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Öğe Changes in the lengths of the gluteus medius and gluteus minimus muscles with trochanteric transfer following pelvic support osteotomy: a biomechanical study(2004) Inan M.; Mahar A.; Swimmer T.; Tomlinson T.; Wenger D.R.OBJECTIVES: Using a synthetic bone model, we investigated changes in the muscle length of the gluteus medius and gluteus minimus following trochanteric osteotomy and pelvic support osteotomy (PSO) and compared the results with those of traditional PSO. METHODS: On two pelvises and four femurs, the lengths of the gluteus medius and gluteus minimus were measured in the following circumstances, with the hips in neutral position and in 45 degrees of flexion: (i) alignment of the hip joint with normal congruency; (ii) dislocated hip joint; (iii) following an osteotomy 2.5 cm below the lesser trochanter and stabilization with an angulation of 45 degrees of abduction; (iv) the insertion point was then moved 2 cm distally and 1 cm laterally, simulating a translation osteotomy of the greater trochanter. RESULTS: The muscle lengths increased with PSO compared to those of the dislocated hips (p<0.0001). Following distal and lateral translation osteotomy, the lengths significantly exceeded those obtained with traditional osteotomy (p<0.002), but were significantly less than those in the neutral position (p<0.001). Measurements in 45 degrees of flexion yielded similar results. Normal lengths could not be obtained in any of the procedures. CONCLUSION: Distal and lateral translation osteotomy following traditional PSO seems to increase the length of the abductor moment arm more than that obtained by traditional PSO alone.Öğe Clinical and radiologic results of surgically-treated acetabular fractures(2003) Elmali N.; Ertem K.; Inan M.; Ayan I.; Denizhan Y.OBJECTIVES: We evaluated the functional and radiologic results of surgical treatment in patients with displaced acetabular fractures. METHODS: The study included 21 patients (13 males, 8 females; mean age 35 years; range 21 to 63 years). Before surgery, all the patients were evaluated with anteroposterior, iliac, and obturator oblique views and computed tomography scans. According to the Letournel-Judet classification, the fractures were simple in 10 patients and complex in 11 patients. Twelve patients had posterior wall and/or the posterior column fractures. Four patients underwent closed reduction under emergency settings for accompanying posterior dislocations. The mean time to surgery was 4.8 days (range 1 to 13 days). Surgery was performed by the Kocher-Langenbeck approach (n=12), a triradiate approach (n=5), and a modified extended iliofemoral approach (n=4). Functional results were assessed by the D'Aubigne-Postel's knee scoring system and radiologic results using anteroposterior, iliac, and obturator oblique views. The mean follow-up was 31 months (range 19 to 64 months). RESULTS: Functional results were excellent in eight patients (38.1%), good in seven (33.3%), satisfactory in four (19.1%), and poor in two patients (9.5%). Radiologic examination showed posttraumatic arthrosis in four patients (19.1%), heterotopic ossification in three patients (14.3%), and avascular necrosis in two patients (9.5%). Radiologic results were excellent and good in 16 patients (76.2%), satisfactory in three patients (14.3%), and poor in two patients (9.5%). CONCLUSION: Clinical and radiologic results showed concordance. The presence of dislocations and inadequate reduction were associated with poor functional results.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 Correspondence on 'Buerger's disease with intramedullary K wire' (multiple letters) [1](W.B. Saunders Ltd, 2005) Walker S.R.; Inan M.[No abstract available]Öğe The effect of continuous passive motion after repair of Achilles tendon ruptures: an experimental study in rabbits(2002) Ertem K.; Elmali N.; Kaygusuz M.A.; Inan M.; Ayan I.; Güner G.; Karakaplan M.OBJECTIVES: The effect of continuous early passive motion on morphologic and histologic healing following repair of Achilles tendon rupture was evaluated in comparison with cast immobilization. METHODS: Achilles tendons of 20 adult rabbits were repaired with the use of modified Kessler technique after surgical transection. Throughout the postoperative six weeks, the rabbits were randomly assigned to cast immobilization (n=10) and to continuous early passive motion four hours a day (n=10). All the rabbits were sacrificed at the end of six weeks and their tendon tissues were removed for macroscopic and histologic examinations. RESULTS: On macroscopic evaluation, findings on adhesions at the operation site, periarticular atrophy, and the ROM of the ankle joint were found significantly more favorable with continuous early passive motion than those of the control group (p<0.001, p<0.05, and p<0.001, respectively). On histologic evaluation, regular collagen bundle alignment was 70% and 20% in the study and control groups, respectively (p<0.05), whereas findings on hyalinization and inflammatory infiltration were not significantly different. CONCLUSION: The utilization of continuous controlled passive motion following repair of Achilles tendon rupture was shown to have beneficial effects on tendon healing and ankle range of movement, without leading to eventual ruptures.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 Treatment of type II and III open tibial fractures with Ilizarov external fixation(2002) Inan M.; Tuncel M.; Karaoglu S.; Halici M.OBJECTIVES: We evaluated the results of patients who were treated with Ilizarov external fixation for type II and III open tibial fractures. METHODS: Forty-five patients (4 females, 41 males; mean age 33 years; range 8 to 65 years) with open tibial fractures were treated with the Ilizarov external fixator. According to the Gustilo-Mendoza classification, the fractures were type II, IIIA, IIIB, and IIIC in 12, 20, 9, and 4 patients, respectively. The mean follow-up was 58 months and 4 days (range 42 months and 10 days to 66 months and 11 days). The fixators were applied for a mean of 17.2 weeks (range 6.8 to 55.7 weeks). RESULTS: Union was achieved in all cases. A significant difference was observed between type II and III fractures in terms of time to union (p<0.05). Compared to type IIIA fractures, the time to union was significantly longer in type IIIB and IIIC fractures (p<0.05). The most frequent complication was pin-tract infections (27.1%). Refracture occurred in four cases (8.8%). Three patients developed late infections at the fracture site. Radiographically, the results were excellent in 14 patients (31%), good in 22 patients (48.8%), moderate in five patients (11.1%), and poor in four patients (8.8%). Functional results were excellent in 21 patients (46.6%), good in 20 patients (44.4%), and moderate in four patients (8.8%). CONCLUSION: Despite technical difficulties and problems associated with pin-tract infections, the Ilizarov external fixator may be the preferred technique in open tibial fractures because of high union rates, the use of thin K-wires with minimal traumatic effect, and more successful functional results.
