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Öğe Application of vac in type III open fractures(Derman Medical Publishing, 2018) Atiç, Ramazan; Alemdar, Celil; Azboy, İbrahim; Bulut, Mehmet; Çaçan, Mehmet Akif; Gem, MehmetAim: Functional results of patients with Type III open long bone fractures treated with vacuum-assisted closure (VAC) and approximating sutures were evaluated. Material and Method: A total of 21 patients (4 female, 17 male with a mean age of 27 years, range: 3-64 years) with Gustilo-Andersen Type 3 open fracture were included in the study. The mean follow-up period was 25.67 months (range, 9-52 months). Thirteen patients had Type IIIB and eight patients had Type IIIC open fractures. Following a large debridement and irrigation in an operating room setting, wound dimensions were measured. Subsequently, VAC was applied. During the application, skin traction sutures were applied over the vacuum sponge. During the last dressing change in which a dean granulation tissue was obtained, the wound was closed following the measurement of its dimensions. Wound dimensions measured during the large debridement in the operating room were compared with the wound dimensions measured after the final VAC application. Results: Mean duration between trauma and operation was 7.57 hours (range, 2-23 hours). The wound was closed with delayed primary suturing in seven patients. In the remaining 14 patients, wound dimensions measured following the last VAC application were found to be decreased with a mean of 40.02% (range, 20-60%). Seven patients underwent a skin graft, two had a free flap application, four had a fasciocutaneous flap, and one had a fasciocutaneous flap + graft application. Two patients underwent revision operations for graft failure. Five patients (23.8%) developed a deep wound infection. The infections resulted in osteomyelitis in two patients (9.5%). Discussion; VAC application together with skin traction sutures in Type IIIB and C open fractures decreases wound size dimension of a graft or flap to be applied. Also it may reduce the requirement for secondary interventions.Öğe Depression, social phobia and quality of life after major lower limb amputation(Haydarpaşa Numune Eğitim ve Araştırma Hastanesi, 2020) Tutak, Yılmaz; Şahin, İlhami; Demirtaş, Abdullah; Azboy, İbrahim; Özkul, Emin; Gem, Mehmet; Adıyeke, LeventIntroduction: In this study, we aimed to compare the social phobia, depression and quality of life in patients with major lower limb amputation to non-amputated.Methods: Patients who were underwent above or below the knee amputation in the past were evaluated retrospectively by examining the hospital records. All the participants were administered Liebowitz Social Anxiety Scale (LSAS), Hospital Anxiety and Depression Scale (HADS), and Short-Form 36 (SF-36).Results: The number of patients was 30 (21 males, nine females) in the amputated group and 30 (22 males, eight females) in the control group. The mean age was 41.8±14.09 years in the amputated group and 43.3±18.68 years in the control group. All LSAS and HADS scores were higher, and SF-36 scores were lower in the amputation group compared to the control group (p<0.05). The patients who were amputated more than five years ago had higher LSAS social fear scores, and lower HAD depression scores compared to patients less than five years (p=0.035, p=0.024, respectively). The employed patients had lower HAD depression and HAD total scores compared to unemployed patients (p=0.008, p=0,049, respectively). The patients amputated due to medical complications had higher scores in anxiety compared to the patients with traumatic amputation (p=0.005, p=0.016, respectively).Discussion and Conclusion: Social phobia, depression and poor quality of life are common problems in patients with major lower limb amputation. After five years, it should not be forgotten that social phobia will increase; depression will decrease along with its seriousness. Therefore, amputated patients should be psychiatrically counseled and treated. It is important to provide permanent employment opportunities to improve the quality of life.Öğe Effect of 4 Hz and multifrequency pulsed electromagnetic field (PEMF) on bone fracture healing(2024) Akdağ, Mehmet Zülküf; Daşdağ, Süleyman; Gelir, Ali; Akdağ, Mahmut Berat; Gem, Mehmet; Baksi, Nazan; Akpınar, Fuat; Bıçak, Tuğçem; Arıca, Enes; Kutluer, Serdar; Arıcan, Rukiye; Kılınç, HalilPulsed electromagnetic fields (PEMF) have been used in bone fracture healing for many years. However, it is still not clear which frequencies are more effective. Therefore, the aim of this study was to investigate the effect of single frequency of 4 Hz and a package of multiple frequencies (220 Hz, 727 Hz, 880 Hz and 10 kHz) on bone fractures of rats. Rats were randomly divided into three groups: sham, R4 and RM. A transverse osteotomy was created in the right medial tibias diaphysis of each rat under anesthesia. The right tibia of the rats in the R4 and RM groups was exposed to 4 Hz, and a package of multiple frequencies, respectively. The rats in both irradiation groups were exposed to a pulsed magnetic field with an amplitude of 10 mT for 1 h/day during 1 month under anesthesia with ketamine (90 mg/kg, i.p.) and xylazine hydrochloride (9 mg/kg, i.p.). The rats in the sham group were kept under the same experimental conditions without any field exposure. At the end of the study, the right tibia of each rat was removed and bone healing was evaluated histopathologically and radiologically, and the concentrations of some elements were measured, such as Na, Mg, K, Cr, Mn, Fe, Zn, Se, Ca and P. The results showed that 4 Hz exposure was more effective in bone fracture healing than the other frequencies in this study. Further studies need to be conducted to determine the mechanisms underlying the effect of 4 Hz PEMF.Öğe Functional and radiologic results of posteromedial limited surgery in developmental dysplasia of the hip(NLM (Medline), 2023) Uzel, Kadir; Gem, Mehmet; Şahin, İlhami; Ziyadanoğulları, Mehmet Onur; Eskandari, Mohammad Mehdi; Arslan, H.PURPOSE OF THE STUDY In treatment algorithm of developmental dysplasia of the hip, posteromedial limited surgery is placed between closed reduction and medial open articular reduction. The aim of the present study was to assess the functional and radiologic results of this method. MATERIAL AND METHODS This retrospective study was performed in 37 Tönnis grade II and III dysplastic hips of 30 patients. The mean age of the patients at operation was 12.4 months. The mean follow-up time was 24.5 months. Posteromedial limited surgery was applied when sufficient stable concentric reduction was not achieved by closed technique. No pre-operative traction was applied. Postoperatively, human position hip spica cast was applied for 3 months. Outcomes were evaluated regarding modified McKay functional results, acetabular index and presences of residual acetabular dysplasia or avascular necrosis. RESULTS Thirty-six hips had satisfactory and one hip had poor functional result. The mean pre-operative acetabular index was 34.5 degrees. It improved to 27.7 and 23.1 degrees at the postoperative 6th month and the last control X-Rays. The change in acetabular index was statistically significant (p<0.05). At the last control, 3 hips had findings of residual acetabular dysplasia and 2 hips had avascular necrosis. CONCLUSIONS Posteromedial limited surgery for developmental dysplasia of the hip is indicated when closed reduction remains insufficient and medial open articular reduction remains unnecessarily invasive. This study, in line with the literature, provides evidences that this method might decrease the incidences of residual acetabular dysplasia and avascular necrosis of the femoral head.Öğe Functional outcomes and quality of life in adult ipsilateral femur and tibia fractures(Elsevier Science Bv, 2019) Demirtaş, Abdullah; Azboy, İbrahim; Alemdar, Celil; Gem, Mehmet; Özkul, Emin; Bulut, Mehmet; Üzel, KadirObjective: The aim of our study is to evaluate the functional outcomes and quality of life in adult ipsilateral femur and tibia fractures. Methods: 26 patients (21 male, 5 female; mean age 30 years, range: 18 to 66) treated for adult ipsilateral femur and tibia fractures were evaluated retrospectively. For femur fractures, intramedullary nails were used in 15 patients (12 antegrade, 3 retrograde), plate in 11 patients (10 locked-plate, and 1 blade-plate with a 95 degree angle). For tibia fractures, locked-plate were used in 13 patients, intramedullary nails in 9 patients, external fixator in 3 patients and multiple screws in 1 patient. According to Blake and McBryde classification, 17 fractures were type I, 9 fractures were type II (7 type 2A and 2 type 2B). The functional outcomes were evaluated by Karlstrom and Olerud criteria, and quality of life was evaluated by Short Form-36. The mean follow-up duration was 4.4 years (range: 1.1 to 7.3 years). Results: The functional outcomes were excellent in 6 patients, good in 8 patients, acceptable in 6 patients and poor in 6 patients. The mean values of quality of life scales were; physical function: 64.8, physical role limitation: 60.5, pain: 68.2, general health: 63.3, vitality: 58.4, social function: 68.2, emotional role limitation: 62.7, and mental health: 65.8. Conclusion: Adult ipsilateral femur and tibia fractures are severe injuries and adversely affect the quality of life and functional outcomes. The quality of life scales should be used along with functional outcome scores in evaluating these injuries. The translational potential of this article: Adult ipsilateral femur and tibia fractures cause severe morbidity. Functional outcomes and quality of life scales should be used together to evaluate these fractures. Karlstrom and Olerud criteria for functional outcomes and Short Form-36 scales for quality of life are suitable methods to evalute these fractures.
