray and MRI were also performed for all patients at 12-month postoperative follow-up visit. Results: Although the mean VAS and Lysholm scores at 3-month follow-up were better in Group 1 and 2 than Group 3, the efficacy of intra-articular PRP on healing process regarding progression of the mean VAS and Lysholm scores through 6- and 12-month follow-ups was significantly better and longer than HA. No statistically significant differences were detected according to Tegner activity scale between the groups at 3 and 6 months; however, Group 2 had better activity level than both Group 1 (p < 0.001) and 3 (p < 0.001) at the end of 12 months after surgery. Conclusion: Intra-articular PRP injection applied as the treatment of concomitant Outerbridge grade 2 chondral lesion in patellofemoral joint during ACL reconstruction revealed better and durable clinical outcomes via decreasing the potentially negative effects of chondral pathology on postoperative healing with respect to HA injection. Level of evidence: III—retrospective comparative study.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2019Clinical and radiographic outcomes of chitosan-glycerol phosphate/blood implant are similar with hyaluronic acid-based cell-free scaffold in the treatment of focal osteochondral lesions of the knee joint
Sofu, Hakan; Camurcu, Yalkin; Ucpunar, Hanifi; Ozcan, Seckin; Yurten, Hakan; Sahin, Vedat
Purpose: To determine the clinical and radiographic efficacy of chitosan-glycerol phosphate/blood implant versus hyaluronic acid-based cell-free scaffold in patients with focal osteochondral lesion of the knee joint. Methods: Clinical data of 46 patients surgically treated using either chitosan-glycerol phosphate/blood implant (25 patients, Group 1) or hyaluronic acid-based cell-free scaffold (21 patients, Group 2) in combination with microfracture were retrospectively evaluated. All lesions were Outerbridge grade III or IV with a mean lesion size of 3.3 ± 0.7 cm 2 . The mean follow-up time was 24.4 months. Visual analogue scale (VAS), Lysholm knee score, and Tegner activity scale were the instruments to evaluate the clinical status. Magnetic resonance observation of cartilage repair tissue (MOCART) system was used to analyze the characteristics of repair tissue. Results: No significant differences were detected between the groups regarding VAS, Lysholm, and Tegner scores at any time interval during the whole follow-up. The mean post-operative VAS and Lysholm scores at the latest follow-up was significantly better in cases with the lesion size ≤ 3 cm 2 in Group 1 (p = 0.001, p < 0.001, respectively). However, no significant differences according to the lesion size were detected in Group 2 (n.s.). Complete repair with the filling of the defect was achieved in 7 (28%) of the knees in Group 1 and it was 7 (33.3%) of the knees in Group 2 according to MOCART system at the latest follow-up. Conclusion: Single-stage regenerative cartilage surgery using chitosan-glycerol phosphate/blood implant combined to microfracture for focal osteochondral lesions of the knee revealed similar clinical and radiographic outcomes with hyaluronic acid-based cell-free scaffold at short-term follow-up. However, clinical outcomes of hyaluronan scaffold were less sensitive to defect size than chitosan. With the advantages of no hypertrophic repair tissue formation as well as no need to arthrotomy during surgery, chitosan is an effective choice especially in patients with the lesion size ≤ 3 cm 2 . Level of evidence: III.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2019Predictors of allocation to surgery in patients older than 50 years with partial-thickness rotator cuff tear
Camurcu, Yalkin; Ucpunar, Hanifi; Ari, Hamza; Duman, Serda; Cobden, Adem; Sofu, Hakan
Background: The purpose of this study was to determine the predictive factors for allocation to surgery in patients older than 50 years with symptomatic chronic partial-thickness rotator cuff tear (PTRCT). Methods: Patients older than 50 years with a confirmed diagnosis of unilateral isolated PTRCT were included in this retrospective study. In the minimum follow-up of 2 years, eventual allocation to surgical or nonsurgical treatment was determined individually. Patients who underwent surgery were defined as failed conservative management and allocation to surgery. Data pertaining to patients' demographics, functional comorbidity index values, duration of symptoms, and American Shoulder and Elbow Surgeons scores were collected from our medical records. Tear side and Ellman classification, subacromial spur, and acromiohumeral intervals were also noted. A regression analysis was performed to determine the major predictors of allocation to surgery. Results: There were 202 patients with a mean age of 62 years in group I (no-surgery group) and 70 patients with a mean age of 57 years in group II (surgery group). The mean age and functional comorbidity index values were significantly higher in group I than in group II (P <.001 and P <.001, respectively). Bursal-sided tears were significantly more common in group II (P =.026). According to the findings of regression analysis, tear side and functional comorbidity index were the major predictors of allocation to surgery (P =.015 and P <.001, respectively). Conclusion: Our study results indicate that in patients older than 50 years with PTRCTs, those with fewer comorbidities and bursal-sided PTRCTs were significantly more likely to undergo surgery.
RDL Kalıcı Kaydıİncele