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    Öğe
    A biomechanical comparison of polymethylmethacrylate-reinforced and expansive pedicle screws in pedicle-screw revisions
    (Turkish Assoc Orthopaedics Traumatology, 2009) Bostan, Bora; Esenkaya, Irfan; Gunes, Taner; Erdem, Mehmet; Asci, Murat; Kelestemur, M. Halidun; Sen, Cengiz
    Objectives: Different techniques and choices exist for revision of pedicle screws, two of which are pedicle screw combined with cement augmentation and expansive pedicle screw fixation. This biomechanical study was designed to compare the pullout strengths of two different revision techniques. Methods: Fourteen lumbar vertebrae obtained from four calves (mean age 15 months) were divided into two groups equal in number. Monoaxial 6.0-mm pedicle screws were inserted into the right pedicles, and axial pullout testing was performed at a rate of 10 mm/min and failure strengths were recorded. Revision was performed with the same-sized pedicle screws reinforced with polymethylmethacrylate in group 1, and with 7.0-mm expansive pedicle screws in group 2, and pullout testing was repeated to record maximum revision pullout strengths. Results: The mean pullout strengths recorded before and after revision were significantly different in both groups, being 2,162.9 +/- 718.5 N and 2,794.3 +/- 979.2 N in group 1 (p=0.041) and 2,605.0 +/- 487.6 N and 3,327.1 +/- 640.8 N in group 2 (p=0.012), respectively. However, the mean pullout strengths recorded before and after revision did not differ significantly between the two groups (p>0.05). Conclusion: Our results showed that expansive pedicle screws 1 mm larger in diameter provide similar pullout strengths to those of same-sized, polymethylmethacrylate-reinforced screws in revision of pedicle screw fixation, suggesting that they can be preferred with the additional advantages of ease of application and avoiding risks for pedicle fracture and cement leakage.
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    Monoplanar versus biplanar medial open-wedge proximal tibial osteotomy for varus gonarthrosis: a comparison of clinical and radiological outcomes
    (Springer, 2013) Elmali, Nurzat; Esenkaya, Irfan; Can, Murat; Karakaplan, Mustafa
    We compared clinical and radiological results of two proximal tibial osteotomy (PTO) techniques: monoplanar medial open-wedge osteotomy and biplanar retrotubercle medial open-wedge osteotomy, stabilised by a wedged plate. We evaluated 88 knees in 78 patients. Monoplanar medial open-wedge PTO was performed on 56 knees in 50 patients with a mean age of 55 +/- A 9 years. Biplanar retrotubercle medial open-wedge PTO was performed on 32 knees in 28 patients with a mean age of 57 +/- A 7 years. Mean follow-up periods were 40.6 +/- A 7 months for the monoplanar PTO group and 38 +/- A 5 months for the biplanar retrotubercle PTO group. Clinical outcome was evaluated using the hospital for special surgery scoring system, and radiological outcome was evaluated by the measurements of femorotibial angle (FTA), patellar height and tibial slope changes. In both groups, post-operative HSS scores increased significantly. No significant difference was found between groups in FTA alteration, but the FTA decreased significantly in both groups. Patellar index ratios decreased significantly in the monoplanar PTO group (Insall-Salvati Index by 0.07, Blackburne-Peel Index by 0.07), but not in the biplanar retrotubercle PTO group. Tibial slopes were increased significantly in the monoplanar PTO group, but not in the retrotubercle PTO group. Biplanar retrotubercle medial open-wedge osteotomy and monoplanar medial open-wedge osteotomy are both clinically effective for the treatment for varus gonarthrosis. Retrotubercle osteotomy also prevents patella infera and tibial slope changes radiologically. Therapeutic study, prospective comparative study, Level II.