Search

ÖZETAmaç:Bu çalışmada koksartrozu mevcut olup kompleks asetabulum kırığı nedeniyle erken ve geç kalça artroplastisi yapılan hastaların klinik sonuçlarını karşılaştırmayı ve klinik sonuçları etkileyen faktörleri araştırmayı amaçladık.Yöntem:2005 ve 2017 yılları arasında asetabular kırık nedeniyle ameliyat edilen hastalar geriye dönük olarak incelendi. Letournel Sınıflamasına göre kompleks kırıklar ve Kellgren-Lawrence radyolojik kriterlerine göre artrozu olan hastalar, çalışmaya dahil edildi. Hastalar artroplasti yapılma zamanlarına göre kırık sonrası erken dönem (grup 1) ve geç dönem (grup 2) olmak üzere iki gruba ayrıldı. Her iki grup Harris kalça skoru, Visual Analogue Scale (VAS), yaş, artroz, ameliyat süresi ve günlük hayata dönme süresi açısından karşılaştırıldı.Bulgular:Çalışmaya alınan hastaların 20'sinin erken dönemde, 21'inin ise geç dönemde artroplasti geçirdiği belirlendi. Ortalama Harris skoru erken artroplasti yapılanlarda 71.60 (± 13.5), geç artroplasti yapılanlarda 61.23 (± 2.6) idi (p = 0.002). Ortalama VAS skoru erken artroplasti yapılanlarda 1.7 (1-3), geç artroplasti yapılanlarda 2.6 (1-5) idi (p = 0,102).Sonuç:Erken artroplasti, koksartroz zemininde kompleks asetabular kırığı olan hastalarda geç artroplastiye göre daha iyi fonksiyonel sonuç ve daha düşük komplikasyon oranları ile daha güvenli bir seçenektir. Koksartroz zemininde kompleks asetabular kırığı olan hastalarda, cerrahın erken veya geç artroplasti kararında arada kaldığı durumlarda, erken artroplasti tercih edilmelidir.Anahtar Kelimeler: Asetabular kırık, koksartroz, total kalça replasmanı, Purpose:We aimed to compare the clinical results of patients who underwent early and late hip arthroplasty due to complex acetabulum fracture with coxarthrosis and investigate the factors affecting the clinical results.Method: Patients who were operated on for acetabular fractures between 2005 and 2017 were retrospectively analysed. Patients with complex fractures according to the Letournel Classification and arthrosis according to the Kellgren-Lawrence radiological criteria were included in the study. Patients were divided in to two groups, post-fracture early period (group 1) and late period (group 2), based on when they underwent arthroplasty. Both groups were compared in terms of Harris hip score, Visual Analogue Scale (VAS), age, arthrosis, operation time, and time to return to daily life.Result: It was determined that 20 of the patients included in the study underwent arthroplasty in the early period and 21 in the late period. The mean average Harris score was 71.60 (± 13.5) in those who underwent early arthroplasty and 61.23 (± 2.6) in those who underwent late arthroplasty (p = 0.002). The average VAS score was 1.7 (1–3) in those who underwent early arthroplasty and 2.6 (1–5) in those who underwent late arthroplasty (p= 0.102)Conclusion:Early arthroplasty is a safer option with better functional results and lower complication rates than late arthroplasty in patients with complex acetabular fractures with coxarthrosis. In patients with complex acetabular fractures with coxarthrosis, early arthroplasty should be preferred when the surgeon is not sure about early or late arthroplasty.Keywords: Acetabular fracture, coxarthrosis, total hip replacement.

Objective The aim of this study was to compare clinical and radiological results of three different techniques (plate-screw, tension band, and intramedullary nail) in the fixation of olecranon osteotomy in patients with intercondylar fracture of the distal humerus surgically treated by the olecranon osteotomy approach. Methods Between January 2010 and December 2018, the study was initiated with 52 patients who underwent an olecranon osteotomy approach for an AO Type C distal humerus fracture. Thirty-seven patients (19 male, 18 female) who had regular control data and a final control examination were included in the study. In osteotomy fixation, we used tension band (K wire cerclage + Screw cerclage) in 20 patients, plate-screw in eight patients, and intramedullary nail fixation in nine patients. The functional evaluation included a measurement of the range of joint motion (flexion, extension, supination, pronation); MAYO elbow performance score; disabilities of the arm, shoulder, and hand (DASH) score; and comparative grip strength measurement, and a subjective pain assessment was performed using the visual analogue scale. Results The mean duration of follow-up was 44 (12-84) months. The mean time to union was 14 (7-32) weeks in patients that achieved union. The mean DASH score was 22 (0-72.7), the meanMAYOelbow performance score was 84 (35-100), and the mean VAS score was 3 (1-7). The mean grip strength was 32 (8-64) kgw in the treated extremity and 37 (17-70) kgw in the intact extremity. No statistically significant difference was detected between olecranon osteotomy fixation methods (tension band, plate-screw osteosynthesis, and intramedullary nailing) in terms of union time, DASH score, MAYO scale score, VAS score, extension, supination, and pronation (P > 0.05). The average grip strength (kgw) was lower than that in the uninvolved extremity, and this ratio was statistically significant (P = 0.04). Conclusion The results of this study have shown that successful and comparable radiological and functional outcomes can be obtained by all the three different olecranon osteotomy techniques in the surgical treatment of intercondylar fracture of the distal humerus. Level of evidence Level III, Therapeutic Study.

Objective: This study was intended to show the effects of melatonin (MEL) in the treatment of cartilage damage in a rat model as a novel field of application. Materials and Methods: Male Sprague Dawley rats aged 3-4 months were assigned into four groups of six rats each. Group I represented the sham group. In groups 2, 3, and 4, the right knee medial meniscus was surgically destabilized. MEL was administered to groups 3 and 4 twice a week at dosages of 0.4 μg/ml and 4 μg/ml, respectively. The application continued for four weeks. Histological examinations, imaging studies [computed tomography and magnetic resonance imaging], and biochemical tests [cartilage and bone turnover markers (COMP and CTX-I)] were performed. Results: The application of MEL initiated regeneration in the damaged areas. However, cartilage repair was not observed in areas with experimental cartilage damage without MEL application. MEL-treated rats had higher T2 scores compared to Group 1 in the median femoral condyle at the 12th week (p

Amaç: Bu çalışmamızda kronik subakromiyal impingement sendromlu (KSİS) hastalara operasyon esnasında subakromiyal bursaya yapılan steroidin operasyon sonrası tedaviye etkisini araştırmayı amaçladık. Materyal Metod: Yaş, cinsiyet ve Constant omuz skoru açısından aralarında fark bulunmayan toplam 116 hasta çalışmaya alındı. Operasyon sırasında subakromiyal bursaya steroid enjeksiyonu uygulananlar(N:60) ve uygulanmayanlar(N:56) olarak iki gruba ayrıldı.. Her iki grubun preoperatif ve postoperatif 1, 3 ve 6. ay kontrollerindeki postoperatif Constant skorları ölçüldü ve istatiksel olarak karşılaştırıldı. Bulgular: Steroid yapılan grupta preoperatif Constant omuz skoru ortalama 37.83 (±8.14) iken steroid yapılmayan grupta 39.61 (±8.08) idi (p:0.231). Postoperatif dönemde steroid yapılan grupta ortalama Constant skoru birinci ayda 76.88 (±9.27) iken, steroid yapılmayan grupta 78.26 (±10.52) (p:0.447) idi. Her iki grubun postoperatif dönem üçüncü ve altıncı ayda ki ortalama Constant skorları karşılaştırıldığında istatiksel olarak anlamlı bir fark görülmedi. (Sırasıyla p:0.101, p:0.173). Çıkarımlar: KSİS’li hastalara intraoperatif yapılan steroidin postoperatif dönemde tedaviye herhangi bir katkısı bulunmamaktadır.

Introduction: We aimed to evaluate the relationship between complete blood parameters reported to be associated with inflammation and development of complications, length of hospital stays and the number of antibiotics used in elderly patients undergoing revision total knee arthroplasty (rTKA). Material and Method: Our retrospective study was conducted in a single center and included 72 older patients who underwent rTKA operations. We recorded patients’ firs day preoperative, first day postoperative and 45th day postoperative whole blood parameters. Results: It was found that the development of postoperative infection and the number of antibiotics used were higher in patients with low preoperative Hb values and high platelet-to-lymphocyte ratio (PLR) rates. In patients with high RDW value and high eosinophil-lymphocyte ratio (ELR) one day after surgery, both the development of infection (P=0.002, P=0.002) and the number of antibiotics used during follow-up were found to be significantly higher ​(P

Giriş ve Amaç: Asetabulum kırıkları sık rastlanmayan, kompleks yaralanmalardır. Bu çalışmada posterior yaklaşımlarla opere ettiğimiz asetabulum kırıklı hastaların radyolojik ve fonksiyonel sonuçlarını değerlendirmeyi amaçladık. Yöntem: 2011 ile 2014 yılları arasında asetabulum kırığı nedeniyle opere edilen, en az 1 yıllık takipleri yapılabilmiş olan 36 olgu bu çalışmaya dahil edilmiştir. Retrospektif olarak planlanan çalışmamızda kırık sınflandırması Letournel Judet sistemine göre, radyolojik değerlendirme Matta kriterlerine göre, fonksiyonel skorlar modifiye Merle d’Aubigne Postel sistemine göre yapıldı. Bulgular: Toplam 36 olgunun 25’i sadece posterior yaklaşımla opere edilmişken 11’inde kombine anterior ve posterior yaklaşım uygulanmıştır. Komplikasyon oranları güncel literatürle uyumlu bulunmuştur. Fonksiyonel skorlar değerlendirildiğinde 29 (%80,6) olguda mükemmel ve iyi sonuç, 3 (%8,3) olguda orta, 4 (%11,1) olguda kötü sonuç elde edilmiş, radyolojik sonuçlar değerlendirildiğinde 29 (%80,6) olguda mükemmel ve iyi sonuç, 3 (%8,3) olguda orta, 4 (%11,1) olguda kötü sonuç elde edilmiştir. Sonuç ve Çıkarımlar: Asetabulum kırıkları cerrahisi, teknik olarak zor, komplikasyon oranları yüksek olmasına rağmen deplase asetabulum kırıklarında açık redüksiyon ve internal fiksasyon endike olduğu durumlarda altın standart tedavi yöntemidir. Olgu sayısı kısıtlı olan 36 olguluk serimizde radyolojik ve fonksiyonel sonuçlarımızın güncel literatürle uyumlu olduğunu gördük.

Aim Bleeding diseases are rarely studied as complications of an orthopedic surgical procedure with postsurgical bleeding. This study aims to present a retrospective cohort-study about the approach to bleeding disorders in an ordinary orthopedic clinic. Material and Methods 344 patients were recorded for our study group between November 2017 and September 2019. These patients were monitored for bleeding disorders, both primary or secondary. Results 27 (7.84 %) patients with bleeding diseases [1 (0.29 %) patient with VWD, 1 (0.29 %) patient with hemophilia, 1 (0.29 %) patient with ITP, 15 (4.36 %) patients with drug use, 5 (1.45 %) patients with vascular disorders, 4 (1.16 %) patients with herbal agent use] were detected in all traumatic cases which were admitted to our clinic in this time period . These patients were divided in 6 groups. Patient with VWD was Group 1, patient with hemophilia was Group 2, patient with ITP was Group 3, patients with drug use formed Group 4, patients with vascular disorders – Group 5, patients with herbal agent use – Group 6. Conclusion We advise to have a careful preoperative control for postsurgical bleeding risks according to three criteria: i) patient anamnesis should be studied carefully (diathesis/hemophilia searching), ii) platelet counts must be checked (twice is guaranteed), iii) coagulation tests [activated partial thromboplastin time (aPTT), prothrombin time (PT), thrombin time (TT) and International Normalized Ratio (INR)] must be studied.

Objective In this study we aimed to evaluate the outcomes of anterior and combined approaches for treatment of acetabular fractures. Materials and methods Thirty-seven acetabular fractures in 35 patients treated with an anterior approach were evaluated retrospectively. Fractures were classified according to Judet-Letournel. Early and final radiological evaluation was based on Matta's criteria. Modified Merle d'Aubigne and Postel criteria were used for functional assessment. Results Eleven (30%) fractures were simple type and 26 (70%) were mixed type. Two (18%) of the simple fractures were transverse and 9(82%) were anterior column fractures. Fourteen (54%) of the mixed type fractures were both column fractures, 5 (19%) were transverse+posterior wall, 5 (19%) were T shaped and 2 (8%) were anterior column+posterior hemitransverse fractures. Surgical approach was ilioinguinal in 15 (43%) patients, Stoppa in 9 (26%) and combined11 (31%). Our functional outcomes were perfect in 10 (27%) hips, good in 20 (54%), moderate in 4 (10%) and poor in 3 (8%). Our radiological results were perfect in 15 (40.5%) hips, good in 15 (40.5%), moderate in 4 (11%) and poor in 3 (8%). Conclusion Anterior surgical approaches provide satisfactory outcomes in appropriate fracture types. Posterior approach can be combined in certain fracture types. We think that rate of the requirement for a concomitant posterior approach for certain fractures of the acetabulum will decrease as experience increases.

Objective:Subacromial Impingement syndrome (SIS) is a common cause of shoulder pain due to compression of rotator cuff muscles. We aimed to compare preoperative and postoperative functional and radiological features after arthroscopic decompression in patients with SIS.Materials and Methods:Forty patients (22 male/18 female) with mean age of 49 (21-76) undergone arthroscopic decompression for SIS. The mean follow-up length was 12 months. Before and after the surgery functional and radiological evaluations were performed. Constant shoulder scoring technique was used for evaluating the shoulder functions. The subacromial distance was measured on the sagittal magnetic resonance imaging sections. In addition, preoperative and postoperative Constant shoulder scores of 15 (37.5%) patients with a history of preoperative trauma and 14 (35%) patients with chronic disease were compared separately with the other patients.Results:Neer and Hawkins tests were positive in 39 (97.5%) patients preoperatively and only 2 (5%) patients had positive results postoperatively. The median score of the preoperative subacromial distance was 9.3 (8.6-9.8) while the median score was 10.9 (9.9-11.8) in the postoperative measurements. The preoperative median value of the Constant shoulder score in all the patients was 11.5 (5-21) and the postoperative median value was 80 (61.25-85.5). While 36 (90%) patients had night-time pain preoperatively, no patients had postoperatively. These values were significantly decreased after surgery (p

Background: In delayed Bankart lesion cases, the joint capsule and glenoid labrum are severely retracted in chronic cases with numerous recurrent dislocations, which results in insufficient viable soft tissue for capsular plication. We have proposed that labral repair with Middle Glenohumeral ligament (MGHL) augmentation could be done to reconstruct anterior stability. In this study, we report the clinical outcomes of patients who had undergone arthroscopic MGHL augmented repair for anterior stabilization for chronic anterior dislocations. Methods: The study was designed as a retrospective study. Patients who had undergone arthroscopic MGHL augmented labral repair for recurrent anterior shoulder dislocation. Rowe and CONSTANT scores were used for the functional evaluation of the patients. Arthroscopic MGHL augmented labral repair is performed on each patients.The Kolmogorov–Smirnov test was used to determine whether the data related to variables included in the analysis followed a normal distribution pattern. The paired-Samples t-test was used to evaluate data with a normal distribution Results: The mean pre-operative Rowe score was 11,19(±9,19), and the mean pre-operative CONSTANT score was 41,7 (±8,12) The data for post-operative functional assessment were recorded at the 24th month follow- up. The mean Rowe score was 92,43 (±7,14), and the CONSTANT score was 82,60 (±11,03). There was a significant improvement in CONSTANT and Rowe scores (p

Amaç: Birkaç ultrason (USG) ölçümüyle Gelişimsel Kalça Displazisi (GKD) deformitesi erken dönemde teşhis edilebilmektedir. Bu çalışmanın amacı, Graf ultrason yöntemini kullanarak gözlemcilerarası güvenirliliği değerlendirmekti.Yöntemler: 62 rastgele ve ardışık olarak sağlanan hasta için Graf USG yöntemi ultrasonic ölçümlerde kullanıldı. Her hasta için her iki kalça USG ölçümü yapıldı. Her USG sonucu, çoklu uğraşlarla, ortopedik cerrahi uzmanı, çocuk hastalıkları uzmanı ve 25 yıl tecrübeli radiyoloji uzmanıyla değerlendirildi.İstatistiksel ölçümler SPSS 20.0 (Windows, IL, ABD) ile yapıldı. Sınıf İçi Korelasyon Katsayısı belirlendi. % 95 Güven Aralığı ve Gerçek Değer 0 ile F Testi tespit edildi. 0,05'ten daha düşük p değerleri istatistiksel olarak anlamlı kabul edildi.Bulgular: Graf USG eğitiminden önceki değerlendirmede bulgular belirlendi. Gözlemcilerarası güvenirlilikte, Sınıf İçi Sınıflama Korelasyonları (ICC) değerleri, sağ kalçalar için Graf Yöntemiyle değerlendirmede USG sınıflamasında 0,939 idi. ICC değerleri, sol kalçalar için Graf Yöntemiyle değerlendirmede USG sınıflamasında 0,907 idi.Graf USG sınıflaması eğitiminden sonraki değerlendirmede, bulgular belirlendi. Graf yöntemiyle USG sınıflama değerlendirmesinde sağ kalçalar için ICC değerleri 0,975 idi. Graf yöntemiyle USG sınıflama değerlendirmesinde sol kalçalar için ICC değerleri 0,970 idi. Bütün p değerleri anlamlıydı. Graf USG yöntemi için eğitimden önce ICC değerleri sağ kalçalarda 0.838, sol kalçalarda 0.765 iken, eğitim sonrası sağ kalçalarda 0.928, sol kalçalarda 0.915 idi. Sonuçlar: USG ile GKD deformitesinin tanısı ciddi bir eğitim dönemi gerektiren karmaşık ve zor bir durumdur. Graf USG yöntemi yüksek gözlemcilerarası güvenirliliğe sahip bulundu. Ayrıca Graf USG sınıflamasına yönelik eğitimin, özellikle çocuk doktorları arasında gözlemci içi güvenilirliği arttırdığını tespit ettik., Aim: Developmental dysplasia of the hip is a hip deformity that can be diagnosed early by numerous ultrasonic measurements. The purpose of this study was to evaluate the interobserver reliability of ultrasonic measurements using the Graf Ultrasound (USG) method.Methods: Ultrasonic measurements that were used by Graf Ultrasound (USG) method were obtained at presentation for 62 randomized and consecutive patients. Bilateral hip USG measurements were made for each patient. Each USG outcome was evaluated on multiple occasions by an orthopedic surgery specialist, a pediatric specialist, and a 25-year experienced radiologist.The statistical measurements were made by SPSS 20.0 (Windows, IL, USA). Intraclass Correlation Coefficient was determined. 95% Confidence Interval and F Test with True Value 0 was detected. P values were accepted as statistically significantly less than 0,05.Results: At the evaluation before education for Graf USG classification, the results were established. In the interobserver reliabilities, Intraclass Classification Correlations (ICC) values were 0,939 for USG classification evaluation with Graf Method for right hips. ICC values were 0,907 for USG classification evaluation with Graf Method for left hips. At the evaluation after education for Graf USG classification, the results were established. ICC values were 0,975 for USG classification evaluation with Graf Method for right hips. ICC values were 0,970 for USG classification evaluation with Graf Method for left hips. All p values were significant. While before education for Graf USG classification ICC was 0,838 in right hips, 0,765 in left hips; after education, it was 0,928 in right hips, 0,915 in left hips.Conclusion: Diagnosis of DDH deformity with USG is a complex and difficult condition that needs a serious education period. Graf USG method was found to have high interobserver reliability. And also, we detected that education for Graf USG classification increased intra-observer reliability, especially among pediatrists.

Objectives: The objective of this retrospective study is to provide contribution for management of the poisonous snake bites by comparison results of this study with the literature data. Patients and Methods: This study retrospectively analyzed the demographic and epidemiologic characteristics of 40 patients who presented due to snake bites. 29 patients were included in this study. Patients’ age, sex, month of admission, duration of follow-up in the emergency room, laboratory outcomes, the regions of snake bite, number of the bites, local and systemic symptoms, and treatment received were assessed. Patients aged under 18 years were excluded from the study. Also patients were excluded if the snakes were not seen after the patients were bitten or if they developed no local or systemic symptoms within four hours after the bite. In addition, patients in whom adequate data could not be obtained were also excluded from the study. Results: Out of the 29 patients included in this study, 15 (51.7%) were females. When the patients were examined according to local and systemic findings; local symptoms were observed in 18 patients (62.1%) and systemic symptoms in 11 patients (37.9%). There was a positive correlation between elevated ALP and diffuse edema in the bite area and hypotension findings. When durations of hospitalization were analyzed, the mean duration of hospitalization was 2.3±1.5 days. Conclusion: We believe that, symptomatic and supportive treatment could be sufficient in majority of the patients with snake bites in our region, and a low dose antiserum therapy would be reasonable when antiserum is needed.

To investigate the effects of conservative therapy applied before arthroscopic subacromial decompression on the clinical outcome in patients with stage 2 shoulder impingement syndrome. Materials and methods: Sixty-eight patients having stage 2 shoulder impingement syndrome and treated with arthroscopic subacromial decompression were included in the study. We divided these patients into 2 groups, whereby 32 (47%) patients received conservative therapy before arthroscopic subacromial decompression and 36 (53%) patients did not receive conservative therapy. We compared both groups in terms of the the Constant, UCLA, and VAS scores for shoulder pain before and after arthroscopic subacromial decompression. Results: Constant, UCLA, and VAS scores were statistically significantly improved in both groups after arthroscopic subacromial decompression (P < 0.001). Constant, UCLA, and VAS scores before arthroscopic subacromial decompression were statistically better in Group 1 than in Group 2 (P < 0.001). No statistically significant difference was found between the groups in terms of Constant, UCLA, and VAS scores after arthroscopic subacromial decompression (P > 0.05). Conclusion: Conservative therapy applied in patients with stage 2 shoulder impingement syndrome before arthroscopic subacromial decompression does not have a positive contribution on the clinical outcome after arthroscopic subacromial decompression.

Objective: The aim of this study was to investigate the radiological and clinical outcomes of Pemberton’s pericapsular osteotomy in toddlers and preschool children with developmental hip dysplasia.Methods: Ninety-one hips of 86 patients (81 girls, 5 boys) with developmental hip dysplasia who underwent Pemberton’s pericapsular osteotomy were included in this study. The mean age of the patients was 34 (range: 18 to 96) months. The mean duration of follow-up was 60 (range: 24 to 158) months. All patients underwent open reduction and Pemberton’s pericapsular osteotomy, including 12 hips in which proximal femur osteotomy had been performed earlier. Clinical results were evaluated according to McKay’s clinical evaluation criteria, radiological results according to Sever’s radiological evaluation criteria, and the presence of avascular necrosis according to Kalamchi-MacEwen’s classification criteria.Results: At the final examinations the mean acetabular index was 12.04° (range: 5° to 24°) and the mean Wiberg’s center-edge angle was 35.5° (range: 20° to 52°). Clinically, excellent results were obtained in 81 (89.0%) hips, good results were obtained in 2 (2.2%) hips, and fair results in 8 (8.8%) hips. Radiologically, excellent results were obtained in 79 (86.8%) hips, good results in 7 (7.7%) and fair results in 5 (5.5%) hips. Clinically and radiologically no poor results were noted. Type 1 avascular necrosis was detected in 9 (9.9%) hips, Type 2 in 7 (7.7%) hips, and Type 3 in one (1.1%) hip. There were no cases with Type 4 avascular necrosis.Conclusion: Pemberton’s pericapsular osteotomy is a safe and effective procedure for the surgical treatment of developmental hip dysplasia in toddlers and preschool children., Amaç: Çalışmamızda gelişimsel kalça displazili, yürüme çağındaki çocukların cerrahi tedavisinde perikapsüler Pemberton osteotomisinin klinik ve radyolojik sonuçlarını değerlendirmeyi amaçladık.Çalışma planı: Pemberton perikapsüler osteotomi uygulanan, gelişimsel kalça displazili 86 (81 kız, 5 erkek) hastanın 91 kalçası çalışmaya alındı. Hastaların ortalama yaşı 34 (dağılım: 18-96) ay, ortalama takip süresi 60 (dağılım: 24-158) ay idi. Hastaların tümüne açık redüksiyon ve Pemberton perikapsüler osteotomi uygulanırken, 12 kalçaya femur üst uç osteotomisinin de yapıldığı tespit edildi. Klinik sonuçlar McKay’ın klinik değerlendirme kriterlerine göre, radyolojik sonuçlar Sever’in radyolojik değerlendirme kriterlerine göre ve avasküler nekroz varlığı Kalamchi-MacEwen avasküler nekroz sınıflaması kriterlerine göre değerlendirildi. Bulgular: Son kontrollerde asetabuler indeks ortalama 12.04° (dağılım: 5°-24°), Wiberg’in merkez-kenar açısı ortalama 35.5° (dağılım: 20°-52°) olarak tespit edildi. Klinik olarak 81 (%89.0) kalçada çok iyi, 2 (%2.2) kalçada iyi ve 8 (%8.8) kalçada orta sonuç elde edildi. Radyolojik olarak 79 (%86.8) kalçada çok iyi, 7 (%7.7) kalçada iyi ve 5 (%5.5) kalçada orta sonuç bulundu. Klinik ve radyolojik açıdan kötü sonuçla karşılaşılmadı. Dokuz (%9.9) kalçada Tip 1, 7 (%7.7) kalçada Tip 2 ve bir (%1.1) kalçada Tip 3 avasküler nekroz görüldü. Olgularda Tip 4 avasküler nekroza rastlanmadı. Çıkarımlar: Yürüme çağındaki gelişimsel kalça displazili çocukların cerrahi tedavisinde Pemberton perikapsüler osteotomisi etkin ve güvenli bir yöntemdir.

To study the efficacy of extramembranous transfer of the tibialis posterior (posterior tibial) tendon for the treatment of drop foot deformity in children.This study included 24 patients (11 girls and 13 boys) with drop foot deformity, who underwent tibialis posterior tendon transfer. The mean age was 12.33 years (range: seven to18 years), and the mean follow-up period was 32.54 months (range: 24 - 55 months). Drop foot developed due to different levels of nerve injury associated with trauma or surgical operation in 18 (75 %) patients, and due to meningomyelocele in six (25 %) patients. Tibialis posterior tendon was flipped from the anteromedial aspect of the tibia and transferred to the lateral cuneiform bone. The patients were evaluated via the Stanmore system questionnaire.Evaluating the outcomes by the Stanmore system, poor results in two feet (8.3 %), fair in two feet (8.3 %), good in eight feet (33.3 %), and excellent in 12 (50 %) feet were obtained. All patients were satisfied with the postoperative outcomes. The mean active ankle dorsiflexion was 8.96 degrees (range: zero to 20 degrees).Extramembranous transfer of the tibialis posterior tendon is a quite successful method in retrieving active dorsiflexion of the foot in patients with drop foot deformity. It is a method which eliminates the need for orthosis and enhances the quality of life of patients.

In this study, we aimed to investigate the prevalence of SLAP lesions in patients with chronic impingement syndrome. We also examined the sensitivity of O'Brien's test.The study included 48 patients with a preliminary chronic impingement syndrome diagnosis to whom arthroscopic decompression had been planned. All patients underwent preoperative Neer's, Hawkins' and O'Brien's tests. We performed shoulder arthroscopy on all patients and evaluated chronic impingement syndrome and SLAP lesions. Then, we compared the statistical sensitivities of these tests.The mean age of patients with chronic impingement was 45.8 years (range, 35-69 years). O'brien's test was positive in 34 (70.8%) of the patients, and Neer's test and Hawkins' test were positive in 46 (95.8%) of the patients before shoulder arthroscopy. Shoulder arthroscopy revealed that 44 (91.7%) of 48 patients had subacromial impingement; 32 (66.7%) had SLAP lesions and internal impingement. In chronic impingement syndrome, sensitivity rates were 95.6% for Neer's test and Hawkins' test, whereas in internal impingement syndrome and slap lesions, the sensitivity of O'brien's test was 94.1%. There was no statistical difference between the tests (p0.05).72.72% of the patients with chronic impingement syndrome had concomitant SLAP lesions. We suggest that O'Brien's test should be used with Neer's and Hawkins' tests for diagnosis of this condition.Çalışmamızda kronik impingement sendromlu hastalar da SLAP lezyonu görülme sıklığını ve O’Brien testinin duyarlılığını araştırmayı amaçladık.Artoskopik subakromiyal dekompresyon plan-lanan, kronik impingement sendromu ön tanısı olan 48 hastayı çalışmamıza aldık. Hastaları omuz artroskopisi öncesi Neer, Hawkins ve O’Brien testleri ile değerlendirdik. Daha sonra omuz artroskopisi yaparak, hastaları kronik impingement sendromu, internal impingement sendromu ve SLAP lezyonları açısından değerlendirdik. Bu testlerin duyarlılıklarını istatiksel olarak karşılaştırdık.Yaş ortalaması 45.8 yıl (dağılım 35–69 yıl) olan, omuz artroskopisi öncesi 46 (%95.8) hastada Neer ve Hawkins testleri, 34 (%70.8) hastada O’Brien testi pozitifti. Omuz artroskopisinde 48 hastanın 44’ünde (%91.7) subakromiyal impingement, 32’sinde (%66.7) SLAP lezyonu ve internal impingement görüldü. Kronik impingement sendromunda; Neer ve Hawkins testleri %95.6 oranında duyarlı iken, İnternal impingement sendromu ve slap lezyonlarında O’Brien testi %94.1 oranında duyarlı idi ve testler arasında istatiksel olarak fark görülmedi (p0.05).Kronik impingement sendromlu hastalarda %72.72 oranında SLAP ve internal impingement lezyonu görülmekte, tanıda Neer ve Hawkins testleri ile beraber O’Brien testinin de yapılmasının gerektiğini düşünmekteyiz.

This study investigated the role of acromion morphology in the aetiology of chronic subacromial impingement syndrome. Forty five patients with chronic subacromial impingement syndrome were included in the study. They were distributed into three groups according to their acromion types: six (13.3%) patients had type 1, 24 (533%) patients type 2 and 15 (333%) patients type 3 acromion. Constant scoring was used for clinical evaluation. Arthroscopic subacromial decompression was performed in all patients in the three groups, without performing any acromioplasty that would change the morphology of acromion. We then compared the average Constant scores changes in all three groups after arthroscopic subacromial decompression. The average follow-up was 28.6 months (range: 12-47). The average change in Constant score after arthroscopic subacromial decompression was 5830 in patients with type 1 acromion, 58.21 in those with type 2 and 54.07 in those with type 3. No significant difference was observed between the changes in the average Constant scores of the three groups (p0.005). The scores were significantly improved following arthroscopic subacromial decompression in all three groups (p0.005).In this study, acromion type was not found to have an important role in the aetiology of chronic impingement syndrome; arthroscopic subacromial decompression without simultaneous acromioplasty thus appears as an appropriate treatment.

Odemis, Turkiye’nin en onemli meyve fidani ve sus bitkileri uretim merkezlerinden birisidir. Bu calisma Izmir Ili’nin Odemis Ilcesi’nde sert ve yumusak cekirdekli meyve fidani yetistiriciligi yapilan alanlarda 2008-2011 yillari arasinda yurutulmustur. Calismada bitki paraziti nematod turleri ve bunlar ile bulasik alanlarin belirlenmesi amaclanmistir. Bu amacla Odemis Ilcesi sert ve yumusak cekirdekli meyve fidani yetistiriciligi yapilan alanlarda elma, seftali, kayisi, kiraz, armut, erik, ayva, ceviz, Trabzon hurmasi, badem, nar, zeytin, igde ve turuncgil fidanliklari olmak uzere 16 farkli meyve cesidinden toplam 368 toprak ornegi alinmistir. Alinan toprak orneklerinden uygun yontemler ile nematodlar elde edilmis ve morfolojik ozelliklerine gore teshisleri yapilmistir. Calismada bitki paraziti nematod turleri; Pratylenchus thornei (Sher & Allen), P. penetrans (Cobb), Meloidogyne incognita (Kofoid & White), M. javanica (Treub), Xiphinema sp. (Cobb), Helicotylenchus spp., Rotylenchulus sp. ve Tylenchulus semipenetrans (Cobb) olarak belirlenmistir. En yaygin turler ise sirasi ile Helicotylenchus spp. Pratylenchus spp. ve Meloidogyne spp. olarak belirlenmistir.

OBJECTIVES: A prospective study to determine how commonly chronic subacromial impingement is associated with subcoracoid impingement and to evaluate clinical outcome after arthroscopic subacromial decompression (ASD). METHODS: Subacromial and coracohumeral distances were evaluated in patients with chronic shoulder pain before and after ASD, using magnetic resonance imaging and the University of California at Los Angeles (UCLA) shoulder scale and Constant—Murley shoulder assessment. RESULTS: A total of 40 patients were included in the study; patients were followed up for a mean of 27.3 months. Before ASD, 14 (35%) patients with chronic subacromial impingement also had subcoracoid impingement. In these patients, the mean coracohumeral distance was 7.18 mm (range 5.00 – 11.00 mm). After ASD, no patient had subcoracoid impingement, and the mean coracohumeral distance was significantly longer than pre-ASD, 12.85 mm (range 11.00 – 15.00 mm). The Constant—Murley shoulder assessment and UCLA shoulder scale both showed improvement after ASD. CONCLUSIONS: Chronic subacromial impingement occurred together with subcoracoid impingement in 35% of patients presenting with chronic shoulder pain. Following ASD, the coracohumeral distance increased with remission from pain.