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Öğe Closed extensor indicis proprius tendon rupture presenting mass clinic on dorsal side of the wrist(2013) Kütahya, Harun; Güleç, Ali; Acar, Mehmet Ali; Güzel, Yunus; Karalezli, Mustafa N.; Toker, SerdarA 28 years old male constructor referred to our clinic for a mass on the dorsal side of the left wrist. He has constricted his hand to the plaster cast machine in hyperflexion posture one month ago and swelling complaint has begun one week ago. MRI revealed tenosynovitis. A wide organized hematoma was appeared in the 4th extensor compartment in the surgical exploration of the patient and it was observed that extensor indicis proprius tendon has detached from the musculotendineous region. Common extensor tendon of the second finger was intact. Tenodesis to the distal end of the ruptured tendon to the intact common extensor tendon by side to side surgical suture technique was performed. There were complete extension in the 2nd finger at the 2nd month after the surgery.Öğe Closed extensor ındicis proprius tendon rupture presenting mass clinic on dorsal side of the wrist(2013) Kütahya, Harun; Güleç, Ali; Acar, Mehmet Ali; Güzel, Yunus; Karalezli, Mustafa N.; Toker, Serdar28 yaşında erkek işçi sol el bileğinde kitle şikayeti ile kliniğimize başvurdu. Hasta 1 ay önce elini hiperfleksiyon pozisyonun- da alçı karıştırma makinesine sıkıştırmış ve 1 hafta önce de şişlik şikayeti başlamış. MRG'de tenosinıvit gözlendi. 4. ekstensör kompartmanın cerrahi eksplorasyonunda geniş organize hematom ve ekstensör indicis proprius tendonunun muskulotendinöz bölgeden koptuğu görüldü. İşaret parmağı kommon ekstensör tendonunun sağlam olduğu görüldü. Kopuk olan ekstensör tendonun distal ucu yan-yana cerrahi dikiş tekniği kullanılarak sağlam olan kommon ekstensör tendona tenodez yapıldı. Ameliyat sonrası 2. ayda işaret parmağında tam ekstansiyon mevcuttu.Öğe Comparison of lateral versus triceps-splitting posterior approach in the surgical treatment of pediatric supracondylar humerus fractures(TURKISH ASSOC TRAUMA EMERGENCY SURGERY, 2016) Turkmen, Faik; Toker, Serdar; Kesik, Kayhan; Korucu, Ismail Hakki; Acar, Mehmet AliBACKGROUND: Supracondylar humerus fracture is the most common fracture of the elbow in children. Closed reduction and per cutaneous pinning is considered to be the optimal treatment strategy; however, in some instances, open reduction may be necessary. The aim of this retrospective study was to compare clinical and functional results of triceps-splitting posterior versus lateral approach in pediatric supracondylar humerus fracture surgery. METHODS: A total of 38 patients underwent surgery; Group I consisted of 30 patients on whom posterior approach was used, while lateral approach was used on the 8 patients in Group 2. Flynn criteria were used to evaluate cosmetic and clinical results. Fracture healing was assessed with anteroposterior and lateral x-rays. Patients and parents were asked to describe time needed for complete return of full elbow range of motion (ROM) and overall satisfaction. RESULTS: Mean fracture union time was 44.1 days and 46.3 days, and time required to regain complete or near complete elbow ROM was 57.5 days and 55.7 days after splint removal for Group I and Group 2, respectively. Twenty-one of 30 (70%) patients (and parents) in Group I, and 6 of 8 (75%) patients (and parents) in Group 2 were totally satisfied with the results. Twenty-one of 30 (70%) patients in Group I, and 6 of 8 (75%) patients in Group 2 had excellent cosmetic and functional results according to Flynn outcome criteria. CONCLUSION: In cases of pediatric supracondylar humerus fracture, early closed reduction and percutaneous pinning is preferred; however, when this method is not applicable, triceps-splitting posterior approach is a safe and comparable method to lateral approach with advantages of easier fracture reduction and shorter operating time.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 Diagnostic accuracy of 0.2 tesla open MR imaging unit in detecting meniscal tears: Correlation with arthroscopy [0.2 tesla açık MR ünitesinin menisküs yırtıklarını saptamada tanı do?rulu?u: Artroskopi ile korelasyon](TIP ARASTIRMALARI DERNEGI, 2011) Koplay, Mustafa; Aksakallı, Elif; Toker, Serdar; Özbek, Seda; Kıvrak, Ali SamiAim: In the assessment of meniscal tears, diagnostic accuracy of 0.2 Tesla (T) magnetic resonance imaging (MRI) was investigated and compared with arthroscopy as standard of reference. Method: 340 patients suspected with meniscal tears were examined by 0.2 Tesla open MRI unit. 47 of the patients underwent arthroscopy. The arthroscopy results were compared with interpretations of MRI retrospectively. Result: In detecting meniscal tears with 0.2 T MRI, sensitivity, specificity and diagnostic accuracy were 90%, 88,2%, 89,4% for medial meniscal tears and 91%, 91,6%, 91,5% for lateral meniscal tears, respectively. Conclusion: O.2 T MRI is effective in detecting meniscal tears and can be safely use in detecting the meniscal pathologies.Öğe Medial opening wedge high tibial osteotomy fixation with short plate without any graft, synthetic material or spacer(SAGE Publications Ltd, 2014) Türkmen, Faik; Sever, Cem; Kaçıra, Burkay Kutluhan; Demirayak, Mehmet; Acar, Mehmet Ali; Toker, SerdarObjectives: Medial opening-wedge high tibial osteotomy (MOWHTO) is an effective surgical procedure for patients who have medial compartmental osteoarthritis of the knee with varus deformity of the limb. The abnormal load on the medial compartment of the knee relocates to the lateral compartment with this procedure. A gap occurs on the proximal tibia during the correction of varus deformity. Filling this gap with bone grafts or synthetic materials has gained wide acceptance for preventing nonunion or osteotomy site collapse. The aim of this study is to report our results of MOWHTOs performed without any bone graft or any other synthetic materials. Methods: We evaluated 41 MOWHTOs performed between 2009 and 2012 with no use of bone grafts, synthetic materials or spacers. Age of the patients ranged from 43 to 67. Thirty five of the patients were female and 3 of them were male. The follow-up time was 6 months. Results: There were no any non-unions or loss of correction. The mean bone union time was 12,8 weeks. No major complications were seen. Conclusion: The results of our study has shown that achieve satisfactory results can be obtained in MOWHTO without using any bone graft, synthetic materials or spacer. © The Author(s) 2014.Öğe Medial opening-wedge high tibial osteotomy fixation with short plate without any graft, synthetic material or spacer(Springer-Verlag France, 2014) Türkmen, Faik; Sever, Cem; Kaçıra, Burkay Kutluhan; Demirayak, Mehmet; Acar, Mehmet Ali; Toker, SerdarPurpose: Medial opening-wedge high tibial osteotomy (MOWHTO) is an effective surgical procedure for patients who have medial compartmental osteoarthritis of the knee with varus deformity of the limb. The abnormal load on the medial compartment of the knee is directed to the lateral compartment with this procedure. A gap occurs on the proximal tibia while providing adequate correction. Filling this gap with bone grafts or synthetic materials has gained wide acceptance for preventing bone union problems or osteotomy site collapse. The aim of this study is to report our results of MOWHTOs performed without any bone graft or any other synthetic materials.Methods: We evaluated 41 MOWHTOs that have been performed between 2009 and 2012 with no use of any grafts or synthetic materials and spacer. Age of the patients ranged from 43 to 67. Thirty-five of the patients were females and three of them were males. The follow-up time was 6 months.Results: Seven knees had opening at the osteotomy site <10 mm, 26 knees had 10–12.5 mm, and eight knees had >12.5 mm (range 7.5–14 mm, mean 11.07 mm). All osteotomies united without loss of correction. The mean bone union time was 12.8 weeks. We did not have any major complication regarding the technique.Conclusion: The results of our study have shown that we can achieve satisfactory and good results by performing MOWHTO procedure without using any bone grafts or synthetic materials and spacer. © 2014, Springer-Verlag France.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 Percutaneous Release of the First Dorsal Extensor Compartment: A Cadaver Study(LIPPINCOTT WILLIAMS & WILKINS, 2016) Gulec, Ali; Turkmen, Faik; Toker, Serdar; Acar, Mehmet AliBackground: To evaluate the efficiency of the percutaneous 18-G needle technique in releasing the fibro-osseous sheath over the first dorsal extensor compartment of the hand. Methods: Using anatomic landmarks, percutaneous release was performed with an 18-G needle on 48 wrists of 24 cadavers. The specimens were then dissected and examined for the completeness of the first dorsal extensor compartment release and any tendon or neurovascular injuries. The tunnel length, number of abductor pollicis longus and extensor pollicis brevis tendons, presence of an intertendinous septum, and the effects of these parameters on percutaneous release were evaluated. Results: Percutaneous release was performed on all of the wrists, and the evaluation of the adequacy of release revealed 25 complete releases, 21 partial releases, and 2 missed releases. There were 19 cases of tendon complications. No neurovascular injuries were noted. The mean tunnel length was 2.66 +/- 30 cm, and the mean number of tendons was 2.75 +/- 0.86. A septum was present in 33.3% of cases. Tunnel length and tendon number had no statistically significant effect on release, whereas the presence of a septum was significantly associated with inadequate tunnel release and the development of tendon complications. Conclusions: Percutaneous release of the first dorsal extensor compartment using an 18-G needle was associated with high rates of incomplete release and tendon damage in the presence of an intertendinous septum. Further study is required under ultrasound guidance to determine the usefulness of percutaneous release in the first dorsal extensor compartment. Clinical Relevance: Release with a percutaneous needle tip in De Quervain's syndrome may provide the advantages of better cosmetic results with less scar formation and an early return to work.Öğe Transverse Carpal Ligament and Forearm Fascia Release for the Treatment of Carpal Tunnel Syndrome Change the Entrance Angle of Flexor Tendons to the A1 Pulley: The Relationship between Carpal Tunnel Surgery and Trigger Finger Occurence(HINDAWI LTD, 2013) Karalezli, Nazim; Kutahya, Harun; Gulec, Ali; Toker, Serdar; Karabork, Hakan; Ogun, Tunc C.Purpose. The appearance of trigger finger after decompression of the carpal tunnel without a preexisting symptom has been reported in a few articles. Although, the cause is not clear yet, the loss of pulley action of the transverse carpal ligament has been accused mostly. In this study, we planned a biomechanical approach to fresh cadavers. Methods. The study was performed on 10 fresh amputees of the arm. The angles were measured with (1) the transverse carpal ligament and the distal forearm fascia intact, (2) only the transverse carpal ligament incised, (3) the distal forearm fascia incised to the point 3 cm proximal from the most proximal part of the transverse carpal ligament in addition to the transverse carpal ligament. The changes between the angles produced at all three conditions were compared to each other. Results. We saw that the entrance angle increased in all of five fingers in an increasing manner from procedure 1 to 3, and it was seen that the maximal increase is detected in the middle finger from procedure 1 to procedure 2 and the minimal increase is detected in little finger. Discussion. Our results support that transverse carpal ligament and forearm fascia release may be a predisposing factor for the development of trigger finger by the effect of changing the enterance angle to the A1 pulley and consequently increase the friction in this anatomic area. Clinical Relevance. This study is a cadaveric study which is directly investigating the effect of a transverse carpal ligament release on the enterance angle of flexor tendons to A1 pulleys in the hand.
