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Öğe The comparison of femoral curves and curves of contemporary intramedullary nails(Springer, 2005) Harma, A; Germen, B; Karakas, HM; Elmali, N; Inan, MThe aim of this study was to evaluate both the cortical and the medullary anterior bowing of the femur, and to compare these measurements with current intramedullary nails to assess the adequacy of their design. Methods: Lateral digital radiographic views of left femurs of 104 normal subjects (18-68 years old) were obtained. Radii of cortical and medullary curvatures of femurs were calculated using these images. The values obtained were compared to the radius of curvatures of ten different intramedullary nails. Results: Medullary bowing was between 114 and 1,389 mm (mean: 722 mm, SD: 230 mm) and the cortical bowing was between 109 and 1,666 mm (mean: 770 mm, SD: 267 mm). For males, these values were 114-1,389 mm (mean: 722 mm, SD: 230 mm) and 109-1,666 mm (mean: 770 mm, SD: 267 mm), respectively. For females, they were 114-1,389 mm (mean: 722 mm, SD: 230 mm) and 109-1,666 mm (mean: 770 mm, SD: 267 mm), respectively. The differences between genders were not significant. Cortical and medullar bowing was strongly correlated with age (r=-0.269, p < 0.006 and r=-0.234, p < 0.017, respectively). These significances were produced by females only. Radii of curvatures of intramedullary nails ranged between 150 and 300 cm and were higher than the mean cortical (77 cm) and medullary (72.2 cm) bowings. Conclusion: The difference between the curves of femur and the contemporary femoral nails implicates the inadequacy of the design of such nails for the Caucasian race living in Anatolia. Therefore, such nails should be revised accordingly to prevent the above-mentioned complications.Öğe Effect of resveratrol in experimental osteoarthritis in rabbits(Springer Basel Ag, 2005) Elmali, N; Esenkaya, I; Harma, A; Ertem, K; Turkoz, Y; Mizrak, BObjective: Resveratrol (trans-3,4',5-trihydroxystilbene) is a phytoalexin found in high concentration in the skins of grapes and red wines which has been shown to have antiinflammatory, anticancerogen and antioxidant properties. Resveratrol is a potent and specific inhibitor of nuclear factor kappa B ( NF-kappa B). Resveratrol also inhibits COX-2 gene expression and enzyme activity. We aimed to determine the in vivo effects of intra-articular injections of resveratrol on cartilage and synovium in an experimental osteoarthritis (OA) model in rabbits. Methods: As OA model, rabbits underwent unilateral anterior cruciate ligament transection (ACLT). Five weeks after test group was injected with 10 mu Mol/kg resveratrol in dimethylsulphoxide ( DMSO) in the knees once daily for two weeks and as the control group at the same time DMSO was injected into the knees. All rabbits were killed one week after the last injection. Cartilage tissue and synovium were evaluated with a histological scoring system. Results: Histological evaluation of cartilage tissue by H&E staining revealed a significantly reduced average cartilage tissue destruction score of 1.7 in the resveratrol group versus 2.8 in the control group ( p = 0.016). Loss of matrix proteoglycan content in cartilage was also much lower, as determined by safranin O staining. Scores of synovial inflammation didn't show difference between groups ( 1,3 vs 2,2; p = 0.057). Conclusion: A characteristic parameter in arthritis is the progressive loss of articular cartilage. This study suggests that intraarticular injections of resveratrol starting at the onset of disease may protect cartilage against the development of experimentally induced OA.Öğe Effects of dominance, body mass index and age on grip and pinch strength(Ios Press, 2003) Ertem, K; Inan, M; Yologlu, S; Elmali, N; Harma, A; Sahin, S; Bora, AMeasurement of grip and pinch strength is an important component in hand evaluation. It assesses the patient's initial limitations and provides a quick reassessment of patient's progress throughout the treatment. This investigation was conducted to examine the effects of hand dominance, body mass index (BMI) and age on grip strength (GS) and pinch strength (PS) tasks. Subjects were 365 apparently healthy young male adults (19-33 years). No correlation was found between the BMI hand strength measures. Grip and pinch strength were measured instrumentally. The rule dominant hand (DH) is approximately 10% stronger than the nondominant hand (NDH) was found to be valid for left handed persons only (11.2%), otherwise these measures should be considered equivalent in both hands in clinical practice.Öğe Evaluation of the gluteus medius muscle after a pelvic support osteotomy to treat congenital dislocation of the hip(Journal Bone Joint Surgery Inc, 2005) Inan, M; Alkan, A; Harma, A; Ertem, KBackground: Many authors have reported that the pelvic support osteotomy prevents a Trendelenburg gait by restoring the biomechanics of the abductor muscle in patients with congenital dislocation of the hip. However, we are not aware of any studies in which the hip abductor muscles were examined following pelvic support osteotomy. The purpose of this study was, first, to use magnetic resonance imaging to measure alterations in the length and volume of the gluteus medius muscle after pelvic support osteotomy and, second, to determine which factors influence the results of the Trendelenburg test. Methods: Eleven patients with a history of congenital hip dislocation who had been treated with a pelvic support osteotomy were examined clinically with the Harris hip score and the Trendelenburg test, radiographically to measure limb-length discrepancy and valgus angulation of the proximal part of the femur, and with magnetic resonance imaging to measure changes in the gluteus medius length and volume. Results: The pelvic support osteotomy achieved a functional and painless hip in all eleven patients. Five of the eleven patients had a persistently positive Trendelenburg gait at the time of the last follow-up visit, at an average of three years after the osteotomy. The muscle volumes were restored to 43% to 89% of the muscle volumes on the normal contralateral side, and the postoperative muscle volume correlated significantly with the result of the Trendelenburg test (r = -0.63; p = 0.03). There was a positive association between age and the result of the Trendelenburg test (p = 0.01): four of the five patients who had a positive test were at least thirty-one years of age at the time of the operation. There was no correlation between the Trendelenburg test and the change in the length of the gluteus medius muscle, which averaged 19.2 mm in the patients with a positive test and 19.3 mm in those with a negative test. Conclusions: Patient age at the time of the operation and the postoperative change in the volume of the gluteus medius muscle have a significant influence on the result of the Trendelenburg test after a pelvic support osteotomy. Moreover, our study demonstrated that restoration of the muscle volume after a pelvic support osteotomy is not sufficient to prevent a Trendelenburg gait in older patients with congenital dislocation of the hip.Öğe An investigation of hand dominance, average versus maximum grip strength, body mass index and ages as determinants for hand evaluation(Ios Press, 2005) Ertem, K; Harma, A; Cetin, A; Elmali, N; Yologlu, S; Bostan, H; Sakarya, BMeasurement of grip strength is an important component in hand evaluation. It assesses the patient's initial limitations and provides a quick reassessment of patient's progress throughout the treatment. This investigation was conducted to examine the determinants of hand dominance of average versus maximum grip strength, body mass index (BMI) and age for hand evaluation. Subjects were 877 apparently healthy male adult volunteers from the Inonu University - students and personnel; average age 21.14 +/- 2.09 (19-40 years). A good correlation was found between the BMI hand strength measures. Grip strength was measured instrumentally. The rule dominant hand (DH) is approximately 10% stronger than the non-dominant hand (NDH) was found to be valid for left handed persons only (7%), otherwise these measures should be considered equivalent in both hands. The difference between maximum and average of three consecutive measurement of grip strength was found significant for both hands. As the significant difference was found between RGSmax (Maximum Grip Strength of Right Hand) and RGSav (Average Grip Strength of Right Hand); LGSmax (Maximum Grip Strength of Left Hand)[LGSav (Average Grip Strength of Left Hand) measures for RDH. RGSmax and LGSmax where correlated only for LDH, Therefore, average of three consecutive measurement of grip strength is more consistent for standard hand evaluation.Öğe Isolated zone III vertical fracture of first sacral vertebra - a case report(Taylor & Francis Inc, 2005) Harma, A; Inan, M; Ertem, K[Abstract Not Available]Öğe The mechanical or electrical induction of medullary angiogenesis - Will it improve sternal wound healing?(Texas Heart Inst, 2004) Alat, I; Inan, M; Gurses, I; Kekilli, E; Germen, B; Harma, A; Eskin, AWe induced angiogenesis in the tibial medulla and cortex of rabbits by electrical and mechanical stimulation, with the aim of future application to ischemic disease. Sixteen New Zealand rabbits were divided into 4 groups: in Group 1, a wire was inserted into the medullary channel; in Group 2 a hole was drilled into the tibia; in Group 3, electrical stimulation was applied to the medullary channel; and in Group 4 (the control group), nothing was done. The interventions were applied during a 21-day period, after which all animals were evaluated scintigraphically and histopathologically. All 3 interventional groups were significantly superior to the control group in regard to medullary and cortical vascularity: the P values were 0.021 in all comparisons to control. However the most fibrotic changes in the medulla occurred in the group that had been treated with electricity (P=0.008). Slight fibrotic changes occurred in the hole group (P=0.040), and none occurred in the K-wire group. In sum, all 3 interventions are capable of inducing medullary angiogenesis, but electricity is inferior in regard to fibrotic change. We believe that this present study can establish a baseline for further work that explores clinical applications to problematic ischemic conditions, including delayed sternal wound healing after cardiac surgery.Öğe Successful treatment of Buerger's disease with intramedullary K-wire: The results of the first 11 extremities(W B Saunders Co Ltd, 2005) Inan, M; Alat, I; Kutlu, R; Harma, A; Germen, BObjective. This study describes a new technique for treatment of Buerger's disease, developed to stimulate angiogenesis, using a Kirschner wire placed in the medullary canal of the tibia. The aim of the study was to evaluate clinical and radiological effects of this technique in patients where medical and surgical therapy had failed. Material and methods. Eleven extremities (six patients) with Buerger's disease were treated with the intramedullary Kirschner wire technique. Inclusion criteria were chronic critical ischemia, Rutherford Grade II or III, with major arterial occlusion shown by Doppler examination and angiography; failure to respond to non-surgical and surgical treatment; and the need for strong analgesics. Results. The mean follow-up time was 19 months (range, 13-25 months). Satisfactory remission in each patient was obtained within 6 weeks of intervention. A significant improvement in clinical manifestations including reduced rest pain and increased claudication distance was observed. Foot ulcers completely healed after Kirschner wire intervention. Conclusion. Despite short-term follow-up and small patient series, the intramedullary Kirschner wire technique can be expected to achieve relief of pain and a decrease in major amputations in patients with Buerger's disease in whom medical and surgical therapy had failed. However, comparative studies with longer follow-up should be done to confirm the benefits of this new treatment.Öğe Successful treatment of high congenital dislocated hips in older children by open reduction, pelvic and femoral osteotomy with external fixator stabilization (average 8.2 years of age)(Lippincott Williams & Wilkins, 2005) Inan, M; Harma, A; Ertem, K; Germen, B; Bowen, RJA new technique using a hinged external fixator to stabilize an open reduction with pelvic and femoral osteotomies has been developed for treating high-dislocated hips in older children with developmental dislocated hip (DDH). This technique was performed in 11 patients (12 hips) at a mean age of 8.2 years. At follow up, radiographic results showed no redislocation/subluxation and clinical results demonstrated 11 hips as excellent/good and only one hip as poor from persistent stiffness. In conclusion, this new technique produces acceptable results in the treatment of older children with high dislocation of the hip from DDH.Öğe Surgical management of transforaminal sacral fractures(Springer, 2005) Harma, A; Inan, MFourteen patients with transforaminal sacral fractures were treated with posterior iliosacral instrumentation. Patients were assessed in terms of surgical technique and functional results. A subjective functional scoring with a five-point scale was performed at the last follow-up. Activity pain, pain at rest, limping and patient satisfaction were evaluated. By considering symptom and satisfaction scores, subjective functional assessment revealed that ten patients had excellent results, two good and two moderate. There were no patients with poor functional outcome. The surgical technique is not a new concept. Combining sacral bar and pediculo-iliac fixation methods, provides vertical as well as horizontal stability and allows early weight bearing, the methods has many advantages. However, vertical and horizontal stabilities achieved by this technique may require further assessment with comparative biomechanical studies.Öğe Treatment of femoral nonunions by using cyclic compression and distraction(Lippincott Williams & Wilkins, 2005) Inan, M; Karaoglu, S; Cilli, F; Turk, CY; Harma, AEleven patients with femoral diaphyseal nonunions after intramedullary nailing were treated with cyclic compression and distraction with an external fixator over the nail. We evaluated the limitations of this technique and whether patients having this closed procedure could achieve union without additional operative procedures. Patients with hypertrophic nonunions (n = 4) were treated with gradual compression of the nonunion site. Cyclic compression and distraction was done in patients with oligotrophic (n = 2) or atrophic nonunions (n = 5) to stimulate consolidation. The average age of the patients was 32.9 years (range, 21-48 years), and the average followup was 40.5 months (range, 24-64 months). Union was achieved in an average of 5.8 months in all patients after one operation and without additional surgical intervention. However, pain necessitating strong analgesic agents and pin-related complications consisting of osteomyelitis, septic arthritis, and pin breakage in the atrophic nonunion group were a major limitation of this technique. Based on our study, the cyclic compression and distraction technique can be used in hypertrophic and oligotrophic nonunions that have failed one or more prior exchange nailings. However, it might not be an option for treatment of patients with atrophic nonunions unless pin-site problems are resolved.
