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Permanent URI for this collectionhttps://hdl.handle.net/20.500.14288/6
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Publication Open Access Treatment of tibial and femoral bone defects with bone transport over an intramedullary nail(Lippincott Williams and Wilkins (LWW), 2020) Daldal, Fehmi; Eralp, Levent; Kocaoğlu, Mehmet; Uludağ, Serkan; Sarı, Seçkin; Baş, Ali; PhD Student; Koç University HospitalObjectives: to evaluate the results of the bone transport over an intramedullary nail (BTON) technique for the treatment of segmental bone defects. DESIGN: Retrospective review of case series. SETTING: Level 1 trauma center. Patients/participants: we included 40 patients who underwent reconstruction of the lower limb with BTON technique between 2000 and 2018. The technique was performed in the tibial segments in 21 patients and in the femoral segments in 19 patients. Intervention: The surgical technique was performed in 2 stages for patients with infected nonunion. Infection was eradicated in all patients at the first stage. For the BTON at the second stage, monolateral external fixators and circular external fixators were used for femoral and tibial defects, respectively. In cases of defects without any infection, debridement with a single-stage BTON was performed. Main outcome measurements: Complications as well as radiological and clinical results were evaluated according to the criteria of Paley-Maar. Results: minor complications occurred in 11 patients: pin site problems (9), cellulitis (1), and skin detachment due to Schanz screw (1). Major complications occurred in 8 patients: docking site nonunion (4), early consolidation and Schanz screw failure (1), knee flexion contracture (1), and ankle equinus contracture (2). Four patients had osteomyelitis as residual sequelae. Bone score was excellent in 27 patients. Excellent functional results were obtained in 31 patients. Conclusions: the BTON technique is associated with low cost because of the short treatment period, low complication risk, and rapid rehabilitation and is not limited by the amount of bone transport.Publication Open Access Giant cell tumor of tendon sheath in the hand: analysis of risk factors for recurrence in 50 cases(BioMed Central, 2019) School of Medicine; Koç University HospitalBackground: giant cell tumor of the tendon sheath is the most common form of giant cell tumors and is the second most common soft tissue tumor of the hand region after ganglion cyst. Magnetic resonance imaging is the diagnostic tool of choice for both diagnosis and treatment planning. The current standard treatment of choice is simple excision. The main concern about the treatment is related to the high recurrence rates. Besides incomplete excision, there is no consensus concerning the effect of other risk factors on recurrence. The literature lacks detailed reports on surgical excision of these tumors with a standardized surgical treatment and an appropriate patient follow up. The aim of this study was to investigate the recurrence rate and the associated recurrence risk factors for giant cell tumor of tendon sheath of the hand following a standardized treatment. Methods: the records of patients treated for giant cell tumor of tendon sheath of the hand treated by the same hand surgeon were evaluated retrospectively. The features obtained from preoperative magnetic resonance imaging, final physical examination, patients' age and sex, anatomical site of the tumor, relationship of the tumor with bone, joint or neurovascular structures, bone invasion, recurrence after surgery and complications like skin necrosis, digital neuropathy or limitation in range of motion were documented. Chi-square test was used to compare categorical variables. Results: Fifty patient were included in the study. The average follow-up time was 84 months. Three recurrences (6%) were recorded. The only significant risk factor for the recurrence was tumor adjacency to the interphalangeal joints of the fingers other than thumb. No major or minor complications were encountered in the postoperative period. Conclusion: With adequate surgical exposure and meticulous dissection provided by the magnification loupes, we were able demonstrate one of the lowest recurrence rates in the literature. Well-designed studies combining the recurrence rates of several hand surgery centers implementing a standardized treatment are needed to better demonstrate the associated risk factors for recurrence.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 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.