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Öğe Assessment of the vulnerability of the proximal tibiofibular joint to injury during osteotomies(2006) Esenkaya I.; Elmali N.; Kaygusuz M.A.; Misirlio?lu M.; Atasever A.OBJECTIVES: We evaluated the dimensions and anatomic localization of the proximal tibiofibular joint (PTFJ) in human cadaver and amputated knees. In addition, we assessed the relation between the osteotomy line and the PTFJ and its vulnerability to injury on radiographs of patients after proximal tibial medial open wedge osteotomy (PT-MOWO). METHODS: In the first phase, dimensions of the tibial part of the PTFJ lying between the lateral tibial condyle and the fibular head were measured by digital calipers in six human cadaver and six fresh amputed tibiae (4 females, 8 males; mean age 57 years) to evaluate the relation between the tibial surface of the PTFJ and the posterior part of the lateral tibial plateau. In the second phase, anteroposterior, lateral, and medial oblique radiographs were assessed with respect to the relation of the osteotomies with the PTFJ following PT-MOWO in 46 knees of 44 consecutive patients (38 females, 6 males; mean age 51 years). RESULTS: On cadaver and fresh amputation materials, the mean long and short axis dimensions of the ellipsoidal articular surface of the PTFJ in the posterolateral aspect of the tibial plateau measured 18.8 mm (range 13 mm to 20 mm) and 14.9 mm (13 mm-17 mm), respectively. The upper articular border lied at a mean of 6.3 mm (2 mm to 11 mm) distal to the posterior border of the articular surface of the lateral tibial plateau. Medial oblique radiographs showed that the osteotomy line extended to the PTFJ in cases in which it was proximally located, particularly in three cases (6.5%) where lateral cortex continuity was interrupted. CONCLUSION: The osteotomy line may encroach upon the PTFJ unless preoperative oblique radiographs are evaluated and a parallel course to the tibial slope of the lateral tibial plateau is followed. In addition, insufficient evaluation of PT-MOWO candidates may result in damage to the lateral cortex, which increases the risk for injury to the PTFJ.Öğe Clinical and radiologic results of surgically-treated acetabular fractures(2003) Elmali N.; Ertem K.; Inan M.; Ayan I.; Denizhan Y.OBJECTIVES: We evaluated the functional and radiologic results of surgical treatment in patients with displaced acetabular fractures. METHODS: The study included 21 patients (13 males, 8 females; mean age 35 years; range 21 to 63 years). Before surgery, all the patients were evaluated with anteroposterior, iliac, and obturator oblique views and computed tomography scans. According to the Letournel-Judet classification, the fractures were simple in 10 patients and complex in 11 patients. Twelve patients had posterior wall and/or the posterior column fractures. Four patients underwent closed reduction under emergency settings for accompanying posterior dislocations. The mean time to surgery was 4.8 days (range 1 to 13 days). Surgery was performed by the Kocher-Langenbeck approach (n=12), a triradiate approach (n=5), and a modified extended iliofemoral approach (n=4). Functional results were assessed by the D'Aubigne-Postel's knee scoring system and radiologic results using anteroposterior, iliac, and obturator oblique views. The mean follow-up was 31 months (range 19 to 64 months). RESULTS: Functional results were excellent in eight patients (38.1%), good in seven (33.3%), satisfactory in four (19.1%), and poor in two patients (9.5%). Radiologic examination showed posttraumatic arthrosis in four patients (19.1%), heterotopic ossification in three patients (14.3%), and avascular necrosis in two patients (9.5%). Radiologic results were excellent and good in 16 patients (76.2%), satisfactory in three patients (14.3%), and poor in two patients (9.5%). CONCLUSION: Clinical and radiologic results showed concordance. The presence of dislocations and inadequate reduction were associated with poor functional results.Öğe Delayed reduction of irreducible chronic posterolateral dislocation of the knee with buttonholing of the medial femoral condyle(2005) Elmali N.; Elmali N.; Esenkaya I.; Harma A.Traumatic knee dislocations are relatively rare and almost always respond to closed reduction; however, a small percentage of knee dislocations are irreducible and in these cases open reduction is frequently required. A 65-year-old man with an unreduced posterolateral knee dislocation with laterally dislocated patella was seen 3 weeks after a motor vehicle accident. Medial femoral condyle was found buttonholed through the medial capsule together with the medial collateral ligament and lying in the medial joint space that allowed posterior rotary dislocation of the joint. Both cruciate ligaments and medial meniscus were torn. There was no evidence of any vascular or nerve injury. Reduction was accomplished by removal of the capsuloligamentous structures which were incarcerated in the trochlea and intercondylar notch and by excision of meniscal tear. Following posterior cruciate ligament reconstruction with patellar tendon autograft, lateral patellar release, vastus medialis advancement, and gracilis transfer were done. © Urban & Vogel.Öğe The effect of continuous passive motion after repair of Achilles tendon ruptures: an experimental study in rabbits(2002) Ertem K.; Elmali N.; Kaygusuz M.A.; Inan M.; Ayan I.; Güner G.; Karakaplan M.OBJECTIVES: The effect of continuous early passive motion on morphologic and histologic healing following repair of Achilles tendon rupture was evaluated in comparison with cast immobilization. METHODS: Achilles tendons of 20 adult rabbits were repaired with the use of modified Kessler technique after surgical transection. Throughout the postoperative six weeks, the rabbits were randomly assigned to cast immobilization (n=10) and to continuous early passive motion four hours a day (n=10). All the rabbits were sacrificed at the end of six weeks and their tendon tissues were removed for macroscopic and histologic examinations. RESULTS: On macroscopic evaluation, findings on adhesions at the operation site, periarticular atrophy, and the ROM of the ankle joint were found significantly more favorable with continuous early passive motion than those of the control group (p<0.001, p<0.05, and p<0.001, respectively). On histologic evaluation, regular collagen bundle alignment was 70% and 20% in the study and control groups, respectively (p<0.05), whereas findings on hyalinization and inflammatory infiltration were not significantly different. CONCLUSION: The utilization of continuous controlled passive motion following repair of Achilles tendon rupture was shown to have beneficial effects on tendon healing and ankle range of movement, without leading to eventual ruptures.Öğe The factors affecting thermal necrosis secondary to the application of the Ilizarov transosseous wire(2005) Inan M.; Mizrak B.; Ertem K.; Harma A.; Elmali N.; Ayan I.OBJECTIVES: We investigated thermal changes associated with the application of the Ilizarov transosseous wires, the extent of necrosis, and the factors affecting necrosis. METHODS: We used a pair of tibiae from a 1-year-old cow. After removal of metaphyseal areas, each of four equal diaphyseal zones marked on both tibiae was drilled at 600, 900, 1,200 and 1,800 rpm, each time with a new wire. Heat changes were recorded with heat electrodes during the application and the speed of the wire was calculated. For histopathological examination, specimens were obtained at the access and exit sites to assess the extent of necrosis. Thermal changes between the zones and immediate and remote cortices were compared. The most significant factor affecting the heat changes was analyzed by linear regression. RESULTS: Heat changes varied between 48.4 degrees C (at 1,200 rpm) and 151.9 degrees C (at 600 rpm). The thickness of the immediate cortex, the time and speed for the wire to pass the cortex were found as significant parameters in heat changes (p=0.003, p=0.01, and p=0.01, respectively). A negative correlation was found between the speed of the wire and the thickness of the necrotic area (r=-0.901, p=0.001). Regression analysis showed that the time for the wire to pass through the cortex was the most significant factor in inducing heat changes in both cortices (p=0.001, p=0.003, respectively). Histopathologically, the extent of necrosis and bone erosion was associated with lower drill speeds. Necrosis was significantly notable in the immediate cortex than that of the remote one (p=0.006). CONCLUSION: Transosseous wires should be passed at high drill speeds and with earliest time elapses to reduce thermal necrosis.Öğe The influence of atorvastatin on tendon healing: An experimental study on rabbits(2010) Esenkaya I.; Sakarya B.; Unay K.; Elmali N.; Aydin N.E.Hyperlipidemia is a major risk factor for coronary heart disease. The most commonly used antihyperlipidemic drugs are 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors (statins), of which atorvastatin is one of the most widely used. Little is known about the relationship between tendinopathy and HMG CoA reductase inhibitors (statins) or the effects of atorvastatin use on tendon healing following surgical repair of tendon rupture. We hypothesized that atorvastatin negatively affects this healing process. The Achilles tendons of 16 New Zealand rabbits were ruptured surgically and repaired with sutures. Eight of the rabbits were given oral atorvastatin. The other 8 served as a surgical control group. Six weeks postoperatively, all the rabbits were sacrificed, and the repaired tendons were removed. After standard histological preparation, fibroblastic activity, revascularization, collagenization, collagen construction, and inflammatory-cell infiltration were evaluated. On comparing the atorvastatin and surgical control groups, we observed no difference in fibroblastic activity. Although it did not reach statistical significance in our study, a difference was noted in revascularization, collagenization, and inflammatory cell infiltration; and a statistical difference was observed in collagen construction. Doubt remains about the adverse effect of atorvastatin use during tendon healing. Further investigations in animal and human models are needed on the effects of tendon healing when atorvastatin is administered for a longer time frame prior to the injury.Öğe Locked posterior dislocation of the hip: a case report(2007) Esenkaya I.; Elmali N.Impaction fractures of the femoral head occurring after anterior or posterior hip dislocations are well described. However, locked posterior hip dislocation resulting in sinking of the posterior acetabular rim into the femoral head has hitherto been undescribed. A 26-year-old male patient presented with complaints of severe pain in the left thigh and marked limitation in the movements of the left hip two weeks after an in-car crash. He could only walk with crutches. Shortly after the accident, he was examined at another center with physical examination and plain radiographies and was given bed rest and medications for pain relief. Computed tomography demonstrated the locked posterior hip by the impact of the posterior acetabular rim against the femoral head. At surgery, the posterior acetabular rim was embedded in the anteromedial surface of the femoral head resulting in an osteochondral impaction fracture with a penetration depth of 12 mm. Due to wide destruction to the cartilage surface, an uncemented bipolar hemiarthroplasty was performed. After 28 months of follow-up, he had no complaints and hip movements were painless with full range of motion.Öğe The medial approach for arthroscopic-assisted fixation of lateral tibial plateau fractures(SAGE Publications Ltd, 2014) Elmali N.; Baysal Ö.; Karakaplan M.; Gülabi D.; Sağlam F.Objectives: Tibial plateau fractures are complex injuries involving the weight bearing surface of the tibia. Open reduction and internal fixation with plates and screws is an established method of treatment for complex fractures (Schatzker types V–VI). Arthroscopically assisted techniques have been used successfully for simple fractures (Schatzker types I–III). Historically, arthroscopic-assisted reduction for lateral tibial plateau fractures have been performed through a laterally based metaphyseal window. We found this technique to have several limitations, including bone grafting through a short subchondral tunnel. Also, there was a risk of lateral vascular supply distrubtion. We proposed that medial window approach technique would provide a longer tunnel for subchondral support and aid in fracture reduction. We aimed to present our initial experiences in first seven cases approaching lateral tibial plateau fractures through a medial metaphyseal window. Methods: Our series involves 7 patients with 5 Schatzker type II and 2 Schatzker type III lateral tibial plateau fractures treated by a single surgeon, using a medial approach for the arthroscopic assisted fixation. There were 5 males and 2 females. The average age at the time of surgery was 34.2 years, (29-52). All of the patients underwent plain radiography and CT scanning in each knee Time from injury to surgery was 7.2 days (4-12 days). Length of follow up was 9 months (6-22 months). There was 2 lateral meniscus tear that treated with partial meniscectomy and 1 MCL injury that treated conservativeely. Surgery was performed in four steps. First step was diagnostic arthroscopy of the injured knee,, second step was reduction of the fracture using a sylindiric tube with fluoroscopic guidance, third step was the arthroscopic verification of the fracture reduction, and finally percutaneous osteosynthesis of the fracture.Care is taken to keep the flow to gravity or, if using a pressure controlled pump, to set the pressure at approximately 40 millimeters of mercury. This will help alleviate the risk of compartment syndrome. Compartment firmness should be continuously monitored throughout the procedure. Results: No complications related to the procedure were observed. All patients reported a relevant reduction in pain, were able to mobilize with full weight bearing in the average 12 weeks (9–15 weeks). No secondary loss of reduction was observed in radiological controls; No revision surgery was required. Functional assessment according to HSS (hospital for special surgery) of the patients were excellent in 5 cases, good in 2 cases. Conclusion: Because depressed fragments are elevated from distal cortical windows, the importance of an intact, or easily restored, “cortical envelope” is paramount. In most Schatzker Type II and III fractures, the cortical envelope is either intact or can easily be restored with a clamp. The main advantage of medial approach for these fracture patterns is the creation of a long tunnel for subchondral support, the ease of fracture reduction and saving the lateral vascular supply. © The Author(s) 2014.Öğe Synovial chondromatosis: a report of four cases with three diverse localizations(2003) Elmali N.; Esenkaya I.; Alkan A.Four patients with three diverse localizations of synovial chondromatosis are presented. Three were men and one was a woman (mean age 32 years; range 21 to 55 years). The site of involvement was the shoulder joint in two patients, and the ankle and hip joints in the remaining two. Pain and restricted joint movement were common complaints. Other clinical complaints included locking, crepitus, loss of muscle strength, instability, and feeling of a mass lesion. Plain roentgenograms showed multiple radiopaque nodules/loose bodies, with the female patient additionally having osteoporosis and bone erosion. The patients underwent arthrotomy followed by synovectomy and the loose bodies were removed. Diagnoses were confirmed by histologic examination. All the patients became asymptomatic following surgical treatment and no evidence of recurrent disease was detected.Öğe Two cases of severe familial ochronotic arthropathy(2006) Elmali N.; Esenkaya I.; Türkmen E.; Hazneci E.Ochronotic spondylarthropathy, a long-term musculoskeletal manifestation of alkaptonuria and involvement of joints may lead to a radiographic appearance similar to that of degenerative joint disease. We report the cases of two siblings with progressive familial ochronotic arthropaty treated with total hip arthroplasty. © Springer-Verlag 2005.
