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Biomedical subjects

Ibrahim Akmaz

Publications and source records attributed to Ibrahim Akmaz.

18 recordsLinked to original sources
PubMed2006

Comparison of outcomes of two different surgeries in regarding to complications for chronic anterior shoulder instability.

INTRODUCTION: The purpose of this study is to compare the early clinical results of two techniques in regarding to complications in the patients who suffered from chronic anterior traumatic isolated shoulder instability. METHOD: Eighty-five patients underwent reconstructive procedures due to chronic isolated traumatic shoulder instability in our clinic between 1990 and 2002. Sixty-four patients in whom preoperatively Bankart lesion were detected with MRI and who participated in the regular follow-up were included in the study. Thirty-four patients were treated with Bankart repair (Group I) and 30 patients were treated with Modified Bristow procedure (Group II). Mean follow-up period was 25 (24-39) months for group I and 28 (24-96) months for group II. All cases were evaluated preoperatively and postoperatively according to Rowe scoring system. RESULTS: Mean Rowe scores were 90 and 88.1 for group I and II, respectively. Due to recurrent dislocation, four revision surgeries (one in group I, three in group II) were performed. Surgical complications were encountered in group II, just as fracture at the bone block in four cases, nonunion in five cases and removal of loose screw in one case. DISCUSSION: According to clinical outcomes, both the techniques are useful and feasible for the treatment of the chronic traumatic isolated anterior shoulder instability; however, complication rate is higher in the Modified Bristow technique and, Bankart repair is directed to the anatomic repair of the original pathology.

Adult↗
PubMed2005

Treatment of rupture of the Achilles tendon with fibrin sealant.

BACKGROUND: The optimal management strategy for acute Achilles tendon ruptures is controversial. These injuries historically were treated by nonoperative methods (cast immobilization, bandaging); however, operative repair of the ruptured tendon has become popular. METHODS: Thirty-two patients who had rupture of the Achilles tendon were treated operatively with use of fibrin sealant, and clinical and functional performance measures were assessed after a mean followup of at least 6 months between November, 1998, and July, 2003. All of the patients were male. Average age was 38.18 (30 to 45) years. All of the patients were followed for at least 18 months after surgery. Average followup time was 22.4 (18 to 56) months. We evaluated all patients according to the scoring system of Thermann et al. RESULTS: Our results were excellent in 24 patients and good in eight patients. One patient had rerupture 3 weeks after surgery. CONCLUSION: Fibrin sealants are biologically compatible, hemostatic agents derived from human plasma that can be used instead of suture or suture support. We think that the treatment of rupture of the Achilles tendon with fibrin sealant is a useful treatment, and there is less risk of complications, such as deep infection, than in other operative procedures. We had no wound closure problems, the incision size was small, and the operating time was short. However, it must be remembered that the risk of disease transfer by fibrin sealant application is still present.

Achilles Tendon↗
PubMed2005

[Early results of reconstruction of chronic anterior cruciate ligament ruptures using four-strand hamstring tendon autografts].

OBJECTIVES: We evaluated the short-term results of reconstruction of anterior cruciate ligament (ACL) ruptures using a four-strand hamstring autograft and cross pin femoral fixation. METHODS: The study included 62 male patients (mean age 24 years; range 21 to 44 years) with chronic ACL ruptures. Involvement was in the right knee in 32 patients, and in the left knee in 30 patients. All the patients were treated with a four-strand hamstring autograft, cross pin femoral fixation (Transfix, Arthrex and Sling Shot, Mitek), and an interference screw on the tibial side. Forty-one patients received treatment for other meniscal pathologies. Final evaluations were made at the end of postoperative 18 months using the Lysholm and IKDC (International Knee Documentation Committee) scoring systems, Telos stress testing, Tegner activity rating, and radiographs. RESULTS: The Lysholm scores were good (n=23) or excellent (n=38) in 61 patients, and poor in one patient, the mean Lysholm score being 93.5. The IKDC scores were grade A (n=35) or B (n=26) in 61 patients, and grade D in one patient. Telos stress testing showed a significant difference between preoperative (mean 14.5 mm) and postoperative (mean 2.6 mm) laxity measurements (p<0.001). None of the patients had a graft rupture. One patient who developed grade III instability after postoperative six months underwent second-look arthroscopy followed by revision surgery. CONCLUSION: Reconstruction of the ACL using four-strand hamstring tendons and cross pin femoral fixation results in considerably high success rates in selected patients.

Adult↗
PubMed2004

Biodegradable implants in the treatment of scaphoid nonunions.

We reviewed 12 male patients with scaphoid nonunions treated by open reduction, bone grafting, and internal fixation with biodegradable implants made of self-reinforced poly- l-lactic acid. Mean patient age was 22.5 (20-25) years. Ten patients had type D2 scaphoid nonunions with a fracture line in the middle one third, one patient had type D2 nonunion with a fracture line in the proximal one third, and one patient had type D1 distal one-third fibrous union. The mean wrist score (modified Mayo wrist score) was 20.8 (10-40) preoperatively and improved after 22-80 months (55-90). All nonunions healed, and the mean solid union time was 4.5 (3.5-7) months. We obtained excellent results in five patients, good results in four, fair results in two, and a poor result in one. The results of this study offer a valid alternative in the fixation of scaphoid nonunions. The major advantage of biodegradable materials is to eliminate the requirement for the removal of the fixation material.

Absorbable Implants↗
PubMed2004

Late reconstruction of neglected metacarpal shaft defects due to gunshot wound.

We evaluated eight patients after delayed treatment of nine metacarpal bone defects due to gunshot injuries. The mean length of the metacarpal defects was 3 cm and the average time between the gunshot injury and the reconstruction surgery was 10 months. Although all of the patients had been treated with wound irrigation and debridement immediately following injury, no attempt had been made to repair the metacarpal defect or to maintain metacarpal length. As a result, serious shortening had occurred. After the original length of the metacarpal had been restored by distraction of the soft tissues (1 mm/day), a tri-cortical iliac bone graft was inserted into the bone defect. The average follow-up time was 15 months. Clinical and radiological union was established in all cases after an average of 12 weeks. The mean grip strength of the hand and the mean range of motion of the metacarpophalangeal joint increased by 24% and 60%, respectively.

Adult↗
PubMed2004

[Delayed diagnosis of isolated ulnopalmar dislocation of the fifth carpometacarpal joint and its treatment with open reduction and internal fixation].

We present a 21-year-old male patient with an isolated ulnopalmar dislocation of the fifth carpometacarpal joint that occurred due to a fall on the hand. Diagnosis was delayed for five weeks and closed reduction was not successful. He was treated with open reduction and internal fixation. Upon removal of fixation materials six weeks after surgery, he developed reflex symphatic dystrophy and limitation in joint movements, which disappeared following rehabilitation and medical treatment at the end of 15 weeks. Functional and radiographic results were satisfactory.

Adult↗
PubMed2003

Humeral shaft fractures secondary to throwing.

Twenty-seven male military recruits with humeral shaft fractures that occurred during throwing of a hand grenade were analyzed to determine the causes and contributing factors of this fracture in recreational pitchers. Average patient age was 22 years (range: 19-27 years). Objective criteria included type and fracture site on radiographs. Subjective data such as throwing style, previous pitching experience, and prodromal arm pain were obtained. The recruits' throwing style was deemed faulty. Analysis of the fracture configurations indicated an external rotation mechanism.

Adult↗
PubMed2003

[Interlocking intramedullary nailing of humeral shaft fractures in adults].

OBJECTIVES: We evaluated the effectiveness of interlocking intramedullary nailing in the treatment of humeral shaft fractures. METHODS: Forty-three patients (30 men, 13 women; mean age 42 years; range 20 to 83 years) were treated with interlocking intramedullary nailing for humeral shaft fractures. All fractures but one (type II open) were closed. Three patients had radial nerve, one patient had radial and ulnar nerve dysfunction. As all the nerve lesions were assessed as neuropraxia, no immediate surgical exploration was performed. Intramedullary nailing was performed by closed (18 fractures) and open technique (25 fractures), with (n=22) or without (n=21) reaming. Functional evaluation was made according to the Constant-Murley's shoulder scoring system. The mean follow-up was 16.5 months (range 5 to 40 months). RESULTS: Radiologically, union was achieved in all patients in a mean of 15.6 weeks. No surgery-associated nerve injuries or infections were encountered. Preoperative nerve dysfunction resolved in all patients in a mean of 12.5 weeks. No signs of rotator cuff impingement or restriction were detected in two patients in whom the nails were placed high in close proximity to the shoulder girdle. Of these, one patient underwent reoperation for the removal of the nail after the fracture union completed. Functional results were excellent in all patients at the end of postoperative three months. No significant correlation was found between the techniques employed and time to union and functional outcome. CONCLUSION: Interlocking intramedullary nailing provides adequate fixation and early mobilization, and results in satisfactory radiographic and functional results in the treatment of humeral shaft fractures.

Adult↗
PubMed2003

[Short-term results of external fixation of unstable distal radial fractures].

OBJECTIVES: We assessed the effectiveness of external fixation in the treatment of unstable distal radial fractures. METHODS: Twenty-five patients (19 males, 6 females; mean age 39 years; range 20 to 71 years) with unstable distal radius fractures were treated by external fixation. Three patients had open fractures. According to the AO classification, the fractures were B1 (1 fracture), B2 (2), C1 (8), C2 (10), and C3 (4). External fixator was combined with K-wires or volar plates in 17 fractures. The fixator was used for a mean of 6.6 weeks, and the mean follow-up was 13.5 months. The earliest radiologic-anatomic and functional evaluations were based on the findings obtained at the end of six months. A modified Sarmiento scoring system was used for radiologic-anatomic assessment. For functional assessment, the scoring system proposed by Sarmiento et al. was used, which was based on the Gartland and Werley's system. RESULTS: Radiologic measurements indicated that anatomical results were excellent in 16 patients (64%), good in eight patients (32%), and fair in one patient (4%). Functional results were excellent in four patients (16%), good in seven patients (28%), fair in 11 patients (44%), and poor in three patients (12%). The complications encountered were pin tract infections in four patients, breakage of the fixator pin holder in one patient, and the development of reflex sympathetic dystrophy in five patients. CONCLUSION: Our data suggest that high success rates in anatomic results do not closely reflect satisfactory functional results. The protocol to be implemented after the application of the external fixator has to be determined according to the type of the fracture.

Adult↗
PubMed2003

Management of Lisfranc's fracture-dislocation.

Lisfranc's joint injuries are rare and complex. A car driver who sustained a traffic accident, was admitted because of partial dorsolateral fracture-dislocation of the Lisfranc's joint. The diagnosis was made by physical examination and radiographs. Reduction and pin fixation were performed under general anesthesia. At the end of the ninth month, range of motion of the foot and ankle was full, with no pain on daily activities.

Accidents, Traffic↗
PubMed2003

[Treatment of femoral shaft fractures by interlocking intramedullary nailing in adults].

OBJECTIVES: We evaluated the radiological, clinical, and functional results of femoral shaft fractures treated by interlocking intramedullary nailing. METHODS: Interlocking intramedullary nailing was performed in 48 femoral shaft fractures of 46 patients (35 men, 11 women; mean age 30.5 years; range 20 to 69 years). Of the fractures, 31 were in the right femur, 13 were in the left femur, and two were bilateral. There were 44 closed and four open femoral fractures. The results were evaluated according to the Thoresen criteria. Final evaluations included 44 fractures whose follow-ups (mean 26.9 weeks; range 20 to 56 weeks) were completed. RESULTS: The mean time to union was 16.5 weeks (range 12 to 42 weeks). Four patients (9%) had a varus angulation, and one patient (2.3%) a valgus angulation of 5 degrees; one patient had a posterior angulation of 10 degrees, one patient had an internal rotation of 10 degrees, and one patient had both an external rotation and valgus angulation of 10 degrees. Two patients (4.5%) developed a shortening of 2 cm. Knee flexion was 90 degrees and extension loss was 15 degrees in one patient. Knee flexion was 90 degrees in two patients, and 110 degrees in one patient. Chronic osteomyelitis developed in one patient who had a segmental femoral shaft fracture. According to the Thoresen criteria, 88.6% of patients had excellent or good results. CONCLUSION: The high success rate obtained with interlocking intramedullary nailing makes it an appropriate method in the treatment of femoral shaft fractures in adults.

Adult↗
PubMed2003

[Ligament reconstruction for the chronic instability of the traumatic thumb carpometacarpal joint].

OBJECTIVES: We evaluated the results of ligament reconstruction performed for chronic instability of the traumatic thumb carpometacarpal joint. METHODS: Seven male patients with traumatic instability of the thumb carpometacarpal joint underwent ligament reconstruction with the use of the technique described by Eaton and Littler. The mean duration between the traumatic event and the operation was eight months. According to the radiological criteria by Eaton and Littler, five patients had stage I, and two patients had stage II disease. The mean follow-up period was 23 months. The results were assessed according to the criteria by Lane and Eaton. RESULTS: Postoperatively, the patients' grip strength and pinch strength increased by a mean of 40.4% (range 31% to 50%) and 75.4% (range 62% to 100%), respectively. No increases in the extent of arthrosis were observed in the carpometacarpal joint during the follow-up period. None of the patients developed morbidity associated with the functions of the flexor carpi radialis and the wrist. The results were excellent in four, and good in three patients. No complications occurred such as infection or recurrent instability, nor were there any problems related to the skin and Kirschner wires. CONCLUSION: Ligament reconstruction for the carpometacarpal joint of the thumb relieves pain and restores stability while preserving a functional range of motion in patients with chronic instability.

Adult↗
PubMed2003

[Evaluation of biomechanical rigidity of K-wire configurations in transverse osteotomies: a comparison of four-point bending test results].

OBJECTIVES: Four-point bending test was performed in transverse osteotomies of chicken humerus in order to assess biomechanical rigidity of fixation techniques that are commonly used in transverse unstable fractures of the tubular bones of the hand. METHODS: Thirty chicken humeral bones were transversely osteotomized and then randomly assigned to six fixation groups equal in number. Osteotomized bones were fixed with the use of two crossed (2 groups) or intramedullary (2 groups) K-wires; in the remaining two groups, crossed K-wires were used in combination with tension band wiring. The sizes of the crossed and intramedullary K-wires were 0.035-inch and 0.045-inch in paired groups, respectively. Biomechanical rigidity was measured by four-point bending test on an Instron testing machine. RESULTS: The most rigid configuration was obtained with 0.045-inch K-wires, followed by 0.035-inch K-wires used in combination with tension band wiring. These techniques provided significantly increased rigid fixations than those obtained by non-supplemented crossed and intramedullary K-wire fixations. CONCLUSION: In the transverse fractures of the tubular bones of the hand, dorsally applied tension band wiring around two crossed K-wires provides adequate rigidity that allows early active motion in the postoperative period.

Animals↗
PubMed2002

Medial peritalar dislocation.

In this paper, a case of closed medial subtalar dislocation and accompanying talar head fracture in a 22-year-old man which occurred while walking on a downhill road is reported. Closed reduction under general anesthesia was unsuccessful. The obstacle for closed reduction was determined at surgery for open reduction and internal fixation as buttonholing of the talar head through the extensor retinaculum. At the 26-month follow-up, he was pain-free in his daily activities.

Adult↗
PubMed2002

Primary bipolar hemiprosthesis for unstable intertrochanteric fractures.

Between 1997 and 2001 we treated 54 elderly patients with unstable intertrochanteric fractures by primary hemiarthroplasty using a cemented bipolar prosthesis. Mean patient age was 75.6 (64-91) years and mean follow-up was 22.3 (5-48) months. Seven patients died before the fourth post-operative month. Thirty-three patients were able to walk with a walker in the first post-operative week. There were no dislocations or aseptic loosening. One deep infection was encountered after 1 year. Acetabular erosion was seen in one patient and non-union of the greater trochanter was seen in four. Five patients experienced leg-length discrepancy. We obtained 17 excellent and 14 good results after 12 months according to the Harris hip-scoring system. We observed that the inner motion of the bipolar head decreased over time.

Aged↗
PubMedDate not supplied

Proximal oblique crescentic osteotomy in hallux valgus.

Twenty-six patients with moderate-to-severe hallux valgus deformities were evaluated before and after treatment. All of the patients had incongruent great toe joints. The patients underwent modified proximal crescentic osteotomy, which was termed proximal oblique crescentic osteotomy. The results were evaluated at an average follow-up time of 55 weeks. Objective criteria were hallux valgus angle, intermetatarsal angle, shortening of the first metatarsal, and angulation at the osteotomy site. Clinical evaluation was made according to the rating system of the American Orthopaedic Foot and Ankle Society. The mean correction of the hallux valgus and intermetatarsal angles was 22.1 degrees and 9.9 degrees, respectively. Short-term results indicate that proximal oblique crescentic osteotomy is effective in the treatment of hallux valgus; its advantages over other procedures include its technical ease and low rate of complications.

Combined Modality Therapy↗