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Öğe A safe method for early rehabilitation of articular fracture at the base of thumb metacarpal bone(Hindawi Limited, 2021) Öç, Yunus; Kılınç, Bekir Eray; Varol, Ali; Kara, AdnanBackground. To evaluate the clinical and radiological results of closed reduction, distraction using an external fixator, and percutaneous fixation in patients with Bennet and Rolando fractures. Methods. Patients over 18 years of age, who had isolated fracture at the base of the first metacarpal bone, had no previous functional limitations and pain complaints, were regularly followed up, and had fixation using K-wire combined with an external fixator, were included. Arthrosis was evaluated according to Eaton and Littler classification. Pain intensity was evaluated using the visual analogue scale (VAS) on a 0-10 scale. Furthermore, patients were questioned regarding limitations in their daily activities and hobbies. Pinch and grasp strengths were evaluated. Results. Thirteen of the patients were male and five were female, with a mean age of 31.5 ± 12.5 years. The surgical procedure was performed on the right extremity in 12 patients and left extremity in six patients. Twelve patients were found to have Bennet fractures, whereas six patients had Rolando fractures. The mean follow-up period of the patients was found to be 29.6 ± 5.4 months. The VAS score was rated as 2 in one patient and 1 in one patient. Other patients had a pain VAS score of 0. The mean Quick-DASH score was calculated to be 1.20. No statistical difference was found in pinch strength between the two extremities (p > 0.05). No difference was observed in terms of the range of motion (p > 0.05). Conclusion. Fixation using K-wire combined with an external fixator has more benefits than its disadvantages and is superior to other methods in the intra-articular fractures of the first metacarpal bone.Öğe Evaluation of the accuracy of lachman and anterior drawer tests with KT1000 in the follow-up of anterior cruciate ligament surgery(Korean Soc Exercise Rehabilitation, 2016) Kılınç, Bekir Eray; Kara, Adnan; Çelik, Haluk; Öç, Yunus; Çamur, SavaşLigament laxity measurement is clinically valuable to diagnose the injury and also to compare the laxity before and after surgical procedure. The aim of the study was to compare the accuracy of the Lachman and Anterior Drawer Tests to evaluate the knee examination with the KT1000 arthrometer after the anterior cruciate ligament (ACL) surgery in early follow-up period. Fourty ACL reconstructed knees were examined with the Lachman and Anterior Drawer Tests, and KT1000 arthrometer with compariable intact knee of the same patients. Physical emanination findings were compared with the KT1000 arthrometer with each power. Spearman correlation and receiver operating characteristic (ROC) analysis were used for the evaluation of relations between parameters. Significance was evaluated in P<0.1 and P<0.05. The mean age was 28.18 +/- 6.21 yr, and the mean follow-up was 23.09 +/- 9.08 months. The mean KT1000 measurements of 40 operated knees state at 6.8, 9.1, 13.6 kg and maxium anterior displacement forces were 4.9, 6.7, 8.7, and 11.9 mm, respectively. The same values for the same acting forces of intact knees were 4.2, 5.9, 7.8, and 10.2, respectively. In Spearman's correlation and ROC analysis at 13.6-kg power on KT1000 arthrometer statistically matched with pyhsical examinations (P<0.1, P<0.01). In our study, correlation of physical examinations with KT1000 arthrometer is a worthy evaluation technique that can be added to examination of ACL reconstructed knee to control with inexperinced examiners' findings. We suggest that at 13.6-kg power with KT1000 arthrometer findings perfectly match the Lachman and Anterior Drawer Tests of the knee.Öğe Evaluation of the coronal malposition of the volar locking plate in the treatment of distal radius fractures(Cureus Inc., 2022) Usta, Emirhan; Akpolat, Ahmet Onur; Kahraman, Ahmet Nedim; Kara, Adnan; Öç, Yunus; Kılınç, Bekir ErayBackground and objectives: Literature does not show any studies regarding plate placement problems in the coronal plane of patients with volar plating due to distal radius fracture diagnosis. We aimed to investigate the functional and laboratory results of the coronal malposition of the volar locking plate in patients with distal radius fracture treated with internal fixation. Methods: In this retrospective study, we included patients who had volar plate fixation, were aged between 18 and 80, had no pathological fracture, had a minimum of six months of follow-up, and had the same rehabilitation protocol. We consider the angle subtended on the coronal axis between the distal radius long axis and the distal radius locking plate as coronal malposition. We named the coronal malposition angle the "AYE Angle." Patients with an AYE angle of over 1 degree were evaluated under group 1. Patients with an AYE angle of 0-1 degrees were evaluated under group 2. Radiological parameters were taken from AP-Lateral X-ray views. Superficial University System of Georgia (USG) examinations were applied to detect tendon problems. The DASH and QUICK-DASH scoring systems were used for clinical evaluation. Grip strength was measured with a dynamometer in all patients. All results were compared between the two groups. Results: Thirteen patients were female and 27 patients were male. Nineteen patients who had coronal malposition were added to group 1, while 21 patients who had no coronal malposition were added to group 2. Fifteen patients had normal USG results in group 2, while 18 patients had edema around the flexor pollicis longus (FPL) tendon as a result of USG in group 1. Statistically, a significant difference was detected between the two groups in terms of the amount of tenosynovitis around FPL (p=0.01). A statistically significant relationship was found between USG grading and malposition grading. The study revealed that a higher rate of USG grade 2 was found in patients with malposition grade 2 (90.9%), while a higher rate of USG grade 1 (50%) was observed in patients with malposition grade 1 (p=0.01). A statistically significant difference was not found between Soong grading and USG in terms of the level of tenosynovitis around the FPL tendon. The amount of tenosynovitis detected around the FPL tendon was 62.5% for Soong and grade 0 level, 60.7% for grade 1 level, and 50% for grade 2 level. There was no statistically significant difference between the two groups in the DASH and QUICK-DASH scoring systems (p=0.96). There was no statistically significant difference between the two groups in the grip strength (p=0.52). Conclusion: Coronal plate position in the treatment of the distal radius fracture is important to avoid potential flexor tendon problems. The volar plate position should be adjusted properly both in the coronal and sagittal axes.Öğe Flexor tendon complications in comminuted distal radius fractures treated with anatomic volar rim locking plates(Turkish Association of Orthopaedics and Traumatology, 2016) Kara, Adnan; Çelik, Haluk; Öç, Yunus; Uzun, Metin; Erdil, Mehmet; Tetik, CihangirObjective: Anatomic volar rim locking plates are designed with the aim of treating intraarticular distal radius fractures. When used to treat comminuted distal radius fractures, these plates can damage the flexor tendons. In this study, we sought to determine the radiological and functional results and rate of complications of these plates. Methods: We retrospectively reviewed the records of 36 patients (28 males, 8 females; mean age: 46.4 years) with AO/OTA Type C2-C3 distal radius fractures treated with anatomic volar rim distal radius plates between January 2011 and December 2014. Radial length, radial inclination and palmar tilt were compared with the intact wrist. Results were evaluated with the Mayo wrist and Lidstrom scores. Complications were documented throughout the follow-up period of 23.8 (range: 12 to 48) months. Results: Postoperative measurements of the radial length, inclination and palmar tilt did not differ significantly. Mayo wrist and Lidstrom scores were good and excellent in 27 and 32 patients, respectively. Flexor tenosynovitis was symptomatic in 15 patients and asymptomatic (localized swelling only) in 21. Plates were removed from 15 patients due to symptomatic tenosynovitis and from six patients due to partial rupture of the flexor pollicis longus tendon. The flexor digitorum profundus tendon of the second finger was also partially ruptured in three patients. Conclusion: Anatomic volar rim locking plates provide satisfying radiological and functional results in treating AO/OTA Type C2-C3 comminuted distal radius fractures. However, if these plates interfere with the union of the fracture, they should be removed to avoid potential tendon problems caused by their placement in the rim region.Öğe Functional, clinical and biomechanical comparison of anterior cruciate ligament reconstruction with anatomical placement of transtibial tunnel placement(SAGE Publications Ltd, 2014) Kılınç, Eray; Kara, Adnan; Öç, Yunus; Çelik, Haluk; Çamur, Savaş; Eren, Osman Tu?rulObjectives: Functional, clinical and biomechanical comparison of Anterior Cruciate Ligament reconstruction with anatomical placement of transtibial tunnel placement. Methods: 55 patients who can be adequately followed-up being divided into transtibial and anatomic groups. Lachman and Pivot-shift tests were performed to all patients. Laxity was measured by performing KT-1000 arthrometer test with 15,20 and 30 pounds power. Muscle strength were evaluated with Cybex II at 60 ° / sec, 240 ° / sec frequencies with flexion and extension peak torque. The maximum force values of untouched knee and the knee with surgery have been compared. Groups were evaluated by using IKDC knee ligament healing standard form, IKDC activity scale, modified Lysholm and Cincinnati evaluation forms. Return to work and return to fitness times of patients were compared. NCSS 2007 & PASS 2008 Statistical Software was used for statistical analysis. Results: Statistically, there was not any observed significant difference between Lachman and Pivot-shift levels. Positive value of Pivot-shift test and incidence of anterior translation in Lachman test were higher in the cases which were subjected to transtibial technique. There was not any statistically significant difference between Lysholm activity levels of cases. Lysholm activity levels of patients who underwent anatomic techniques significantly higher than transtibial technique. There was not any statistically significant difference between Modified Cincinnati activity levels. Modified Cincinnati activity levels of patients who were subjected anatomical techniques, are significantly higher than transtibial technique. There was not any statistically significant difference between post treatment IKDC activity levels. Intense activity after treatment rate of patient who were subjected to anatomic techniques was significantly higher than transtibial technique. There was a statistically significant differences between Cybex extension-flexion 60 measurements and Extension 240 measurements. Results of KT-1000 arthrometer testing anatomical technique was found to be stable than transtibial technique in antero-posterior translation of the knee kinematics at 20 and 30 pounds of forces. Return to sport times of patients who underwent transtibial technique, significantly higher than anatomic technique. There was not any statistically significant difference between return to work times of patients. Conclusion: Previously published studies we observed that anatomic single band ACL reconstruction is better than transtibial ACL reconstruction by providing rotational and anterior translational stability control, in reducing the complications and it is more effective in returning normal functions after operation. As an important implication, a single-band anatomic ACL reconstruction’s clinical, functional and laboratory results are found to be better than the transtibial technique.Öğe Is anterior cruciate ligament surgery technique important in rehabilitation and activity scores?(Korean Soc Exercise Rehabilitation, 2016) Kılınç, Bekir Eray; Kara, Adnan; Çelik, Haluk; Öç, Yunus; Çamur, SavaşTo compare the two different anterior cruciate ligament surgery techniques' effect in rehabilitation and activity performance. Fifty-five patients were evaluated. Twenty-seven patients with transtibial technique (TT), 28 with anatomic single-bundle technique (AT) included. Tegner Activity Scale (TAS) was performed at preoperation and follow-up. The returning time of the sport and work was evaluated at follow-up. Single-leg hop test was performed at follow-up. Outcomes were compared between the two groups. The determined length difference between the operated knee and the intact knee was compared between the two groups. Average age of TT and AT was 27.9 +/- 6.4 yr, 28.3 +/- 6 yr, respectively. There was a significant difference between the two groups in duration of returning to sport. 7 group had higher duration to return to sport (P< 0.01). No difference between the two groups in duration of returning to work (P> 0.05). There was a significant difference between the two groups. 7 group had significantly higher values than AT group (P<0.01). No difference in TAS between the two techniques at preoperation and at last follow-up (P> 0.05). The increase of TAS in patients who had AT was higher than the patients who had TT (P> 0.05). No difference in single-leg hop test at 55%-65%, 65%-75%, and 85%-95% level (P> 0.05). In this test at 75%-85% TT group had higher values than AT group (P< 0.05), AT group had higher values at 95%-105% level (P<0.05). Good short and long-term knee outcome scores depend on rehabilitation protocol after surgery. Surgery technique should provide the adequate stability in rehabilitation period. AT obtains better outcomes in rehabilitation.Öğe Reconstruction of neglected achilles tendon ruptures with gastrocnemius flaps: excellent results in long-term follow-up(Springer, 2016) Şeker, Ali; Kara, Adnan; Arma?an, Raffi; Öç, Yunus; Varol, Ali; Sezer, Hasan BasriObjective: Repair of the neglected achilles tendon ruptures can be challenging due to retraction of tendon stumps. Different repair and augmentation techniques were described. This study aims to investigate long-term results of neglected achilles tendon rupture repair with gastrocnemius flaps. Patients and methods: Between 1995 and 2005, 21 neglected achilles tendon rupture reconstructions were performed with using gastrocnemius fascial flaps. Mean age was 32.1 years. Mean period between rupture and operation was 8.4 weeks. Ankle range of motion, calf circumference, heel raise test, Visual Analog Scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) hindfoot and Foot and Ankle Disability Index (FADI) scores were checked. Results: The average gap length was 6.4 cm. Mean follow-up was 145.3 months. Median dorsiflexion/plantar flexion values for operated and uneffected sides were 18°/30° and 19°/30°, respectively. The mean values for AOFAS and FADI scores were 98.5 points and 98.9 %, respectively. VAS score was 0 point for all patients. With the numbers available, no significant difference could be detected in terms of ankle range of motion, calf circumference measures and dynamometric analysis. Mean time for return to daily activities was 11.1 (8–16) weeks after surgery. Prerupture activity level was achieved 14.1 months postoperatively. All patients were able to perform heel raise test. Conclusion: Repair of neglected achilles tendon ruptures with gastrocnemius flaps has satisfactory long-term results.Öğe The effect of the cerclage wire in the treatment of subtrochanteric femur fracture with the long proximal femoral nail: A review of 52 cases(Elsevier Science Bv, 2018) Kılınç, Bekir Eray; Öç, Yunus; Kara, Adnan; Erturer, Ramazan ErdenIntroduction: To present the effect of the cerclage fixation, which was performed for the purpose of preserving the alignment obtained by open reduction, on the long-term clinical and radiological results of subtrochanteric fractures. Materials and methods: The inclusion criterias were at least 2 years of follow-up, no severe cognitive impairment, and to be able to walk independently prior to fracture. Patients with transverse or short oblique subtrochanteric hip fractures (AO/OTA class 32-A3.1), patients underwent previous femoral or hip operation for the same side and those with segmental fractures, bilateral fractures and pathological fractures were not included in the study. The clinical and radiological results of the patients were evaluated. The clinical evaluations were performed with Palmer and Parker Mobility Score (PPM), Lower Extremity Functional Score (LEFS), visual analogue score (VAS) and return to pre-injury activity status. The elapsed time between the trauma and the surgery date, the duration of surgery the estimated amount of bleeding, and the length of hospital stay of patients were assessed. Results: Thirty-two of the 52 patients were female and 20 were male. The mean age of females was 77.80 +/- 9.75 years and the mean age of the males was 79.18 +/- 6.50 years. The mean follow-up period of the patients was 62.25 +/- 34.68 months. The mean time until the patients' surgery was 6.18 +/- 3.32 days. The mean duration of surgery was 52.6 +/- 13.8 min. The mean amount of bleeding was 176 +/- 90 ml. The mean length of patients' hospital stay was 6.2 +/- 3.2 days. The postoperative mean duration of union was found to be 3.8 +/- 1.6 months. The mean value of varus/valgus angulation in coronal plane measurements was 0.52 degrees. No complication was observed in any patient during the cerclage application. The mean number of wire was 1.3. LEFS difference was statistically significant. PPM decline was not statistically significant. Conclusion: Open reduction and the use of cerclage did not produce a negative effect in terms of fracture union. The generation of medial support by anatomical reduction of the fracture prevents the implant failure and provide a basis for union.Öğe The evaluation of results of repair using all-soft suture anchor in the treatment of chronic tendinous mallet finger surgery(Galen S.R.O., 2020) Gülenç, Barış; Öç, Yunus; Yalçın, Sercan; Şener, Barış; Çamur, Savaş; Kara, AdnanPURPOSE OF THE STUDYThe purpose of this study is to evaluate the results of chronic tendinous mallet finger repair with all soft suture anchors.MATERIAL AND METHODSIn this retrospective study we evaluated 14 patients. Data included age, side of surgery, the degree of extensor lag, the ratio of the damaged articular surface, postoperative recovery period and time to return to work. We recorded extensor lag and Crawford scores of all patients at the last follow-up.RESULTSMean follow-up period was 22.07 months. The preoperative and postoperative extensor lags were 27.2 (15-35) and 3 (0-19), respectively. Crawford scores of patients were moderate in 1 patient, fair in 2 patients and excellent in 10 patients. We observed only one skin complication in the postoperative period.CONCLUSIONSAll-soft suture anchors have high patient satisfaction rates and functional results. Thus, they could be used in the treatment of patients with chronic tendinous mallet finger. The low complication rate is a major advantage.Öğe Transtibial vs anatomical single bundle technique for anterior cruciate ligament reconstruction: A retrospective cohort study(Elsevier Science Bv, 2016) Kılınç, Bekir Eray; Kara, Adnan; Öç, Yunus; Çelik, Haluk; Çamur, Savaş; Bilgin, Emre; Erten, Yunus Turgay; Şahinkaya, Türker; Eren, Osman TuğrulIntroduction: Most of the ACL reconstruction is done with isometric single-bundle technique. Traditionally, surgeons were trained to use the transtibial technique (TT) for drilling the femoral tunnel. Our study compared the early postoperative period functional and clinical outcomes of patients who had ACL reconstruction with TT and patients who had ACL reconstruction with anatomical single-bundle technique (AT). Material method: Fifty-five patients who had ACL reconstruction and adequate follow-up between January 2010-December 2013 were included the study. Patients were grouped by their surgery technique. 28 patients included into anatomical single-bundle ACL reconstruction surgery group (group 1) and 27 patients were included into transtibial AC reconstruction group (group 2). Average age of patients in group 1 and group 2 was 28.3 +/- 6, and 27.9 +/- 6.4, respectively. Lachman and Pivot-shift tests were performed to patients. Laxity was measured by KT-1000 arthrometer test with 15, 20 and 30 pound power. All patients' muscle strength between both extremities were evaluated with Cybex II (Humac) at 60 degrees/sec, 240 degrees/sec frequencies with flexion and extension peak torque. The maximum force values of non-operated knee and the operated knee were compared to each other. Groups were evaluated by using International Knee Documentation Committee (IKDC) knee ligament healing Standard form, IKDC activity scale, modified Lysholm and Cincinnati evaluation forms. Return to work and exercise time of patients were compared. Functional and clinical outcomes of two groups were compared. NCSS 2007 and PASS 2008 Statistical Software programs were used for statistical analysis. Result: There was no statistically significant difference between Lachman and Pivot-shift results (p > 0.01). Positive value of Pivot-shift test and incidence of anterior translation in Lachman test were higher in the patients who had TT. Lysholm activity level of patients who had TT, 33.3% (n = 9) were excellent, 51.9% (n = 14) were good and 14.8% (n = 4) were moderate; patients who had AT, 57.1% (n = 16) were excellent, 39.3% (n = 11) were good and 3.6% (n = 1) was good level. There was no statistically significant difference between Lysholm Activity level of the patients (p < 0.01). Lysholm Activity level of patients who had AT significantly higher than TT. There was no statistically significant difference between Modified Cincinnati activity level of the patients (p < 0.05). Modified Cincinnati activity level of patients who had AT were significantly higher than those had TT. There was no statistically significant difference between two groups with post treatment IKDC activity level (p < 0.01). Intense activity after treatment rate of patient who had AT was significantly higher than those had TT. There was statistically significant difference between Cybex extension-flexion 60 measurement and extension 240 measurement of the patients (p < 0.01). KT-1000 arthrometer test results with AT was better than the TT in antero-posterior translation of the knee kinematics at 20 and 30 pound of forces. Return to exercise time of patients who had TT was significantly higher than those had AT (p < 0.01). There was no statistically significant difference between return to work time of patients (p > 0.05). Conclusion: Single-bundle anatomic ACL reconstruction was better than the TT in term of clinical, functional, and laboratory results. We believe that AT ACL reconstruction will increase in use and traditional method which is TT ACL reconstruction surgery will decrease in the long term. Theoretically, anatomic relocation of the ACL can provide better knee kinematics.Öğe Ultrasonic evaluation of the flexor pollicis longus tendon following volar plate fixation for distal radius fractures(W B Saunders Co-Elsevier Inc, 2016) Kara, Adnan; Çelik, Haluk; Bankaoğlu, Müjdat; Öç, Yunus; Bülbül, Murat; Sügün, Tahir SadıkPurpose To evaluate with ultrasound the thickness of the flexor pollicis longus (FPL) tendon and its relationship to the volar locking plate after the fixation of distal radius fractures. Methods We evaluated 27 type C2 and C3 distal radius fractures with ultrasound to evaluate damage to the FPL tendon after volar plate fixation. The thickness of the FPL tendon and its distance to the volar plate in the involved wrists and to the volar rim in the contralateral uninjured wrist were measured on sonograms taken 12 months postoperatively. Measurements of the involved wrists were compared with those of the intact wrists. Results The mean plate-tendon distance in the involved wrist was considerably shorter than the mean volar rim-tendon distance in the intact wrist, and the FPL tendon was considerably thicker in the involved wrist than in the intact wrist. Conclusions In distal radial fractures treated with volar locking plates, increases in the thickness of the FPL tendon and a consequent decrease in the distance between the tendon and the plate can be determined with ultrasonography. This finding is a warning that asymptomatic tenosynovitis may eventually cause tendon ruptures.Öğe Ultrasonography or direct radiography? A comparison of two techniques to detect dorsal screw penetration after volar plate fixation(Biomed Central Ltd., 2018) Öç, Yunus; Kılınç, Bekir Eray; Gülcü, Anıl; Varol, Ali; Ertuğrul, Rodi; Kara, AdnanBackground: Complications related to extensor tendons have begun to increase with the use of volar plates in the treatment of distal radius fractures. In this study, we aimed to compare four-plane radiography and ultrasonography in the evaluation of dorsal cortex screw penetration following volar plate fixation. Methods: We recruited 47 patients (33 males, 14 females, mean age 37.4 years; range 18-58 years). To evaluate dorsal screw penetration in all patients, we performed radiographs at 45 degrees pronation, 45 degrees supination and obtained dorsal tangential graphs at maximum palmar flexion, and a wrist lateral radiograph. Wrist ultrasonography was performed in all patients. Results: Dorsal screw penetration was detected in 12 of the 47 patients undergoing VLP application. While there was > 2 mm screw penetration in seven patients, there was < 2 mm screw penetration in five patients. On four-plane radiographs, screw penetration > 2 mm was detected in seven patients and screw penetration < 2 mm was detected in two patients. On four-plane radiography, dorsal screw penetration was not detected in three out of five patients, who were shown to have < 2 mm screw penetration by ultrasonography. In addition to perioperative four-plane radiographs are also required to detect dorsal cortex penetration in patients undergoing VLP due to distal radius fracture. However, the detection of screw penetrations < 2 mm is more likely with ultrasonography compared to four-plane radiography. Conclusion: We recommend that dorsal cortex screw penetration should be evaluated with perioperative ultrasonography.
