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Öğe Clinical comparison of hook plate fixation versus extension block pinning for bony mallet finger: a retrospective comparison study(SAGE PUBLICATIONS LTD, 2015) Acar, Mehmet Ali; Güzel, Yunus; Güleç, Ali; Uzer, Gökçer; Elmadağ, Nuh MehmetThe aim of this retrospective study was to determine whether traumatic mallet fractures had better outcomes when treated by hook plate fixation (13 patients) or extension block pinning (19 patients). We assessed outcomes using Crawford's criteria; distal interphalangeal joint range of motion; the DASH score; and a visual analogue scale score for pain. We measured radiological parameters. No significant differences were observed in functional and clinical outcomes and in complications. Whereas the operative time was longer in the hook plate group, intraoperative fluoroscopy use, time to bone union and time to return to work were greater in the extension block group. Although the hook plate method is more technically demanding, it provides good stable reduction, earlier mobilization and an earlier return to work. The extension block pinning technique is easier and as effective but it requires greater peri-operative fluoroscopy.Öğe Hamstring tendonu kullanılarak ön çapraz bağ rekonstrüksiyonu yapılmış hastalarda oluşan tünel genişlemesinin kliniğe olan etkisi(Selçuk Üniversitesi Tıp Fakültesi, 2009) Elmadağ, Nuh Mehmet; Yel, MustafaÖn çapraz bağ rekonstrüksiyonu sonrasında oluşan tünel genişlemesi oldukça yeni bir fenomendir. Günümüzde artmış ön çapraz bağ rekonstrüksiyonları sonrasında revizyon cerrahilerinde artış meydana gelmektedir. Bu nedenle tünel miktarındaki genişleme revizyon cerrahileri öncesinde önem kazanmaktadır. Ocak 2006 ? Eylül 2008 tarihleri arasında Selçuk üniversitesi meram tıp fakültesi ortopedi ve travmatoloji anabilim dalı tarafından 143 hastaya dörtlü hamstring tendon otogrefti ile öçb rekonstrüksiyonu yapılmış olup bu çalışmada 40 hasta takibe alınmıştır. Operasyon esnasında en küçük yaş 15,en büyük yaş 42,ortalama yaş 26.4 (SD±7,32) dır. Hastaların başvurma sebepleri arasında 25 hasta güvensizlik,20 hasta ağrı,13 hasta kilitlenme,10 hasta hareket kısıtlılığı, 14 hasta merdiven inip çıkamama olarak değerlendirildi. Hastaların ameliyat öncesi olarak lokal ve genel fizik muayeneleri, direkt grafileri, MR grafileri çekildi. Ameliyat öncesi ve son kontrollerinde hastaların değerlendirilmesi hastaların lysholm, IKDC, tegner, rolimetre, 3 boyutlu tomografi ve subjektif şikayetlerine göre değerlendirmeler yapıldı. Hastaların tomografileri standardizasyon için aynı cihaz kullanılarak (Simens AG Medical Solitions, Erlangen Germany) çekimleri yapıldı. Çekimlerden elde edilen görüntüler 3 boyutlu reformat hale getirilerek diğer ölçüm tekniklerinde oluşabilecek hatalar en aza indirildi. Ölçümler aynı radyoloji uzmanı tarafından yapıldı. Hastaların kontrol süreleri en az 1 yıl ile en fazla 24 ay arasında ortalama olarak 16 ay'dı. Ön çekmece değerlendirmelerinde, ameliyat öncesi en düşük 2+ en yüksek 3+ ortalama 2,62 olarak bulunmuş olup ameliyat sonrası en düşük 0 en yüksek 1 ortalama 0,52 olarak değerlendirildi. Lachman değerlendirmelerinde, ameliyat öncesi en düşük 2+ en yüksek 3+ ortalama 2,75 olarak bulunmuş olup ameliyat sonrası en düşük 0 en yüksek 1 ortalama 0,52 olarak değerlendirildi. Femoral ve tibial tüneller için drill çapları en düşük 7,5 mm. ile en yüksek 10 mm. arasında ortalama olarak 8,26mm(0,57±SD) bulundu. Sonuçlarımız klinik olarak literatür ile uyumlu bulunmuştur. Ancak tünel genişleme insidansı ve genişleme miktarı literatüre oranla daha fazla bulduk. Bu yüksek oranları da 3 boyutlu reformat yaptığımız görüntüler ile daha sensitif ölçümlere bağladık. Ölçümlerden elde edilen yüksek oranlar ile klinik olarak bağlantı bulundu.Öğe The olecranon osteotomy provides better outcome than the triceps-lifting approach for the treatment of distal humerus fractures(2014) Elmadağ, Nuh Mehmet; Erdil, Mehmet; Bilsel, Kerem; Acar, Mehmet Ali; Tuncer, Nejat; Tuncay, İbrahimIntroduction: Intra-articular distal humeral fractures can be approached in a variety of ways. The purpose of this study is to evaluate and compare the functional outcomes of two approaches: approach with olecranon osteotomy and triceps-lifting approach for the treatment of intra-articular distal humeral fractures. Methods: This study shows a consecutive series of 54 intra-articular distal humeral fractures of 54 patients who were treated with open reduction and internal fixation with anatomic plating. Lateral plating was performed in 10 (45.5 %) patients, and medial and lateral parallel plating was performed in 12 (54.5 %) patients in olecranon osteotomy group, while lateral plating was performed in 8 (25 %) patients, and medial and lateral parallel plating was performed in 24 (75 %) patients in triceps-lifting group. Results: Mean follow-up was 38.3 months for olecranon osteotomy group and 41.4 months for triceps-lifting group. Functional outcomes according to MAYO elbow score and extension-flexion motion arc values were significantly better in olecranon osteotomy group (p < 0.05). Conclusion: Approach with olecranon osteotomy provided better functional outcomes than triceps-lifting approach. Additionally, intra-articular distal humerus fractures can be safely treated with olecranon osteotomy which provides more control over the elbow joint and better visualisation and allows early postoperative rehabilitation. Level of evidence: IV. © 2012 Springer-Verlag France.Öğe Patients with black hip and black knee due to ochronotic arthropathy: Case report and review of literature(2013) Acar, Mehmet Ali; Erkoçak, Ömer Faruk; Aydın, Bahattin Kerem; Altan, Egemen; Şenaran, Hakan; Elmadağ, Nuh MehmetOchronotic arthropathy is a manifestation of longstanding alkaptonuria. With increasing age, an accumulation of pigment deposits of homogentisic acid in the joint cartilage results in ochronotic osteoarthritis. We present a case of a 62-year-old female who underwent staged left uncemented total hip and right cemented total knee arthroplasty for osteoarthritis secondary to ochronosis. © OMSB, 2013.Öğe Safety of modified Stoppa approach for Ganz periacetabular osteotomy: A preliminary cadaveric study(TURKISH ASSOC ORTHOPAEDICS TRAUMATOLOGY, 2016) Elmadağ, Nuh Mehmet; Uzer, Gökçer; Yıldız, Fatih; Ceylan, Hasan H.; Acar, Mehmet AliObjective: The aim of this cadaveric study was to investigate the efficacy of the modified Stoppa approach in Ganz periacetabular osteotomy (PAO). Methods: The Ganz PAO was performed on 10 hemipelvises with normal hips, from 5 cadavers using the modified Stoppa approach through the Pfannenstiel incision. All of the osteotomies were performed under fluoroscopic control and direct visualizing the osteotomy site from the same incision. After the osteotomy, the acetabulum was medialized and redirected anterolaterally, and fixed with 2 screws. The neurovascular structures and the joints were examined by dissecting the soft tissues after fixation of the osteotomies. Outcome parameters were center-edge (CE) angle, the distances between the osteotomy and anterior superior iliac spine (ASIS), and between the osteotomy and the sciatic notch, neurovascular and joint penetrations. Results: After the osteotomy, the mean CE angle was improved from 19.8 degrees to 25.2 degrees, mean distance between the osteotomy and ASIS was 3.1 cm, and the mean distance between the osteotomy and the sciatic notch was 10.2 mm. The neurovascular structures and the joints were examined by dissecting the soft tissues after fixation of the osteotomies. No damage to the joint, surrounding arteries, veins or nerves was detected in any of the cadavers. Conclusions: Bilateral dysplastic hips can be treated with a 10 cm, cosmetically more acceptable incision in the same session using this approach. Quadrilateral surface of the acetabulum can be directly seen using this approach and the osteotomy can be safely performed. (C) 2016 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V.Öğe Safety of modiŞed Stoppa approach for Ganz periacetabular osteotomy: A preliminary cadaveric study(2016) Elmadağ, Nuh Mehmet; Uzer, Gökçer; Yıldız, Fatih; Ceylan, Hasan H.; Acar, Mehmet AliObjective: The aim of this cadaveric study was to investigate the efŞcacy of the modiŞed Stoppa approachin Ganz periacetabular osteotomy (PAO).Methods: The Ganz PAO was performed on 10 hemipelvises with normal hips, from 5 cadavers using themodiŞed Stoppa approach through the Pfannenstiel incision. All of the osteotomies were performedunderfluoroscopic control and direct visualizing the osteotomy site from the same incision. After theosteotomy, the acetabulum was medialized and redirected anterolaterally, andŞxed with 2 screws. Theneurovascular structures and the joints were examined by dissecting the soft tissues afterŞxation of theosteotomies. Outcome parameters were center-edge (CE) angle, the distances between the osteotomyand anterior superior iliac spine (ASIS), and between the osteotomy and the sciatic notch, neurovascularand joint penetrations.Results: After the osteotomy, the mean CE angle was improved from 19.8to 25.2, mean distance between the osteotomy and ASIS was 3.1 cm, and the mean distance between the osteotomy and the sciaticnotch was 10.2 mm. The neurovascular structures and the joints were examined by dissecting the softtissues afterŞxation of the osteotomies. No damage to the joint, surrounding arteries, veins or nerveswas detected in any of the cadavers.Conclusions: Bilateral dysplastic hips can be treated with a 10 cm, cosmetically more acceptable incisionin the same session using this approach. Quadrilateral surface of the acetabulum can be directly seenusing this approach and the osteotomy can be safely performed.© 2016 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V. This isan open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)Öğe The Stoppa approach versus the ilioinguinal approach for anterior acetabular fractures: A case control study assessing blood loss complications and function outcomes(ELSEVIER MASSON, CORPORATION OFFICE, 2014) Elmadağ, Nuh Mehmet; Güzel, Y.; Acar, Mehmet Ali; Uzer, Gökçer; Arazi, MehmetBackground: The modified Stoppa approach was introduced to manage fracture of the anterior column instead of the ilioinguinal approach to reduce morbidity. However there is no clinical evidence to confirm its efficiency. Therefore this study was designed to ascertain: (1) if the Stoppa approach versus ilioinguinal allows less blood loss, (2) if functional and radiological results are superior to that of the ilioinguinal approach, (3) if the rate of complication was different. Hypothesis: The modified Stoppa approach allows less blood loss than the ilioinguinal in management of fractures of the anterior column of the acetabulum. Patients and methods: Nineteen patients who were treated with the ilioinguinal approach (Group A) at a mean follow-up of 33 months and 17 patients who were treated with the modified Stoppa approach (Group B) at a mean follow-up of 28.9 months were retrospectively reviewed. Patients were called to the final follow-up examination, mean follow-up durations were set and the functional evaluation of patients was made with measurement of range of motion, Harris Hip Scores (HHS), and Merle D'Aubigne score. Results: Average blood loss was determined at a mean 1170 mL (range, 750-2150 mL) in Group A and at a mean 1110 mL (range, 450-2000 mL) in Group B (P=0.168). The mean HHS (group A=89.4 [73-99] and group B = 88.4 [75-97]) and Merle D'Aubigne scores (group A = 16.8 [13-18] and group B = 16.5 [13-18]) showed no significant difference between the groups (P=0.169). At the final follow-up, the mean hip flexion was found to be 106.83 +/- 12.47 and the hip extension was 10.33 +/- 6.12 in Group A, while these values were 103.71 +/- 14.32 and 10.69 +/- 8.17 in Group B (NS between groups regarding flexion [P= 0.678] and extension [P= 0.445]). The complication rate was 31% in Group A (6 patients) and 23% in Group B (4 patients) (P > 0.05). Discussion: Both surgical approaches give successful results in the treatment of acetabular fractures. Contrary to expectations, there was no difference in the amount of bleeding at the wound site from the Stoppa technique, even though it is minimally invasive, compared to the ilioinguinal approach. Level of evidence: Level III retrospective case control study. (C) 2014 Elsevier Masson SAS. All rights reserved.Öğe Treatment of Posttraumatic Cubitus Varus With Corrective Supracondylar Humeral Osteotomies Using the Methyl Methacrylate External Fixator(LIPPINCOTT WILLIAMS & WILKINS, 2014) Acar, Mehmet Ali; Yıldırım, Serhat; Elmadağ, Nuh Mehmet; Şenaran, Hakan; Ogün, Tunç C.Background: In upper and lower extremity fractures and osteotomy fixation, the use of methyl methacrylate (MM) as an external fixator presents an alternative method. The primary aim of this retrospective study was to evaluate the midterm outcome of pediatric patients who underwent corrective humeral supracondylar lateral closing-wedge osteotomy, with the external fixation system composed of MM and multiplane K-wires. Methods: Fourteen consecutive cases with cubitus varus, who underwent corrective osteotomy with a limited lateral approach stabilized with MM and the multiplane K-wires external fixator system between January 2006 and May 2010, were retrospectively evaluated. Time of union, preoperative and postoperative elbow range of motion, and humeroulnar angle were measured. Results were rated as excellent, good, or poor, according to Bellemore criteria. Results: There were a total of 6 female patients and 8 male patients with a mean age of 5.7 years (range, 3 to 9 y). The mean follow-up period was 28.2 months (range, 24 to 48 mo). The mean humeroulnar angle was (-) 18.6 degrees preoperatively, and (+) 16.3 degrees at the final follow-up. Thirteen patients were evaluated as excellent and 1 patient as good, according to Bellemore criteria. Union was seen in all patients at mean 7 weeks (range, 6 to 8 wk). Pin tract infection was observed in 1 patient and treated with oral antibiotics. Loss of correction was not observed in any patient during follow-up. Conclusions: External fixation of corrective supracondylar humeral osteotomy with MM and multiplane K-wires is a practical, effective, reliable, and cheap alternative method that can be applied. Level of Evidence: Level IV. Retrospective study.
