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Permanent URI for this collectionhttps://hdl.handle.net/20.500.14288/6

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    PublicationOpen Access
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    PublicationOpen Access
    Quantitative comparison of a laterally misplaced pedicle screw with a re-directed screw. How much pull-out strength is lost?
    (Elsevier, 2018) Şanyılmaz, Kerim; Özkunt, Okan; Gemalmaz, Halil Can; Akgül, Turgut; Sungur, Mustafa; Dikici, Fatih; Baydoğan, Murat; Korkmaz, Murat; Doctor; Koç University Hospital
    Objective: redirecting of a laterally misplaced pedicle screw into the accurate position decreases the pull-out strength due to the reinsertion, lateral wall cortical perforation and widening of the pedicle hole. Thus, this biomechanical study was performed to quantitatively analyze the pullout strength of a redirected laterally misplaced pedicle screw into the accurate position. Methods: thirty pedicules of 15 bovine vertebrae were separated to 3 groups, according to the screw placement method: 1) standard flawless trajectory; 2) trajectory with lateral pedicle wall perforation; 3) trajectory with lateral wall perforation redirected to the standard trajectory. Samples were placed on a universal testing machine and pullout loads were measured. Kruskal-Wallis test was utilized within 95% confidence interval and p value <0.05 to test for the statistical significance. Results: the mean pullout strength was 2891 +/- 654,2 N(1383-3814,5) in Group 1; 817,8 +/- 227,6 N(308,6-1144,9) in Group 2 and 2081,1 +/- 487,7 N(1583,5-2962,5) in Group 3. The results found out to be statistically significant (p<0.05). Inter-group comparisons revealed that lateral pedicle wall perforation significantly decreases the pullout strength (p<0.05) and redirection of the screw increases the strength (p<0.05), however it was still weaker than the screws with flawless standard trajectory but this was not statistically significant (p>0.05). Conclusion: The results of this study confirm that pullout strength of pedicle screw decreases by approximately 71% when the lateral wall is perforated and decreases 28% after redirection to the accurate position.
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    PublicationOpen Access
    Preliminary results of a new intercalary modular endoprosthesis for the management of diaphyseal bone metastases
    (Turkish Joint Diseases Foundation, 2021) Göker, Barlas; Tokgözoğlu, Mazhar; İnan, Ulukan; Özkan, Korhan; Çolak, Tahsin Sami; Ayvaz, Mehmet; Büyükdoğan, Kadir; Aslan, Lercan; Deveci, Mehmet Ali; Doctor; Faculty Member; Faculty Member; School of Medicine; Koç University Hospital; N/A; N/A; 206311
    Objectives: this study aims to evaluate functional outcomes of patients and to analyze complication rates of modular intercalary endoprosthetic reconstruction after resection of metastatic diaphyseal bone lesions. Patients and methods: between December 2017 and February 2020, 22 patients (15 males, 7 females; median age: 64.2 years; range, 49 to 91) who underwent reconstruction with modular intercalary endoprostheses for metastatic bone tumors at five different centers were retrospectively analyzed. Age, sex, diagnosis, follow-up duration, previous treatments of patients, and resection lengths were recorded. The Musculoskeletal Tumor Society Scores (MSTS) were used to assess functional status of available patients at the final follow-up. Failures were categorized according to the Henderson classification. Results: locations of the resected tumors included 10 humeri (45.5%), five tibiae (22.7%), and seven femurs (31.8%). The length of the resected tissues ranged from 35 mm to 180 mm. Seven patients (31.8%) died of disease, and one patient died of pneumonia within follow-up period. The functional outcomes of surviving patients were satisfying with a median MSTS score of 86.9% (range, 70 to 100%) at a median follow-up of 17 months (range, 8 to 26). There were two cases of type II (9%), one cases of type IIIa (4.5%), two cases of type IIIb (9%), and one case of type IV (4.5%) failure. Complications were most commonly observed in tibial reconstructions. Conclusion: the good short-term functional results were achieved in surviving patients. Uncomplicated patients were able to perform daily living activities without limitations. The overall rate of complications was relatively low and, among them, mechanical problems were the most commonly encountered problems.
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    PublicationOpen Access
    Ultrasonographic measurement of the dimensions of proximal and distal patellar fragments after Niebauer-King Procedure for the management of congenital dislocation of the knee
    (Aves, 2021) Biçer, Ö. S.; Tekin, M.; Eren, Ö. F.; Mirioğlu, A.; Soyupak, S.; Deveci, Mehmet Ali; Faculty Member; School of Medicine; 206311
    Objective: the aim of this study was to ultrasonographically measure the dimensions of the proximal and distalpatellar fragments to determine whether postoperative growth differences existbetween the fragments in children with congenital dislocation of the kneetreated by Niebauer Kings quadricepsplasty. Methods: this retrospective study included six congenitaldislocated knees of four children with arthrogryposis multiplex congenita (AMC)(3 girls; mean age = 40 months; age range = 9-44 months), presented with severe hyperextension knee contractures,which were treated by Niebauer-King's quadricepsplasty.The transverse, craniocaudal, and anteroposterior dimensions of the patellaewere measured ultrasonographically 20 (range = 6-42) months postoperatively by a singleradiologist. Results: the mean transverse, craniocaudal, and anteroposteriordimensions of proximal and distal halves of the patellae were: 11.46 (7.0-16.9)-10.5 (8.0-14.4); 17.4 (14.0-21.0) -16.68 (14.5-19.3); 6.76 (5.6-7.9) -7.76 (7.0-9.4) mm respectively. There was no significantdifference in craniocaudal and transverse dimensions, but the anteroposteriordimension (thickness) of the distal patellae articulating the knee joint had agreater thickness (P = 0,01). Conclusion: evidence from this study has shown that a bettergrowth can be expected in the distal fragment of the patella compared with theproximal fragment following treatment with Niebauer-King's quadricepsplasty in children with congenital dislocation ofthe knee.
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    PublicationOpen Access
    Clinical and radiological outcomes of Salter versus Pemberton osteotomies in the management of developmental dysplasia of the hip: a retrospective comparative study
    (Aves, 2022) Mirioğlu, A.; Biçer, Ö.S.; Tekin, M.; Özkan, C.; Bağır, M.; Deveci, Mehmet Ali; Faculty Member; School of Medicine; 206311
    Objective: the aim of this study was to investigate whether there is a relationship between Salter and Pemberton pelvic osteotomies and avascular necrosis of femoral head in the management of developmental dysplasia of the hip (DDH). Methods: This retrospective study included 69 hips of 52 patients aged between 12-36 months, diagnosed as DDH who had undergone either Salter or Pemberton pelvic osteotomy with Smith Petersen approach. There were 35 patients in Salter Pelvic Osteotomy and 34 patients in Pemberton Pelvic Osteotomy groups. Before the treatment of DDH, Tönnis classification was used, preoperative and 24th month postoperative Acetabular Index (AI) angles were measured. Kalamchi-MacEwen grades of avascular necrosis were determined in terms of presence of avascular necrosis of the femoral head. Results: There were no significant differences between two osteotomy groups at the end of mid-term follow up in terms of the radiological parameters and avascular necrosis of femoral head. However it was found that the increased avascular necrosis incidence was significantly associated with Tönnis grade 4 hips. Conclusion: Salter and Pemberton osteotomies can be both used safely in the treatment of DDH regarding their effect on the femoral head. Level of evidence: Level III, Therapeutic Study.
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    PublicationOpen Access
    Cross-cultural adaptation and validation of the Turkish version of the Toronto Extremity Salvage Score in patients with musculoskeletal tumors
    (Aves, 2021) Ocaktan, Bahadır; Yapar, Aliekber; Tokgöz, Mehmet Ali; Deveci, Mehmet Ali; Şimşek, Sezai Aykın; Faculty Member; Faculty Member; School of Medicine; 206311; 133305
    Objective: the aim of the study was to translate the Toronto Extremity Salvage Score (TESS) into Turkish and perform across cultural adaptation for patients with musculoskeletal tumors. Methods: thirty-six patients (20 male, 16 female; mean age = 36.6 ± 15.4 years) who were diagnosed with malignant bone and soft tissue sarcoma or benign aggressive bone tumors between the years 2007 and 2012 were included in the study. TESS was translated into Turkish and back translated to determine language validity. To test convergent validity, the Turkish versions of the Short Form-36 (SF-36), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Disabilities of the Arm, Shoulder, and Hand (DASH) were used. SF-36 was used on all patients while WOMAC and DASH were used on patients with lower extremity tumors and upper extremity tumors respectively. The tests were repeated 15 days later and the intraclass correlation coefficient (ICC) was used to determine test-retest reliability. Results: the Turkish version of TESS was found to have a strong negative correlation with WOMAC (r = -0.702; P < 0.001) and DASH (r = -0.774; P < 0.001) as well as a strong negative correlation with ROMS (r = 0.601; P < 0.001). Turkish TESS also had a statistically significant correlation with SF-36–Physical functioning, SF-36–Role Physical, SF-36–Bodily Pain, and SF36–General Health at levels ranging from 0.326 to 0.669 (r values ranging from 0.326 to 0.669, P < 0.001). The internal consistency (Cronbach’s ?:0.96 for lower extremity and Cronbach’s ?:0.94 for upper extremity) and test-retest reliability of Turkish TESS were found to be excellent (ICC lower extremity: 0.96 [0.935-0.983]; P < 0.001 and ICC upper extremity: 0.99 [0.967-0.997]; P < 001). ICC values varied between 0.674 and 0.987 for each item of the scale for both extremities. Conlusion: the Turkish version of TESS seems to be a valid and reliable patient-reported outcome measure to evaluate physical function after musculoskeletal tumor surgery in Turkish patients. Level of Evidence: level II, diagnostic study