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Öğe Clinical and radiological evaluation of surgically treated acetabulum fractures(DergiPark, 2022) Muratoğlu, Osman Görkem; Yılmaz, Murat; Atlihan, Doğan; Yıldırım, Cem; Muslu, Duran CanAim: Acetabular fractures were evaluated by Judet and Letournel in two main groups as elementary and associated fractures. There are publications in the literature that the results are worse as the complexity of the fracture increases. The aim of this study was to evaluate whether clinical outcomes are worse in associated fractured patients. Material and Methods: The study included 48 acetabular fractures admitted to the emergency room and treated surgically between December 2011 and October 2020. Patient’s trauma, additional injuries, surgical method, early or late complications, and range of motion at the last follow-up were documented. Clinical and radiological results of the patients were evaluated by modified Merle d'Aubigné, functional capacities by Harris hip scoring systems. Results: There were 25 elementary fractures and 23 associated fractures in patients. When the complication rates were examined, the rate of those without complications was 52.0% (n=13) among elementary fractures, while the rate was 34.8% (n=8) in associated fractures. When the fracture types were evaluated according to the Harris hip score, elementary fractures have better score than associated fractures, but no statistically significant difference was observed between them (p=0.056). When evaluated according to Merle d'Aubigne score, it was observed that elementary fractures had significantly better scores (p=0.004). Conclusion: As the complexity of the fracture increases, it can be predicted that the clinical outcomes of the patient will be worse. It is also concluded that the elementary fracture type had better clinical outcomes than the associated fracture type in our own surgically treated acetabular fractures.Öğe Comparison of the radiological parameters between dynamic-referencing tactile guidance robotic system and microplasty (r) instrumentation in unicompartmental knee arthroplasty(TURKISH JOINT DISEASES FOUNDATION, 2022) Çabuk, Haluk; Turan, Kaya; Muratoğlu, Osman Görkem; Ergün, Tuğrul; Öztürk, Çağatay; Ertürer, Ramazan ErdenObjectives: This study aims to compare the radiological outcomes of unicompartmental knee arthroplasty (UKA) performed by a navigation-based robotic system versus Microplasty (R) instrumentation. Patients and methods: Between January 2018 and January 2019, a total of 90 knees of 75 patients (65 males, 10 females; mean age: 62.0 +/- 9.4 years; range, 50 to 73 years) were included. Among these, 54 knees underwent Oxford mobile-bearing UKA with an Microplasty (R) instrumentation set and 36 knees were operated with the aid of a Restoris (R) MCK with MAKO navigation-based robotic system. Postoperative anteroposterior and lateral X-rays of all patients were evaluated according to nine different parameters. On the femoral side, femoral varus-valgus angle, flexion-extension angle, femoral condyle posterior fit; on tibial side, tibial component varus/valgus, tibial posterior slope, medial, anterior, posterior and lateral fit of tibial component assessed. Results: There was no significant difference between groups in terms of age, sex, and affected side. On the femoral side, no significant difference was observed in the component position between groups. On the tibial side, tibial component medial fit (p=0.032) and anterior fit (p=0.007) were better in navigation-based robotic system group. Conclusion: Microplasty (R) instrumentation may lead to comparable implant positioning compared to a tactile-based navigated robotic instrumentation.Öğe Current approaches and problems faced by orthopedic surgeons in all-inside arthroscopic meniscus repairs(2023) Turan, Kaya; Erturer, Ramazan Erden; Çabuk, Haluk; Muratoğlu, Osman Görkem; Ergün, TuğrulAim: All-inside meniscal sutures are frequently the treatment of choice in arthroscopic practice. However, the literature contains limited evidence of the technical issues experi- enced during the procedure. We aimed to evaluate the technical difficulties encountered during the placement of all-inside meniscal repair sutures according to the surgeon’s ex- perience and the success rate of the suture placement. Materials and Methods: We invited orthopedic surgeons across the country to com- plete a questionnaire through an online platform. Participants were asked ten questions about their demographic information, general surgical approach to meniscal tears, and experience with intraoperative complications specific to all inside meniscus sutures. Results: A total of 100 orthopedic surgeons participated in our study. Of these, 37% had been working as an orthopedic surgeon for more than ten years. Twenty-five per cent performed more than two arthroscopic knee surgeries per week. Fifty-six per cent of the surgeons were protective for the displaced red-white zone meniscal tears. Although 90% of the participants stated that the technique was more effortless, only 12% thought the clinical results were better than the other techniques. More than 50% of the participants indicated that they had difficulty when placing the sutures successfully. The most common problem was the inability to fix the meniscus sufficiently and the deformation of the instruments inside the joint. When we compared the complications according to the surgeon’s experience, even among the surgeons who performed more than 100 arthroscopic surgeries per year, 34% had trouble applying these sutures successfully. Conclusion: Although all-inside meniscus sutures are generally believed to decrease the operative time and be technically more straightforward, even the most experienced surgeons have difficulty applying these sutures, and the reliability of these sutures is low.Öğe Does the clamping method in local and systemic TXA applications in total knee arthroplasty change the game?: a retrospective comparative cohort study(Lippincott Williams and Wilkins, 2022) Turan, Kaya; Muratoğlu, Osman Görkem; Ergün, Tuğrul; Çabuk, Haluk; Ertürer, Ramazan ErdenMany different methods and drain clamping periods have been described in systemic and local tranexamic acid (TXA) applications, and the superiority of the methods to each other has not been clearly demonstrated. The method of local infusion in combined TXA applications may not alter the Hb drop or total or hidden blood loss. We aim to compare two different combined TXA application methods. We retrospectively analyzed 182 patients who underwent total knee arthroplasty between 2018 and 2021. Patients over 40 years of age who underwent TKA for degenerative knee arthritis were included in the study. Unicondylar, revision, or bilateral arthroplasties and patients with the cardiovascular or cerebrovascular disease were excluded from the study. All patients in the study received 1 g TXA intravenously half an hour before the incision. For the first group, 1 g TXA was given intra-articularly at the drain site after closure, and the clamp was kept closed for 1 hour. In the second group, the drain was clamped for an additional 6 hours, and a 1 g intravenous dose was administered at the 5th hour postoperatively. No local applications were used in the control group. Total, hidden, and visible blood loss (total blood loss, hidden blood loss, visible blood loss), postoperative decreases in hemoglobin and hematocrit level (?Hgb, ?Htc), blood transfusion rates, and hospital stay durations were evaluated. There were 72 patients in the first group, 52 in the second, and 58 in control. A total of 37 patients received one or more blood transfusions postoperatively, and there was no statistical difference in the need for blood transfusions between the groups (P?=?.255). Although a statistically significant difference (P?=?.001) in total blood loss, hidden blood loss, visible blood loss and ?Hgb values was observed between the groups, the difference between the first and second groups was insignificant (P?=?.512). The duration of hospital stay was observed to be less in the first and second groups (P?=?.024). Local and systemic TXA applications were observed to be more effective than only systemic applications in reducing blood loss after total knee arthroplasty, regardless of the local method.Öğe The effect of weekday preference on length of stay in unilateral bicompartmental total knee arthroplasty(Galenos Publishing House, 2022) Turan, Kaya; Ergün, Tuğrul; Muratoğlu, Osman Görkem; Çabuk, Haluk; Öztürk, ÇağatayAim: There are few studies in the literature evaluating the effect of the day of surgery on length of hospital stay. This study evaluates the effect of the day of surgery on the duration of hospitalization in unilateral primary total knee arthroplasty (TKA) in a group of hospitals providing wide-ranging health services and clarifies the implications for reducing economic burdens. Methods: Between March 2020 and January 2022, patients treated by TKA with the code P612420 according to the Health Practice Communique were retrospectively scanned in a group of hospitals with different levels. Patients who underwent bilateral TKA on the same day or during hospitalization, underwent any secondary surgical procedures, or developed early complications were excluded from the evaluation. Results: The data of 743 patients who underwent unilateral TKA were evaluated. The mean hospital stay was 3.32 (2-14) days. It was seen that the shortest hospitalization periods were in the surgeries performed on Saturday (3.15 days), while the longest ones were on Friday (3.62 days). It was found that the patients who underwent surgery on Saturday had significantly shorter hospital stays than on Friday (p=0.006). Conclusion: While planning TKA, the choice of surgery day is a factor that should be addressed to reduce hospital stays and, therefore, costs. © 2022 by The Medical Bulletin of Istanbul Haseki Training and Research Hospital The Medical Bulletin of Haseki published by Galenos Yayinevi.Öğe The intra- and interobserver reliability of five commonly used intertrochanteric femur fracture classification systems(2022) Yıldırım, Cem; Turan, Kaya; Ergün, Turğul; Mısır, Abdulhamit; Aydın, Mahmud; Muratoğlu, Osman GörkemObjectives: This study aims to evaluate the effect of surgical experience on reliability for Boyd-Griffin, Evans/Jensen, Evans, Orthopaedic Trauma Association (main and subgroups), and Tronzo classification systems. Patients and methods: Between January 2013 and December 2014, radiological images of a total of 60 patients (13 males, 47 females; mean age: 78.9±21.9 years; range, 61 to 96 years) with the diagnosis of intertrochanteric femur fracture were analyzed. Radiographs were evaluated and classified by five residents and five orthopedics and traumatology surgeons according to the Evans, Boyd-Griffin, Evans/Jensen, OTA, and Tronzo classification systems. Intra- and interobserver reliability were calculated using the kappa statistics. Results: The worst intraobserver compatibility among the residents was the classification system with OTA subgroups (?=0.516), while the classification system with the best intraobserver fit was found to be OTA main groups (?=0.744). The worst agreement among surgeons was in the Evans classification system (?=0.456). However, the best intraobserver agreement was in the OTA main groups (?=0.741). The best interobserver agreement was observed regarding the OTA main groups (?=0.699). Conclusion: The classification that has the best harmony both among residents and surgeons, and between residents and surgeons is the OTA main group classification.Öğe Patient anxiety levels in orthopedic outpatient clinics at hospitals with different patient population densities(DergiPark, 2022) Turan, Kaya; Tuncez, Mahmut; Muratoğlu, Osman Görkem; Ergün, Tuğrul; Çabuk, HalukBackground/Aim: Prolonged wait times for examination and delayed hospital appointment times can negatively affect patients. Increased anxiety in orthopedic outpatient clinic patients can disrupt diagnosis and treatment, and increase psychological tension in both patients and healthcare professionals. The aim of our study is to compare the anxiety levels of patients at institutions with different patient population densities. Methods: This cross-sectional survey study included 189 patients who voluntarily completed the Beck Anxiety Scale while registering for treatment of non-traumatic conditions at the orthopedics and traumatology outpatient clinics of two tertiary health care hospitals. Patients were grouped by hospital attended. The study assessed patients’ age, education level, estimated monthly income levels, and anxiety levels. Results: 99 patients from the public hospitals and 90 from the private hospitals participated in the survey. A significant positive correlation existed between educational status and income level (P<0.001). No significant difference in income level existed between the two groups (P=0.063), but the education level of patients in the private hospital group was significantly higher than in the public hospital group (P<0.001). The anxiety levels of the patients in the private hospital group was significantly higher (P=0.043); this difference was correlated to education level rather than income level. Patients with higher education levels demonstrated significantly higher anxiety levels (P<0.001). Conclusion: The study concluded that the anxiety levels of patients who applied to the orthopedic outpatient clinics were independent of facility patient density and related primarily to patient attributes. Prospective studies are needed examining the relationship between patient anxiety levels and waiting time.Öğe Total diz artroplastisi sonrası geç dönemde gelişen peroneal palsi: Vaka sunumu(DergiPark, 2021) Turan, Kaya; Çabuk, Haluk; Muratoğlu, Osman GörkemTotal diz artroplastisi sonrası gelişen peroneal sinir palsi klinik sonuçları önemli derecede olumsuz etklileyen ve nadir görülen bir sorundur. Bu çalışmamızda 62 yaşında sağ dizde ileri derecede gonartroz nedeniyle total diz artroplastisi uyguladığımız hastada ameliyat sonrası 15. günde gelişen peroneal palsinin klinik ve elektrofizyolojik takip sonuçlarını sunuyoruz. Elektromyografik değerlendirmede peroneal sinir motor dalının fibula başı seviyesinde ağır derecede parsiyel aksonal hasarı izlendi. Medikal tedavi ile takibi sonrası 6. Haftadan itibaren klinik iyileşme bulguları başlayan hastada, peroneal sinir eksplorasyon ve nöroliz gerekliliği olmadan, 6. ayda total klinik ve elektrofizyolojik iyileşme sağlandı. Dejeneratif disk hastalığına bağlı klinik bulgu vermeyen kök basısı olan hastalarda uygulanan total diz artroplastisinde peroneal palsi yatkınlığında artış olabileceği akılda tutulmalıdır.Öğe Treatment of ingrown toenail with a minimally invasive nail fixator: Comparative study with winograd technique(Sheridan Publications, 2022) Ergün, Tuğrul; Korkmaz, Mehmet; Ergün, Dilan; Turan, Kaya; Muratoğlu, Osman Görkem; Çabuk, HalukBackground: Many surgical techniques have been reported for the treatment of ingrown toenails. Occurrences of infection after matricectomy procedures could cause clinicians to prefer using external braces to treat ingrown toenails. This study compares patients with ingrown toenails who underwent the nail fixation technique and the Winograd technique. Methods: Patients who underwent ingrown toenail surgery were retrospectively reviewed. The patients' demographic characteristics (age, gender, body mass index [BMI] morphology according to Heifetz classification, surgical technique, visual analog scale (VAS) values, time to return to daily activities (days), complications, and satisfaction levels were all recorded. Results: Seventy patients were included in the study. Of the patients, 33 underwent nail fixation and 37 underwent the Winograd technique. No significant statistical differences were found in terms of patients' age, gender, BMI, preoperative clinical features, long-term satisfaction, and ingrown toenail recurrence rates between the two groups, but time to return to daily activities and VAS values were statistically significantly lower in patients treated using nail fixation compared with the Winograd technique. Conclusion: Nail fixation can be an effective surgical treatment option for an ingrown toenail.Öğe Ultrasonography vıew for acute ankle ınjury: comparison of ultrasonography and magnetic resonance ımaging(Springer, 2022) Ergün, Tuğrul; Peker, Ahmet; Aybay, Muhsin N.; Turan, Kaya; Muratoğlu, Osman Görkem; Çabuk, HalukIntroduction: We aim to asses the diagnostic performance of ankle ultrasonography in patients presenting with acute ankle sprain injury, with comparison to MRI (Manyetik Rezonans İmaging). Materials and methods: The study included patients who applied to the hospital within 48 h after an ankle sprain, and who presented with signs of pain, swelling, and tenderness in the ankle. Ankle ultrasonography examination was performed and an ankle MRI took place the same day. Results: 30 patients were included in the study. 53.3% (n = 16) were female. The mean age was 30 ± 6.4 years. The ultrasonography examination determined 76.6% (n = 23) of the patients to have anterior talofibular ligament (ATFL) injury, 33.3% to have (n = 10) CFL injury, and 33.3% to have (n = 10) anterior inferior tibia-fibular ligament (AITFL) injury. The MRI of the patients determined 73.3% (n = 22) of the patients to have ATFL injury, 43.3% (n = 13) to have calcaneal fibular ligament (CFL) injury, and 33.3% to have (n = 10) AITFL injury. The ATFL, CFL, and AITFL injuries diagnosed on ultrasonography correlated with the MRI results (ICC = 0.875, ICC = 0.879, and ICC = 0.858). However, among the ATFL injuries observed on MRI, 26.6% (n = 8) were grade I, 26.6% (n = 8) were grade II, and 20% (n = 6) were grade III injuries. Of the ATFL injuries observed on ultrasonography, 46.6% (n = 14) were grade I, 8.6% (n = 2) were grade II, and 30.4% (n = 7) were grade III injuries. Conclusions: Findings on all types of ATFL, CFL and AITFL appear to have a higher degree of correlation. Ultrasonography could have an added role as a triaging tool, to fast-track MRI.
