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Amaç: Bu çalışmadaki amacımız üst ekstremite pozisyonun değişimi ve eklem hareketlerinden kaynaklanan sinir hareketinin ölçümünü değerlendirmek.Gereç ve Yöntem: On taze insan kadavrasının üst ekstremiteleri, üst ekstremitenin konumlandırılması ile sinirlerin kayma mesafesi arasındaki ilişkiyi tanımlamak için diseke edildi. Radial, medial ve ulnar sinirlerin her biri için literatürde sinir mobilizasyon – germe terapi (SMG) teknikleri bahsedilmektedir. SMG uygulaması ile omuz, dirsek, el bileği ve parmak hareketine bağlı sinir ekskürsiyonu dirsek seviyesinde değerlendirildi. Başlangıçta ekstremiteler ve baş anatomik pozisyonda konumlandırıldı. Median sinir için ekstremite pozisyonu dirsek ekstansiyonu, önkol supinasyonu, el bileği ve parmak ekstansiyonu idi. Ulnar sinir için üst ekstremite pozisyonu dirsek fleksiyonu, tam önkol pronasyonu ve el bileği ve parmak dorsifleksiyonuydu. Son olarak, dirsek ekstansiyonu, ön kol pronasyonu, el bileği ve parmak palmar fleksiyonu pozisyonunda radial sinirin ekskürsiyonu gözlendi.Bulgular: Ulnar, radyal ve medyan sinir ekskürsiyonu sırasıyla 13.5, 29.75 ve 11.37 mm idi.Sonuç: Bu çalışma, omuz, dirsek, el bileği ve parmak eklemlerinin farklı konumlardaki hareketleriyle, radial, median, ulnar sinirlerin longitudinal; ekskürsiyon hareketi gözlenmiştir. SMG teknikleri ortopedi rehabilitasyonunda sinir dokusunun mobilizasyonuna katkı sağlayabilir., Objective: The purpose of this study was to assess the measurement of nerve gliding, resulting from joint motion and changes of upper extremity position.Methods: The upper extremities of ten fresh human cadavers were dissected to delineate relationship between the positioning of upper extremity and gliding distance of nerves. Nerve mobilization – stretching therapy (SMG) techniques are mentioned in the literature for each of the radial, medial and ulnar nerves. Nerve excursion secondary to motion of shoulder, elbow, wrist, and fingers was evaluated at the elbow via SMG application. Initially extremities and the head were positioned with anatomic position. For the median nerve, extremity position was elbow extension, forearm supination, wrist and finger extension. For the ulnar nerve upper extremity position was elbow flexion, full forearm pronation, and wrist and finger dorsiflexion. Finally, the excursion of the radial nerve was observed with the position of elbow extension, forearm pronation, wrist and finger palmar flexion.Results: The ulnar, radial and median nerves excursion were 13.5, 29.75 and 11.37 mm respectively.Conclusion: In this study, longitudinal excursion movement of radial, median and ulnar nerves was observed with movements of shoulder, elbow, wrist and finger joints in different positions. SMG techniques can contribute to the mobilization of nerve tissue in orthopedic rehabilitation.

Aim: The narrowing of the nail plate or debulking of soft tissues is the mainstay of the different surgical techniques used to treat ingrown toenails. However, neither of these methods is sufficient alone to treat all types of ingrown toenail. The aim of this study was to present a new surgical wedge resection procedure for an ingrown toenail that includes a definitive narrowing of the nail plate, debulking of the lateral fold and attachment of the remaining lateral fold to the nail plate using a novel suturing technique.Material and Methods: Fifty two patients with grade 2-3 ingrown toenails were operated on. Twelve of these cases involved bilateral toes and 11 toes had bilateral lesions; 75 lesions on 64 toes were therefore surgically treated. Recurrence and cosmetic satisfaction were the main outcomes to be assessed. Results: No recurrence was detected in any subject and all patients were satisfied with the cosmetic results. Conclusion: Our new surgical procedure is a very effective alternative treatment for an ingrown toenail which produces excellent cosmetic results.

Objective: The aim of this study was to evaluate the clinical results and re-rupture rate of single row suture anchor repair with mini open surgical technique, in the treatment of full thickness rotator cuff tear. Methods: Patients with full thickness rotator cuff tears were included. Single row suture anchor technic with mini-open approach was used for treatment. The mean follow-up period was 9.8 months. The preoperative and postoperative functional and clinical status of patients was evaluated by UCLA (University of California at Los Angeles) and Constant scoring systems. The re-rupture of the rotator cuff was detected by MRI (Magnetic Resonance Imaging) at the last control. Preoperative and postoperative datas were compared to each other. Results: Twenty-three patients, (13 male, 10 female) were included. The mean age was 52 years (range 18 to 68 years). At the pre-operative evaluation, the mean results of UCLA score was 11.7, the Constant scores was 26.83 whereas the postoperative scores were found as 29.91, 82.04, respectively. The increases in these scores at the postoperative period were statistically significant (p, Amaç: Tam kat Rotator manşet yırtığı (RMY) tamirinde mini-açık yaklaşımla tek sıra anchor tekniğinin klinik sonuçlarını ve yeniden yırtık oranını değerlendirmeyi amaçladık Yöntemler: Tam kat RMY lezyonu tanılı hastalar çalışmaya dâhil edildi. Mini açık yaklaşımla tek sıra anchor tekniği ile tamir yapıldı. Hastaların ortalama takip süresi 9,8 ay idi Hastaların ameliyat öncesi ve sonrası fonksiyonel ve klinik durumları UCLA (University of California at Los Angeles) ve Constant skorlaması ile değerlendirildi. Hastaların son kontrollerinde yeniden yırtık olup olmadığı MRG (Magnetik rezonans görüntüleme) ile değerlendirildi Bulgular: Yirmi üç hasta (13 erkek, 10 kadın) çalışmaya dahil edildi. Ortalama yaş 52 (18-68 yaş) idi. Ameliyat öncesi ortalama UCLA skoru 11.7, Constant skoru 26.83 olarak bulundu. Ameliyat sonrasında ise sırasıyla 29.91, 82.04 yükseldiği görüldü. Her iki skorlamadaki artış istatistiksel olarak anlamlı idi (p

The side-to-side (SS) tenorrhaphy technique has been used in tendon transfer surgery. The mechanical properties of SS tendon suture have been studied previously. However, the histo-pathological healing of the SS tenorrhaphy of the tendons is unknown. The aim of this study was to assess the gross and histological effects of SS tenorrhaphy in a rabbit model.Twenty New Zealand rabbits were used. The extensor hallucis longus and tibialis anterior tendon were sewed SS at the level distal to the ankle joint. The patellar tendon (PT) at the same side was used as control group. A unilateral midline incision was made and repaired with a single suture. The animals were killed at the 12th week postoperatively. The histological sections were obtained from the side of surgery from each group. Each sample was stained with hematoxylene and eosin (HE). Gross and microscopic healing was compared between the two groups.Gross examination of the control group showed complete healing with a thin peri-tendinous sheath formation around the suture site, whereas in the study group, a thick peri-tendinous sheath was formed around the area of the tendon-tendon anastomosis. In the control group, at the 12th week after surgery, the healing was almost completed in all samples. In the study group, a thick fibro vascular sheath has formed around the side of anastomosis. In all specimens few inter-digitations were observed between the tendons;however, the trough was still present.The result of the current study showed that histological healing and union of SS tenorrhaphy differ from that in primary tendon injury and healing. Further studies are required to clarify the healing stages at the tenorrhaphy site.

Objective: The second most common pediatric age fracture after the forearm fractures is distal humeral fractures. The aim of the current study is to retrospectively evaluate the results of the surgical treatment of pediatric supracondylar fractures in our clinic and compare it to the literature. Methods: During the period between 2006-2011 54 patients having supracondylar humeral fractures who were surgically treated with open reduction and crossed medial and lateral K wire fixation through posterior approach in our institution included in the study. The sex, etiology and type of the fracture, accompanying injuries, postoperative complications, radiologic parameters, cosmetic and functional results were evaluated. Results: 38 (70,4%) male and 16 (29,6%) female patients were evaluated with a mean age of 5.51 (range;1–11) years. The mean length of hospital stay was 2,29 days. The average follow up was 140 weeks. There was no iatrogenic vascular and nerve injuries. Pin tract infection and heterotopic ossification were observed only in one patient respectively. The functional results were excellent in 90,7%, good in 9,3% and cosmetic results were 90,7 excellent, 5,6% good, 1,9% satisfied, 1,9% bad according to the Flynn criteria. Conclusion: When taking into consideration the duration of hospital stay, the rate of neurovascular complication, the functional and cosmetic results it seems that treating the supracondylar humeral fractures using the posterior approach with crossed medial and lateral K-wire is a safe and effective method., Amaç: Çocuklarda humerus alt uç kırıkları, ön kol kırıklarından sonra ikinci en sık görülen kırıklardır. Bu çalışmanın amacı, kliniğimizde cerrahi olarak tedavi edilen çocuk suprakondiler humerus kırıklarında uygulanan tedavi yöntemimizi değerlendirmek ve literatürle karşılaştırmaktır.Yöntemler: 2006 ve 2011 yılları arasında kliniğimizde tedavi edilen 54 suprakondiler kırıklı hasta değerlendirmeye alındı. Çalışmada hastaların demografik verileri, kırığın oluş nedenleri, kırık tipleri, eşlik eden yaralanmalar, postoperatif komplikasyonlar, radyolojik parametreler, kozmetik ve fonksiyonel sonuçlar değerlendirildi.Bulgular: 38 erkek (%70,4) ve 16 kız hasta çalışmaya dahil edildi. Ortalama yaş 5,51 olarak bulundu. Hastanede ortalama yatış süresinin 2,29 gün yine ortalama takip süresinin ise 140 hafta olduğu görüldü. İyatrojenik damar ve sinir yaralanmasına rastlanmadı. Bir hastada çivi dibi enfeksiyonu diğer bir hastada ise heterotopik ossifikasyon saptandı. Flynn kriterlerine göre fonksiyonel sonuçlar %90, 7 mükemmel, %9,3 iyi; kozmetik sonuçlar ise %90, 7 mükemmel, %5,6 iyi, %1,9 orta, %1,9 kötü olarak bulundu. Sonuç: Çocuklarda suprakondiler humerus kırıklarında hastanede yatış süresi, nörovasküler komplikasyonlar, fonksiyonel ve kozmetik sonuçlar göz önüne alındığında posterior yaklaşım ile medial ve lateralden çapraz K-teli ile tespitin güvenli ve etkin bir yöntem olduğu görüldü

Amaç: Akromioklaviküler eklem çıkıkları daha çok genç atletlerde sık görülen bir yaralanmadır. Bu çalışmanın amacı endobutton sistemi ile tespit edilmiş akut akromioklaviküler eklem çıkıklarının postoperatif fonksiyonel sonuçlarını değerlendirmektir. Yöntemler: Bu tespit yöntemi 10 hastaya uygulandı. Rockwood sınıflamasına göre yedi has-tada tip V, üç hastada tip III çıkık vardı. Korakoklaviküler aralık ve akromioklaviküler eklem iki endobutton kullanılarak redükte edildi. Bir endobutton klavikulanın üzerine ikincisi korakoid çı- kıntının altına yerleştirildi. Sonuçlar Constant omuz skoru ve vizüel analog skala ile değerlendirildi. Bulgular: Tüm hastaların intraoperatif olarak fiksasyonunun sağlam olduğu görüldü. Ameliyattan hemen sonra, 6. haftada ve 1 yıl sonra çekilen grafilerde, korakoklaviküler aralık ve akromioklaviküler eklemin yeterli derecede redükte olduğu tespit edildi. Ortalama Constant omuz skoru ameliyatlı omuzda 89 (88-92), sağlam omuzda ise 90 (88-93) olarak bulundu. Constant omuz skoru ile değerlendirildiğinde akromioklaviküler çıkık olan taraf ile normal taraf arasında anlamlı istatiksel fark bulunamadı ve herhangi bir komplikasyonla karşılaşılmadı. Sonuçlar: Bu metod akromioklaviküler eklemin tespiti için güvenli ve etkin bir yöntemdir., Objective: Acromioclavicular (AC) joint dislocation is a common injury frequently affecting young athletes. The aim of this study is to evaluate postoperative functional results in cases diagnosed with acute AC joint dislocation stabilized with endobutton system. Methods: This fixation procedure has been applied on 10 patients. Indications of the technique included: a grade V AC joint dislocation (7 patients), and grade III AC joint dislocation (3 patient) according to Rockwood classification. The coracoclavicular (CC) interval and AC joint were reduced using two endobuttons. One endobutton was fitted on the clavicle and the second was placed at the undersurface of the coracoid. Outcomes were assessed with the Constant shoulder score and visual analog pain scale. Results: All the patients had powerful intraoperative fixation. Immediately after surgery, and 6 weeks, and 1 year postoperative radiographs showed adequate reduction of the CC distance and the AC joint. The mean Constant shoulder score was 89 (88–92) in the injured shoulder and 90 (88–93) in the uninjured shoulder. There was no statically significant difference between the injured and normal shoulder in terms of Constant shoulder score and there was no complication during the process. Conclusion: This technique is a safe and effective method for providing fixation for the AC joint.

Scapular winging is a relatively rare disorder than the othershoulder diseases. Scapulothoracic fixation has beenshown to be effective in relieving pain, improving cosmetics,and restoring function. The most common cause isparalysis of the serratus anterior muscle. Paralysis ofthe serratus anterior muscle may result from a variety ofcauses. Sixteen year old male patient developed wingingof the scapula after long thoracic nerve injury (serratus anteriormuscle paralysis) following a blunt trauma. Scapulothoracicfixation was considered in order to relieve thepatient’s complaints. Stabilization of the scapulothoracicjoint was performed using an undescribed method withthe use of a endobutton system (Smith &Nephew). Aftera six-month follow up the patient’s complaint of pain disappeared,shoulder imbalance was restored with an improvementin shoulder abduction and in flexion.Key words: Scapular winging, long thoracic nerve injury,scapulothoracic fixation

Aim: The narrowing of the nail plate ordebulking of soft tissues is the mainstay of the different surgical techniquesused to treat ingrown toenails. However, neither of these methods is sufficientalone to treat all types of ingrown toenail. The aim of this study was topresent a new surgical wedge resection procedure for an ingrown toenail thatincludes a definitive narrowing of the nail plate, debulking of the lateralfold and attachment of the remaining lateral fold to the nail plate using anovel suturing technique.Material and Methods: Fifty twopatients with grade 2-3 ingrown toenails were operated on. Twelve of thesecases involved bilateral toes and 11 toes had bilateral lesions; 75 lesions on64 toes were therefore surgically treated. Recurrence and cosmetic satisfactionwere the main outcomes to be assessed. Results: No recurrence was detected in anysubject and all patients were satisfied with the cosmetic results.Conclusion: Our new surgical procedure is a very effectivealternative treatment for an ingrown toenail which produces excellent cosmeticresults., Amaç: Tırnak batmalarında tırnak yatağınındaraltılması ve yumuşak dokudaki şişliklerin giderilmesi birçok cerrahimüdahalenin ortak noktasıdır. Ancak bu cerrahi tekniklerin hiçbiri tek başınacerrahi tedavide yeterli olmamaktadır. Bu çalışmada amaç kama şeklinde etrafyumuşak dokuda eksizyon yapılarak tırnak yatağının daraltılması ve kalanyumuşak dokuların ise yeni geliştirilen bir sütür tekniği ile yeniden tırnakyatağı oluşturulmasını sağlamaktır. Gereç ve Yöntem: Çalışmamızasınıf 2-3 tırnak batması olan 52 hasta dahil edildi. Bu olguların 12’sinde heriki ayakta ve 11’inde ise aynı ayakta tırnağın her iki tarafındatırnak batmasımevcuttu. Toplam 64 ayaktaki 75 lezyon cerrahi olarak tedavi edildi. Nüks vekozmetik memnuniyet açısında sonuçlar değerlendirildi.Bulgular: Hiçbir hastada nüks görülmedi ve tümhastalar kozmetik sonuçlardan memnundu Sonuç: Yeni geliştirilen bu cerrahi tekniğintırnak batması tedavisinde çok etkili, mükemmel kozmetik sonuçlar doğuranalternatif bir yöntem olduğunu düşünmekteyiz.

DOI: 10.4328/JCAM.912 Received: 02.02.2012 Accepted: 20.02.2012 Printed: 01.03.2015 J Clin Anal Med 2015;6(2): 230-2 Corresponding Author: Yunus Imren, Bezmialem Vakif University, Faculty of Medicine, Orthopaedics & Traumatology Department, Vatan Cad. Fatih, 34093, Istanbul, Turkey. E-Mail: yunusimren@yahoo.com Ozet Kronik osteomyelit cocuklarda cok nadir gorulen bir durumdur. Herediter duyusal ve otonomik noropati tiplerinden biri olan anhidrozla birliktelik gosteren dogumsal agri duyarsizligi da sinir sisteminin otozomal resesif gecisli cok nadir bir hastaligidir. Agri duyarsizligi, anhidroza bagli ates, tekrarlayan kiriklar, kronik osteomyelit, mental retardasyon, kendine zarar verme egilimi, yara ulserleri gorulebilir. Bu sunumda agri duyarsizligi, sag uyluk alt ucunda kronik osteomyelit, bilateral korneal opasite ve mental geriligi olan 10 yasinda bir erkek cocugunu takdim etmekteyiz.

Objectives: Ingrown toenail is a frequent problem which can be seen in all ages. There are many treatment methods both surgical and nonsurgical. In this study we evaluated the results of wedge resection of ingrown toe nail. Patients and Methods: A total of 80 toenails of 74 patients (55 female, 19 male) who complaint with discharge and deformity of their toenail underwent partial wedge resection of the nail and nail matrix. According to the Heifetz\'s staging system, 34 toenails were grade II, 46 toenails were grade III. There was active drainage due to an infectious process in all effected toe nails. All patients were operated after 10 day of oral antibiotic treatment. We evaluated the recurrence, postoperative infection, patient satisfaction and time to return to work. Results: The mean follow up period was 8 months (4-12 months). There was no recurrence in any patient. Two patients came with wound drainage in postoperative 14th day. Intravenous antibiotic treatment, debridement and wound dressing with rifampicine every other day were accomplished. All patients expressed their satisfaction with surgery. Conclusion: In treatment of ingrown toenail; wedge resection of nail, nail matrix and nail bed is a very effective treatment. Recurrence rate following this technique is negligible if it is done properly and it has high patient satisfaction.

Objectives: The aim of this study is to compare the clinical outcomes of the femoral head osteonecrosis treatead with core decompression (CD) combined with a suction drain into the core tract versus simple CD. Materials and Methods: Thirtynine osteonecrotic hips in 25 patients were divided into 2 groups. Patients in group 1 (19 hips) were treated with CD, and those in group 2 (20 hips) received suction drain into the core tract after CD. Outcome between the 2 groups were compared clinically. Clinical assessments included assessment Harris hip score (HHS). Difference in HHS between the two groups were calculated using the Mann-Whitney U test. Results: At the end 6 months, patients compared with HHS. No significant differences were found between the two groups, but there was significant statical difference within the groups. Conclusions: Treatment of the early stage of osteonecrosis of the femoral head with CD improved the HHS but combined with the a suction drain into the core tract after CD seems to be not better than simple CD, Amaç: Bu çalışmanın amacı sadece kordekompresyon yapılan hastalar ile kordekompresyondan sonra, açılan tünelevakumlu dren konulan hastalarınsonuçlarını karşılaştırmaktır.Yöntem ve Gereç: 25 hastanın 39 kalçasıiki eşit gruba bölündü. Birinci gruba(n=19) sadece kor dekompresyon, ikincigruba (n=20) ise kor dekompresyondansonra açılan tünele vakumlu dren konuldu.İki gup arasındaki fark klinik olarakkarşılaştırıldı. Klinik olarak Harris kalçaskorlaması kullanıldı. İki grubukarşılaştırmak için Mann-Whitney U testiuygulandı.Bulgular: Altıncı ayda, Harris kalçaskorlaması ile hastalar karşılaştırıldığındaiki grup arasında anlamlı fark bulunamadı.Fakat gruplar kendi içindekarşılaştırıldığında kor dekompresyonunsonuçları önemli ölçüde iyileştirdiğigözlenmiştir.Sonuç: Erken evre osteonekrozuntedavisinde kor dekompresyon Harris kalçaskorunu önemli ölçüde iyileştirmiştir fakatkor dekompresyon ile açılan tünelevakumlu dren konulmasının, sonuç üzerineherhangi bir etkisi olmadığı gözlenmiştir.Anahtar kelimeler; Femur başıosteonekrozu; Kor dekompresyon; Kalça

ÖZET: Elastofibroma dorsi, fibröz dokudankaynaklanan nadir bir benign yumuşak dokutümörüdür. Tümör genellikle skapulanın altköşesinde toraks duvarının periostuna yapışıkhalde bulunur. Hastaların % 50 sinde klinikyakınmaya yol açmayabilir. Tümör genel olarakşişlik, sırt ve omuz ağrısı, sırtta atlama sesi gibiyakınmalara yol acar. Lezyonun genellikle 55 yaşınüzerinde ve kadınlarda daha sık görülür, ayrıcaolguların %90 ında tek taraflı tutulum vardır.Elastofibroma dorsinin tanısında en önemliradyolojik değerlendirme yöntemi MRI’dır.Elastofibroma dorside tedavi kitlenin total olarakçıkarılmasıdırAnahtar Kelimeler: Skapula, benign yumuşakdoku tümörü, elastofibromadorsi, Elastofibroma dorsi is a rare benign tumor which arises from fibrous tissue. Usually it is located under the bottom corner of scapula and attached to the periost of thorax wall. It may not lead to clinical complain in 50% of patients. Most of the time it is presented with swelling, back pain, shoulder pain and sound of sliding on back. The lesion is usually more common in women over the age of 55, as well as single-sided involvement is present in 90% of cases. MRI is the most important radiological evaluation method in the diagnosis of elastofibroma dorsi. Treatment of elastofibroma dorsi is total removal of the mass

Aim: This study aimed to compare the training programs, the infra-structure and social resources of the postgraduate training orthopedic residences in the newly established medical faculties or teaching institutes to that of the older faculties. Materyal and method: A new application form was used in this study to evaluate and determine the problem facing the residents regarding their teachers, teaching program, problems and social resources in orthopedic training programs in the newly established medical faculties or teaching institutes the residents. The form was converted into electronically applicable form and send to participants.Up to the data that obtained from TOTBID, assuming that 951 orthopedics assistants were present and α = 0,05,the sample size must have been at least 196 with 95% confidence bounds. The institutes were classified into older (established before 1980), medium and new (established after 2001). Findings:Up to the information obtained from TOTBID the datas of August 2010 revealed that 20.75% of 122 orthopedics and travmatology assistants whom gave education after graduation responsed. postgraduate teaching is not satisfactory in the newly established institutes. Results: The accreditation of the postgraduate training institutes is a most. All institutes most apply the training programs approved by Turkish orthopedic and trauma teaching institute (TOTEK). Electronic residents evaluation report, visiting institutes, central exam, regular feedback from doctors who completed the orthopedic training , teaching certificates and recertification are among the important goals to be achieved by these institutes, Amaç: Biz bu çalışmada yeni kurulmuş tıpfakülteleri ve eğitim kurumları ile daha eski veoturmuş deneyimli kadroların bulunduğu eğitimkurumlarının asistan eğitimi, alt yapı ve sosyalimkânlar açısından görüşlerini almayı amaçladık.Gereç ve yöntemler: Yeni kurulmuş tıpfakültelerinde ve eğitim kurumlarında uzmanlıköğrenciliğine başlayan asistanların karşılaştıklarıeğitimleri, eğiticileri ile ilgili sorunları, sıkıntılarıve sosyal koşulları hakkında düşüncelerinibelirlemek üzere bir anket formu oluşturuldu. Formelektronik ortamda cevaplanabilir hale getirilerekgönderildi. 2010 tarihinde TOTBİD’ ten elde edilen951 ortopedi asistanı mevcut olduğuvarsayıldığında α = 0,05 alındığında % 95 güvenaralığında örneklem büyülüğünün en az 196 olmasıgerekliydi. Gelen cevaplar asistanların çalıştığıeğitim kurumlarının eski (kuruluş tarihi 1980öncesine ait olup gelişmiş eğitim kurumu olarakkabul edilenler), orta, (kuruluş tarihleri 1981 – 2000yılları arasında olanlar) ve yeni kurulmuş (2001 vesonrası) olmasına göre değerlendirildi.Bulgular: TOTBİD den elde edilen bilgilere göreTürkiye’de ağustos 2010 verilerine göre Mezuniyetsonrası eğitimi (MSE) 122 ortopedi ve travmatolojianabilim dalında uzmanlık eğitimi yapanasistanların % 20.75 geri dönüş elde edildi.Asistanların tümü, alt yapısı tamamlanmamışkurumlarda uzmanlık eğitiminin başlatılmasınınülkemizin içinde bulunduğu koşullar çerçevesindekabul edilebilir bir durum olmadığınısöylemişlerdir.Sonuç: MSE eğitimi için kurumların akrediteedilmesi zorunluluğu, TOTEK tarafından belirlenenmüfredata uyulması, elektronik asistan karnesi,merkezi sınav, kurum ziyaretleri, uzmanlığını alanhekimlerin geri bildirimi, eğitici sertifikası veresertifikasyon eğitim konusunun en önemlibaşlıkları olarak karşımızda durmaktadır.Anahtar Kelimeler: Yeni kurulmuş tıp fakülteleri,eğitim kurumları, asistan olmak

Purpose: The aim of this study was to test a simple technique to augment the pullout resistance of an anchor in an over-drilled sheep humerus model. Methods: Sixty-four paired sheep humeri were harvested from 32 male sheep aged 18 months. Specimens were divided into an augmented group and non-augmented group. FASTIN RC 5-mm titanium screw anchors (DePuy Mitek, Raynham, MA) double loaded with suture material (braided polyester, nonabsorbable USP No. 2) were used in both groups. Osteoporosis was simulated by over-drilling with a 4.5-mm drill. Augmentation was performed by fixing 1 of the sutures 1.5 cm inferior to the anchor insertion site with a washer screw. This was followed by a pull-to-failure test at 50 mm/min. The ultimate load (the highest value of strength before anchor pullout) was recorded. A paired t test was used to compare the biomechanical properties of the augmented and non-augmented groups. Results: In all specimens the failure mode was pullout of the anchor. The ultimate failure loads were statistically significantly higher in the augmented group (P < .0001). The mean pullout strength was 121.1 +/- 10.17 N in the non-augmented group and 176.1 +/- 10.34 N in the augmented group. Conclusions: The described augmentation technique, which is achieved by inferior-lateral fixation of 1 of the sutures of the double-loaded anchor to a fully threaded 6.5-mm cancellous screw with a washer, significantly increases the ultimate failure loads in the over-drilled sheep humerus model. Clinical Relevance: Our technique is simple, safe, and inexpensive. It can be easily used in all osteoporotic patients and will contribute to the reduction of anchor failure. This technique might be difficult to apply arthroscopically. Cannulated smaller screws would probably be more practical for arthroscopic use. Further clinical studies are needed.

Despite the screening programs for newborn children with hip ultrasonography, neglected developmental dysplasia of the hip (DDH) is still continuing to be a problem in the east and southeast parts of our country. The main complications are redislocation, avascular necrosis, and joint stiffness. We present an unusual complication, femoral neck fracture during passive motion under general anesthesia, of a six-year-old girl with neglected DDH treated by open reduction and Pemberton osteotomy without femoral shortening. The fracture was treated by open reduction and internal fixation combined with proximal femoral shortening. After 5 years the patient had excellent clinical results, no avascular necrosis was seen, and the radiologic appearance was type IA according to modified Severin classification. In conclusion older children with neglected DDH are more likely to have joint stiffness after open reduction. If there is even a little doubt about joint stiffness after open reduction, one should not refrain from femoral shortening. Also passive motion under general anesthesia should be applied very carefully with fluoroscopic control.

Amaç: Bu çalışmada, lateral epikondilitin (LE) tedavisinde topikal gliseril trinitrat (GTN) formunda nitrik oksit (NO) uygulaması ile tedavi edilen hastaların tedavi sonuçlarının değerlendirilmesi amaçlanmıştır. Çalışma planı: Lateral epikondiliti olan 40 hasta rastgele 2 eşit gruba bölündü. Seçim kriterleri ağrı, hassasiyet ve ağrı uyarıcı manevraların pozitifliği olarak kabul edildi. Teadvi grubunda GTN yamaları, kontrol grubunda ise plasebo yamalar günde bir kez olmak üzere en çok hassasiyet olan bölgeye uygulandı. Hastaların görsel analog skala (GAS) ile ağrının ne derece giderildiği bazında değerlendirildi ve sonuçlar Verhaar ve ark.’nın kriterlerine göre sınıflandırıldı. Mükemmel ve iyi sonuçlar başarılı tedavi olarak kabul edildi. Gruplar arası GAS skorundaki farklılık Mann-Whitney U-testi ile hesaplandı. Kategorik değişkenlerin dağılımları (cinsiyet, etkilenen taraf) ve gruplar arası iyi ve mükemmel sonuçların karşılaştırılması için ki-kare testi kullanıldı. Bulgular: Tedavi başlangıcında, iki grup arasında klinik parametreler açısından istatistiksel olarak anlamlı bir fark yoktu. Hastaların 3. hafta sonundaki GAS değerlendirmesinde iki grup arasında istatiksel olarak anlamlı ölçüde fark bulundu (kontrol ve tedavi gruplarının ortalama GAS skorları, sırasıyla, 6.45 ve 3.15 idi) (p=0.001). Gliseril trinitrat uygulanan hastalar ve kontrol grubundaki hastalarda 3. hafta sonunda anlamlı derecede düşük GAS skoru (GTN grubunda GAS skoru başlangıç değeri 8.05’ten 3.15’e, kontrol grubunda ise başlangıç değeri 8.80’den 6.45’e gerilemişti) ve azalmış dirsek ağrısı saptandı. Kontrol grubunda hiç mükemmel ve iyi sonuç olmamasına rağmen, tedavi grubunda 18 hastada (%90) başarı kaydedildi. Altıncı ay sonunda grupların GAS skorları arasında istatistiksel olarak anlamlı ölçüde fark belirlendi (kontrol ve tedavi gruplarının ortalama GAS skorları, sırasıyla, 4.85 ve 0.70 idi) (p=0.001). Çıkarımlar: Gliseril trinitrat yaması kullanılarak tendinopatili bölge üzerine uygulanan NO, kronik LE’deki ağrı ve diğer semptomları azaltmaktadır., Objective: The aim of this study was to evaluate the treatment results of the application of nitric oxide (NO) in the form of topical glyceryl trinitrate (GTN) for the treatment of lateral epicondylitis (LE). Methods: The study included 40 patients with LE randomized into 2 equal groups. Selection criteria included the presence of pain, tenderness, and positive pain stimulating maneuvers. Glyceryl trinitrate patches were applied to the area of maximal tenderness once a day in the treatment group and placebo patches in the control group. Outcomes in terms of pain relief was assessed using the visual analog scale (VAS) and were evaluated according to the criteria of Verhaar et al. Excellent or good results were considered successful. Differences in VAS scores between the two groups were calculated using the Mann-Whitney U-test and the chi-square test was used to investigate distributions of categorical variables (sex, affected side) and good and excellent results among groups. Results: There were no significant differences in any of the baseline clinical parameters between groups. At the 3rd week follow-up, there were statistically significant differences in the pain measured using VAS between groups (mean VAS score of the control and treatment groups were 6.45 and 3.15, respectively) (p=0.001). Patients in the GTN group and control group had lower VAS pain scores and reduced elbow pain at 3 weeks (3.15 vs 8.05 in the GTN and 6.45 vs 8.80 in the control group). In the control group, no patient had excellent or good results while 18 (90%) patients in treatment group reported successful treatment. There was statistically significant difference in the VAS measured at 6 months between groups (mean VAS score of the control and treatment groups were 4.85 and 0.70, respectively) (p=0.001). Conclusion: The administration of NO directly over an area of tendinopathy through a GTN patch reduces pain and other symptoms in chronic LE.

Objective: The aim of this study was to ascertain the effect of gender and cultural habits on hip, knee and ankle range of motion (ROM) and to determine the differences between the ROM of right and left side symmetric joints of the lower extremities.Methods: The study included 987 (513 males and 474 females) healthy volunteers. Individuals with a history of illness, prior surgery or trauma involving any joint of either lower extremity wereexcluded from the study. The terminology and techniques of measurements used were those suggested by the American Academy of Orthopedic Surgeons.Results: Left side passive hip flexion and active internal rotation was higher than the right side. Passive flexion of the hip joint was higher in male subjects and internal and external rotation was higher in female subjects. In the knee joint, passive extension was higher in males. Plantarflexion and inversion of the ankle joint were higher in male subjects and dorsiflexion and eversion were higher in female subjects. The differences were considered insignificant in clinical terms as all were less than 3 degrees.Conclusion: There is no clinically significantly difference between right and left side hip, knee and ankle joints ROM. Gender and cultural habits do not appear to have clinically significantly effects on lower extremity joint ROM., Amaç: Bu çalışmanın amacı, cinsiyetin ve kültürel alışkanlıkların kalça, diz ve ayak bileği eklem hareket açıklığına (EHA) olan etkisini ve alt ekstremitenin sağ ve sol taraf simetrik eklemlerinin EHA’ları arasında fark olup olmadığını belirlemekti.Çalışma planı: Çalışmaya 987 (513 erkek ve 474 kadın) gönüllü alındı. Alt ekstremite eklemlerinden herhangi birisiyle ilgili hastalık öyküsü bulunan, ameliyat veya travma geçirmiş olanlar çalışmaya dahil edilmedi. Terminoloji ve ölçüm tekniklerinde Amerikan Ortopedik Cerrahlar Akademisi’nin yönergeleri temel alındı.Bulgular: Sol taraf kalça pasif fleksiyonu ve aktif iç rotasyonu sağ tarafa göre daha yüksek olarak ölçüldü. Kalça ekleminde; pasif fleksiyon erkeklerde daha yüksek olduğu halde, iç ve dış rotasyon kadınlarda daha yüksekti. Dizde; pasif ekstansiyon erkeklerde daha yüksekti. Ayak bileğinde; plantarfleksiyon ve inversiyon erkeklerde daha fazla iken, dorsifleksiyon ve eversiyonun kadınlarda daha fazla olduğu görüldü. Ölçülen farklılıkların hiçbiri üç dereceden fazla olmadığı için klinik olarak anlamlı değildi.Çıkarımlar: Kalça diz ve ayak bileği EHA’larında sağ ve sol taraf arasında klinik olarak anlamlı bir fark olmadığı, cinsiyet ve kültürel alışkanlıkların alt ekstremite eklemlerindeki EHA’yı klinik olarak anlamlı bir şekilde etkilemediği saptandı.

Synovial fibrosis is one of the main outcomes of osteoarthritis. Some authors have reported that urotensin-II (U-II) may cause pathologic fibrosis in cardiovascular system, lung and liver. However there are no previous reports available in the literature about its relationship with the synovial fibrosis in osteoarthritis. The aim of this study was to compare the U-II levels in knee synovial fluids obtained from osteoarthritic and non-osteoarthritic patients. Two groups were created, the osteoarthritis group and non-osteoarthritic control group. The control group was consisted of patients who underwent arthroscopic surgery for other reasons than cartilage disorders. In the osteoarthritis group all patients had grade 4 primer degenerative osteoarthritis and were treated with total knee arthroplasty. Minimum 1 mL knee synovial fluids were obtained during operation. Levels of U-II were measured by using ELISA kit U-II levels were significantly higher in the osteoarthritic group than that in the control group. No correlation was found between U-II levels and age. In conclusion, the significantly high U-II levels in the knee synovial fluid of osteoarthritic patients supported our hypothesis that “U-II may be associated with the synovial fibrosis in osteoarthritis”.

BACKGROUND: In the present study, it was aimed to assess the demographics, clinical features, and treatment costs of cases referred to our hospital after the Syrian civil war. METHODS: Of 1355 Syrian civil war victims referred to our hospital during the 14-month period between June 2011 and July 2012, 482 cases presenting to the emergency department were included in the study. The electronic data of these patients were retrospectively analyzed. RESULTS: Of 482 cases, 428 were male (88.8%) and 54 (11.2%) were female, with a mean age of 30.4±14.9 years (1-79 years). The mean age was 30.8±17.2 years (1-79 years) in males and 27.3±16.9 years (1.5-66 years) in females. There was a significant difference in terms of sex (p=0.007). It was found that the majority of the cases (41.1%) were aged 21-30 years. The highest number of admissions was recorded in June 2011 (159 patients, 33%), whereas the lowest number of admissions was in September 2011 (5 patients, 1%). All cases were transported to our hospital from nearby district hospitals and camps by emergency medical services. The most frequent presenting complaint was gunshot injury (338 cases, 70.1%). The most common diagnosis was extremity injury (153 cases, 31.7%). The number of forensic cases was found as 364 (75.5%). Of all the cases, 136 cases (28.2%) were managed in the emergency service, and the remaining cases were admitted to other services. They were most frequently admitted to the orthopedics ward (146 cases, 30.3%). The mean length of the hospital stay was 9.9 days (1-141).Overall, 456 cases (94.6%) were discharged, 22 cases died, and 4 cases were transferred to other facilities. The mean cost per case was estimated as 3723Turkish lira (TL) (15-69556). A positive correlation was found between cost and length of hospital stay. CONCLUSION: Among all Syrian cases, the majorities of young males and gunshot injuries was striking. Most of the cases were discharged after appropriate management. Preventive measures can avoid these negative outcomes and so avoidable costs will not occur, and this can preclude the damage to the budgets of the countries. Language: en

Introduction In locking intramedullary nails, the most important problem is to put the distal interlocking screw accurately and quickly with minimum radiation exposure. The purpose of this clinical study was to compare the fluoroscopic time and surgical time required for distal locking with either free-hand fluoroscopic guidance or with an electromagnetic navigation system. Materials and methods The study comprised 54 patients with 58 fractures of the lower extremity. The patients were divided in two groups: distal locking with freehand fluoroscopic guidance (group I) and distal locking with electromagnetic navigation (group II). The primary outcome in this study was fluoroscopy time. The secondary outcome was the operative time in distal interlocking. Results In group I, the mean operation time was 108 (81–135) min, the mean time for distal interlocking was 18.35 (9–27) min, the total fluoroscopy time was 47.77 (19–74) s, the mean fluoroscopy time during distal interlocking was 18.29 (2–29) s and the mean attempt at number of distal locking for two screws was 9.96 (2–18) times. In group II, the mean operation time was 80.96 (63–100) min, the mean time for distal interlocking was 7.85 (6.5–10) min, the total fluoroscopy time was 22.59 (15–32) s, the mean fluoroscopy time during distal interlocking was 1.62 (0–2) s and the mean attempt number of distal interlocking was 2 (2–2). Conclusion Fluoroscopy time to achieve equivalent precision is significantly reduced with electromagnetism-based surgical navigation compared with free hand fluoroscopic guidance. Also the operative time is significantly reduced with electromagnetic based navigation.

OBJETIVO: Desenvolver uma nova técnica de liberação percutânea do dedo em gatilho, usando microbisturi oftalmológico vitreorretiniano (MVR) de lâmina 19. MÉTODO: O tratamento conservador do dedo em gatilho inclui, com frequência, injeção local de esteroide. Esse método apresenta alta taxa de falha, sendo necessárias injeções repetitivas. Quando o tratamento conservador falha, recomenda-se a liberação a céu aberto da polia A1. Foram relatados vários métodos que empregam diversos instrumentos. Usamos um microbisturi oftalmológico vitreorretiniano (MVR, de microvitreoretinal blade) de lâmina 19 na liberação percutânea do dedo em gatilho. RESULTADOS: Liberamos 50 dedos em gatilho por via percutânea com essa lâmina. CONCLUSÃO: Foram obtidos resultados satisfatórios em 45 deles (90%). Nivel de Evidência VI, série de casos. OBJECTIVE: Object of this study is to produce a new technique for percutaneous release of trigger finger using 19 gauge microvitreoretinal (MVR) ophthalmic knife. Conservative treatment of trigger finger includes often local injection of steroid. This has a high rate of failure and repeated injections may be required. METHODS: When conservative treatment fails, open release of the A1 pulley is recommended. Various methods using various instruments have been reported. We used 19 gauge microvitreoretinal (MVR) ophthalmic knife in percutaneous release of trigger finger. RESULTS: We released 50 trigger fingers percutaneously with this knife. CONCLUSION: Satisfactory results were achieved in 45 of them (90%). Level of Evidence: Level IV cases series.

Peripheral neuropathies caused by ganglion cysts are rare. They seldom cause serious complications especially in the lower extremities. The case was a 51-year-old woman referred by her physician to the vascular surgeon with diagnosis including intermittent (vascular) claudication and deep venous thrombosis. Primarily vascular surgeon performed a doppler ultrasound of the lower extremity and calculation of the ankle-brachial index. There were no abnormal pathological findings. Careful physical examination revealed soft swelling and tenderness around the fibular head and neck. Weakness was observed in foot eversion and dorsiflexion. There was pain and tingling in the distribution of the peroneal nerve. and referring the patient to orthopedic surgeon owing to concern for a potential compressive lesion at the right proximal tibiofibular region. Electromyogram studies and physical examination confirmed a diagnosis of compression neuropathy of common peroneal nerve. Magnetic resonance imaging revealed a fluid-filled, lobulated mass indicating a ganglion cyst. One months after decompression, the patient had no complaint. Fast diagnosis and immediate management are essential to regain best possible recovery.