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Öğe Comparison of Arthrodesis, Resurfacing Hemiarthroplasty, and Total Joint Replacement in the Treatment of Advanced Hallux Rigidus(ELSEVIER SCIENCE INC, 2013) Erdil, Mehmet; Elmadag, Nuh Mehmet; Polat, Gokhan; Tuncer, Nejat; Bilsel, Kerem; Ucan, Vandet; Erkocak, Omer FarukThe purpose of the present study was to compare the functional results of arthrodesis, resurfacing hemiarthroplasty, and total joint replacement in hallux rigidus. The data from patients treated from 2006 to 2010 for advanced stage hallux rigidus were retrospectively reviewed. A total of 38 patients who had at least 2 years (range 24 to 66 months, mean 31.1) of follow-up were included in the present study. Of the 38 patients, 12 were included in the total joint replacement group (group A), 14 in the resurfacing hemiarthroplasty group (group B), and 12 in the arthrodesis group (group C). At the last follow-up visit, the functional outcomes were evaluated using the American Orthopaedic Foot and Ankle Society-Hallux Metatarsophalangeal Interphalangeal (AOFAS-HMI) scale, visual analog scale (VAS), and metatarsophalangeal range of motion. Significant improvements were seen in the AOFAS-HMI score, with a decrease in the VAS score in all 3 groups. According to the AOFAS-HMI score, no significant difference was found between groups A and B. However, in group C, the AOFAS-HMI scores were significantly lower than in the other groups owing to the lack of motion. According to the final VAS scores, no significant difference was found between groups A and B; however, the VAS score had decreased significantly more in group C than in the other groups. No major complications occurred in any of the 3 groups. After 2 years of follow-up, all the groups had good functional outcomes. Although arthrodesis is still the most reliable procedure, implant arthroplasty is also a good alternative for advanced stage hallux rigidus. (C) 2013 by the American College of Foot and Ankle Surgeons. All rights reserved.Öğe Does femoral back wall failure affect the functional results of arthroscopic anterior cruciate ligament surgery?(EDIZIONI MINERVA MEDICA, 2013) Elmadağ, Mehmet; Erdil, Mehmet; Bilsel, Kerem; Acar, Mehmet Ali; Tuncay, I.; Yel, M.Aim. The aim of the study was to evaluate the effects of femoral back wall failure (FBWF) due to tunnel enlargement after anterior cruciate ligament (ACL) surgery on clinical outcomes. Methods. The functional results of 40 ACL reconstructions were evaluated prospectively. The study includes ACL reconstructions with transtibial single bundle technique with hamstring autografts whereas those with concomitant knee ligament injuries were excluded. Tunnel enlargements were measured with CT scan at the end of the 12th month after surgery Functional results were evaluated at the first year follow-up by an anterior drawer test, Lachman test, rollimeter, IKDC, and Lysholm Knee Scale. Results. Femoral and tibial tunnel enlargement was measured in all of our patients with 39% mean enlargement in femoral tunnels and 48% in tibial tunnels. No significant correlation between amount of tunnel enlargement and clinical outcomes was obtained. Additionally, no significant correlation between tibial fixation type and tibial tunnel enlargement was found (P>0.05). In nine patients (22.5%), FBWF was evaluated. These nine patients did not show any significant difference in clinical outcomes than the other 31 patients (P>0.05). Conclusion. Excessive femoral tunnel enlargements after ACL surgeries may lead FBWF. This pathology does not affect clinical outcomes. However, FBWF with bone defect may cause more complicated ACL revision surgery. This fact must be kept in mind by orthopedic surgeons.Öğe The mid- to long-term results of the anterior cruciate ligament reconstruction with hamstring tendons using Transfix technique(SPRINGER, 2007) Asik, Mehmet; Sen, Cengiz; Tuncay, Ibrahim; Erdil, Mehmet; Avci, Cem; Taser, Omer F.In this study, mid to long-term results of anterior cruciate ligament reconstruction with hamstring tendons and Transfix technique were evaluated. Anterior cruciate ligament (ACL) reconstruction with four-strand hamstring tendon was performed with Transfix technique on 271 (198 males, 73 females; mean age 25.7; 17-52) patients with anterior cruciate ligament ruptures. The patients were followed up with clinical examination, Lysholm and Tegner activity scales, IKDC scoring system, KT-1000 test and radiological examination. The mean follow-up period was 82 (48-100) months; 204 (75%) patients had no subjective complaints. According to the KT-1000 test, only 14 (5%) patients had more than 5 mm laxity postoperatively, whereas, 161 (59%) patients had more than 5 mm laxity preoperatively. In addition to this, only 19 (7%) patients had Lysholm scores less than 80 postoperatively, whereas 154 (57%) patients scored less than 80 preoperatively. When compared with Tegner activity scale, 189 (70%) patients scored < 6 preoperatively and only 24 (8%) postoperatively: 78 (29%) patients scored D preoperatively and only 5 (2%) patients scored D postoperatively on the basis of the IKDC scoring system. Our functional results were found to be satisfactory in more than 90% of patients. Commonly seen problems in ACL reconstruction such as inaccurate graft placement and tunnel widening were found to be consistent with the values in relevant literature. However, we demonstrated that the functional results and the stability of the knee were not related with tunnel widening. This study concludes that the reconstruction of ACL with hamstring tendons and the Transfix technique is reasonably successful, safe and causes low morbidity. Furthermore, we believe that proper graft preparation, accurate tunnel placement, notch-plasty, fixation and rehabilitation program are all as important as the choice of graft and fixation material.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.
