Özer, Mustafa; Ataoğlu, Muhammet Baybars; Çetinkaya, Mehmet; Ayanoğlu, Tacettin; Kaptan, Ahmet Yiğit; Kanatli, Ulunay

Objectives: This study aims to evaluate the accompanying intraarticular pathologies in patients who underwent arthroscopic distal clavicle resection (DCR) for symptomatic acromioclavicular (AC) joint degeneration based on age groups and to reveal which additional pathologies should be considered across different age groups during physical examination of patients suspected of AC joint degeneration. Patients and methods: The study included 156 patients (55 males, 101 females; mean age 57.2±10.0 years; range, 35 to 80 years) who underwent arthroscopic DCR between January 2006 and December 2017 and had at least one clinical positive test for AC joint degeneration during the preoperative physical examination. The patients were divided into three groups as those aged < 50 years (group 1), between 50-65 years (group 2), and > 65 years (group 3). The concomitant intra-articular pathologies were evaluated across different age groups and compared between the groups. Results: Concomitant intra-articular pathologies were detected in 117 (75%) of a total of 156 patients. Additional pathology rate increased with increasing age (p=0.002). More than one concomitant intraarticular pathologies were detected in 37 patients (23.7%). This rate increased with increasing age (p=0.002). The number of patients with superior labrum anterior posterior (SLAP) lesion as the only additional pathology was 33 (21.2%). This rate decreased with increasing age (p=0.015). In group 1, the rate of concomitant SLAP lesion was 44.1%. Conclusion: The high incidence of intra-articular pathologies accompanying symptomatic AC joint degeneration raises the importance of careful physical examination, detailed imaging, and arthroscopic surgery to obtain good results in patients scheduled for DCR. The frequency of AC joint degeneration and concomitant SLAP lesions, particularly in younger patients, should be considered during clinical examinations. © 2019, Turkish Joint Diseases Foundation.; Amaç: Bu çalişmada semptomatik akromioklaviküler (AK) eklem dejenerasyonu için artroskopik distal klavikula rezeksiyonu (DKR) uygulanan hastalarda eşlik eden eklem içi patolojiler yaş gruplarina göre değerlendirildi ve AK eklem dejenerasyonundan şüphelenilen hastalarda fizik muayene sirasinda farkli yaş gruplarinda hangi ek patolojilerin düşünülmesi gerektiği ortaya koyuldu. Hastalar ve yöntemler: çalişmaya Ocak 2006 - Aralik 2017 tarihleri arasinda artroskopik DKR uygulanan ve ameliyat öncesi fizik muayenesinde AK eklem dejenerasyonu ile ilişkili en az bir klinik testi pozitif olan 156 hasta (55 erkek, 101 kadin; ort. yaş 57.2±10.0 yil; dağilim, 35-80 yil) dahil edildi. Hastalar < 50 yaş (grup 1), 50-65 yaş arasi (grup 2) ve > 65 yaş (grup 3) olmak üzere üç gruba ayrildi. Eşlik eden eklem içi patolojiler farkli yaş gruplarina göre değerlendirildi ve gruplar arasinda karşilaştirildi. Bulgular: Toplam 156 hastanin 117'sinde (%75) eşlik eden eklem içi patoloji saptandi. Yaş arttikça ek patoloji orani artti (p=0.002). Otuz yedi hastada (%23.7) birden fazla eşlik eden eklem içi patoloji saptandi. Bu oran yaş arttikça artti (p=0.002). Ek patoloji olarak sadece superior labrum anterior posterior (SLAP) lezyonu olan hasta sayisi 33 (%21.2) idi. Bu oran yaş arttikça azaldi (p=0.015). Grup 1'de, eşlik eden SLAP lezyonu orani %44.1 idi. Sonuç: Semptomatik AK eklem dejenerasyonuna eşlik eden eklem içi patolojilerin yüksek ortaya çikiş sikliği, DKR planlanan hastalarda iyi sonuçlar alinmasi için dikkatli fizik muayene, detayli görüntüleme ve artroskopik cerrahinin önemini artirmaktadir. Akromioklaviküler eklem dejenerasyonu ve eşlik eden SLAP lezyonlarinin sikliği özellikle daha genç hastalarda klinik muayeneler sirasinda akilda tutulmalidir.

Çetinkaya, Mehmet; Kanatli, Ulunay; Ataoğlu, Muhammet Baybars; Özer, Mustafa; Ayanoğlu, Tacettin; Bölükbaşi, Selçuk

Objectives: This study aims to identify the forelock sign of partial tears of the subscapularis and to compare the incidences of this sign and air bag sign. Patients and methods: One hundred and twenty patients (39 males, 81 females; mean age 51.3 years; range, 25 to 79) diagnosed as isolated subscapularis tear or isolated supraspinatus tear from among patients who underwent shoulder arthroscopy between January 2013 and January 2016 were divided into four groups of 30 patients each as the subscapularis tear (group 1), fullthickness supraspinatus tear (group 2), bursal-side supraspinatus tear (group 3), and articular-side supraspinatus tear (group 4) groups. All patients had video records of their operation. The integrity of the long head of biceps tendon (LHBT), Lafosse classification of the subscapularis tear, and the incidence of the forelock and air bag signs were evaluated. Results: The incidence of the air bag sign in group 1 was 10% and that of the forelock sign was 60%. The forelock sign was significantly more frequent in group 1 than in the other groups (odds ratio 10.46: 3.9-27.8 with 95% confidence interval) and the air bag sign (p < 0.001). The LHBT was mostly pathologic in this group, which was also statistically significant (p < 0.01). The incidence of the forelock sign in group 1 was similar in each LHBT pathology and Lafosse subgroups. Conclusion: The forelock sign identified in this study was significantly frequent (60%) in partial subscapularis tendon tears with strong inter- and intra-observer consistency while the air bag sign was rare (10%). The LHBT disorders were strongly associated with subscapularis tears; however, the forelock sign was not an indicator of the condition of the LHBT and type of partial subscapularis tendon tear according to the Lafosse classification.

Issin, Ahmet; Kockara, Nizamettin

Amaç: Bu çalışmada sitrik asit ve sodyum bikarbonat karışımının polimetilmetakrilat kemik çimentosunda efervesan olarak kullanımının daha iyi ilaç elüsyonu açısından etkileri araştırıldı.Hastalar ve yöntemler: İçeriğinde 10'ar gram glikoz ve farklı miktarlarda efervesan (E) olan; parça sayıları (P), yüzey alanları, hacimleri ve poroziteleri farklı silindir çimento bloklar hazırlandı. Tüm blokların fiziksel özellikleri hesaplandı. Bloklar serum fizyolojik içeren kavanozlara konuldu ve sıvı içerisine salınan glikoz konsantrasyonları önceden belirlenen aralıklarda ölçüldü. Elüsyon hızı ve fiziksel özellikler arasındaki ilişkiler tanımlandı.Bulgular: Efervesanlı numunelerden elüsyon oranları anlamlı derecede daha yüksekti. Kırk beşinci günün sonunda EP glikoz içeriğinin ortalama %21'ini saldı. Bu değer E0P2, E0P4, E2P1 ve E4P için sırasıyla %38, %61, %82 ve %88 idi. Su absorbsiyon oranları, yüzey alanları, porozite ve glikoz elüsyonu oranları arasında güçlü korelasyonlar saptandı (r=0,942, p<0,01; r=0,894, p<0,05; r=0,918, p<0,05).Sonuç: Sodyum bikarbonat ve sitrik asidin efervesan olarak kemik çimentosu içinde kullanılması, daha iyi antibiyotik elüsyonu için tatmin edici porozite oluşumunu sağlamaktadır. Yekpare bir spacer ve daha iyi lokal antibiyotik elüsyonu gereken durumlarda bu yöntem işe yarayabilir.

Koçkara, Nizamettin; Sofu, Hakan; Issin, Ahmet; çetinkaya, Mehmet; Tayfur, Mahir; Süleyman, Bahadir

Objectives: This study aims to assess the radiographic, histological, and biomechanical effects of pregabalin on fracture healing in a rat model of femur fracture. Materials and methods: A total of 32 female Wistar- Albino rats (mean age 12±1 weeks; mean body weight 236±12 grams) were randomized into four groups with eight rats in each group. Groups A and B were the control groups whereas C and D were the treatment groups. Drugs were delivered by oral gavage. Radiographic, histological and biomechanical evaluations were performed after sacrificing the rats in groups A and C on 15th postoperative day and the rats in groups B and D on 30th postoperative day. Results: Although radiographic results were better in groups A and B than groups C and D at the end of 15th day, no significant difference was detected at the end of 30th day. No statistically significant differences were observed between the groups on 15th a nd 3 0th days in terms of histological or biomechanical evaluation. Conclusion: Administration of pregabalin did not affect fracture healing process adversely in rats.

Çamurcu, Yalkin; Sofu, Hakan; Issin, Ahmet; Koçkara, Nizamettin; Genç, Erdinç; Çetinkaya, Mehmet

Objectives: This study aims to compare the results of talon tibial intramedullary (IM) nailing with the results of conventional distal locked tibial IM nailing. Patients and methods: The study included 60 patients (37 males, 23 females; mean age 42.2 years; range 18 to 92 years) who underwent tibial IM nailing with the diagnosis of unilateral, closed or open (Gustilo-Anderson type 1) tibial diaphyseal fracture (Orthopaedic Trauma Association 42) between January 2013 and January 2016. Patients were separated into two groups as talon tibial IM nailing group (group 1, n=30) and distal locked tibial IM nailing group (group 2, n=30). All patients' operative and total radiation exposure times were recorded. At last control, American Orthopaedic Foot and Ankle Society and Tegner Lysholm scores were evaluated for clinical outcomes. All complications were recorded. Results: Mean operative time was 43.8 minutes in group 1 and 50.2 minutes in group 2. Mean radiation exposure time in group 1 was 5.4 minutes, which was three times shorter than the time of group 2, which was 17.5 minutes. Mean time until union was 16.9 weeks in group 1 and 12.2 weeks in group 2. Statistically significant differences were present between two groups in operative, radiation exposure time and time until union (p=0.019, p=0.001, p=0.001, respectively). When American Orthopaedic Foot and Ankle Society and Tegner Lysholm scores were compared, there were no statistically significant differences (p=0.951 and p=0.896). Conclusion: Talon tibial IM nailing is an easier and safer alternative to conventional distal locked tibial IM nailing with shorter operative and radiation exposure times. However, it should be kept in mind that the time until radiographic union may be longer compared to conventional tibial IM nailing.

Issin, Ahmet; Koçkara, Nizamettin

Objectives: This study aims to investigate the effects of the use of citric acid and sodium bicarbonate mixture as an effervescent in polymethylmethacrylate bone cement in terms of better drug elution. Patients and methods: Multiple cylinder cement blocks each containing 10 g of glucose and different amounts of effervescent (E), with different numbers of pieces (P), surface areas, volumes, and porosities were prepared. Physical properties of all blocks were calculated. Blocks were placed in jars containing saline solutions and the released glucose concentrations were measured at predefined intervals. Correlations between elution rate and physical properties were defined. Results: Elution rates were significantly higher in samples with effervescent. At the end of 45th day, E0P1 released mean 21% of its glucose content. This value was 38%, 61%, 82% and 88% for E0P2, E0P4, E2P1 a nd E4P1, respectively. Strong correlations were detected between water absorption ratio, surface areas, porosity and glucose elution rates (r=0.942, p < 0.01; r=0.894, p < 0.05; r=0.918, p < 0.05). Conclusion: Using sodium bicarbonate and citric acid as effervescent in bone cement provides satisfactory porosity development for better antibiotic elution. This method may be useful when a monolithic spacer and better local antibiotic elution are required.

Gürsu, Şükrü Sarper; Sofu, Hakan; Yildirim, Timur; Şahin, Vedat; Issin, Ahmet

Amaç: Bu çalışmada ortoröntgenogramlarda bacakların orta hatta olan uzaklığının alt ekstremite dizilimi ve açıları üzeri- ne olan etkileri incelendi. Hastalar ve yöntemler: Mart 2012 - Nisan 2013 tarihleri arasında, eklemdeki laksite miktarının anlaşılabilmesi ama- cıyla farklı iki pozisyonda ortoröntgenogram çekilmiş olan 56 hastanın varus deformitesi olan 95 ekstremitesi çalışmaya dahil edildi. İlk grafi, ayak bilekleri birbirine değecek şekilde çekilirken, ikinci grafinin, ayaklar hastanın omuz genişliği mesafesi kadar açık olacak şekilde çekildi. Her bir ortorönt- genogramda, ortalama mekanik aks açıları, anatomik akslar ve eklem hattı oryantasyon açıları ölçüldü. Varus deformitesi >10° olan 43 ekstremite için ölçümler ayrıca tekrarlandı. Bulgular: Ayakların bitişik olduğu pozisyonda çekilen orto- röntgenogramlarda, ortalama mekanik aks değeri 9.58°±5.7°, (0.20°; 26.0°), ortalama anatomik aks 3.65°±6.14°, (-9.0°; 21.0°) ve ortalama eklem hattı oryantasyon açısı -3.41°±2.52°, (-12.0°; 1.60°) olarak hesaplandı. Ayakların omuz mesafesinde açık olduğu pozisyonda çekilen ortoröntgenogramlarda ise; orta- lama mekanik aks değeri 7.73°±5.58°, (-3.0°; 23.0°), ortalama anatomik aks 2.62°±5.87°, (-11.0°; 18.30°) ve ortalama eklem hattı oryantasyon açısı -2.44°±2.41°, (-13.0°; 3.0°) olarak hesaplandı. İki pozisyon arasındaki açısal farklar istatistiksel olarak anlamlı bulundu (p<0.005). Sonuç: Çalışma bulgularımız, varus gonartrozlu hastalarda, ayaklar bitişik pozisyonda çekilen ortoröntgenogramlarda, meka- nik aks, anatomik aks ve eklem hattı oryantasyon açılarının ortalama değerlerinin ayakların omuz mesafesinde açık olduğu pozisyonda çekilen grafiye göre daha büyük olduğunu gösterdi. Bu durumun ameliyat öncesi planlamada hatalara yol açabileceği kanısındayız. Muhtemel sorunları en aza indirmek için bacakların durması gereken ideal pozisyonların standardize edilmesi gerekir.

Gürsu, Sarper; Yildirim, Timur; Issin, Ahmet; Sofu, Hakan; Sahin, Vedat

Objectives: In this study, we evaluated the effects of the distance of the legs from the midline on alignment and angles of the lower extremities in orthoroentgenograms. Patients and methods: Between March 2012 and April 2013, 95 limbs of 56 patients with varus deformity who underwent orthoroentgenogram to identify the amount of joint laxity in two positions were included in this study. The initial X-ray was performed with the feet in contact, while the other was performed as the legs were abducted to be in line with the shoulders. For each orthoroentgenogram, the mean mechanical axis angle, anatomical axis, and joint line orientation angles were measured retrospectively. These measurements were repeated for 43 limbs with varus deformity > 10 degrees. Results: In the orthoroentgenograms with the feet in contact, the mean mechanical axis angle was 9.58 degrees +/- 5.7 degrees, (0.20 degrees; 26.0 degrees), the mean anatomical axis angle 3.65 degrees +/- 6.14 degrees, (-9.0 degrees; 21.0 degrees), and the mean joint line orientation angle -3.41 degrees +/- 2.52 degrees, (-12.0 degrees; 1.60 degrees). In the orthoroentgenograms with the legs abducted, the mean mechanical axis angle was 7.73 degrees +/- 5.58 degrees, (-3.0 degrees; 23.0 degrees), the mean anatomical axis angle 2.62 degrees +/- 5.87 degrees, (-11.0 degrees; 18.30 degrees), and mean joint line orientation angle was -2.44 degrees +/- 2.41 degrees, (-13.0 degrees; 3.0 degrees). The differences in the angles between the two positions were statistically significant (p < 0.005). Conclusion: Our study results showed that the mean values of mechanical axis angle, anatomical axis and the joint line orientation angle were higher in orthoroentgenograms with the feet in contact than the orthoroentgenograms with the legs abducted in patients with yarns gonarthrosis. We suggest that this may lead to mistakes in the preoperative planning. Ideal positions should be standardized to minimize possible problems.

Sofu, Hakan; Şahin, Vedat; Gürsu, Sarper; Yildirim, Timur; Issin, Ahmet; Ordueri, Mehmet

Objectives: This study aims to evaluate midterm clinical results of the use of two autogenous graft types. Patients and methods: Between June 2005 and November 2010, clinical data of 44 patients who were operated were retrospectively analyzed. Quadriceps tendon-patellar bone autograft was used for reconstruction surgery in 23 patients (QT-PB group), while quadrupled hamstring tendon autograft was used in 21 patients (HT group). The Tegner's activity scale, Lysholm scoring system, single-leg-hop test and KT-2000 arthrometric measurements were used for data collection. Results: The mean length of follow-up was 37.6 months. Although the mean Lysholm score increased in both groups, excellent results in HT group were two-fold higher compared to QT-PB group. The mean laxity for the operated knee joint was 5.65 mm (3.5 to 8.0 mm) in QT-PB group and 3.67 mm (3.0 to 5.5 mm) in HT group. Head-to-head analysis using KT-2000 arthrometer demonstrated that 12 patients (52.1%) in QT-PB group and two patients (9.6%) in HT group had more than 3 mm of anterior laxity difference. Conclusion: Quadrupled hamstring tendon autograft is superior to central quadriceps tendon-patellar bone in arthroscopic anterior cruciate ligament reconstruction surgery.