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Öğe A comparison between the use of a monolateral external fixator and the Ilizarov technique for pelvic support osteotomies(2004) Inan M.; Bomar J.D.; Küçükkaya M.; Harma A.OBJECTIVES: We compared the results of monolateral external fixator and the Ilizarov technique for pelvic support osteotomies in the treatment of neglected congenital hip dislocation. METHODS: Seventeen female patients with congenital dislocation of the hip underwent pelvic support osteotomy using a monolateral external fixator (MEF) (n=7; mean age 23.2 years; range 17 to 39 years) or the hybrid advanced Ilizarov method (HAIM) (n=10; mean age 25.9 years; range 17 to 36 years). The mean leg discrepancies, durations of the external fixator, and follow up-periods in the MEF and HAIM groups were as follows, respectively: 5.5 cm and 5.2 cm; 201.5 days (range 185 to 241 days) and 197 days (164 to 248 days); 30.4 months (23 to 39 months) and 40.5 months (21 to 65 months). The two groups were compared with respect to patients' discomfort related to the use of external fixators and pin tract infections classified according to the Paley criteria. RESULTS: Overall, six pins required removal because of grade 3 pin track infections (5 in the HAIM group, 1 in the MEF group). The number of patients who reported extreme discomfort for the use of external fixator was three in the HAIM group and one in the MEF group. Although the range of motion of the knee was similar in both groups (p>0.05), clinically, patients treated with MEF exhibited a more comfortable range of motion of the knee with external fixation and, after removal of the fixator, reached a knee flexion of 90 degrees in a shorter time (36 days versus 47 days). CONCLUSION: The use of MEF for pelvic support osteotomies seems to be preferable because it is associated with a lower rate of pin tract infections and a higher degree of patient comfort.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 Determination of sex from the femur in Anatolian Caucasians: A digital radiological study(2007) Harma A.; Karakas H.M.Determination 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.Öğe Emergency pelvic external stabilization as the first step treatment in high risk pelvic fractures(2004) Harma A.; Inan M.[No abstract available]Öğe The factors affecting thermal necrosis secondary to the application of the Ilizarov transosseous wire(2005) Inan M.; Mizrak B.; Ertem K.; Harma A.; Elmali N.; Ayan I.OBJECTIVES: We investigated thermal changes associated with the application of the Ilizarov transosseous wires, the extent 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 degrees C (at 1,200 rpm) and 151.9 degrees 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 The mechanical or electrical induction of medullary angiogenesis: Will it improve sternal wound healing?(2004) Alat I.; Inan M.; Gurses I.; Kekilli E.; Germen B.; Harma A.; Eskin A.We 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 K 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 The Morel-Lavallée lesion: a conservative approach to closed degloving injuries(2004) Harma A.; Inan M.; Ertem K.OBJECTIVES: We evaluated the results of conservative treatment for closed degloving injuries (Morel-Lavallée lesion) of the pelvic girdle and lower extremities. METHODS: The Morel-Lavallée lesion developed in five male patients (mean age 25.6 years; range 6 to 40 years) due to crush under a vehicle (n=3) and traffic accidents (n=2). The lesions were localized in the pelvic girdle in three cases (2 lumbosacral, 1 lateral lumbar) and gluteal and trochanteric regions in two cases. Treatment was performed with compressive elastic bandages or corsets in all the patients, three of whom also underwent surgery due to accompanying pelvic fractures. Healing was defined as the loss of fluctuation and elicitation of the normal mobility of the injured skin on manual examination. The mean follow-up period was 23.6 months (range 10 to 41 months). RESULTS: Sacral decubitus ulcer developed in a patient in whom the detection of the lesion was obscured because of an associated femoral fracture and a perianal deep soft tissue lesion. Another patient with a wide fluctuating lesion in the gluteal-trochanteric region required aspiration, which yielded a negative culture. However, the lesion recurred early. Except for the patient with a sacral decubitus ulcer, all the lesions healed within a mean of six weeks (range 4 to 12 weeks) without any infections or necrosis. No recurrences were detected during the follow-up period. CONCLUSION: Closed degloving lesions in the pelvic and gluteal regions can be managed conservatively when the overlying skin is intact and the fluid accumulation is not excessive.Öğe Radial artery pellet embolism: a case report(2004) Ertem K.; Ayan I.; Harma A.; Türköz R.; Bora A.[No abstract available]
