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Öğe Acil pelvik eksternal stabilizasyon: Yüksek riskli pelvis kırıklarında ilk adım(Ulusal Travma Dergisi, 2004) Harma, Ahmet; İnan, MuharremÖz: AMAÇ Hemodinamik ve/veya kırığa, bağlı instabilitesi olan hastalarda resusitasyon ve pelvik stabilizasyonun ilk basamağı olarak acil pelvik eksternal stabilizasyon (APES) uygulamasının klinik etkinliği değerlendirildi. GEREÇ VE YÖNTEM Yirmi üç hastaya (12 erkek, 11 kadın; ort. yaş.32; dağılım 9-67) yüksek riskli pelvis kırığı nedeniyle APES uygulandı. Sistolik kan basıncının Undefined control sequence \leg90 mmHg olduğu olgular ve vertikal ve/veya rotasyonel instabil pelvis kırıkları veya riskli kırıklar yüksek risk grubu olarak değerlendirildi. Pelvis kırıklarının tanımlanmasında Tile sınıflaması kullanıldı. BULGULAR On hastada riskli kırığa hemodinamik instabilite de eşlik etmekteydi. Hemodinamik instabilite görülen olgularda elektif pelvik stabilizasyonu için ortalama 17.7 gün (dağılım 7-28 gün); riskli kırık grubunda ise üç gün (dağılım 2-8 gün) beklendi. Acil pelvik eksternal stabilizasyonu için harcanan süre ortalaması 30 dakikanın altındaydı (dağılım 20-40 dak). Pelvis kırığının neden olduğu kanama nedeniyle ölen hasta olmadı. Bir hasta hemodinamik stabilizasyon sağlandıktan 14 gün sonra sepsis nedeniyle kaybedildi. Beş hastada birinci derece yüzeyel çivi dibi enfeksiyonu saptandı; bunların dördü lokal pansuman ile tedavi edildi. Bir hastada ise gevşeyen iki çivinin değiştirilmesi gerekti. SONUÇ Yüksek riskli pelvis kırıklarında resusitasyon amaçlı ve kırık risklerine karşı uygulanan APES akut dönemde güvenli ve etkin bir yaklaşım olarak değerlendirilebilir. Başlık (İngilizce): Emergency pelvic external stabilization as the first step treatment in high risk pelvic fractures Öz (İngilizce): BACKGROUND: We evaluated the clinical effectiveness of emergency pelvic external stabilization (EPES) as a first step of resuscitation and pelvic stabilization in trauma patients with hemodynamic and/or fracture instabilities. METHODS: Twenty-three patients (12 males, 11 females; mean age 32 years; range 9 to 67 years) with high risk pelvic fractures underwent EPES. The presence of a systolic blood pressure equal to or below 90 mmHg, vertical and/or rotational instabilities, or fractures at risk were defined as high risk fractures. Pelvic fractures were assessed according to the Tile’s classification. RESULTS: Hemodynamic instability was detected in 10 patients. The mean durations to the elective pelvic stabilization were three days (range 2 to 8 days) and 17.7 days (range 7 to 28 days) in patients with or without hemodynamic instability, respectively. The mean duration for EPES application was below 30 minutes (range 20 to 40 minutes). No deaths occurred due to blood loss caused by pelvic fractures. One patient died due to sepsis 14 days after hemodynamic stabilization. Superficial pin-track infections of grade 1 were detected in five patients, four of whom were treated with local dressings. In one patient, two pins had to be replaced because of loosening. CONCLUSIONS: Emergency pelvic external stabilization for resuscitation and high risk fractures is an effective intervention in the acute phase of polytraumatized patients presenting with high risk pelvic fractures.Öğe Aşil tendon rüptürlerinin onarımı sonrası devamlı pasif hareketinin etkisi(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2001) Ertem, Kadir; Elmalı, Nurzat; İnan, Muharrem; Harma, Ahmet; Ayan, İrfan; Karakaplan, MustafaÖz: Bu kesitsel çabşma, Malatya kent merkezinde yaşayan kişilerin yıllık ortalama hekime başvuru sayısı ve bunu etkileyen gönenler ile son bir yılda yatarak tedavi görenlerin hastanelerden memnuniyetlerini belirlemek amacıyla yapılmıştır. Malatya'da mahallelerin sosyoekonomik düzeyine göre tabakalı örnekleme yöntemiyle saptanan adreslerde 1962 kişiye Ekim-Kasım 1998'de yüzyüze görüşme yöntemiyle anket uygulanmıştır. Kişi başına yılda ortalama hekime başvuru sayısı üçtür. Hekime başvuruyu etkileyen en önemli etken, kronik hastalık varlığıdır. Son 15 gün içinde hekime başvuranların sadece %3'ü Malatya dışındaki hekimlere başvurmuştur. Başvurulan kurumlar içinde Malatya SSK Hastanesi %33.2 ile en çok başvurulan kurumdur; bunu %20.3 ile özel hekimler ve %16.5 ile Malatya Devlet Hastanesi izlemektedir. Hekime muayene olabilmek için bekleme süresi 52 dakika (ortanca)dır ve başvuranların yarısı bu süreyi uzun bulmaktadır. Muayene süresi ise beş dakika (ortanca) olup, başvuranların %43'ü bu süreyi yetersiz bulmaktadır. Araştırmaya katılanların %4.4'ü son bir yıl içinde hastaneye yatırılmışlardır. Bunların %15'i Malatya'nın dışındaki şehirlerde yatırılmışlardır. Hastanelerden en çok şikayet edilen konular; hastalardan hastane dışından ilaç-malzeme getirmelerinin istenmesi, ücretlerin yüksekliği, yemekler ve temizliktir. Sağlık hizmetlerinin kullanımının artırılması için sağlık kuruluşlarının daha iyi organize olmaları ve hastaların memnuniyetine daha çok önem verilmesi önerilebilir. Başlık (İngilizce): The effect of continuous passive motion after repair of achilles tendon ruptures Öz (İngilizce): This cross-sectional study was performed to determine the annual average physician contacts number of people living in central Malatya with influencing factors and also to determine the patients' satisfaction who were hospitalized during last year. Stratified cluster sampling was used according to the socioeconomic status of the localities and 1962 individuals were administered a face to face questionnaire during October-November 1998. Annual average physician contact number was three. The main influencing factor related to contact with physician is the presence of a chronic disease. Within the last 15 days, only three percent of applicants had contacted with the physicians who work outside Malatya. The most applied health institution was SSK Hospital (33.2 %) followed by private physicians (20.3 %) and Malatya State Hospital (16.5%). Median waiting time to see the physician was 52 minutes and 50.0% of the applicants thought that this duration is too long. Median examination time was five minutes and 43.0% of applicants believe that examination time was not sufficient. 4.4% of the participitants were hospitalized during last year. 15.0% of the hospitalized patients were hospitilized in cities outside Malatya. Main complaints against hospitals are, patients' being asked to bring drug and other supply outside hospital, and high costs, meals and cleanliness. To increase the utilization of health services, a better organization of health institutions and taking patient satisfaction into consideration could be suggested.Öğe A comparison between the use of a monolateral external fixator and the Ilizarov technique for pelvic support osteotomies(Acta Orthop Traumatol Turc, 2004) İnan, Muharrem; Küçükkaya, Metin; Harma, AhmetÖğe The comparison of femoral curves and curves of contemporary intramedullary nails(Surgical and Radiologic Anatomy, 2005) Harma, Ahmet; Germen, Burak; Karakaş, Hakkı Muammer; Elmalı, Nurzat; İnan, MuharremAbstract The 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 Determination of sex from the femur in anatolian caucasians: A digital radiological study(Journal of Forensic and Legal Medicine, 2007) Harma, Ahmet; Karakaş, Hakkı MuammerDetermination of the sex is one of the most important steps when evaluating decomposed bodies or skeletal remnants. However, relevant data exhibit significant ethnic and temporal variation. This study provides information on in vivo femoral dimensions of Anatolian Caucasians. 50 males and 54 females with ages between 18 and 68 years were investigated with computed tomography. For males, mean maximum length (ML) was 448.2 mm, mean vertical head diameter (VHD) was 48.8 mm, mean midshaft transverse diameter (MTD) was 26.5 mm, and mean anterior bowing (AB) was 759.3 mm. For females, these were 419.0 mm, 43.4 mm, 25.6 mm, and 779.5 mm, respectively. Femoral dimensions of Anatolian Caucasians were not entirely similar to a single racial group that was already reported. There was a significant difference between males and females regarding ML and VHD (p < 0.0001 for both). MTD and AB did not exhibit sexual dysmorphism. Discriminant analysis for sex type produced 83.3% accuracy when ML was used, and 76.9% accuracy when VHD was used (p < 0.0001). Combined use of both parameters increased overall accuracy to 84.6% (p < 0.0001). For VHD, cut-off value of 44.9 mm produced 94% sensitivity and 83% specificity. For ML, cut-off value of 428.6 produced 80% sensitivity and 67% specificity. 2006 Elsevier Ltd and AFP. All rights reserved.Öğe Dizdeki travmatik veya dejeneratif kıkırdak lezyonlarının değerlendirilmesinde farklı MRG sekanslarının etkinliği(Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.), 2006) Kıroğlu, Yılmaz; Elmalı, Nurzat; Doğan, Metin; Esenkaya, İrfan; Harma, Ahmet; Şahin, M. ŞükrüÖz: Amaç: Dizdeki travmatik veya dejeneratif kıkırdak lezyonlarının değerlendirilmesinde farklı manyetik rezonans görüntüleme (MRG) sekanslarının etkinliği araştırıldı. Hastalar ve yöntemler: Dizde travmatik veya dejeneratif kıkırdak lezyonu tanısıyla artroskopi planlanan 27 hastaya (16 erkek, 11 kadın; ort. yaş 44; dağılım 23-67) işlem öncesinde MRG yapıldı. Kıkırdak lezyonları proton hızlı spin eko (proton TSE), T2 hızlı spin eko (T2 TSE), manyetizasyon transfer kontrast (MTK) ve üçboyutlu yağ baskılayıcı gradiyent eko (3D SPIR) sekanslarıyla değerlendirildi. Her olgu için dört farklı sekansta sekiz ayrı kıkırdak bölgesi (toplam 216 bölge) iki radyolog tarafından ayrı ayrı yorumlandı. Artroskopi MRG incelemelerinden sonra üç hafta içinde uygulandı. Kıkırdak lezyonları Outerbridge sınıflamasına göre evrelendirildi. Bulgular: Artroskopide, en sık medial femoral kondilde olmak üzere toplam 109 kıkırdak bölgesinde lezyon saptandı. Her bir MRG tekniği en yüksek duyarlılığı evre 4 lezyonlarda gösterdi. Tüm kıkırdak lezyonları değerlendirildiğinde duyarlılık ve özgüllük oranları sırasıyla proton TSE’de %91.7 ve %89.7, T2 TSE’de %66.9 ve %91.5, 3D SPIR’de %75.2 ve %93.5 ve MTK’de %62.4 ve %94.3 bulundu. Proton TSE dışındaki teknikler ile artroskopi arasında anlamlı farklılık vardı. Sadece proton görüntülerde gözlemciler arasında gerçek uyum saptandı (kappa 0.68). Sonuç: Proton TSE dışındaki tekniklerin, dizdeki kıkırdak lezyonlarının değerlendirilmesi ve evrelendirilmesinde tek başına kullanımlarının etkinliği düşük bulundu. Proton TSE tekniğine T2 TSE tekniğinin eklenmesiyle hem kıkırdak lezyonları daha etkin saptanabilecek hem de eşlik eden diğer patolojiler daha iyi tanınabilecektir.Öğe Effect of resveratrol in experimental osteoarthritis in rabbits(Inflammation Research, 2005) Elmalı, Nurzat; Esenkaya, İrfan; Harma, Ahmet; Ertem, Kadir; Türköz, Rıza; Mızrak, BülentObjective: 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-kB). Resveratrol also inhibits COX-2 gene expressionand 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 mMol/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 intraperitoneally administered folic acid on the healing of repaired tibial nerves in rats(Journal of Reconstructive Microsurgery, 2015) Harma, Ahmet; Şahin, Mehmet Şükrü; Zorludemir, SuzanBackground Complete nerve regeneration and clinical healing remain a challenge despite considerable advances in the treatment of peripheral nerve injuries. To improve nerve regeneration, several experimental molecular procedures have been attempted. This study aimed to investigate the effects of folic acid on peripheral nerve healing after transection and end-to-end suture repair of the tibial nerve in rats. Methods In this study, 20 adult male Wistar Albino rats weighing 225 to 250 g were used. The right tibial nerves of 20 rats were explored, transected, and sutured using the end-to-end technique. The rats were randomly allocated to either the intraperitoneally administered folic acid group (test group) or the control group. Preoperative and 6-week postoperative neurophysiological studies were performed by the same researcher. Myelin-sheathed axons were counted. Results The results demonstrated that the folic acid–treated group exhibited improved electromyographic results compared with the control group. Histological evaluation revealed that the axons were well preserved and that the axon quantity and density were increased in the test group compared with the control group. Quantitative results also increased in the test group compared with the control group (p ¼ 0.001). Conclusion In this study, 6-week intraperitoneal administration of 80 μg/kg of folic acid significantly improved peripheral nerve healing. Histological analysis of the group that received folic acid revealed increased axon myelination with little granular tissue or fibrosis. We propose that folic acid supplementation may be an effective component of peripheral nerve injury treatment.Öğe Effects of Intraperitoneally Administered Folic Acid on the Healing of Repaired Tibial Nerves in Rats(Thieme Medical Publ Inc, 2015) Harma, Ahmet; Sahin, Mehmet Sukru; Zorludemir, SuzanBackground Complete nerve regeneration and clinical healing remain a challenge despite considerable advances in the treatment of peripheral nerve injuries. To improve nerve regeneration, several experimental molecular procedures have been attempted. This study aimed to investigate the effects of folic acid on peripheral nerve healing after transection and end-to-end suture repair of the tibial nerve in rats. Methods In this study, 20 adult male Wistar Albino rats weighing 225 to 250 g were used. The right tibial nerves of 20 rats were explored, transected, and sutured using the end-to-end technique. The rats were randomly allocated to either the intraperitoneally administered folic acid group (test group) or the control group. Preoperative and 6-week postoperative neurophysiological studies were performed by the same researcher. Myelin-sheathed axons were counted. Results The results demonstrated that the folic acid treated group exhibited improved electromyographic results compared with the control group. Histological evaluation revealed that the axons were well preserved and that the axon quantity and density were increased in the test group compared with the control group. Quantitative results also increased in the test group compared with the control group (p = 0.001). Conclusion In this study, 6-week intraperitoneal administration of 80 mu g/kg of folic acid significantly improved peripheral nerve healing. Histological analysis of the group that received folic acid revealed increased axon myelination with little granular tissue or fibrosis. We propose that folic acid supplementation may be an effective component of peripheral nerve injury treatment.Öğe Effects of resveratrol in ınflammatory arthritis(Inflammation, 2007) Elmalı, Nurzat; Baysal, Özlem; Harma, Ahmet; Esenkaya, İrfan; Mızrak, BülentSummary: Nuclear factor kappa B (NF-kB), is a pivotal transcription factor involved in the activation of the TNF-a and IL-1b genes. Activation of NF-kB in synovial cells is a feature seen in arthritis patients. Resveratrol, a polyphenolic, natural phytoalexin found with particularly high levels in grape skin and red wine is potent and specific inhibitor of TNF-! and IL-1b induced NF-kB activation. We aimed to determine the in vivo effects of intra-articular injections of resveratrol on cartilage and synovium in an experimental rabbit inflammatory arthritis model. Materials and methods: Arthritis was induced by intra-articular injection of three times of 50 mg lipopolysaccharide (LPS) at day 0, 4 and 8 at 4-day intervals into the knee joints of rabbits. To the test group, 10 mMol/kg resveratrol in the DMSO was injected in the knees at day 0 and then it was continued once daily for 2 weeks. To the control group the same time and amount of DMSO was injected the knees of rabbits. All rabbits were killed 1 week after the last injection and cartilage tissue and synovium were evaluated with semiquantitative scoring histologically. Results: According to control group in the resveratrol group, significantly decreased cartilage destruction was determined by H&E staining (p = 0.04). Loss of matrix proteoglycan content in the cartilage was much lower, as determined by safranin O staining (p = 0.03). We also observed marked synovial inflammation after intra-articular injection to control knees, but not in the resveratrol treated group knees (p = 0.01). Conclusion: This study suggests that intra-articular injection of resveratrol may protect cartilage against the development of experimentally induced IA.Öğe Emergency pelvic external stabilization as the first step treatment in high risk pelvic fractures(Ulus Travma Acil Cerrahi Derg, 2004) Harma, Ahmet; İnan, MuharremÖğe Estimating femoral nail length in bilateral comminuted fractures using fibular and femoral head referencing(Injury, 2007) Karakaş, Hakkı Muammer; Harma, AhmetObjective: Femoral nail length can be estimated preoperatively by several methods, but this usually requires an intact contralateral femur. The aim of this study was to determine an alternative method using fibula and femoral head as references. Materials and methods: Digital radiographic views of the lower limbs of 102 healthy volunteers were used to compare femoral medullary length with the sum of fibular length and transverse head diameter. Results: Femoral medullary length and the estimated length were highly correlated (r = 0.942, p < 0.0001). Paired samples t-testing has produced a high significance ( p < 0.002). Conclusion: The formula provides a simple and accurate estimation of femoral medullary length, and may be used in nailing, particularly of bilateral comminuted femoral fractures. # 2007 Elsevier Ltd. All rights reserved.Öğe Evaluation of the gluteus medius muscle after a pelvic support osteotomy to treat congenital dislocation of the hip(The Journal of Bone and Joint Surgery (American), 2005) İnan, Muharrem; Harma, Ahmet; Ertem, KadirBackground: 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. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.Öğe The factors affecting thermal necrosis secondary to the application of the Ilizarov transosseous wire(Acta Orthop Traumatol Turc, 2005) İnan, Muharrem; Mızrak, Bülent; Ertem, Kadir; Harma, Ahmet; Elmalı, Nurzat; Ayan, İrfanObjectives: We investigated thermal changes associated with the application of the Ilizarov transosseous wires, the extent of necrosis and the factors affecting necrosis. Me t h o d s : 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. R e s u l t s : Heat changes varied between 48.4 ¡C (at 1,200 rpm) and 151.9 ¡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 Femoral shaft bowing with age: a digital radiological study of Anatolian Caucasian adults(Turkish Soc Radiology, 2008) Karaka, Hakki Mummer; Harma, AhmetPURPOSE To determine the dimensions of the femoral shaft and their relationship to age in Anatolian Caucasian men and women. MATERIALS AND METHODS Maximum femoral length (MFL), mid-shaft transverse diameter (MTD), and anterior bowing (AB) were studied in a sample of 104 adults. The linear dimensions and AB of the femoral shafts were measured on digital images. RESULTS In males, mean MFL, MTD, and AB were 448.2 mm, 26.5 mm, and 759.3 mm, respectively. In females these measurements were 419.0 mm, 25.6 mm, and 779.5 mm. Males had longer MFL (P < 0.0001) and there was no difference between males and females regarding the other parameters. MFL and age were correlated in females (r = -0.374, P< 0.005), whereas they were not correlated in males. In females, MFL decreased until about 45 years of age and stabilized thereafter. MTD was correlated with age in males (r = 0.428, P < 0.002), increasing from adolescence to maturity. This correlation was insignificant in females and there was only a slight increase in diameter after about 30 years of age. AB and age were significantly correlated in females (r = -0.401, P < 0.003), with AB continuously increasing with age. The correlation between AB and age was insignificant in males. CONCLUSION The increase in bone cross-sectional area in aging males may contribute to the maintenance of adequate mechanical competence throughout adulthood. In females this compensatory mechanism appears to be much less efficient and, accordingly, the end result of this process is AB of the femur and inevitable shortening of the bone.Öğe Grisel syndrome: nontraumatic atlantoaxial rotatory subluxation(Journal of Craniofacial Surgery, 2008) Harma, Ahmet; Fırat, YezdanGrisel syndrome is the subluxation of atlantoaxial joint as a result of infectious or inflammatory processes of the head and neck region. The etiopathogenesis of this clinical entity is not clear yet. Early interventions (antibiotherapy, cervical traction, and immobilization) are critical to avoid catastrophic outcome. Early detection of pediatric atlantoaxial subluxation is essential. It requires a combination of clinical assessment and appropriate radiographic imaging. In this report, we present a clinical and radiologic follow-up of a Grisel syndrome; by this way, we discuss the role of radiology on the diagnosis of this rare entity and preview the relevant literature.Öğe Grisel syndrome: Nontraumatic atlantoaxial rotatory subluxation(Lippincott Williams & Wilkins, 2008) Harma, Ahmet; Firat, YezdanGrisel syndrome is the subluxation of atlantoaxial joint as a result of infectious or inflammatory processes of the head and neck region. The etiopathogenesis of this clinical entity is not clear yet. Early interventions (antibiotherapy, cervical traction, and immobilization) are critical to avoid catastrophic outcome. Early detection of pediatric atlantoaxial subluxation is essential. It requires a combination of clinical assessment and appropriate radiographic imaging. In this report, we present a clinical and radiologic follow-up of a Grisel syndrome; by this way, we discuss the role of radiology on the diagnosis of this rare entity and preview the relevant literature.Öğe Ilizarov transosseöz telin kemikten geçirilmesine bağlı oluşan termal nekrozu etkileyen faktörler(Acta Orthopaedica et Traumatologica Turcica, 2005) İnan, Muharrem; Mızrak, Bülent; Ertem, Kadir; Harma, Ahmet; Elmalı, Nurzat; Ayan, İrfanÖz: Amaç: Ilizarov transosseöz telin (TT) kemikten geçirilmesi sırasında ortaya çıkan ısı değişimleri, buna bağlı oluşan nekroz ve bunu etkileyen faktörler deneysel olarak araştırıldı. Çalışma planı: Bir yaşındaki bir dananın iki tibiasının metafiz bölgeleri çıkartıldıktan sonra diafız kısımları üzerinde dört eşit bölge işaretlendi. Her bölge ve devir (600, 900, 1200 ve 1800 devir/dk) için ayrı bir TT kullanıldı. Telin korteksten geçirilmesi sırasında oluşan ısı değişimleri elektrotlarla kaydedildi ve TT'nin ilerleme hızı ölçüldü. Histopatolojik inceleme için telin giriş ve çıkış bölgelerinden örnekler alınarak nekroz oluşan bölgelerin kalınlıkları ölçüldü. Bölgeler ve yakın ve uzak korteksler arasındaki ısı değişimlerikarşılaştırıldı. Isı değişimini etkileyen en önemli etkenin belirlenmesi için lineer regresyon analizi kullanıldı. Sonuçlar: Uygulama sırasında oluşan ısı 48.4 °C (1200 devirde) ile 151.9 °C (600 devirde) arasında dağılım gösterdi. Yakın korteksin kalınlığı, tel geçiş süresi ve hızı açısından bölgeler arasında anlamlı farklılık bulundu (sırasıyla, p=0.003, p=0.01 ve p=0.01). Telin devir hızı ile nekroz ala¬nı kalınlığı arasında negatif korelasyon görüldü (r=-0.901, p=0.001). Regresyon analizinde, yakın ve uzak kortekste ısı oluşumunu belirleyen en önemli etken, telin korteksi geçiş süresi olarak belirlendi (sırasıyla, p=0.001 ve p=0.003). Histopatolojik incelemede, telin devir hızının düşük olduğu bölgelerde nekroz alanı ve kemik erozyonu daha fazlaydı. Yakın korteksteki nekroz alanı uzak kortekse göre anlamlı derecede fazlaydı (p=0.006). Çıkarımlar: Termal nekrozu azaltmak için TT'yi korteksten yüksek devir hızında ve mümkün olan en kısa sürede geçirmek gerekir. Başlık (İngilizce): The factors affecting thermal necrosis secondary to the application of the Ilizarov transosseous wire Öz (İngilizce): Objectives: We investigated thermal changes associated with the application of the Ilizarov transosseous wires, the Ijextent 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 °C (at 1,200 rpm) and 151.9 °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 Interpedicular Approach in Percutaneous Sacroplasty for Treatment of Sacral Vertebral Body Pathologic Fractures(Springer, 2011) Firat, Ahmet Kemal; Gumus, Burcak; Kaya, Emin; Kuku, Irfan; Harma, AhmetFor this technique, bone needle is introduced into the S1 vertebral body through the interpedicular route by penetrating the central spinal canal at the level of S3-4 and passing through the vertebral body of S2-3 parallel to the anterior border of sacrum. With the interpedicular approach, two sacral vertebral bodies can be injected in one session and lower sacral body injection also is available. interpedicular technique is a safe, practical, and effective technique for the treatment of sacral vertebral body pathologic fractures.Öğe Interpedicular approach in percutaneous sacroplasty for treatment of sacral vertebral body pathologic fractures(CardioVascular and Interventional Radiology, 2011) Fırat, Ahmet Kemal; Gümüş, Burçak; Kaya, Emin; Kuku, İrfan; Harma, AhmetFor this technique, bone needle is introduced into the S1 vertebral body through the interpedicular route by penetrating the central spinal canal at the level of S3-4 and passing through the vertebral body of S2-3 parallel to the anterior border of sacrum. With the interpedicular approach, two sacral vertebral bodies can be injected in one session and lower sacral body injection also is available. interpedicular technique is a safe, practical, and effective technique for the treatment of sacral vertebral body pathologic fractures.
