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    Bilateral low-energy sequential femoral shaft fractures in patients on long-term bisphosphonate therapy
    (2013) Çakmak, Selami; Mahiroğulları, Mahir; Keklikçi, Kenan; Sarı, Enes; Erdik, Baran; Rodop, Osman
    The aim of this study was to evaluate the demographic characteristics of patients with bilateral bisphosphonate-related low-energy femoral shaft fractures. Methods: The clinical registry was reviewed for patients with bisphosphonate-related low-energy fractures localized at femoral shaft between January 2008 and January 2012. Patients with a diagnosis of postmenopausal osteoporosis, bisphosphonate usage of at least 5 years and prodromal pain prior to fracture were included the study. Results: Five women met the inclusion criteria. All patients had bilateral low-energy sequential femoral shaft fractures. Fracture patterns were similar and atypical (transverse-short oblique fractures with lateral cortical thickening). Mean period of bisphosphonate treatment was 8.6 years. Mean patient age was 76.2 years. Union time of three patients was between 20 and 28 weeks. The remaining two fractures were revised for delayed union or nonunion. Conclusion: Long-term (over 5 years) use of bisphosphonates may cause insufficiency fractures due to increased fragility and brittleness which have a close relationship with depressed bone remodeling. While there is still no causal relationship between bisphosphonates and atypical, low-energy femoral shaft fractures, we have some concerns about the optimal usage time and long-term safety of bisphosphonate drugs. © 2013 Turkish Association of Orthopaedics and Traumatology.
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    Do we know multifarious organ abnormalities of adults with Klippel-Feil syndrome?
    (Gulhane Medical School, University of Health Sciences, 2016) Çakmak, Selami; Mahiroğulları, Mahir; Uz, Ömer; Erkul, Evren; Keklikçi, Kenan; Rodop, Osman
    Klippel-Feil syndrome (KFS) is characterized by a classical triad (short neck, low posterior hair line, limitation of neck movements). Segmentation problems of cervical vertebra cause the main clinic in patients, and extraskeletal anomalies are also reported. The aim of this study is to review and emphasize common clinical findings of KFS patients. Between 2000 and 2011, 120 individuals with facial asymmetry and short neck were evaluated. Forty-two adult patients with KFS were included in this study. Patients were assessed for associated skeletal and extraskeletal pathologies. There were 41 male (98%) and 1 female (2%) individuals. Of forty-two patients, thirty-one (n=31; 74%) were classified as type I, nine (n=9; 21%) as type II, and two (n=2; 5%) as type III. Classical clinical triad was detected in all patients. Congenital scoliosis has been observed in all patients except one. Sprengel deformity was observed in 10 individuals (24%). Associated other system disorder ratios were 9.5% for urogenital problems, 23.8% for cardiovascular pathologies and 31% for audiological problems. Spinal and other multi-organ pathologies of patients with KFS may lead to serious problems which may eventually need medical treatment. Detailed assessment for possible systemic disorders and close follow-up may be helpful for KFS patients.
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    What is the fate of clubfoot patients treated by posteromedial release?
    (Springer Verlag, 2015) İşyar, Mehmet; Çakmak, Selami; Mahiroğulları, Mahir; Keklikçi, Kenan; Ekinci, Mustafa Bahadır; Rodop, Osman
    Introduction: Management and long-term results of operatively treated clubfoot deformity still remains controversial. The aim of this study was to evaluate the radiological and clinical results of adult clubfoot patients treated with posteromedial release. Materials and methods: Between 2005 and 2012, we evaluated patients with congenital foot deformities regarding clubfoot who were operatively treated with complete posteromedial release. Out of 320 patients evaluated, 29 patients (40 feet) were included the study. We also included foot radiographies of 40 healthy adults. Talocalcaneal angle on the dorsoplantar projection (TC-DP) and lateral projection (TC-L) and talus–first metatarsal angle on the dorsoplantar projection (TFM-DP) were measured for both clubfeet and control groups. Laaveg–Ponseti functional rating system was used for clinical evaluation and measurement of lower leg circumference was used for detection of atrophy. Results: The average age was 21.5 years (range 19–34). The mean TC-DP angle was 16.97 in the clubfeet group and 21.03 in the control group. The mean TC-L angle was 23.34 in the clubfeet group and 33.98 in the control group. The mean TFM-DP angle was 9.02 in the clubfeet group and 7.9 in control group. There were statistically significant difference between clubfoot and control groups regarding the TC-DP angle and the TC-L angle. The average Laaveg–Ponseti score was 74 points (range 42–96). While no significant correlations could be detected between the TC-DP angle, the TC-L angle, the TFM-DP angle and the functional score, a significant correlation was detected between circumferential measurement of lower leg and functional score (p = 0.04). Conclusion: Functional outcome may be affected by lower leg muscular atrophy instead of foot alignment disturbance. Lastly we believe that results for treatment of clubfoot—a three-dimensional deformity—need to be evaluated with three-dimensional imaging techniques.