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Öğe Bone grafts and nuclear medicine: Review(Turkiye Klinikleri, 2005) Kekilli E.; Ya?mur C.; Ertem K.; Türk Bilen B.Bone grafts find application in multiple settings: joint fusion and reconstruction, bone infection and resection, prothesis complications, congenital malformation and cosmetic adjustments, cranio-maxillofacial reconstruction, as well as the treatment of various trauma injuries such as fractures resulting in delayed unions and non-unions. Bone grafts have often played the roles of scaffolds, bridges, spacers, defect fillers, and bone-loss replacements. There is a growing trend in bone graft usage today. The use of autolog bone grafts is widespread in Turkey. Nuclear medicine has proven to be a helpful adjunct in the determination of graft viability. In particular, the status of vascular anastomoses can be shown on bone scintigraphy short periods after cortical and pedicle bone grafts. With added knowledge of individual pathophysiology, the interpretation of scintigraphic results is greatly facilitated. Non-vascularized bone grafts improve with revascularisation and remineralisation. In cancellous autografts, the vascular response is much greater than in cortical grafts. The entire cancellous bed may be completely revascularized within approximately 1 to 2 weeks. Healing of vascularized bone grafts and pedicles is similar to the process manifested in fractures. Allograft bone simply provides calcium scaffolding and does not possess bone-growing cells or proteins. Previous studies utilizing bone scintigraphy have shown that allograft healing proceeds not unlike that of autografts, with the exception that revascularisation and remineralisation are delayed. The authors review the current literature on bone grafting procedures and discuss the possible applications of nuclear medicine in this setting. Copyright © 2005 by Türkiye Klinikleri.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 Consecutive posterior shoulder fracture dislocation after a cerebral saccular aneurysm episode: a rare case(Elsevier B.V., 2022) Sağır A.; Köse H.; Ertem K.[No abstract available]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 effect of injury level, associated injuries, the type of nerve repair, and age on the prognosis of patients with median and ulnar nerve injuries(2005) Ertem K.; Denizhan Y.; Yologlu S.; Bora A.OBJECTIVES: In this study, we aimed to evaluate the functional results of nerve repair (median and/or ulnar) in patients with forearm clean-cut injuries and investigated the effect of injury level, associated injuries, the type of repair (primary or secondary), and age on the prognosis. METHODS: The study included 42 patients (34 males, 8 females; mean age 31 years; range 9 to 62 years) who were treated for forearm clean-cut injuries. Involvement was in the proximal forearm in four, mid-forearm in 11, and distal forearm in 27 cases. There were 51 nerve injuries affecting the median nerve (n=30) and the ulnar nerve (n=21). Nerve injuries were isolated in 12 patients, associated with tendon injuries in nine patients, and with tendon and artery injuries in 21 patients. The patients were evaluated in four age groups including 0-15, 16-30, 31-45 years, and 46 years or above. Functional evaluations were made using the Seddon classification. The effect of injury level, associated injuries, the type of repair, and age on the prognosis was assessed. The mean follow-up was 39 months (range 11 to 57 months). RESULTS: Although the clinical and functional results of primary and late-primary repairs were less favorable than those of secondary repairs, the difference did not reach a significant level (p>0.05). The injury level, associated injuries, and age did not influence the Seddon scores significantly (p>0.05). In the age group of 0-15 years, the results were very good in all the patients (100%), but good and very good results accounted for only 20% in the age group of 46 years or above. CONCLUSION: In appropriate cases with clean-cut nerve injuries, primary repair must be the first choice. Taking the low regeneration capacity into consideration, priority should be given to reconstructive procedures in patients at older ages.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 A giant solitary schwannoma of the arm mimicking cyst hydatid(2006) Ertem K.; Altinok M.T.; Gokce H.; Kirimlioglu H.We present a 77-year-old female with a size of 9.5×9×7 cm 3 giant schwannoma of musculocutaneous nerve volarly located in midarm, which was misdiagnosed as cyst hydatid on ultrasonographic and magnetic resonance image examination. There was not any neurologic sequele after the operation. In case of the similarity of their clinical and radiological findings, schwannoma should be included in the differential diagnosis of hydatid cysts especially in endemic countries. © Springer-Verlag 2006.Öğe An isolated acute pisiform fracture: Usefulness of magnetic resonance imaging(2004) Altinok M.T.; Ertem K.; Si?irci A.; Alkan A.The incidence of pisiform fracture is very low, and generally it is associated with other carpal or distal radial injuries. We present the case of an acute isolated pisiform fracture suspected on plain films and diagnosed on magnetic resonance imaging (MRI). MRI revealed a fracture line within the pisiform bone and helped to exclude additional fractures and soft-tissue injuries. Immobilization in a short arm cast was applied for 4 weeks, and the patient had good clinical response.Öğe Mid term results of radial metaphyseal core decompression on Kienböck’s disease(Verduci Editore s.r.l, 2017) Sevimli R.; Ertem K.; Aslantürk O.; Ari B.OBJECTIVE: Kienböck’s disease is a commonly seen posttraumatic avascular necrosis characterized by avascular necrosis of the lunate bone of the wrist which involves the dominant hand. In our study, we aimed to present midterm outcomes of 12 cases treated with radial metaphyseal core decompression. PATIENTS AND METHODS: In our clinic, 12 patients who applied to our outpatient clinic with intractable pain despite at least six weeks of conservative treatment were previously diagnosed and evaluated as Kienböck’s disease between the years 2006 and 2014. Patients at early stage received radial metaphyseal core decompression. RESULTS: The patients were evaluated as postoperative grip strength, flexion-extension gap, ulnar-radial deviation gap, VAS, Quick DASH and MAYO wrist scoring and patient satisfaction. CONCLUSIONS: We determined that interventions performed for Kienböck’s disease cannot halt radiological progression. We are of the opinion that radial metaphyseal core decompression, aiming at increasing blood perfusion, improve early diagnosis and treatment of Kienböck’s disease, increasing the patient satisfaction. © 2017 Verduci Editore s.r.l. All rights reserved.Öğe The Morel-Lavallée lesion: a conservative approach to closed degloving injuries(2004) Harma A.; Inan M.; Ertem K.OBJECTIVES: We evaluated the results of conservative treatment for closed degloving injuries (Morel-Lavallée lesion) of the pelvic girdle and lower extremities. METHODS: The Morel-Lavallée lesion developed in five male patients (mean age 25.6 years; range 6 to 40 years) due to crush under a vehicle (n=3) and traffic accidents (n=2). The lesions were localized in the pelvic girdle in three cases (2 lumbosacral, 1 lateral lumbar) and gluteal and trochanteric regions in two cases. Treatment was performed with compressive elastic bandages or corsets in all the patients, three of whom also underwent surgery due to accompanying pelvic fractures. Healing was defined as the loss of fluctuation and elicitation of the normal mobility of the injured skin on manual examination. The mean follow-up period was 23.6 months (range 10 to 41 months). RESULTS: Sacral decubitus ulcer developed in a patient in whom the detection of the lesion was obscured because of an associated femoral fracture and a perianal deep soft tissue lesion. Another patient with a wide fluctuating lesion in the gluteal-trochanteric region required aspiration, which yielded a negative culture. However, the lesion recurred early. Except for the patient with a sacral decubitus ulcer, all the lesions healed within a mean of six weeks (range 4 to 12 weeks) without any infections or necrosis. No recurrences were detected during the follow-up period. CONCLUSION: Closed degloving lesions in the pelvic and gluteal regions can be managed conservatively when the overlying skin is intact and the fluid accumulation is not excessive.Öğe Our clinical experience in the treatment of snakebites(2005) Ertem K.; Esenkaya I.; Kaygusuz M.A.; Turan C.OBJECTIVES: We evaluated the results of medical and surgical treatment for venomous snakebites and reviewed current principles of first aid and therapy for affected patients. METHODS: Fourteen venomous snakebite victims (8 males, 6 females; mean age 22 years; range 7 to 75 years) were enrolled in the study. Six patients received medical treatment alone, while eight patients required both medical and surgical treatments. Injury was in the upper and lower extremities in nine and five patients, respectively. Fasciotomy was performed in seven patients due to ensuing compartment syndrome, which was manifest with extreme swelling in the affected extremity and severe pain on passive stretching of the muscles at the site of the lesion. Fasciotomy site was primarily closed in three patients, whereas four patients required debridement and skin grafting. One patient, who developed necrosis due to an excessively tight tourniquet at the time of first aid, underwent amputation of the third finger at the level of the middle phalanx. The mean follow-up was 11.5 months (range 3 to 30 months). RESULTS: Following fasciotomy, a long incision line remained in all the patients and a marked scar tissue due to skin grafting, which were associated with flexion contracture deformities in two elbows (35 and 105 degrees). Hemopericardium detected in one patient was dealt with by medical treatment. The mean length of hospital stay was 11.3 days for medically treated patients, and 18.2 days following surgical treatment. No incidence of late serum disease or mortality was encountered. CONCLUSION: Management of snakebite victims include an appropriate first aid and treatment at the hospital; identification of compartment syndrome through clinical means and measurements should lead to an indication for fasciotomy.Öğe Radial artery pellet embolism: a case report(2004) Ertem K.; Ayan I.; Harma A.; Türköz R.; Bora A.[No abstract available]Öğe Somatotrophic reorganization in the brain after extremity replantation, revascularization and amputations: Investigated by SPECT analysis(2006) Ertem K.; Kekilli K.E.; Ya?mur C.; Ayan I.; Turgut S.; Bostan H.; Bora A.BACKGROUND: We wanted to investigate the somatotropic reorganization occurring in the motor and somatosensory cortex by using 99mTc-HMPAO SPECT analyses, after the extremity revascularization, replantation or amputation. METHODS: Twelve patients (11 men, 1 female; mean age 38.9±14.7 years) and controls (5 men, mean age 32.2±7.9 years) were enrolled in this study. After reconstruction, lower, middle and upper orbitomeatal slices with precentral and postcentral slices were obtained. All images were visually and semi-quantitatively evaluated. Mann-Whitney U-test was used for statistical analysis. RESULTS: In the revascularization and replantation patients, postcentral and precentral hypoperfusions were seen at dominant hemisphere. In the amputated patients, postcentral (in 3 of 4 cases) and precentral hypoperfusions were seen at non-dominant hemisphere and postcentral hypoperfusion (in 1 of 4 cases) was seen at dominant hemisphere. In our patients, most significant difference in regional cerebral blood flow was found in posterior parietal cortex (somatic associated area). CONCLUSION: Changes that take place in precentral and postcentral cortical areas subsequent to the extremity replantation-revascularization of the organ is a good indicator of somatotrophic reorganization.Öğe Ultrasonograpic Assessment of Relationship Between the Palmaris Longus Tendon and the Flexor Retinacular Ligament and the Palmar Aponeurosis of the Hand(TIP ARASTIRMALARI DERNEGI, 2010) Ertem K.; Si?irci A.; Karaca S.; Si?irci A.; Karakoç Y.; Yolo?lu S.Malatya, TurkeyAim: This study aimed to evaluate the presence of the Palmaris Longus Tendon (PLT) and the relationship between the Flexor Retinacular Ligament (FRL) and the Palmar Aponeurosis (PA) of the hand. Method: 62 voluntary subjects (31 female, 31 male students and personnel from the Inonu University, at the average age 28.38 ± 6.86 years ranging from 19 to 48 years) took part in this study using ultrasound. Result: Significant differences were found in the PA p-m-d diameters of subjects between with and without PLT bilaterally, on the right and the left hand (p<0.05), whereas there was no meaningful difference considering FRL diameters (p>0.05). Furthermore, this ultrasonographic assessment revealed the continuity of collagen bunches of the PL tendon up to FRL, but not PA. Conclusion: Although not demonstrated by ultrasonography here, the increased thickness of the PA in subjects with a PLT supports the findings in the literature in which the structural continuity between the PLT and PA have been stressed.
