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Permanent URI for this collectionhttps://hdl.handle.net/20.500.14288/6
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Publication Open Access Transfer of the lesser tuberosity for reverse hill-sachs lesions after neglected posterior dislocations of the shoulder: a retrospective clinical study of 13 cases(Elsevier, 2017) Demirel, M.; Ersen, A.; Karademir, G.; Atalar, A.C.; N/A; Demirhan, Mehmet; Faculty Member; School of Medicine; 9882Objective: This study aimed to present middle-term functional and radiological outcomes of the transfer of the lesser tuberosity in the management of reverse Hill-Sachs lesions following posterior dislocations of the shoulder. Patients and methods: With a diagnosis of neglected posterior shoulder dislocation (8 locked, 5 recurrent), 13 male patients (age range: 28-72; mean age: 39.3 years) who underwent the transfer of the lesser tuberosity due to reverse Hill-Sachs lesions, were retrospectively reviewed based on functional and radiological data. The etiologies were: epilepsy in 9 patients, a traffic accident in 2 patients, and fall in 2 patients. To assess the patients' functional level, American Shoulder and Elbow Surgeons (ASES) and Constant Scores were used, and the patients' range of motion at the last follow-up was measured. To evaluate the development of arthrosis, the final follow-up control plain radiographs were examined. The average size of the defects calculated from the axial computed tomography sets was 27% (range: 20%-40%). Results: The average length of follow-up was 30 months (range: 12-67 months). At the last follow-up visit, the main ASES and Constant Scores were 78 and 85, respectively, and the average degrees of flexion, abduction, and external rotation were 163,151, and 70 respectively. The concentric reduction was observed postoperatively. Conclusion: McLaughlin procedure appears to be a safe and effective method in the treatment of neglected posterior shoulder dislocations with reverse Hill-Sachs lesion. Level of Evidence: Level IV, Therapeutic study. (C) 2017 Turkish Association of Orthopaedics and Traumatology.Publication Open Access Biomechanical comparison of orthogonal versus parallel double plating systems in intraarticular distal humerus fractures(Elsevier, 2017) Atalar, A. C.; Tunali, O.; Ersen, A.; Kapicioglu, M.; Saglam, Y.; N/A; Demirhan, Mehmet; Faculty Member; School of Medicine; 9882Objectives: In intraarticular distal humerus fractures, internal fixation with double plates is the gold standard treatment. However the optimal plate configuration is not clear in the literature. The aim of this study was to compare the biomechanical stability of the parallel and the orthogonal anatomical locking plating systems in intraarticular distal humerus fractures in artificial humerus models. Methods: Intraarticular distal humerus fracture (AO13-C2) with 5 mm metaphyseal defect was created in sixteen artificial humeral models. Models were fixed with either orthogonal or parallel plating systems with locking screws (Acumed elbow plating systems). Both systems were tested for their stiffness with loads in axial compression, varus, valgus, anterior and posterior bending. Then plastic deformation after cyclic loading in posterior bending and load to failure in posterior bending were tested. The failure mechanisms of all the samples were observed. Results: Stiffness values in every direction were not significantly different among the orthogonal and the parallel plating groups. There was no statistical difference between the two groups in plastic deformation values (0.31 mm-0.29 mm) and load to failure tests in posterior bending (372.4 N-379.7 N). In the orthogonal plating system most of the failures occurred due to the proximal shaft fracture, whereas in the parallel plating system failure occurred due to the shift of the most distal screw in proximal fragment. Conclusion: Our study showed that both plating systems had similar biomechanical stabilities when anatomic plates with distal locking screws were used in intraarticular distal humerus fractures in artificial humerus models. (C) 2016 Turkish Association of Orthopaedics and Traumatology.Publication Open Access Comment on “Bosworth and modified Phemister techniques revisited. A comparison of intraarticular vs extraarticular fixation methods in the treatment of acute Rockwood type III acromioclavicular dislocations”(Elsevier, 2019) N/A; Demirhan, Mehmet; Birsel, Olgar; School of Medicine; 9882; N/APublication Open Access Disc rehydration after dynamic stabilization: a report of 59 cases(Korean Spine Society, 2017) Yılmaz, Atilla; Yıldırım, Hakan; N/A; Şentürk, Salim; Sasani, Mehdi; Öktenoğlu, Bekir Tunç; Yaman, Onur; Süzer, Süleyman Tuncer; Özer, Ali Fahir; Doctor; Faculty Member; Doctor; Faculty Member; School of Medicine; N/A; N/A; N/A; N/A; 221691; 1022Study Design: A retrospective study investigating decrease in the nucleus pulposus signal intensity or disc height on magnetic resonance imaging (MRI) and disc degeneration. Purpose: Although a degenerated disc cannot self- regenerate, distraction or stabilization may provide suitable conditions for rehydration and possible regeneration. This study aimed to evaluate clinical outcomes and disc regeneration via MRI in a series of patients with degenerative disc disease (DDD) who underwent lumbar stabilization with a dynamic stabilization system (DSS). Overview of Literature: A dynamic system provides rehydration during early DDD. Methods: Fifty- nine patients (mean age, 46.5 years) who undedwent stabilization with DSS for segmental instability (painful black disc) between 2004 and 2014 were retrospectively evaluated. All patients underwent MRI preoperatively and 12 months postoperatively. Intervertebral disc (IVD) degeneration grades at the implanted segment were categorized using the Pfirrmann classification system. Patients were followed for a mean of 6.4 years, and clinical outcomes were based on visual analog scale (VAS) and Oswestry disability index (ODI) scores. Results: Significant improvements in back pain VAS and ODI scores from before surgery (7 and 68%, respectively) were reported at 6 (2.85 and 27.4%, respectively) and 12 months postoperatively (1.8 and 16.3%, respectively). Postoperative IVD changes were observed in 28 patients. Improvement was observed in 20 patients (34%), whereas progressive degeneration was observed in eight patients (13.5%). Thirty- one patients (52.5%) exhibited neither improvement nor progression. Single Pfirrmann grade improvements were observed in 29% of the patients and two- grade improvements were observed in 5%. Conclusions: Our observations support the theory that physiological movement and a balanced load distribution are necessary for disc regeneration. We conclude that DSS may decelerate the degeneration process and appears to facilitate regeneration.Publication Open Access Lumbar single-level dynamic stabilization with semi-rigid and full dynamic systems: a retrospective clinical and radiological analysis of 71 patients(Korean Orthopaedic Association, 2017) Yilmaz, A.; Erbulut, D.U.; N/A; Özer, Ali Fahir; Öktenoğlu, Bekir Tunç; Egemen, Emrah; Sasani, Mehdi; Yaman, Onur; Süzer, Süleyman Tuncer; Faculty Member; Faculty Member; Doctor; School of Medicine; 1022; N/A; N/A; N/A; N/A; 221691Background: This study compares the clinical and radiological results of three most commonly used dynamic stabilization systems in the field of orthopedic surgery. Methods: A total of 71 patients underwent single-level posterior transpedicular dynamic stabilization between 2011 and 2014 due to lumbar degenerative disc disease. Three different dynamic systems used include: (1) the Dynesys system; (2) a dynamic screw with a PEEK rod; and (3) a full dynamic system (a dynamic screw with a dynamic rod; BalanC). The mean patient age was 45.8 years. The mean follow-up was 29.7 months. Clinical and radiological data were obtained for each patient preoperatively and at 6, 12, and 24 months of follow-up. Results: Clinical outcomes were significantly improved in all patients. There were no significant differences in the radiological outcomes among the groups divided according to the system used. Screw loosening was detected in 2 patients, and 1 patient developed screw breakage. All patients with screw loosening or breakage underwent revision surgery. Conclusions: Each procedure offered satisfactory outcome regardless of which system was applied.Publication Open Access Peritendinous injection of platelet-rich plasma to treat tendinopathy: a retrospective review(Elsevier, 2017) Unlu, M. C.; Kivrak, A.; Kayaalp, M. E.; Akgun, I.; N/A; Birsel, Olgar; School of MedicineObjective: The aim of this study was to determine factors associated with the likelihood of a better clinical outcome after the peritendinous injection of PRP for the treatment of chronic tendinopathy and identify whether PRP represents an effective treatment option for chronic tendinopathies. Methods: The study included 214 patients (86 males and 128 females; mean age: 39.3 (18-75) years) who received PRP injections for tendinopathy refractory to conventional treatments. The mean duration of symptoms at the moment of the PRP treatment was 8.3 months. Primary outcome measurement was perceived improvement in symptoms for each anatomic compartment for upper and lower limbs at 6 months after treatment. Also, a visual analog scale (VAS) score (pain intensity on a 0-10 scale) was used for pain scoring questionnaire before treatment, 6 weeks and 6 months following the PRP injection(s). To identify factors associated with the likelihood of a better clinical outcome, patients were categorized on the basis of their perceived improvement in symptoms 6 months after the PRP injection(s) dthat is, as lower (less than 50% global improvement) or higher (more than 50% global improvement). Results: A visual analogue scale score and perceived improvement in symptoms were significantly lower after peritendinous injection in 6-week and 6-month follow-ups compared with the baseline (P < 0.001) except for peroneal and Achilles tendons. Overall, 83% of patients indicated moderate to complete improvement in symptoms. The most common injection sites were the lateral epicondyle, Achilles, and patellar tendons. Furthermore, 30% of patients received only 1 injection, 30% received 2 injections, and 40% received 3 or more injections. A total of 85% of patients were satisfied (more than 50% global improvement) with the procedure. In addition, upper limb tendons, increase in the age, and female gender were associated with a higher likelihood of perceived improvement in symptoms. Conclusions: In the present retrospective study assessing PRP injections in the treatment of chronic tendinopathy, a moderate improvement (> 50%) in pain symptoms was observed in most of the patients. Our research found that results were most promising with patellar and lateral epicondylar tendinopathy in the short to medium term. Female patients, patients with upper extremity tendinopathy and older patients appeared to benefit more from PRP injection.Publication Open Access Modified latarjet procedure for patients with glenoid bone defect accompanied with anterior shoulder instability(Elsevier, 2013) Atalar, Ata Can; Bilsel, Kerem; Eren, İlker; Çelik, Derya; Çil, Hilal; N/A; Demirhan, Mehmet; Faculty Member; School of Medicine; 9882Objective: The aim of this study was to assess the effects of coracoid bone block (modified Latarjet) procedure on clinical and functional results in cases with glenoid bone defect accompanied with anterior shoulder instability. Methods: The study included 35 patients (average age: 35 years; range: 20 to 58 years) with glenoid bone defect and recurrent dislocations treated with the modified Latarjet procedure. There were 12 sports injuries, 5 post-epileptic cases and 18 recurrent anterior shoulder dislocation following non-sports-related injuries. Recurrence was reported in 7 patients formerly treated with the Bankart procedure. Average number of preoperative dislocations was 10.8±6.5 and average time range between the first dislocation and surgery was 14.9±13.2 months. All patients underwent preoperative diagnostic arthroscopy. Postoperative isometric exercises in braces were assigned for the first 6 weeks, followed by active strengthening exercises. Pre- and postoperative functional results were evaluated using the ASES (American Shoulder and Elbow Surgeons) and Rowe scores and pain using the VAS (Visual Analog Scale). Results: Osseous union of coracoid graft was achieved in all patients. Average follow-up was 24±12.2 (range: 12 to 74) months. No degenerative arthritis or continuing instability was detected in any of the patients. Average forward flexion was 165°±20° and external rotation 59°±13°. Mean preoperative ASES and Rowe scores of 49.6±10.6 and 47.9±21.5 increased postoperatively to 91.3±11 and 89.1±9.2, respectively. Mean VAS scores decreased significantly from 6.2±2.4 to 1.8±0.6 postoperatively (p<0.05). Conclusion: Shoulder functionality and former activity levels can be successfully achieved in terms of increased patient satisfaction through use of the modified Latarjet surgery in the treatment of glenoid bone defect and anterior shoulder instability.Publication Open Access Arthroscopic versus open release of internal rotation contracture in the obstetrical brachial plexus paralysis (OBPP) sequela(Elsevier, 2019) N/A; Demirhan, Mehmet; Faculty Member; School of Medicine; 9882Background: Latissimus dorsi (LD) and teres major (TM) tendon transfers are effective surgical procedures to improve shoulder abduction and external rotation for children with obstetrical brachial plexus palsy (OBPP). Open pectoralis major (PM) tendon Z-plasty and arthroscopic subscapularis (SS) release are 2 options for the release of internal rotation contractures to enhance muscle transfers. This study compared the functional results of LD and TM tendon transfers with open PM tendon Z-plasty or arthroscopic SS release. Methods: the study included 24 patients who underwent LD and TM tendon transfers for OBPP (9 arthroscopic SS release, 15 open PM tendon Z-plasty) with a mean follow-up of 41.33 months (range, 36-60 months) and 47.2 months (range, 36-60 months), respectively. Functional evaluation was made according to range of motion and Mallet scoring system. Results: shoulder abduction–external rotation degrees and scores in all sections of the Mallet scoring system significantly increased in both groups (P <.001). Postoperatively, the arthroscopic SS release group had significantly better abduction degrees (P =.003), total Mallet scores (P <.001), and superior abduction (P =.043), active external rotation (P =.043), hand-to-head (P =.043), and hand-to-mouth (P <.001) scores for the Mallet scoring system. Discussion: transfer of LD together with TM tendons combined with one of the internal rotation contracture release procedures yielded good clinical and functional results in patients younger than age 7, regardless of the type of release method. However, arthroscopic SS release, although requiring an experienced surgeon, revealed better clinical and functional outcomes and is considered to be a less invasive and superior method.