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    A comparison of continuous interscalene block versus general anesthesia alone on the functional outcomes of the patients undergoing arthroscopic rotator cuff repair
    (Springernature, 2019) Gurger, Murat; Ozer, Ayse Belin
    PurposeThe aim of this prospective and randomized study was to compare the effects of general anesthesia to the combination of general anesthesia and continuous interscalene block on postoperative pain and functional outcomes in patients undergoing arthroscopic rotator cuff repair.MethodsThis study included a total of 85 patients aged 45-74 years, who were scheduled for elective arthroscopic rotator cuff repair. One group consists of patients who underwent only general anesthesia (GA, N=43), and the other group consists of patients who underwent a combination of continuous interscalene brachial plexus block and general anesthesia (CISB+GA, N=42). Pain levels of the patients were evaluated postoperatively by a visual analog scale. Shoulder function was evaluated preoperatively and postoperatively using the Constant score.ResultsPatients in the CISB+GA group had lower postoperative visual analog scores and less additional analgesic needs during the early postoperative period than those in the GA group. Constant scores of the patients in the CISB+GA group at postoperative week 6 were higher than those in the GA group. Evaluation of the functional outcomes at 6 months postoperatively showed that there were no significant differences between the two groups.ConclusionAlthough CISB significantly improved postoperative pain control and early (in the first 6 weeks) functional outcomes following arthroscopic rotator cuff repair, there was no significant difference between the CISB group and CISB+GA group at 6 months.Level of evidenceLevel II, Randomized Controlled Trial, Treatment Study.
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    The effect of biceps tenotomy on clinical results in patients with rotator cuff rupture
    (2019) Once, Gokhan; Gurger, Murat; Demir, Sukru
    Aim: This study aims to evaluate the effect of tenotomy on clinical and radiological outcomes in the treatment of biceps long head tendon pathologies associated with rotator cuff tears.Material and Methods: The study was conducted with 66 patients who met the inclusion criteria and were available (Group 1: Tenotomy, n = 40; Group 2: Non-tenotomy, n = 26). Clinical evaluation of the patients was performed with Modified Constant-Murley Scoring, radiological evaluation with ultrasonography, functional evaluation with dynamometer and visual evaluation with the detection of Popeye Sign finding. Results: The mean age of the patients in group 1 was 58.17 ± 7.95, the follow-up period was 28.87 months, the mean age of the patients in group 2 was 60.61 ± 4.66, and the follow-up period was 35.28 months; there was no statistically significant difference between two groups (p> 0.05). The mean score of the patients in group 1 was 89.83 ± 7.87, whereas the mean score of the patients in group 2 was 86.19 ± 7.07 (p> 0.05). In the ultrasonographic examination, the tendon cut in 24 (60%) of the 40 patients who underwent tenotomy was seen in the bicipital groove, but not in the groove in 16 (40%) patients, but only 3 of these patients had “Popeye Sign” findings.Conclusion: Tenotomy for the treatment of biceps tendon pathologies associated with rotator cuff tear may be an effective treatment method in terms of cost, pain relief and postoperative rehabilitation in the appropriate patient group.Keywords: Rotator cuff, long head of biceps, tenotomy, popeye sign.
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    Our clinical results in the management of proximal humeral fractures
    (2020) Key, Sefa; Demir, Sukru; Emeli, Adem; Gurger, Murat; Sevimli, Reşit; Once, Gokhan
    Aim: The aim of this study was to evaluate the clinical, radiological and functional results of patients treated with different methods in our clinic for proximal humerus fracture. Material and Methods: A total of 106 patients with a diagnosis of proximal humerus fracture, who were scheduled for treatment, received management and followed up periodically after discharge were included. Patient files, X-RAY radiographs in the PACS system, surgical notes and outpatient epicrisis were used. Functional results were evaluated according to Constant shoulder score at the last visit.Results: The mean age of the patients was 53.6 years (17-94). The mean follow-up period was 11.3 months (6-40 months). 55 (51.9%) had Type II, 35 (33%) had Type III and 16 (15.1%) had Type IV proximal end humeral fractures. As a result of the evaluation performed at the last follow-up of the patients, Constant-Murley’s total score was 64.50 out of 100 (31-88). Score distribution according to Neer classification of patients; A Constant-Murley score median with a Neer Type II fracture was 74.00 (36-88), a Constant-Murley Score median with a Neer Type III fracture was 61.00 (31-78), and a Constant-Murley score median with a Neer Type IV fracture was 44.50 (33-70). Conclusion: When the fracture type and functional outcome of the patients were compared, functional outcome decreased as the fracture type increased. Young patients had better functional results than older patients.
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    Relationship between anesthesia method and recurrence rate after surgical treatment of ganglion cysts
    (2020) Demir, Sukru; Kazez, Muhammet; Sevimli, Reşit; Key, Sefa; Gurger, Murat; Once, Gokhan
    Aim: Recurrence is frequently reported in patients operated on with the diagnosis of ganglion cyst. In this study, it was aimed to investigate the relationship between relapse and anesthesia method in patients who underwent total surgical excision.Material and Methods: 133 patients who were operated with a preliminary diagnosis of ganglion cyst in the orthopedics and traumatology Clinic between 2015-2019 were included in the study. The demographic features of the patients, the location of the cyst and the anesthesia method applied were evaluated retrospectively.Results: Of the 120 patients operated on, 76 (63.3%) were female and 44 (36.7%) were male. General anesthesia was performed in 44 (37%), sedation anesthesia in six (5%), regional anesthesia in 42 (35%), and local anesthesia in 28 (23%). During routine follow-up, 19 (15.8%) patients showed recurrence on average 6-12 months after the operation. When anesthesia method of patients who developed recurrence after surgery was examined, it was found that local anesthesia was performed in 13 (46.4%) of 19 patients.Conclusion: It has been determined that ganglion cysts are more likely to recur with local anesthesia during surgery than other anesthesia methods. The result obtained suggests that local anesthesia causes surgical failure due to the limited working field of the surgeon, the patients feel pain when deeper tissues are reached and the lack of adequate exposure.