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Öğe A new method of calculating the rotation angle in pediatric forearm fractures using direct radiographs(Ios Press, 2017) Kömür, Baran Heval; Durmuş, Tahir Mutlu; Mutlu, Serhat; Güler, Olcay; Mutlu, Harun; Yücel, BülentBACKGROUND: The aim of this study was to measure the rotational angle defect between fracture ends in paediatric forearm diaphyseal fractures on radiographs. METHODS: Evaluations were performed on 78 paediatric patients who presented at the emergency department with a diaphyseal forearm fracture during 2013-2014. Thirty-two patients who underwent conservative treatment and had < 10 degrees of angulation and translation of not more than half the bone diameter after application of a plaster cast were included in the study. A rotational formula was used with diameter values to determine changes. The degree of rotation of both ends of the fracture line and the forearm rotational defect of the fracture line were calculated. FINDINGS: Fractures included an isolated radius in 16 cases, an isolated ulna in four cases, and both bones in 12 cases. The mean lateral angular (LAT-theta) value was 26.13 +/- 5.93 degrees on the proximal fracture end, and the distal mean LAT-theta was 30.29 +/- 6.24 degrees (p = 0.037). The mean proximal anteroposterior angular (AP-theta) value was 26.83 +/- 5.75 degrees, and the distal mean AP-theta was 30.58 +/- 7.27 degrees (p = 0.008). A significant correlation was detected between the AP-Delta and LAT-Delta measurements (p = 0.883). INTERPRETATION: The rotational defect was mathematically calculated directly from radiographs using a rotational measurement formula.Öğe An evaluation of partial matrix excision with winograd method for the surgical treatment of ıngrown toenails(2014) Güler, Olcay; Mahiroğulları, Mahir; Mutlu, Serhat; Çerçi, Halis; Şeker, Ali; Mutlu, HarunObjective: The most frequent nail pathology of the hallux is the ingrown toenail. In our study, we evaluated Winograd s partial matrix excision method as a treatment for unilateral ingrown hallux toenail. Methods: Winograd s partial toenail excision was performed on 239 patients (127 males, 112 females; mean age 37.4 years) with an ingrown toenail. Primary patient complaints included a painful hallux toenail, discharge, nail deformation, and difficulty walking. According to the Heifetz staging system, there were 62 patients evaluated as Stage l, 96 as Stage ll, and 81 as Stage lll. A total of 174 (74%) patients had discharge from infection. In infected cases, an antibiotic was administered until inflammatory signs and discharged ceased, at which time surgical treatment was performed. Patients duration to return to daily living and work, recurrence ratio, satisfaction, and cosmetic issues were evaluated. The mean follow-up time was 27 months (range: 14-45 months). Results: Patients returned to daily living in 10-15 days (mean 11.3) and to work in 8.7 days (range: 6-13 days). A total of 230 patients (96.3%) were satisfied with the procedure, and 231 patients (96.6%) were satisfied with the cosmetic results. Nine patients were dissatisfied with the surgical outcome, and eight patients who experienced recurrence were dissatisfied with the cosmetic results. None of the patients experienced deep tissue infections or neurovascular complications. Conclusion: Winograd s partial matrix excision method is a beneficial surgical procedure for ingrown toenail, resulting in low recurrence and high satisfaction rates.Öğe Anterior glenohumeral instability: Classification of pathologies of anteroinferior labroligamentous structures using MR arthrography(Hindawi, 2013) Mutlu, Serhat; Mahiroğulları, Mahir; Güler, Olcay; Uçar, Bekir Yavuz; Mutlu, Harun; Sönmez, Güner; Mutlu, HakanWe examined labroligamentous structures in unstable anteroinferior glenohumeral joints using MR arthrography (MRA) to demonstrate that not all instabilities are Bankart lesions. We aimed to show that other surgical protocols besides classic Bankart repair are appropriate for labroligamentous lesions. The study included 35 patients (33 males and 2 females; mean age: 30.2; range: 18 to 57 years). MRA was performed in all patients. The lesions underlying patients’ instability such as Bankart, anterior labral periosteal sleeve avulsion (ALPSA), and Perthes lesions were diagnosed by two radiologists. MRA yielded 16 diagnoses of Bankart lesions, 5 of ALPSA lesions, and 14 of Perthes lesions. Albeit invasive, MRA seems to be a more reliable and accurate diagnostic imaging modality for the classification and treatment of instabilities compared to standard MRI.Öğe Arthroscopic treatment of focal osteochondral lesions of the first metatarsophalangeal joint(BioMed Central Ltd., 2017) Kuyucu, Ersin; Mutlu, Harun; Mutlu, Serhat; Gülenç, Barış; Erdil, MehmetBackground: Although arthroscopic surgical treatment of the first metatarsophalangeal (MTP) joint involves painful sesamoid excision, synovectomy, debridement, and partial cheilectomy, no gold standard treatment technique has been defined in the literature for hallux rigidus and focal osteochondral lesions. This study aimed to assess the arthroscopic treatment for early-grade focal osteochondral lesions of the first MTP joint and to determine the impact of arthroscopic microhole drill surgery on foot function and activities of daily living in a group of patients who failed conservative treatment. Methods: This prospective study included 14 patients with hallux rigidus and focal osteochondral lesions of the first MTP joint who underwent surgery in 2014 and were followed on a regular basis thereafter. Results: The patients had mean preoperative VPS (visual pain scale) and AOFAS (American Orthopedic Foot and Ankle Society)-Hallux scores of 8.14 ± 0.86 SD and 48.64 ± 4.27, respectively; the corresponding postoperative values of both scores were 1.86 ± 0.66 SD and 87.00 ± 3.70, respectively. Both VPS and AOFAS-Hallux scores changed significantly. Discussion: In this prospective study, we explored the impact of arthroscopic microhole drill surgery on foot function and activities of daily living in patients with focal osteochondral lesions of the first MTP joint. Our results showed significant improvements in VPS and AOFAS scores with this treatment. Conclusions: An arthroscopic microhole drill technique can be used with impressive functional scores and without any complications in patients who failed conservative therapy for hallux rigidus with focal chondral injury.Öğe Arthroscopic treatment of focal osteochondral lesions of the first metatarsophalangeal joint(BioMed Central Ltd., 2017) Kuyucu, Ersin; Mutlu, Harun; Mutlu, Serhat; Gülenç, Barış; Erdil, MehmetBackground: Although arthroscopic surgical treatment of the first metatarsophalangeal (MTP) joint involves painful sesamoid excision, synovectomy, debridement, and partial cheilectomy, no gold standard treatment technique has been defined in the literature for hallux rigidus and focal osteochondral lesions. This study aimed to assess the arthroscopic treatment for early grade focal osteochondral lesions of the first MTP joint and to determine the impact of arthroscopic microhole drill surgery on foot function and activities of daily living in a group of patients who failed conservative treatment.Methods: This prospective study included 14 patients with hallux rigidus and focal osteochondral lesions of the first MTP joint who underwent surgery in 2014 and were followed on a regular basis thereafter.Results: The patients had mean preoperative VPS (visual pain score) and AOFAS (American Orthopedic Foot and ankle Society)-Hallux scores of 8.14 +/- 0.86 SD and 48.64 +/- 4.27, respectively; the corresponding postoperative values of both scores were 1.86 +/- 0.66 SD and 87.00 +/- 3.70. Both VPS and AOFAS-Hallux scores changed significantly.Discussion: In this prospective study, we explored the impact of arthroscopic microhole drill surgery on foot function and activities of daily living in patients with focal osteochondral lesions of the first MTP joint. Our results showed significant improvements in VPS and AOFAS scores with this treatment.Conclusions: An arthroscopic microhole drill technique can be used with impressive functional scores and without any complications in patients who failed conservative therapy for hallux rigidus with focal chondral injury.Öğe Arthroscopic treatment of focal osteochondral lesions of the first metatarsophalangeal joint (vol 12, 68, 2017)(BMC, 2019) Kuyucu, Ersin; Mutlu, Harun; Mutlu, Serhat; Gülenç, Barış; Erdil, MehmetThis article [2] was published twice [1] due to a production error. The original article [1] should be considered the version of record and used for citation purposes. The publisher apologizes to the authors and readers for the error and any inconvenience caused.Öğe Efficacy of periarticular injection applied trough knee other than posterior capsule in simultaneous bilateral total knee arthroplasty(Reed Elsevier India, 2015) Güler, Olcay; Mutlu, Serhat; İşyar, Mehmet; Mutlu, Harun; Bülbül, Ahmet Murat; Mahiroğulları, MahirBackground: We aimed to evaluate periarticular multimodal drug injection (PMDI) in bilateral total knee arthroplasty. Methods: In 154 knees of 77 patients, PMDI was administered intraoperatively through the regions other than posterior capsule to one knee; other knee was control. Results: Drug-injected knees had lower visual analog scale scores and higher passive range of motion postoperatively (p < 0.05). The active straight leg raise was higher in drug-injected knees (47 [61%] vs 19 [24.7%], p < 0.001). Conclusions: PMDI is a safe and effective method of early postoperative pain management in total knee arthroplasty when applied through regions other than posterior capsule.Öğe Eksternal fiksatör ile tedavi ettiğimiz eklem içi distal radius kırıklarının sonuçları(Istanbul Medeniyet University, 2014) Güler, Olcay; Mutlu, Serhat; Uygur, Esat; Mutlu, Harun; Mutlu, BurcuRadius distal kırıklarının kapalı redüksiyon eksternal fiksasyon yöntemi ile tedavi sonuçlarının klinik ve radyolojik olarak değerlendirilmesini amaçladığımız bu çalışmada Şubat 2008- Ekim 2011 tarihleri arasında tedavi edilen 17 radius distal kırığı değerlendirildi. AO sınıflamasına göre 6 kırık tip C, 11 kırık ise tip B idi. Tüm kırıklar kapalı redüksiyon eksternal fiksatör ile tedavi edildi ve ortalama 25 ay (12-46 ay) takip edildi. Fonksiyonel değerlendirmede Gartland ve Werley skorlamasının Sarmiento modifikasyonu, radyolojik değerlendirmelerde ise Modifiye Sarmiento skorlaması kullanıldı. Güncel yaşam aktivite değerlendirilmesinde DASH skorlama sistemi kullanıldı. Radyolojik ölçümlerin sonucuna göre yapılan anatomik değerlendirmede 11 kırık (% 64) kusursuz, 4 kırık (% 24) iyi, 2 kırık (% 12) orta-kötü olarak tespit edildi. Radyolojik değerlendirmede orta-kötü sonuçları olan 2 olgunun biri C1 diğeri de C2 tipi kırıklar idi. Gartland ve Wesley skorlaması Sarmiento modifikasyonuna göre 9 olgu çok iyi, 5 olgu iyi, 2 olgu orta, 1 olgu kötü olarak değerlendirildi. Güncel yaşam aktivite değerlendirmelerinde DASH skorlama sistemine göre ortalama değer 8.57 idi. Toplam 4 (% 23) olguda Refleks Sempatik Distrofi ve 8 (% 47) olguda yüzeyel çivi dibi infeksiyonu gelişti. Radius distal uç kırıklarının tedavisinde eksternal fiksatör yöntemi, klinik ve radyolojik sonuçları açısından uygun olgularda iyi bir tedavi seçeneğidir.Öğe Evaluation of the short-term outcomes of platelet-rich plasma intraarticular injections for treating patients with early stage gonarthrosis(Anatolian Journal of Clinical Investigation, 2015) Güler, Olcay; Mahiroğulları, Mahir; Dönmez, Ferdi; Mutlu, Serhat; Çakmak, Selami; Mutlu, HarunThe aim of this study was to evaluate the short-term clinical outcomes of intra-articular platelet-rich plasma (PRP) treatment and to evaluate the increase in functional activity and quality of life in patients with early stage gonarthrosis. We planned our study retrospectively. Eighty-six patients (54 females and 32 males) with 108 knees (54 right and 54 left) who had pain and swelling for > 4 months due to all grades of knee osteoarthritis according to the Kellgren–Lawrence grading scale were evaluated. Our patients were homogenous in terms of age and body mass index. Three intra-articular PRP injections were administered once per week, and the patients were clinically evaluated prospectively before treatment and at 2 and 6 months after treatment with the visual analogue scale (VAS), the Knee Society Score (KSS), and the Short Form-36 (SF-36). No major complications due to treatment were observed. Seventeen patients had transient swelling and pain for 2 days. Significant improvements on the VAS, KSS and SF-36 scores were obtained at the 2- and 6-month followups (p < 0.05). The VAS, KSS, and SF-36 scores improved significantly at the 6-month evaluation compared to those at the month 2 follow up. We believe that intra-articular PRP treatment is effective during the early stage of gonarthrosis and increases the quality of life and functional activity of recipients.Öğe Magnetic resonance imaging-based diagnosis of occult osseous injuries in traumatic knees(Bentham Open, 2015) Mutlu, Serhat; Mutlu, Harun; Kömür, Baran; Güler, Olcay; Yücel, Bülent; Parmaksızoğlu, AtillaBackground: Occult osseous knee injuries, such as bone bruises, can produce persistent pain and functional loss. Although bone bruises cannot be identified through direct examination or traditional radiographs, magnetic resonance imaging (MRI) has emerged as an effective diagnostic method. Nevertheless, the natural history of these injuries remains to be fully defined. Therefore, we used MRI to detect and follow bone bruise injuries secondary to knee trauma. Methods: We retrospectively reviewed knee MRIs from patients with bone bruising caused by trauma. Occult injuries were initially identified by MRI and subsequently rescanned for follow-up at 3 and 9 months. All patients underwent physical examinations, direct radiological imaging, and MRI. Results: Although direct radiographs showed no abnormalities, we used MRI to identify a total of 22 patients (age range: 19–42 years; mean: 28 years) with bone bruising. After 3 months, injuries remained detectable in 68.2% of the subjects, whereas 18.2% displayed bone bruising after 9 months. The majority of Type I lesions resolved spontaneously, whereas 80% of Type II injuries remained following 3 months, and 30% persisted at 9 months. Ligament and meniscal lesions were observed in 63.6% of patients with bone bruising and appeared to hinder recovery. Conclusion: Bone bruises generally resolved within 3 to 9 months in subjects with no soft tissue lesions and minor trauma. However, ligament and meniscal lesions were observed in the majority of patients, and these individuals required longer treatment and recuperation. Overall, these findings can contribute to improving the management of occult osseous knee injuries.Öğe Need for bone grafts in the surgical treatment of displaced intra-articular calcaneal fractures(Elsevier Science Inc, 2017) Duymuş, Tahir Mutlu; Mutlu, Serhat; Mutlu, Harun; Özel, Ömer; Güler, Olcay; Mahiroğulları, MahirControversy is ongoing regarding the use of bone grafts to fill cavities that occur with collapse of the posterior facet in the joint and for repair of the calcaneal height with plating. The present study included 40 patients with 43 displaced intra-articular calcaneal fractures treated with open reduction and internal fixation from March 2009 to November 2013. In the present case-control study, the patients were separated into 2 groups: group A received an allograft (20 patients, 22 calcaneal fractures) and group B did not (20 patients, 21 calcaneal fractures). The calcaneal height and Miller's angle were compared between the 2 groups. The final outcomes for all patients were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle hindfoot scale score and compared between the 2 groups. No significant differences were observed between the groups with regard to the basic demographic variables (p > .05). Using Sanders classification, 8 (18%) were type 2, 19 (44%) were type 3, and 16 (37%) were type 4 fractures. The comparisons between the 2 groups showed a loss of Bohler's angle and loss of calcaneal height that was significantly greater in group B (p < .001). No significant differences were observed between the 2 groups in the AOFAS ankle hindfoot scale scores (p > .05). In conclusion, although no differences were found in the clinical results between the 2 groups, more satisfactory radiologic results were obtained in group A, in which bone grafts were used.Öğe Plate selection for fixation of extra-articular distal humerus fractures: A biomechanical comparison of three different implants(Elsevier, 2015) Mutlu, Serhat; Mutlu, Harun; Erdil, MehmetWe have read the biomechanical study entitled ‘Plate selection for fixation of extra-articular distal humerus fractures: A biomechanical comparison of three different implants.’ By John A. Scolaro et al. with great interest in the issue of Injury 45(12), (2014), 2040–2044 [1]. We would like to congratulate the authors for their valuable biomechanical study. However, we would like to raise an important issue about the bone models used in the study. According to the official website of the company, bone models used in this biomechanical study (model number 1028, Pacific Research Laboratories, Inc., Vashon, WA) are made of foam cortical shell which include cancellous inner material. It is highlighted that they are ideal for large-scale surgical skills courses or different exercises [2]. The studies investigating the biomechanical properties of the implants or surgical methods of the humerus bone are usually performed with the fourth generation Sawbones [3,4]. These biomechanical models (model number 3404, Pacific Research Laboratories, Inc., Vashon, WA) are producted for the use of biomechanical testing according to the official website of the company [5]. We would like to share this technical detail with the authors and the readers. We believe that using biomechanical test materials that are used as an alternative testing medium to human cadaver bone would provide a more reliable and valuable experiment. Once again, we congratulate the authors.Öğe Prone versus supine position during surgery for supracondylar humeral fractures(Sage Publications INC, 2016) Güler, Olcay; Mutlu, Serhat; İşyar, Mehmet; Mutlu, Harun; Çerci, Halis; Mahiroğulları, MahirPurpose. To compare the supine versus prone position in closed reduction and percutaneous pinning for supracondylar humeral fractures in children in terms of patient characteristics and outcome. Methods. Records of 25 girls and 31 boys aged 4 to 9 (mean, 6.7) years who underwent closed reduction and percutaneous pinning in the prone (n=27) or supine (n=29) position each by one experienced surgeon for supracondylar extension type-3 humeral fractures were reviewed. Results. The prone and supine groups were comparable in terms of patient characteristics and outcome, except that anaesthesia duration was shorter in surgery performed in the supine position (46.7 vs. 37.2 minutes, p<0.001). Conclusion. In surgery for supracondylar humeral fractures in children, patient position affected only the duration of anaesthesia.Öğe Symptoms of discoid lateral menisci(Reed Elsevier India Pvt. Ltd., 2014) Mutlu, Serhat; Mutlu, Harun; Mutlu, Burcu; Güler, Olcay; Duymuş, Tahir MutluPurpose: This study aims to determine the symptoms of the patients with discoid lateral meniscus. Methods: We prospectively collected cases of the knees with discoid lateral meniscus. Twenty patients (7 female, 13 male) admitted between January 2012 and February 2014 were enrolled in this study. The mean age of the patients was 34 years (range 28-40). Results: The identified symptoms of a discoid lateral meniscus were "pain, stiffness, popping of the knee, feeling that the knee is "giving way", inability to fully extend (straighten) the knee". Thirteen patients (65%) had pain, 11 (55%) had popping of the knee, 4 (20%) had stiffness, 2 (10%) had "giving way" feeling, and 1 (5%) had inability to fully extend the knee. These symptoms did not prevent any patient's daily activities. No patients required surgical treatment. Conclusions: Pain and popping of the knee were the most common symptoms in patients with a discoid lateral meniscus. The other symptoms were stiffness, feeling that the knee is "giving way", and inability to fully extend the knee, respectively. No symptoms had been required surgical treatment.Öğe The effects of preoperative non-invasive cardiac tests on delay to surgery and subsequent mortality in elderly patients with hip fracture(IOS Press, 2016) Mutlu, Harun; Bilgili, Fuat; Mutlu, Serhat; Karaman, Özgür; Çakal, Beytullah; Özkaya, UfukOBJECTIVE: To investigate the effects of preoperative cardiac tests on the surgical treatment plan and subsequent effects on mortality in elderly patients with hip fracture. METHODS: In this retrospective study, 116 patients aged 60 years or above who underwent hip fracture surgery between 2010-2013 were evaluated. Of the patients with similar preoperative clinical risk factors, 20 patients with additional preoperative cardiac tests such as echocardiography or thalium scintigraphy constituted Group 1, whereas 28 patients without additional cardiac tests constituted Group 2. Statistical analyses were performed using the SPSS 21 statistical package software. Normal distribution of the data was determined by the Shapiro-Wilk test and histography. Intergroup and mortality comparisons were performed by Mann-Whitney U, Yates-corrected chi-square and Fisher's exact tests. RESULTS: The mean time between fracture and operation was 6 days (range, 4-14) in Group 1, and 2 days (range, 0-3) in Group 2. There was a significant difference in time-to-operation between the groups (p < 0.001). The age and gender distribution of both groups were homomgenous (p = 0.64, p = 1.0). Both groups were comparable in terms of fracture type, treatment, and anesthesia (p = 0.36, p = 0.42, p = 1.0). At the end of 1 year, six (30%) patients in Group 1 and three (10.7%) patients in Group 2 were deceased. Both groups were comparable in terms of mortality (p = 0.137). There was a significant difference between the two groups in terms of complications (p < 0.05). CONCLUSIONS: Unnecessary cardiac tests in elderly patients with hip fracture led to a delay in their surgery, yet did not change their cardiac treatment plan. This delay in obtaining hip fracture surgery increases complication rates, hospitalization duration, and costs.Öğe Tourniquet use during total knee arthroplasty does not offer significant benefit: A retrospective cohort study(Elsevier, 2015) Mutlu, Serhat; Güler, Olcay; Mutlu, Harun; Karaman, Özgür; Duymuş, Tahir Mutlu; Parmaksızoğlu, Atilla SancarIntroduction: Tourniquets are routinely employed during total knee arthroplasty; however, their use remains controversial. Methods: This study investigates the efficacy and safety of this practice. A retrospective analysis of 186 patients was performed to assess benefits and/or risks associated with tourniquet use during knee arthroplasty. Total knee arthroplasty was performed using the Biomet Vanguard (R) PCL Prosthesis (Biomet, Warsaw, IN, USA). In total, 126 patients who had undergone total knee arthroplasty were included in our final analysis. Results: Patients with tourniquets had significantly less intraoperative blood loss than patients without (P < .001); patients without tourniquets required more blood transfusions (P = .551), and had significantly longer surgical times (P = .011). However, patients with tourniquets had more postoperative blood loss (P < .001), longer hospital stays (P = .013), and more frequent complications (P = .571). Blood transfusion requirement was significantly associated with complications (P < .001). Conclusions: Tourniquet use provided no overall benefit.Öğe Yaşlılarda görülen radius alt uç kırıklarında konservatif tedavi sonuçlarımız(Logos Medical Publishing, 2014) Mutlu, Serhat; Güler, Olcay; Uygur, Esat; Mutlu, Harun; Mutlu, Burcu; Söylemez, Mehmet SalihBu çalışmada radius alt uç kırığı olan 60 yaş ve üzeri has-talarda cerrahi dışı yöntemlerle yapılan tedavi sonuçlarımız değerlendirildi. Çalışmada 60 yaş ve üstü 52 hasta (34 kadın, 18 erkek; ort. yaş 68.2) deplase radius alt uç kırığı nedeniyle kapalı yer-leştirme ve dirsek altı sirküler alçı ile tedavi edildi. AO (Ar-beitsgemeinschaft für Osteosynthesefragen) sınıflamasına göre hastaların kırık tipleri 28 hastada tip B, 24 hastada ise tip C idi. Klinik sonuçlar Q-DASH (Quick-Disability of Arm, Shoulder and Hand) ile, radyolojik değerlendirme ise Stewart değerlendirme ölçütleri ile yapıldı. Ortalama takip süresi 11 ay (5-18 ay) idi.Elli iki hastanın DEXA (dual energy x-ray absorbsiyometri) ile yapılan kemik yoğunluğu ölçümlerinde 37 hastada (% 71.1) T skorunun -2,5’in altında olduğu tespit edilerek osteoporoz olarak değerlendirildi. Kırıkların tümü ortalama 4.3 (3.7-6.1) haftada kaynadı. Stewart değerlendirme ölçüt-lerine göre 35 hastada (% 67.3) iyi, 12 hastada (% 23) orta, 5 hastada (% 9.7) ise kötü sonuç alındı. Q-DASH puanı 2. ayda 40±10.2, 4. ayda 30±7.4 son kontrolde ise 21±3.2 bu-lundu. İki hastada kötü kaynama gelişti ve bu hastalara dü-zeltici osteotomi ameliyatı önerildi. Yaşlılarda görülen radius alt uç kırıkları normal populasyo-na göre daha düşük enerjili travma ile oluşmaktadır. Genç hastalar ile karşılaştırıldığında tedavisinde konservatif kalma eğilimi daha fazla kabul görmektedir. Çalışmamızın sonucu da bu görüşü destekler niteliktedir. Yaşlı hastaların cerrahiye engel diğer sistemik riskleri ve fonksiyonel bek-lentileri de göz önüne alındığında distal radius kırıklarının kapalı yerleştirme ve kısa kol alçı ile tedavi edilebileceği sonucuna varıldı.
