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Ahmet Kapukaya

Publications and source records attributed to Ahmet Kapukaya.

At least 19 recordsLinked to original sources
PubMed2006

Technique and complications of callus distraction in the treatment of bone tumors.

INTRODUCTION: This study investigated the effects of chemotherapy, defect length, and patient age on the outcome and complications of callus distraction as a limb salvage technique in 17 patients. MATERIALS AND METHODS: The mean patient age was 18.4 years (range 7-47). Of 17 patients, 8 received chemotherapy and the remaining 9 patients did not. The mean defect length after excision of the lesion was 13 cm (range 8-20). The mean follow-up period for the patients whose treatments were completed was 55 months (range 20-90), the mean distraction index was 12.55 days/cm (range 11-15.7), and the mean external fixation index was 34.73 days/cm (range 30-41). RESULTS: In two patients, local recurrence occurred before distraction was completed. Two patients died, and one of them was a patient in whom local recurrence had occurred. Complications included non-union in one patient, osteomyelitis in one patient, and premature callus, osseous bridge, and varus of the femur in one patient. The extremity functional score was 80% (range 26-100). Chemotherapy and defect length had no significant effect on the distraction or external fixation indices. In contrast, the increase in the external fixation index in those over 20 years old was significant (P=0.043). CONCLUSION: We found that chemotherapy and defect length have no significant effect on the outcome and complications with this technique, which was more successful in patients younger than 20 years.

Adolescent↗
PubMed2006

Osseous lipoma: eleven new cases and review of the literature.

This study describes the clinical features, radiological appearance, and treatment of 11 new cases of osseous lipoma and reviews 301 other cases in the literature. Osseous lipomas are classified by the site of origin: either within bone (intraosseous lipoma) or on the surface of bone (juxtacortical). Intraosseous lipomas include intramedullary and intracortical lesions. Surface lipomas include subperiosteal and parosteal lesions. The authors added their cases to those found in the literature. Intramedullary osseous lipoma (n=262) : the most common presenting symptoms were pain and swelling (69%). The most frequent localisations were the calcaneus (24%) and the femur (22%). On plain radiographs, these lesions consisted of a well-circumscribed radiolucent area with central calcification and a sclerotic rim, occasionally with cortical expansion. Computed tomography (CT) and magnetic resonance imaging (MRI) showed that the lesions had attenuation values and a signal intensity identical to that of adipose tissue. In symptomatic lesions and in cases with impending fracture, operative treatment was indicated. Parosteal lipoma (n=47): the most common presenting symptoms were local swelling and pain (58%). This lesion was most frequent in the radius (31%) and in the femur (23%). The classic radiographic appearance of parosteal lipoma was that of an exostosis-like bony prominence capped with a radiolucent layer of fat. CT-scan and MRI showed similar features. Intracortical (n=2) and subperiosteal lipomas (n=11): only a few cases were found in the literature. Their localisation differs from that of the other osseous lipomas. The differential diagnosis of osseous lipoma in general is extensive and should include benign and malignant tumours. Combination of radiological and histological data is essential to determine whether an osseous lipoma is actually present.

Adolescent↗
PubMed2005

Non-reducible, open tibial plafond fractures treated with a circular external fixator (is the current classification sufficient for identifying fractures in this area?).

While some researchers advocate primary arthrodesis for the treatment of open, severely comminuted tibial plafond fractures, others argue that an external fixator is an alternative. In this study, we obtained intermediate clinical and radiological outcomes on treating such fractures with a circular external fixator. Twelve patients with non-reducible, open tibial plafond fractures were treated with a circular external fixator and minimal osteo-synthesis. The fractures were grouped using a modification of the Ruedi and Allgower classification: eight, two, and two of the patients had Type III, IVA, and IVB fractures, respectively. The bone transport technique was applied in the patients with a Type IVB fracture. Four parameters were tracked in the patients: the reduction score of the joint surface, early complications, and the radiological and clinical findings of the ankle. The average follow-up period of the patients was 54.5 months. In the postoperative radiological examinations, the reduction score of the joint surface exceeded 15 in four patients and was 12-15 in eight patients. Type III and IVA fractures united with an average healing time of 4.25 months. Surface wound infection was observed in three patients. One patient each developed fibular osteomyelitis, claw toe, and 2cm shortness. Among the patients with Type IVB fractures, nonunion and malunion in the newly forming callus was observed in one patient, and nonunion alone was observed in another patient. On the final check, both the clinical and radiological findings were poor for all of the patients, with a reduction score exceeding 15. High-energy and poor joint surface reduction scores are two important factors affecting both the clinical and radiological results. For the fractures with reduction scores below 15, it is particularly difficult to predict the clinical results. Therefore, we recommend that such fractures be treated with a circular external fixator and believe that arthrodesis in accordance with the patient's choice is a desirable treatment method.

Accidental Falls↗
PubMed2005

Tuberculosis of the shoulder joint.

OBJECTIVES: Skeletal tuberculosis is less common than the pulmonary form. The involvement of the shoulder joint is infrequent. We report our experience treating tuberculosis of the shoulder in 11 patients. METHODS: There were seven men and four women, ranging in age from 19 to 55 years (average 28.09 years). The duration of their complaints at presentation ranged from 3 to 24 months. The most common presentation was pain, which was seen in 10 joints. All of the patients had mild to moderate restriction of motion of the shoulder. On laboratory examination, the erythrocyte sedimentation rate was increased mildly. No patient had an active tuberculosis lesion or history of pulmonary disease. The diagnosis was based on the clinical picture and radiographic features, and was confirmed by open biopsy. The diagnosis was not confirmed by biopsy in one patient, but the family history and clinical and radiological features were highly suggestive of tuberculosis. Surgical debridement was done in two patients and open biopsy in eight patients in order to obtain samples for pathology. Arthrodesis was done in only one patient. In all patients, treatment began with a four-drug regimen for 2 months, followed by a two-drug regimen for 10 months. RESULTS: The mean follow-up period after the end of treatment was 28.72 months (range, 22-52 months). At the time of the last visit, all the lesions had healed without recurrence. Five cases had a painless, mobile shoulder, while three had mildly restricted shoulder motion without pain, and three had residual limitation of motion of the affected shoulder. CONCLUSIONS: Tuberculosis of the shoulder can be difficult to diagnose in the early stages. If not diagnosed early, bony tuberculosis may reduce the quality of life. Therefore, tuberculosis should be suspected in cases of long-standing pain in the shoulder. It is necessary to keep tuberculosis in the differential diagnosis of several osseous pathologies. Arthrodesis should be reserved only for lesions that fail to heal after adequate chemotherapy and rehabilitation.

Adult↗
PubMed2005

Characteristics of traumatic spinal cord injuries in south-eastern Anatolia, Turkey: a comparative approach to 10 years' experience.

The purpose of this study was to determine the demographic and epidemiological characteristics of traumatic spinal cord-injured patients. The hospital records of 539 patients (416 men, 123 women) with spinal cord injuries (SCIs) admitted to four hospitals that were major referral centers for trauma in the south-eastern region of Turkey from 1990 to 1999 were reviewed retrospectively. The patients with SCI were investigated for two periods; the first period covered patients admitted between 1990 and 1994 during which time an influx of people from rural to urban areas occurred and firearm injuries were common. In the second period (1995-1999) the influx of people declined and firearm injuries were reduced. The most common causes of injuries were road traffic accidents (200, 37.12%), followed by falls (172, 31.90%) and bullet wounds (115, 21.34%). In the first period, incomplete paraplegia was encountered more often than in the second period (P<0.001). In conclusion, in our series, while the leading cause of SCI for the two time periods was road traffic accidents, firearm injuries for the first period and falls for the second period were second-most frequent causes of SCI. In addition, the present study suggests that demographic and epidemiological factors may affect the characteristics of SCI in a region-based population even in a 10-year period of time.

Accidental Falls↗
PubMed2005

Management of comminuted closed tibial plafond fractures using circular external fixators.

Various types of external fixators have been used to treat Ruedi and Allgöwer Type III pilon fractures, as serious complications can occur using conventional treatment principles. However, insufficient reduction and loss of reduction are two of the main disadvantages of external fixator treatments. We conducted a retrospective review of 14 patients with severe highly comminuted closed fractures of the distal tibia (Ruedi type III) treated using cross-ankle external fixators. Five patients underwent closed reduction, while the others required open reduction using minimal incision techniques. The reduction score, reduction loss, early and late complications, and ankle symptoms and functions were evaluated. The patients were followed for an average of 48 months (range: 31 to 84); superficial wound infection developed in one case and minimal angular deformity in another. In ten cases, the reduction of the articular surface was anatomical; in the other four cases, it was non-anatomical. Except for one case which developed an angular deformity, no loss of reduction was observed. On radiological control, only one case did not display osteoarthrosis; in the other 13 cases, osteoarthrosis was diagnosed at different levels. The most important disadvantage of this technique is retarded joint movement. Nevertheless, for such fractures, we consider cross-ankle circular external fixators as an alternative treatment method because it combines the advantage of a minimal risk of deep infections with better stabilisation of the limb, while providing early mobilisation.

Adolescent↗
PubMed2004

Tuberculosis of the metacarpals and phalanges of the hand.

Skeletal tuberculosis (TB) is less common than the pulmonary form. Involvements of the metacarpals and phalanges of the hand are infrequent. The authors report their experience with treatment and outcome of TB of the metacarpals and phalanges of the hand in 7 patients. There were 4 women and 3 men in the study who ranged in age from 3 to 60 years (average age, 22.7 years). The duration of complaints at presentation ranged from 4 to 17 months (average, 9 months). The most common presentation was pain and swelling. The presumptive preoperative diagnoses were bone tumor in 4 patients, spina ventosa in 2, and chronic pyogenic osteomyelitis in 1 patients. The results of the laboratory examination showed a mild increase in the erythrocyte sedimentation rate. No patient had an active tubercular lesion or history of pulmonary disease. The diagnosis was based on the clinical picture and radiographic features, and was confirmed by open biopsy. No patient had bony debridement or arthrodesis to control the infection. The treatment of all patients began with a 4-drug regimen for 2 months, followed by a 2-drug regimen for 10 months. The mean follow-up was 30.28 months (range, 16-52 months). At the time of the last follow-up, all lesions had healed with no recurrence. The functional results were satisfactory in all patients. One patient with thumb metacarpophalangeal TB had joint irregularity and thumb metacarpal shortening. Arthrodesis was not needed in any patient. TB of the metacarpals and phalanges of the hand can be difficult to diagnose during the early stages. TB should be suspected in cases of long-standing pain and swelling in the metacarpals and phalanges. It is necessary to keep TB in mind when making the differential diagnosis of several osseous pathologies.

Adult↗
PubMed2004

Early prophylactic autogenous bone grafting in type III open tibial fractures.

The authors report the results achieved in patients with type III open tibial fractures who underwent primary autogenous bone grafting at the time of debridement and skeletal stabilisation. Twenty patients with a mean age of 35.8 years (range, 24-55) were treated between 1996 and 1999. Eight fractures were type IIIA, 11 were type IIIB, and 1 was type IIIC. At the index procedure, wound debridement, external fixation and autogenous bone grafting with bone coverage were achieved. The mean follow-up period was 46 months (range, 34-55). The mean time to fixator removal was 21 weeks (range, 14-35), and the mean time to union was 28 weeks (range, 19-45). Skin coverage was achieved by a myocutaneous flap in 2 patients, late primary closure in 4, and split skin grafting in 14. One (5%) of the patients experienced delayed union, and 1 (5%) developed infection. In tibial type III open fractures, skin coverage may be delayed, using the surrounding soft tissue to cover any exposed bone after thorough débridement and wound cleansing. Primary prophylactic bone grafting performed at the same time reduces the rate of delayed union, shortens the time to union, and does not increase the infection rate.

Adult↗
PubMed2004

Congenital patellar aplasia in conjunction with trisomy 8. A case report.

Congenital patellar aplasia and hypoplasia are quite rare. Bilateral flexion deformity of the fifth finger, patellar aplasia in the right knee and patellar hypoplasia in the left knee were noted in a 6-year-old boy brought in for treatment of curvature of both little fingers. Active and passive movements of the knees were within normal range, and the quadriceps muscle was of normal strength. Trisomy 8 was determined on chromosome analysis. In contrast with the literature, the patellar abnormality was not concomitant with any other syndromes in our case, and most clinical findings of trisomy 8 were absent.

Abnormalities, Multiple↗
PubMed2003

[The floating knee in adults: twenty-four cases of ipsilateral fractures of the femur and the tibia].

OBJECTIVES: We evaluated the presenting features of ipsilateral femoral and tibial fractures in adults, and the effects of both fracture type and severity of skeletal injury on the results. METHODS: The study included 24 patients (22 men, 2 women; mean age 38 years; range 17 to 75 years). According to the classification by Letts et al., the types of the fractures were as follows: type A (7), type B (2), type C (5), type D (7), and type E (3). Femur fractures were treated by locked intramedullary nails, AO plates, plate-screws, unilateral external fixator, or dynamic condylar screws, and tibia fractures by external fixator, plate-screws, locked intramedullary nailing, or with conservative methods. Amputation at the fracture level was required in a patient with type 3C open tibia fracture. The mean follow-up was 3.2 years (range 1.3 to 7 years). RESULTS: According to the criteria by Kalström and Olerud, the results were excellent in three patients, good in nine patients, fair in five patients, and poor in six patients. The mean skeletal injury scores were 4.4 and 3 in patients having fair and poor results and in those with good and excellent results, respectively. Fair and poor results corresponded to type A (1 patient), type C, type D, or type E fractures. Five patients with type 3 open fractures had fair or poor results. Thirteen patients (54%) had at least one complication. CONCLUSION: Patients with type C, D, or E fractures and those with greater skeletal injury scores are more likely to have fair or poor results due to the open nature of the fracture and to increased involvement of the knee joint. Although there is not an ideal method, rigid internal fixation seems to be more appropriate in fractures other than type 3 open tibia fractures.

Adolescent↗
PubMed2003

[Comparison between the results of intramedullary nailing and compression plate fixation in the treatment of humerus fractures].

OBJECTIVES: The results of open reduction and internal fixation of humeral shaft fractures by either an intramedullary nail or a dynamic compression plate were compared. METHODS: The study included 60 patients (43 males, 17 females; mean age 38 years; range 19 to 61 years) with humerus fractures. Thirty-three patients were treated with intramedullary nails and 27 patients with dynamic compression plates. Functional results were evaluated according to the Stewart and Hundley's criteria. The two methods were compared. The mean follow-up period was 42 months (range 28 to 72 months). RESULTS: Healing times did not differ between the two treatment groups (p>0.05). Radial nerve palsy occurred only in the dynamic compression plate group, with four patients being affected. On the other hand, the rate of non-union was significantly higher in patients treated with intramedullary nailing (p<0.05). CONCLUSION: No ideal fixation technique exists in the treatment of humerus fractures. Despite higher non-union rates, intramedullary nailing may be the method of choice in the treatment of humerus fractures because of such advantages as low morbidity, small dissection of soft tissues, and greater ease of application.

Adult↗
PubMed2003

Giant-cell reparative granuloma of the tibia.

Giant-cell reparative granuloma (GCRG) occurs in the jaw, temporal bone, and short tubular bones of the hands and feet. Although GCRG can affect long bones, only small numbers of such cases have been sporadically reported. This report describes a giant-cell reparative granuloma in the proximal tibia in a 60-year-old woman, describes features of GCRG in long bones and reviews the literature. A 60-year-old female patient was referred to us with complaints of moderately tender swelling of the right leg. Whole-body scintigraphic scanning was performed, which incidentally also disclosed a distal femoral lesion. The patient was admitted for surgery and incisional biopsies were performed on both lesions. Pathology analysis of the specimen from the tibia showed new bone lamellae encircled by osteoblasts and multinucleated giant cells which were more numerous in the haemorrhagic regions of the stroma; the latter displayed fibroblasts, histiocytes and inflammatory cells. The specimen from the femoral lesion showed typical features of a benign enchondroma. The patient was readmitted for surgery. The femoral enchondroma was curetted and the cavity was packed with bone graft. The tibial GCRG was treated with marginal resection, autogenous and allogenous bone grafting and intramedullary nailing. Follow-up examination after two years showed no clinical or radiological evidence of a recurrence. Although GCRG is uncommon, it should be considered whenever a lucent, expansile, and possibly destructive lesion of a long bone is encountered. It should be distinguished from true giant cell tumours occurring in the same locations because they have different biologic behaviours.

Bone Diseases↗
PubMed2002

Problem fractures associated with gunshot wounds in children.

Twenty-seven fractures in 22 children (14 female, 8 male; average age: 10.5) who suffered gunshot wounds were retrospectively evaluated. Fourteen of the fractures were caused by high-velocity weapons, four by low-velocity weapons, and nine by shotguns. One of the fractures was undisplaced, two were displaced, 10 were comminuted, seven were comminuted and displaced, and seven had bony defects. Accompanying pathologies included four physeal, three articular, four visceral, four arterial, six peripheral nerve, and one spinal cord injury. Initial treatment involved external fixation in 15 patients and internal fixation in one patient for bone stabilization, while the remaining patients were treated conservatively.Late-stage surgery was necessary to achieve soft-tissue coverage in three patients and to achieve union in six patients. Major complications included amputation in one patient, non-union in two, delayed union in one, osteomyelitis in one, paraplegia in one, and loss of peripheral nerve functions in three. The treatment of fractures associated with firearm injuries in children is never simple. Fracture defects, accompanying peripheral nerve damage and involvement of the joint negatively is affect the outcome, increasing the chance that late-stage surgery will be necessary. Internal bone transport appears to be an efficacious technique in the treatment of bone and soft-tissue defects associated with firearm injuries in children.

Adolescent↗
PubMed2002

[Treatment of femoral shaft fractures with interlocking intramedullary nailing].

OBJECTIVES: Fractures of the femoral shaft are one of the most common fractures and may result in extensive disability, prolonged morbidity, or mortality unless appropriate treatment is applied. There are several treatment alternatives. In this study, we evaluated early results of interlocking intramedullary nailing in patients with femoral shaft fractures. METHODS: Femoral fractures of 42 patients (34 males, 8 females; mean age 32 years; range 16 to 67 years) were treated with interlocking intramedullary nailing. The mean follow-up was 14.4 months (range 8 to 32 months). Radiologic and clinical results were evaluated. RESULTS: Union was obtained in all but one patient within a mean duration of 18.2 weeks. Discrepancy of leg length was measured as 10 mm in six patients, and 25 mm in one patient. One patient (2.38%) developed deep infection. Knee flexion was more than 120 degrees in 95.23%. According to Thoresen's criteria, the results were excellent and good in 89% of patients. CONCLUSION: Interlocking intramedullary nailing proved an acceptable alternative in the treatment of femoral shaft fractures.

Adolescent↗