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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 Comparison of the pull-out strengths of three different screws in pedicular screw revisions: a biomechanical study(2006) Esenkaya I.; Denizhan Y.; Kaygusuz M.A.; Yetmez M.; Keleştemur M.H.OBJECTIVES: We investigated the possible effects of three pedicular screws on axial pull-out strength in pedicular revision surgery. METHODS: Two study groups were formed from calf lumbar vertebrae. Initially, Alici pedicular screws with an outer diameter of 6.5 mm were applied (with or without tapping) to all the pedicles. All the pedicles were subjected to axial pull-out testing to induce pedicular insufficiency. Then, Alici pedicular screws with an outer diameter of 7 mm were applied to the left pedicles. The right pedicles in the two study groups were assigned to receive two different types of pedicular screws with an expandable (enlargeable) end, respectively. Axial pull-out testing was repeated in both groups and the results were compared with the initial pull-out strength values. RESULTS: In the first group, 65% and 64% of the initial pull-out strengths were obtained with 7-mm Alici pedicular screws and with expandable pedicular screws, for the left and right pedicles, respectively. The corresponding pull-out strengths in the other study group were 70% and 68.5% of the initial values, respectively. Tapping of the screw hole entrance resulted in a mean decrease of 13% in the pull-out strength compared to screw applications without tapping. CONCLUSION: Pedicular screw revisions using a 0.5 mm greater screw in diameter did not provide adequate screw-bone inter-face strength and pedicle filling. Similarly, expandable pedicular screws did not contribute to screw stability.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 Fixation of proximal tibia medial opening wedge osteotomy using plates with wedges(2005) Esenkaya I.OBJECTIVES: The indications, surgical technique, and the results of fixation using plates with metal wedges were assessed in proximal tibia medial opening wedge osteotomy. METHODS: Forty knees in 38 consecutive patients (5 men, 33 women; mean age 51 years; range 36 to 65 years) with medial compartment osteoarthritis of the knee were treated with proximal tibia medial opening wedge osteotomy using plates with wedges. Following arthroscopic debridement, medial proximal tibial osteotomy was performed laterally and proximally on an oblique line and 3-4 cm distal to the medial joint space. Disruption of the lateral cortex was avoided. Fixation of the osteotomy was performed using plates with wedges. The plates which were designed by the author were either rectangular in shape with two or four holes or had an inverse "L" shape with four holes, bearing metal wedges at varying heights from 5 to 15 mm. The plates were fixed with screws. Tricortical (n=8) or bicortical (n=25) iliac bone autografts and allografts (n=7) were used. Clinical and functional evaluations were made using the HSS scoring system. The mean follow-up was 17 months (range 9 to 36 months). RESULTS: The mean preoperative and postoperative tibiofemoral angles were 4.3 degrees varus (0 degrees -10 degrees ) and 5.8 degrees valgus (3 degrees -11 degrees ), respectively. The mean HSS score increased from 59 (range 52 to 75) preoperatively to 90 (range 79 to 96) on final evaluations. During surgery, lateral tibial plateau fissures and lateral cortex fractures occurred in three (7.5%) and 11 (27.5%) knees, respectively. Delayed healing and delayed union and breakdown of a distal screw were encountered in one patient (2.5%). CONCLUSION: Fixation of proximal tibia medial opening wedge osteotomy using plates with wedges provides adequate stabilization to maintain the desired correction and to allow early functional rehabilitation in the treatment of medial osteoarthritis of the knee.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 A morphologic evaluation of the sacroiliac joint and plate fixation on a pelvic model using a S1 pedicular screw, transiliosacral screws, and a compression rod for sacroiliac joint injuries(2002) Esenkaya I.OBJECTIVES: Morphological measurements were performed, of the articular surfaces and adjacent bone structures of the sacroiliac joint on dry bone specimens to determine the projection of the sacroiliac joint on the outer table of the posterior ilium. In addition, the effect of plate fixation using transiliosacral screws and a pedicular screw on S1 attached via a compression rod was evaluated on pelvic models to be applied in sacroiliac joint injuries. METHODS: Quantitative caliper measurements of dry bone specimens including 20 os coxae and 10 sacrum were made on the articular surfaces of the sacrum and the posterior ilium, thickness of the posterior iliac bone at different levels, and the distance from the outer walls of S1 and S2 foramina to the sacral facies articularis. After the construction of a plate matching the projection of the lateral sacral mass on the outer table of the posterior ilium, four transiliosacral screws were applied lateral to the sacral foramina on pelvic models. A pedicular screw sent to S1 was attached to the plate with a threaded compression rod. RESULTS: The mean values for the articular surface of (i) the posterior ilium were 53.3 mm (base length), 38.5 mm (height), and 56.2 mm (the distance from the anterior margin of the articular surface to the spina iliaca posterior superior); and (ii) the sacrum, 57.2 mm (base length), and 34.6 mm (height). The mean thickness of the posterior ilium was 19.2 mm, and the mean distance from the lateral walls of the sacral foramina at S1 and S2 levels to the articular surface was 21.7 mm. For the deduced projection, the perpendicular line from the middle of the base was found to be the safe zone for screw applications. CONCLUSION: Through a plate applied matching the projection area, multiple screws may be sent lateral to S1 and S2 foraminal levels without damage to the sacral neural and surrounding vital structures. A stable fixation can be achieved by combining the plate/screw system with a S1 pedicular screw.Öğe Opening wedge proximal tibial osteotomy using the plate with wedge(2006) Esenkaya I.Because of the increased life expectancy and the higher activity levels, corrective osteotomies have become more popular in the elderly population to avoid the total knee arthroplasty or to delay its application age. Proximal tibial osteotomy (PTO) is a widely accepted and an extensively used surgical procedure for the treatment in medial compartment osteoarthritis of the knee with malalignment, particularly in young and active patients.In the past, many PTO applications were performed just by radiological evaluations of the patients, even of the patients with severe osteoarthritis and deformity. In these patients, internal fixation was not usually performed. However, even if it was performed, not enough stabilization was provided, and the plaster cast immobilizaton was being applied for a long time postoperatively. It is usual to have poor results in some of these patients that should be normally kept out of indication. In the contemporary PTO techniques, the lateral compartment is preoperatively evaluated with arthroscopy. But for patients who do not for osteotomy, the procedure cannot be applied to them. For the patients who fit for osteotomy, if necessary, the treatment can be initially performed for the intraarticular knee pathologies. Internal or external fixation systems make the cast application unnecessary and let the rehabilitation facilities begin in the early period because of their sufficient stabilization. These results remind us of the applicability of alternatives other than prosthesis, which enables activity without forming artificial joint in patient groups with unicompartmental involvement whose profession requires high activity or who are willing to take sport actively. Recall that in the past, patients with severe osteoarthritis who previously had had osteotomy should be initially kept out of the indication. We think that patients with PTO indication should be separated from the patients of tricompartmental osteoarthritis who will have total knee prosthesis. Moreover, the unicompartmental knee arthroplasty can be an alternative for osteotomy, and the total knee arthroplasty applications should not be chosen as an alternative to PTO but as an advanced treatment step (stage). We also think that arthroplasty applications are not innocent at all because of the possible complications and consequences. Performing the osteotomy carefully by using fixation systems with sufficient stabilization in suitably selected patients, we can obtain satisfactory, intermediate, and long-term results of postoperative fast rehabilitation program.Medial opening wedge osteotomy, as one of the PTO techniques, can be applied as (a) an acute fixation with a plate in which the distraction is acutely applied to treat the present deformity or (b) as a distraction osteogenesis (callus distraction or hemicallotasis) in which the distraction is gradually applied, and the fixation is done by an external fixator. Osteotomy can be performed monoplanar, obliquely or transversely, on mediolateral plane on a flat line or biplanar and by leaving the tibial tubercle in the distal (V-shaped biplanar osteotomy) or proximal (retrotubercular osteotomy) fragment. Plates with various designs are used for the fixation, whereas in the distraction osteogenesis, various types of external fixators are used.A wedge plate designed by the author in proximal tibia medial opening wedge osteotomy, fixating the osteotomy surfaces by supporting them with wedge-shaped protuberances on the plate, is a fixation system that has a sufficient stabilization and enables early rehabilitation in the postoperative period. © 2006 Lippincott Williams & Wilkins, Inc.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 Radiologic and morphologic evaluation of the lateral sacral mass(2003) Esenkaya I.; Aluçlu M.A.; Kavakli A.; Bulut H.T.OBJECTIVES: Morphologic measurements of the lateral sacral mass (LSM) and adjacent bone structures were made on dried sacrum specimens, together with radiologic evaluations on computed tomography (CT) scans in order to assess the appropriateness of this area in iliosacral screw applications. METHODS: On thirty dried human sacral bone specimens, morphologic measurements of the LSM were made by a compass sensitive to millimeters. Computed tomographic views of S1 and S2 pedicle-bodies and intervertebral foramina were obtained to make radiologic measurements by a millimeter-sensitive ruler to examine the relationship between LSM and the neural canal and intervertebral foramina. RESULTS: The average widths of the LSM on the posterior and anterior surfaces of the sacrum were as follows. Posterior aspect: 24.1 mm on S1, 18.4 mm on S2 levels on the right; 24.5 mm on S1 and 18.8 mm on S2 levels on the left. Anterior aspect: 28.9 mm on S1, 22.6 mm on S2 levels on the right; 29.1 mm on S1 and 23 mm on S2 levels on the left. The average (oblique) heights of LSM on the postero-lateral surface were 39 mm on S1, 28.6 mm on S2 levels on the right; 37.4 mm on S1, 27.6 mm on S2 levels on the left. The average depth of the sacral ala was 50.6 mm on the right, 50.7 mm on the left. The average posterior alar height was 26 mm on both sides. On CT scans, the average widths of pedicle+sacral ala were measured as 37.6 mm (right) and 36.3 mm (left) at the S1 pedicle-body level. The average widths of LSM were 22 mm (right) and 22.3 mm (left) at the S1 intervertebral foramina level. The average widths of pedicle+LSM were 27.8 mm (right) and 26.4 mm (left) at the S2 pedicle-body level. The average widths of LSM at the S2 intervertebral foramina level were 15.9 mm (right) and 16.3 mm (left). CONCLUSION: Our results suggest that iliosacral screw fixation may be more safely performed, especially at the S1 pedicle-body level and lateral to the sacral neural canal and intervertebral foramina. Injury to the neural tissues and surrounding structures is more unlikely if preoperative measurements of LSM are made on CT scans.Öğe Removal of the wadding from the wound in shotgun-pellet injuries(2002) Esenkaya I.OBJECTIVES: Most of the gunshot injuries are caused by low-velocity bullets and shotgun pellets, resulting in mild soft tissue damage. They are sometimes associated with vascular involvement and fractures depending on the angle of entry. Bullets and especially pellets usually lodge in soft tissues. For those that are not easily detected, surgical exploration is not recommended unless they are of vital localizations. However, the removal of wadding, which may incite a local inflammatory response and harbor bacterial contaminants, is strongly recommended. METHODS: Of forty-one patients with shotgun injuries, eight patients were found to bear waddings that required removal. RESULTS: Waddings made of cork and plastic were removed from one and seven patients, respectively. In addition to patients' histories and wound-related features, radiolucent plastic waddings were predicted by the presence of a cluster of pellets on radiographs. Fractures were encountered in the injured extremity in six patients. No infections developed related to the primary wound. CONCLUSION: Although it is often difficult to locate a lodged wadding in the body, its removal is necessary because it can incite a local inflammatory response and harbor bacterial contaminants.Öğe Surgical treatment of scapular fractures(2003) Esenkaya I.OBJECTIVES: To evaluate the findings and results in patients who were treated surgically for scapular fractures. METHODS: Six patients (4 females, 2 males; mean age 40 years; range 25 to 59 years) with scapular fractures were treated by open reduction and internal fixation. All the fractures were caused by traffic accidents and all the patients had associated injuries. Four patients had scapular neck fractures, three of whom had accompanying ipsilateral clavicular fractures. In two patients, the fractures involved the glenoid fossa. The mean follow-up period was 27 months (range 18 to 38 months). Functional evaluations were made according to the scoring system described by Herscovici et al. RESULTS: The results were excellent in six patients, good in one, and fair in one patient. Four patients had no pain. Three patients returned to preinjury jobs. Two patients who were housewives were able do their housework. The range of movement was greater than 120 degrees in both abduction and flexion, and the muscle strength was 5 in four patients. No postoperative complications were encountered. CONCLUSION: Open reduction and stabilization followed by early rehabilitation may be successful in preventing stiffness, pain, and disability in scapular neck fractures accompanied by ipsilateral clavicle fractures, or fractures involving the glenoid fossa and leading to significant displacement.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 Traumatic anterior dislocation of the hip associated with ipsilateral femoral neck fracture: a case report(2002) Esenkaya I.; Görgeç M.A thirty-nine-year-old female patient was brought to the emergency room following an automobile accident. Radiographic examination revealed a subcapital fracture of the left femur associated with anterior femoral head dislocation, and a contralateral comminuted femoral shaft fracture. Computed tomography showed that the acetabulum was empty, with the femoral head dislocated anteriorly close to the obturator foramen. Uncemented total hip arthroplasty and locked intramedullary nailing were performed on the left and right sides, respectively. Sixty-two months after surgery, she had no difficulty in performing daily activities.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.
