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Öğe Arthroscopic removal of an ununited ossicle due to persistent Osgood Schlatter disease(2013) Erkoçak, Ömer Faruk; Aydın, Kerem; Altan, E.; Acar, Mehmet AliAlthough conservative measures are usually sufficient, sometimes surgery may be required in the management of unresolved adult type Osgood Schlatter (OS) disease. The most widely used procedure consists of the excision of ossicles with or without removal of the prominent tibial tubercle. For this purpose we used an arthroscopic technique. Low anterolateral and anteromedial portals were used for this operation. After the fat pad and soft tissue debridement, the ossicle became visualiable and removed by a motorized burr. Post operatively patient allowed full weight bearing and unrestricted range of motion. Postoperatively at the sixth week he reported complete resolution of his knee pain and his pleasure about the surgery. This technique showed that arthroscopic removal of persistent OS ossicle is more benefical than the open procedure.Öğe Arthroscopic Retrograde Fixation of A Hoffa Fracture With an Accompanying Medial Plateau Fracture(2012) Altan, Egemen; Şenaran, Hakan; Aydın, Kerem; Acar, Mehmet Ali; Erkoçak, Ömer FarukUnicondylar lateral coronal plane fractures (Hoffa fractures) are uncommon and commonly treated with open reduction and internal fixation through a wide lateral or parapatellar approach because of difficulty in accessing the fracture. The accompanying medial tibial plato fracture is also an extreme case, and such a fracture pattern has not been reported in the literature so far. In our case report, after a motor vehicle accident, a 32-year-old man suffered a Hoffa fracture and a medial tibial plato fracture of his left knee. Reduction and fixation were performed under arthroscopic visualization through the standard portals. Reduction was achieved using a pair of towel forceps as a fulcrum to elevate the fragment through the lateral portal. After confirmation of anatomic reduction with arthroscopy, 2 divergent headless compression screws were inserted into the fracture through an accessory lateral portal with the knee hyperflexed. The concomitant medial tibial plato fracture was treated with a buttress plate, and reduction was confirmed arthroscopically. The fracture healed clinically and radiographically at 3 months, and the patient had no limitation of motion and was back at work. Thus, an undesired extensive arthrotomy over the joint was avoided with this technique for a better outcome.Öğe Comparison of monoplanar versus biplanar medial opening-wedge high tibial osteotomy techniques for preventing lateral cortex fracture(SPRINGER, 2017) Türkmen, Faik; Kaçıra, Burkay Kutluhan; Özkaya, Mustafa; Erkoçak, Ömer Faruk; Acar, Mehmet Ali; Özer, Mustafa; Toker, SerdarThe purpose of this study was to investigate the mechanical strength of both monoplanar and biplanar medial opening-wedge high tibial osteotomy (MOWHTO) procedures and assess the risk of lateral cortex disruption for both techniques. Twelve synthetic tibia models with cortical shells were used as test models. Saw cuts for monoplanar MOWHTO and biplanar MOWHTO were generated on the test models in equal numbers (n = 6 for both groups). Wedge opening load and wedge gap distance were evaluated via compressive tests. The mean gap distance just before the lateral cortex fracture in the monoplanar group was 14.7 +/- 2.9 mm, which was significantly narrower than that in the biplanar group of 19.1 +/- 2.0 mm (p = 0.015). The mean load just before the occurrence of lateral cortex fracture of 32.4 +/- 3.2 N in the monoplanar osteotomy group was significantly lower than that in the biplanar osteotomy group of 111.8 +/- 9.3 N (p = 0.009). Performing a MOWHTO via the biplanar rather than the monoplanar technique allows larger-sized wedges to be opened with less risk of lateral cortical fracture. Thus, larger gaps can be opened and higher angle corrections can be achieved using the biplanar osteotomy procedure. From a clinical viewpoint, the biplanar osteotomy technique reduced the risk of lateral cortical hinge fracture during MOWHTO.Öğe Comparison of Ultrasound-Guided Femoral Nerve Block with Combined Spinal Epidural Anesthesia in Total Knee Arthroplasty(2018) Çiçekci, Faruk; Yıldırım, Ahmet; Önal, Özkan; Erkoçak, Ömer Faruk; Çelik, Jale Bengi; Kara, İnciObjective: The objective of this study was to compare postoperative early (48 hours) visual analoguescale (VAS) scores following combined spinal epidural anesthesia (CSEA) and ultrasound-guidedfemoral nerve block (FNB) in patients undergoing total knee arthroplasty (TKA).Material and Methods: This retrospective study included 302 patients who underwent CSEA(Group CSEA) and FNB (Group FNB) for elective unilateral total knee arthroplasty between May2016 and May 2017. Postoperative Visual analogue scale (VAS) scores at rest and during activity (30thmin, 2, 6, 12, 24 and 48th hours), the total amount of morphine consumed (48th hour) by the patientcontrolled analgesia (PCA) device, and the complications were evaluated.Results: The demographic characteristics of the patients were similar (p0.05). There was nostatistically significant difference between the two groups in terms of resting and active VAS scoresaccording to timepoints (p0.05). However, there was a significant difference in complications(hypotension, nausea and vomiting, neurological damage, respiratory depression, pruritus) betweenthe two groups (p0.05).Conclusion: Pain levels after total knee arthroplasty showed that FNB had a similar effect with CSEAin providing pain relief, but FNB was superior to CSEA in terms of postoperative complications.Öğe Effect of Ankaferd blood stopper on tendon healing: An experimental study in a rat model of Achilles tendon injury(2015) Aydın, Bahattin Kerem; Altan, Egemen; Acar, Mehmet Ali; Erkoçak, Ömer Faruk; Ugraş, SerdarAmaç: Bu in vivo çalışmada yeni geliştirilen topikal bir hemostatik ajan olan Ankaferd Kanama Durdurucu nun (ABS) sıçan Aşil tendon yaralanma modeli kullanılarak tendon iyileşmesi üzerine etkileri araştırıldı. Gereç ve yöntemler: Çalışmada 12 erkek Wistar-Albino sıçan kullanıldı. Sıçanların sağ bacakları çalışma grubu, sol bacakları kontrol grubu olarak belirlendi. Anestezi altında iki taraflı Aşil tendon yaralanmaları oluşturuldu ve cerrahi olarak tamir edildi. Cerrahi sahalara sağ taraf için 1 mL ABS, sol taraf için ise 1 mL serum fizyolojik solüsyonu uygulandı. Hayvanlara ameliyat sonrası 21. günde ötenazi yapıldı ve ekstremitelerden tendon örnekleri alındı. Histolojik analizler yarı kantitatif tendon skorlama sistemine (Bonar Sınıflaması) göre yapıldı. Bulgular: Toplam tendon iyileşmesi skorları çalışma grubunda kontrol grubuna göre anlamlı şekilde kötüydü. Tenosit morfolojisi, esas madde boyama derecesi ve vaskülarite açısından gruplar arasında anlamlı farklılık olmasa da kollajen morfolojisi skorları çalışma grubunda anlamlı şekilde kötüydü. Sonuç: Çalışmamızda, ABS uygulaması sıçanlarda tendon iyileşmesi üzerinde histolojik olarak olumsuz etkiye sahipti. Öte yandan, bu sonuçları desteklemek için ileri biyomekanik ve immünohistokimyasal çalışmalar gereklidir.Öğe The effect of hyaluronan combined with microfracture on the treatment of chondral defects: An experimental study in a rabbit model(2013) Tuncay, İbrahim; Erkoçak, Ömer Faruk; Acar, Mehmet Ali; Toy, HaticeBecause articular hyaline cartilage has low potential for regeneration, numerous methods and techniques have been proposed to induce the reparation process. Microfracture is a convenient procedure for this purpose. However, the quality of the new cartilage after microfracture is still not as proper as original. In this experimental study, we used microfracture in combination with intraarticular application of hyaluronan in rabbit knee articular defect. Bilateral knee arthrotomies, chondral defects, and microfracture were created on each intercondylar notch in thirty rabbits. Rabbits received intraarticular injections of hyaluronan once a week for 3 weeks in the right knee, started from 1 week after injury. The left knees, which served as controls, were injected with normal saline. Biopsy was taken from both knees at the 4th and 6th weeks. In comparison with the control group, after 6 weeks we observed a higher potential for healing in the experimental group, with thicker and more organized repair tissue filling the defect. The current study reveals that application of hyaluronan after the microfracture might be beneficial in inducing articular cartilage defect reparation. © 2012 Springer-Verlag.Öğe Ipsilateral total hip replacement for femoral neck fracture in an above-the-knee amputee patient(Edizioni Minerva Medica, 2014) Acar, Mehmet Ali; Erkoçak, Ömer Faruk; Aydın, Kerem; Yılmaz, G.; Güleç, Ali[Abstract not Available]Öğe Lower extremity rotational deformities and patellofemoral alignment parameters in patients with anterior knee pain(SPRINGER, 2016) Erkoçak, Ömer Faruk; Altan, Egemen; Altıntaş, Murat; Türkmen, Faik; Aydın, Bahattin Kerem; Bayar, AhmetAnterior knee pain is a common musculoskeletal condition amongst young adult population. Lower extremity structural factors, such as increased femoral anteversion and lateral tibial torsion, may contribute to patellofemoral malalignment and anterior knee pain. The aim of this study was to evaluate the lower extremity structural factors and related patellofemoral alignment parameters that play a role in the aetiology of anterior knee pain. This study involved three groups: patients with unilateral symptomatic knees (n = 35), asymptomatic contralateral knees in the same patients and a control group (n = 40). All subjects were physically examined, and Q-angles were measured. The lower extremities of all subjects were imaged by a very low-dose CT scan, and the symptomatic knees of patients were compared with their asymptomatic contralateral knees and with the healthy knees of controls regarding femoral anteversion, tibial torsion, sulcus angle, patellar tilt angle and lateral patellar displacement. Regarding the Q-angle, femoral anteversion and lateral tibial torsion, no significant differences were found between the symptomatic and asymptomatic knees, whereas significant differences were found between the symptomatic knees and controls. The symptomatic group demonstrated significantly greater sulcus angle only in 30A degrees of knee flexion than did the controls. Patients with unilateral anterior knee pain may have similar morphology at their contralateral asymptomatic lower extremity, and different morphology compared with healthy controls. Lower extremity rotational deformities may increase the risk of anterior knee pain; however, these deformities alone are not sufficient to cause knee pain, and may be predisposing factor rather than a direct aetiology. Diagnostic study, Level III.Öğe A new diagnostic parameter for patellofemoral pain(E-CENTURY PUBLISHING CORP, 2015) Türkmen, Faik; Acar, Mehmet Ali; Kaçıra, Burkay Kutluhan; Korucu, İsmail H.; Erkoçak, Ömer Faruk; Yolcu, Bayram; Toker, SerdarPurpose: Q-angle measurement procedure have not been well standardised. There is a lack of consensus about subject position and knee flexion angle while measuring the Q-angle. Morover Q-angle value which obtained in a single position is a static value and gives an information about the subject's current position. The aim of this study is to obtain a more significant parameter which includes different postures (supine, standing, sitting) and different knee flexion angles instead of a single Q-angle in a fixed position. At the same time this parameter must be functional and dynamic, not a static value like Q-angle. We named this parameter as Delta Q. Methods: Our study was applied on case and control groups. All subjects in both groups were male. Case group was consisted of 14 subjects who had patellofemoral pain. Control group was consisted of 14 subjects who had normal knees and normal lower extremities with no reported knee problems. We obtained 3 different Q-angle values and 3 different Delta Q values for each subject in both groups. Pearson correlation analysis was used for investigation of continuous variables in normal distribution, Spearman correlation analysis was used in abnormal distribution. t test was used in the comparison of values. Logistic regression analysis(forward conditional mod) was used for detecting of determinants of pain. Results: Delta Q1s of both groups were found as the only statistical significant predictive value for patellofemoral pain. Conclusion: There is not an agreement about a standardised q-angle measurement procedure in the literature. Moreover, present procedures provide information about a single and fixed position. In this situation Q-angles which obtained in these fixed positions are static values. We think that we can overcome these problems with this new value. Delta Q contains multiple q-angles and gives information about all. Also it is a dynamic value for being oriented to position change. Therefore, Delta Q is an useful indicator for evaluating patellofemoral pain.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 Posterior girişimle hemivertebrektomi: Olgu sunumu(2004) Özdemir, H. Mustafa; Erkoçak, Ömer Faruk; Tuna, Serkan; Kapıcıoğlu, M. İ. SafaAmaç: Hemivertebra nadir görülen ve skolyoza sebeb olabilen bir spinal anomalidir. Cerrahi tedavisinde tek başına posterior girişim ile hemivertebrektomi yeni, efektif ve konvansiyonel yöntemlere göre daha az invazifdir. Olgu sunumu: 20 aylık erkek bir çocukta lomber 2’de tam segmentleşmiş hemivertebra ve buna bağlı progresif skolyoz nedeniyle yalnız posterior girişim kullanılarak hemivertebrektomi yapıldı. Sonuç: Postoperatif dönemde hem sagittal ve hem de koronal planda tam korreksiyon sağlandı. On iki aylık takiplerinde ciddi korreksiyon kaybı saptanmadı. Posterior girişimle hemivertebrektomi; konvansiyonel hemivertebra cerrahisine gore minimal invazif bir girişim olup, deformitenin 3 boyutlu korreksiyonunda oldukça etkili bir yöntemdir.Öğe Reconstruction of dorsal hand and finger defects with reverse radial fasciocutaneous forearm flaps(Springer-Verlag France, 2015) Acar, Mehmet Ali; Güleç, Ali; Aydın, Bahattin Kerem; Erkoçak, Ömer Faruk; Elmadağ, Mehmet; Türkmen, FaikObjectives: To evaluate the midterm outcome and the degree of satisfaction of patients who underwent reconstruction of dorsal hand and finger defects with reverse flow radial fasciocutaneous forearm flaps and to test whether or not this is a reliable method which can be applied without the need for microsurgery. Patients and methods: Eleven patients were admitted with post-traumatic complex hand defects and treated by reconstruction with reverse flow radial fasciocutaneous forearm flaps from January 2010 to May 2013. The patient demographics, size of the hand and finger defects, and complications were recorded. The functional status of each of the patients was evaluated using the quick disabilities of the arm, shoulder and hand (DASH) scoring system, and patient satisfaction was assessed using Likert scores. Results: The patients comprised nine males and two females with a mean age of 30.7 ± 9.7 years. The mean follow-up period was 18.4 ± 5.2 months. The average defect size was 41 ± 14.3 cm². None of the patients had circulation defects caused by the sacrifice of the radial artery. The mean quick DASH score was determined as 30.2 ± 15.3. The Likert patient satisfaction evaluation was good in one patient, and very good in ten patients. All flaps survived well with only two complications; superficial skin necrosis occurred at the suture site in one patient and venous insufficiency occurred in the other patient. Both complications recovered with secondary healing following wound debridement. Conclusions: The reverse-flow radial forearm flap is a reliable method in the management of dorsal defects of the hand and does not require micro-surgical techniques. © 2014, Springer-Verlag France.Öğe Reconstruction of multiple fingertip injuries with reverse flow homodigital flap(ELSEVIER SCI LTD, 2014) Acar, Mehmet Ali; Güzel, Yunus; Güleç, Ali; Türkmen, Faik; Erkoçak, Ömer Faruk; Yılmaz, GüneyAim: Hand trauma may lead to multiple fingertip defects, causing functional restrictions. We evaluated the use of reverse-flow homodigital flap reconstruction of the distal phalanx and pulp defects associated with multiple finger injuries. Methods: We retrospectively evaluated 11 male patients who presented at our emergency department (January 2011-March 2013) with multiple fingertip injuries and who were treated with a reverse-flow homodigital flap. Evaluations included age, sex, defect size, flap survival rate, complications, cold intolerance, two-point discrimination, range of motion (ROM), quick disabilities of the arm, shoulder, and hand (DASH) score, and return to work time. Results: Completely, 22 reverse-flow homodigital flaps were applied to at least two fingertip injuries at the distal phalanx. Ten flaps survived postoperatively. The exception was partial flap loss on one finger. The mean follow-up was 14.2 months. At the final follow-up, the mean static two-point discrimination value was 10.3 mm. Mean ROMs of interphalangeal joints were 65.31 degrees (distal) and 105.77 degrees (proximal). Donor sites were covered with full-thickness skin grafts from the wrist or antecubital area. There were no complications related to the donor site and no development of cold intolerance in any finger. The mean quick DASH score was 4.12. All patients returned to work in an average of 8.3 weeks. Conclusions: The reconstruction of multiple fingertip injuries with reverse-flow homodigital flaps is a safe, effective method that can be combined with other local finger flaps. These flaps can be applied to two consecutive fingers without reducing finger length or function. (C) 2014 Elsevier Ltd. All rights reserved.Öğe Total Knee Arthroplasty due to Knee Osteoarthritis: Risk Factors for Persistent Postsurgical Pain(NATL MED ASSOC, 2016) Albayrak, İlknur; Apilioğulları, Seza; Erkoçak, Ömer Faruk; Kavalcı, Hidayet; Özerbil, Önder Murat; Levendoğlu, FundaObjective: The aim of this study was to identify whether different patient characteristics and clinical factors can be risk factors in patients with persistent postsurgical pain (PPSP) after total knee arthroplasty (TKA). Methods: Patients who underwent TKA due to knee osteoarthritis were divided into two groups: those who experienced no or mild PPSP ( Numerical Rating Scale [NRS] <= 3) (group 1, n = 91) and those who experienced moderate to severe PPSP ( NRS > 3) ( group 2, n = 183). Information on the characteristics of patients, comorbid diseases and pre-surgical NRS scores were obtained retrospectively from hospital charts. The follow-up time; presurgical and last control time walking distance; and ratings on the NRS, Pain DETECT Questionnaire (PDQ) and patient satisfaction scales were recorded from the standard questionnaire presented to patients during the telephone interview. Results: The mean follow-up time was 22.8 +/- 12.3 months. The rate of moderate to severe PPSP among patients amounted to 66.7% after TKA. No neuropathic pain was found in Group 1. In Group 2, 22.9% of patients experienced neuropathic pain, the results for 18% of patients were uncertain, and 59% of patients did not experience neuropathic pain. Group 2 had worse scores on the patient satisfaction scale following the last control time compared with Group 1. Being widowed, having a low education level, being a housewife, having employment that requires physical effort, presurgical pain intensity at rest and pre-surgical restricted walking distance are risk factors for Group 2. Conclusions: PPSP and the neuropathic component in PPSP after TKA are not underestimated for pain management and patient satisfaction. Subgroups of patients, particularly widowers, having a primary school education level or under, housewives, people with jobs that require physical effort, individuals with intense pre-surgical pain during rest and those suffering from pre-surgical restricted walking distance, are at higher risk of developing PPSP following TKA.
