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Öğe Analysis of lower extremity alignment in achondroplasia - Interobserver reliability and intraobserver reproducibility(Lippincott Williams & Wilkins, 2006) Inan, M; Jeong, C; Chan, G; Mackenzie, WG; Glutting, JThis study was designed to evaluate the reliability and reproducibility of frontal plane malalignment measurements using the mechanical axis deviation method in achondroplasia and to determine whether the patient's age has any influence on these measurements. A total of 150 anteroposterior standing radiographs of the lower extremities were randomly selected for the study. Radiographs were divided into three groups according to age: group 1, younger than 6 years of age; group 2, 6 to 10 years of age; group 3, older than 10 years of age. Interobserver agreement for the medial proximal tibial angle and the lateral distal tibial angle measurements were poor (0.32 and 0.38, respectively) in group 1, but agreement increased between observers with increasing patient age. Good to excellent intraobserver reproducibility was found in all groups, except measurement of the medial proximal tibial angle in group 1, where the results were poor (0.36). Significant measurement errors in the proximal and distal tibial joint lines are possible in children less than 6 years of age with achondroplasia.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 Correction of rotational deformity of the tibia in cerebral palsy by percutaneous supramalleolar osteotomy(British Editorial Soc Bone Joint Surgery, 2005) Inan, M; Ferri-de Baros, F; Chan, G; Dabney, K; Miller, EA percutaneous supramalleolar osteotomy with multiple drill holes and closed osteoclasis was used to correct rotational deformities of the tibia in patients with cerebral palsy. The technique is described and the results in 247 limbs (160 patients) are reported. The mean age at the time of surgery was 10.7 years (4 to 20). The radiographs were analysed for time to union, loss of correction, and angulation at the site of the osteotomy. Bone healing was obtained in all patients except one in a mean period of seven weeks (5 to 12). Malunion after loss of reduction at the site of the osteotomy developed in one tibia. Percutaneous supramalleolar osteotomy of the tibia is a safe and simple surgical procedure.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 Fracture healing and bone mass in rats fed on liquid diet containing ethanol(Lippincott Williams & Wilkins, 2002) Elmali, N; Ertem, K; Ozen, S; Inan, M; Baysal, T; Güner, G; Bora, ABackground: Studies in animal models for alcohol abuse have suggested that ethanol inhibits bone growth, decreases bone formation, and increases fracture risk. Methods: Experimental tibia fracture healing in rats fed a liquid diet containing 7.2% ethanol for 8 weeks was investigated with histological and osteodensitometric studies with respect to the control group. After 4 weeks of vitamin A- and sucrose-enriched milk containing 7.2% ethanol feeding, we created closed tibia fractures, which were then fixed with intramedullary nails, in 10 rats. After a follow-up time of 4 weeks, the rats were killed for examination. The same procedure was performed in another 10 rats, which were fed on the same diet (isocaloric modified liquid diet) but without ethanol and used as the control group. A histological scoring system was developed for fracture healing. Results: Histological evaluation of fracture region revealed an average fracture healing score of 1.9 in the ethanol-fed group versus 2.6 in the control group (p = 0.014). In the test group, dual-energy x-ray absorptiometry measurements in the fracture region showed a mean bone mineral density of 0.11 +/- 0.03 g/cm(2), whereas it was 0.130 +/- 0.051 g/cm(2) in the control group (p = 0.000). The mean bone mineral content in the fracture region was 0.103 +/- 0.08 g/cm(3) in the test group versus 0.128 +/- 0.06 g/cm(3) in the control group (p = 0.000). A significant correlation was found among histological scores, bone mineral density (r = 0.64, p = 0.04), and bone mineral content (r = 0,63, p = 0.04). Conclusions: This study showed that rats fed on a diet mixed with ethanol have a histologically delayed fracture healing associated with decreased bone density and mineral content. Besides the negative effects of ethanol on bone metabolism, it also interferes with the fracture-healing process.Öğe Induced angiogenesis with intramedullary direct current: experimental research(Amer Physiological Soc, 2005) Inan, M; Alat, I; Gurses, I; Kekilli, E; Kutlu, R; Eskin, A; Aydin, OMThe purpose of this study was to evaluate angiogenesis after the use of intramedullary direct electrical current in rabbit tibia. Thirty-two New Zealand rabbits were divided into four groups: group 1, false electrode group; group 2, hole group; group 3, control group; and group 4, intramedullary electrical stimulation group. One-half of the rabbits in each group were evaluated angiographically, pathologically, and scintigraphically on day 7, and the rest were evaluated on day 21. Results proved that electrical stimulation was not capable of the induction of angiogenesis in the subjects killed on day 7 and day 21. Furthermore, we found some fibrotic changes secondary to electrical stimulation on day 7 ( P = 0.04) and day 21 ( P = 0.01). However, an increase in new capillary vessels occurred in the false electrode group ( P = 0.02). We found no useful effect of electrical stimulation in our study, a finding that is possibly due to our use of a method previously undocumented in the literature. We believe that this study can be the new baseline for further studies into the stimulation or inhibition of angiogenesis using intramedullary wire with or without electrical stimulation.Öğe Intramedullary nail fixation of femoral and tibial percutaneous rotational osteotomy in skeletally mature adolescents with cerebral palsy(Lippincott Williams & Wilkins, 2006) Ferri-de-Barros, F; Inan, M; Miller, FTwenty percutaneous rotational osteotomies, stabilized with interlock nails, were performed in the lower limbs of 15 skeletally mature adolescents with cerebral palsy to correct rotational deformities. The medical records and radiographs of those patients were retrospectively reviewed. Nineteen osteotomies (95%) in 15 patients healed without major complications. One patient had one tibia (5%) pseudarthrosis, which was successfully treated with additional fibular osteotonty and exchanging the nail. Excluding this case, the average healing time for the femoral and tibial osteotomies was 8 weeks, ranging from 7 to 9 and from 6 to 10 weeks, respectively. Casting was not required to add stability. Percutaneous rotational osteotonty with intramedullary nail fixation is a reliable and effective treatment option to correct rotational malalignment of the lower limb in skeletally mature patients with cerebral palsy.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 Lengthening of the amputation stumps in hand by distraction osteogenesis(Medimond S R L, 2002) Gürlek, A; Inan, M; Bilen, BT; Aydogan, H; Ersöz, A; Çelik, M; Fariz, ADigital amputations have been seen commonly at the emergency services. Mutilation, functional, cosmetic and psychological problems occur when they can not be transplanted or failed after transplantation. Bone lengthening was carried out on 18 digital amputation stumps of 10 patients by distraction osteogenesis (Ilizarov's method) during the period of January 2000 to January 2002. Mean age was 14.2+/-8.1, ranging between 4 and 27 years. The average lengthening achieved 28.4 +/- 83 (15 - 50 mm). Distraction durations varied between 20 -70 (mean 35.2 +/- 8.3) and consolidation between 45 -120 days (mean 74.2 +/- 17.1). Two pin-tract infections, one bone fracture because of trauma, one early fusion of osteotomy and severe pain in two patients due to distraction were observed as complication. Distraction osteogenesis is very effective, simple, no necessity to donor area in the treatment of amputation stumps to get function; in spite of requiring long duration, patience and a good cooperation of both family and patient.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 Occult spinal dysraphism and its association with hip dysplasia in females(Springer-Verlag, 2003) Ucar, DH; Ömeroglu, H; Eren, A; Inan, M; Baktir, A; Aksoy, MC; Ömeroglu, SWe examined the pelvic radiographs of two groups of patients (more than 12 years of age) from six medical centres. Hip dysplasia was considered to be present if Shenton's line was broken and more than one third of the femoral head was revealed to be uncovered in an antero-posterior radiograph of the pelvis. Patients with hip dysplasia due to teratological or neurological causes were excluded. There were 291 patients with treated or untreated hip dysplasia in the dysplastic group. The control group of 415 individuals was collected from consecutive outpatients (with a pre-set standardised female/male ratio) for whom an antero-posterior radiograph of the pelvis had been made in one of two medical centres and which did not disclose any abnormality of the hip joints. The aim of the study was to assess the coexistence of hip dysplasia and occult spinal dysraphism. Radiographs of all patients were examined, and any partial or complete defect of the posterior vertebral arch was recorded. In the dysplastic group, a defect was recorded in 23% (67/291) radiographs and in the control group in 12% (48/415). In both groups, L5 and S1 were the most commonly recorded sites with a defect. In the dysplastic group, a defect was recorded in 56/190 females and in the control group in 30/302 females. In males, there was no significant difference between the recorded findings in the two groups. In females with hip dysplasia, occult spinal dysraphism seems to be fairly common.Öğe A pelvic support osteotomy and femoral lengthening with monolateral fixator(Lippincott Williams & Wilkins, 2005) Inan, M; Bowen, RJPelvic support osteotomies for chronically dislocated hips improve stability but result in limb-length discrepancy and valgus deformity of the knee. We prospectively evaluated and followed up 16 patients (14 females, two males) to ascertain whether a monolateral external fixator could achieve a pelvic support osteotomy and eliminate the limb-length discrepancy without disturbing knee motion. The patients had a mean age of 25.3 years at the time of surgery. The Harris hip score, knee range of motion, and Trendelenburg sign were evaluated preoperatively and at followup. The average time from fixator application until removal was 7 months (range, 5.2-9.5 months). The followup averaged 52.5 months (range, 26-84 months). The mean Harris hip score increased from 50 points (range, 32-73 points) preoperatively to 87.6 points (range, 67-98 points) at last followup. Four patients retained a positive Trendelenburg sign. At the time of fixator removal, 88% of preoperative knee range of motion was retained, and preoperative knee motion was achieved at last followup in all patients. The monolateral external fixator was suitable for a pelvic support osteotomy, equalizing limb-length discrepancy, and obtaining lower extremity alignment. This method achieved a pain-free, functional hip and good knee motion. Level of Evidence: Therapeutic study, Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.Öğe Response to: Correspondence from Walker et al.(W B Saunders Co Ltd, 2005) Inan, M[Abstract Not Available]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.
