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Öğe Ayak Başparmağı Distal Falanksta Gerçek Osteokondrom: Olgu Sunumu+(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2010) Ertem, Kadir; Doğan, seyfullah; Pepele, Demet; Baydar, Mehmet; Aydın, EnginOsteokondrom ya da ekzositoz iskelet sisteminin en sık görülen tümörüdür. Tüm benign kemik tümörlerinin %20-50’sini, tüm kemik tümörlerinin %10-15’ini oluşturur. Bu çalışmada sol ayak 1. parmak distal falanks proksimalinde gerçek osteokondromu olan olguyu sunmayı amaçladık.Öğe Comparison of the effects of sodium hyaluronate-chondroitin sulphate and corticosteroid in the treatment of lateral epicondylitis: a prospective randomized trial(Elsevier, 2015) Tosun, Haci Bayram; Gumustas, Seyitali; Agir, Ismail; Uludag, Abuzer; Serbest, Sancar; Pepele, Demet; Ertem, KadirBackground Hyaluronic acid and glycosaminoglycans have shown positive effects in improving lateral epicondylitis and other tendinosis conditions. Therefore, we designed a prospective, randomized study to compare the effects of a combined sodium hyaluronate and chondroitin sulfate (HA + CS) injection versus a triamcinolone injection in the treatment of lateral epicondylitis. Methods In total, 57 consecutive patients with clinically diagnosed lateral epicondylitis were divided randomly into two groups. In the HA + CS group, 25 patients received a single injection of a solution containing an HA + CS combination and prilocaine HCl, while the 32 patients in the triamcinolone group received a single injection of a solution of triamcinolone and prilocaine HCl. We evaluated the pain and function outcome measures using the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire at the beginning of the study, and 3 and 6 months after the injection. Additionally, the Minimum Clinically Important Difference values and percentage changes in the PRTEE subscale scores between the assessments were calculated. Results No serious adverse events were reported throughout the study. The mean pain and function scores for the HA + CS and triamcinolone groups had significantly improved at 3 months, but the mean function scores in the HA + CS group were statistically significantly better when compared to the triamcinolone group. At 6 months, both groups had significantly improved mean pain and function scores, compared to the baseline scores; however, the mean pain and function scores in the 6-month HA + CS treatment group were better than in the 6-month triamcinolone group. The relative change for the mean total score in the HA + CS group was much better when compared with the triamcinolone group, and the HA + CS treatment group showed clinically significant improvement when compared with triamcinolone group at 3 and 6 months. Conclusions This study supports the idea that for a single injection treatment of patients with lateral epicondylitis, a combination injection of HA + CS may offer better pain benefits for 6 months after injection, when compared to triamcinolone. Type of study/level of evidence Level II, Randomized Clinical Trial, Prospective Comparative Study.Öğe Early Results of Anatomic Double Bundle Anterior Cruciate Ligament Reconstruction(Derman Medical Publ, 2015) Pepele, Demet; Karakaplan, Mustafa; Elmali, Nurzat; Topgul, Haldun; Ozen, MetehanAim: The goal in anterior cruciate ligament reconstruction (ACLR) is to restore the normal anatomic structure and function of the knee. In the significant proportion of patients after the traditional single-bundle ACLR, complaints of instability still continue. Anatomic double bundle ACLR may provide normal kinematics in knees, much closer to the natural anatomy. The aim of this study is to clinically assess the early outcomes of our anatomical double bundle ACLR. Material and Method: In our clinic between June 2009 and March 2010, performed the anatomic double bundle ACLR with autogenous hamstring grafts 20 patients were evaluated prospectively with Cincinnati, IKDC and Lysholm scores and in clinically for muscle strength and with Cybex II dynamometer. Results: The mean follow-up is 17.8 months (13-21 months). Patients' scores of Cincinnati, IKDC and Lysholm were respectively, preoperative 18.1, 39.3 and 39.8, while the post-op increased to 27.2, 76.3 and 86.3. In their last check, 17 percent of the patients according to IKDC scores (85%) A (excellent) and B (good) group and 3 patients took place as C (adequate) group. The power measurements of quadriceps and hamstring muscle groups of patients who underwent surgery showed no significant difference compared with the intact knees. Discussion: Double-bundle ACL reconstruction is a satisfactory method. There is a need comparative, long-term studies in large numbers in order to determine improving clinical outcome, preventing degeneration and restoring the knee biomechanics better.Öğe Otojen hamstring tendonları ile yapılan çift bant ön çapraz bağ rekonstrüksüyonunun erken dönem sonuçları(İnönü Üniversitesi, 2010) Pepele, Demetİnönü Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji kliniğine Haziran 2009 ile Ocak 2010 tarihleri arasında başvuran, ÖÇB lezyonu tanısı konan 16 hasta çalışmamıza dahil edildi. Çalışmamız prospektif bir çalışma idi. Hastalarımızın hepsi erkek idi. Hastaların yaş ortalaması 26.9 (20-47)'du. Tüm hastalara otojen hamstring greftleri ile femoral askı yöntemi kullanarak çift tünel ÖÇB rekonstruksiyonu yapıldı. Postop hastalara hızlandırılmış rehabilitasyon prosedürü uygulandı. Ortalama takip süresi 7.8 ay (3-12 ay) olarak bulundu. Hastaların Lysholm skor ortalaması preop 39.6 (dağılım 11-65) iken post op 86.3 (dağılım 70-100)'dü. Hastaların Tegner aktivite skorları ortalaması travma öncesi 7.37, travma sonrası 4, post op 6,43'idi. Son kontrollerinde IKDC skorları uygulanan hastaların 13 (%81.25)'ü A (mükemmel) ve B (iyi) grubunda yer aldı. C grubunda 3 hasta bulunurken, D (kötü) grubunda hastamız bulunmamaktadır. Hastaların IKDC subjektif diz değerlendirme formu ortalamaları pre op 39.3 (dağılım 20.6-66) iken son muayenede 76.3 (dağılım 50-97)'ye yükselmiştir. Cincinnati skoru preop 18.18 (dağılım 15-22) iken, postop ortalama 27.25 (dağılım 20-30) `dir. Bu sonuçlara göre travma sonrası (pre-op) ve post-op ortalamalar arasındaki farklar tatmin edici değerlerdedir (p=0.0001). Cybex II dinamometresi ile yapılan kuadriseps ve hamstring kas gruplarına ait güç ölçümlerinde hiçbir hastada %15'in üzerinde güç kaybıyla karşılaşılmadı. Sonuç olarak hamstring tendonları ile femoral askı yöntemi kullanarak çift tünel ÖÇB rekonstrüksiyonu literatür verileri ve aldığımız sonuçlar ışığında kullanılabilir ve tatmin edici sonuçlar alınabilir bir yöntemdir. Tekniğin, dejenerasyonu engelleme ve diz biyomekaniğini daha iyi restore etme açısından yararlarını kanıtlamak ve aynı zamanda benzer çalışmalarla karşılaştırmak için uzun dönem sonuçlarını görmek gerekmektedir.Öğe Outcomes of open tibial shaft fractures treated by external fixation method(2022) Baydar, Mehmet; Harma, Ahmet; Pepele, Demet; Kalın, CoskunerTibia is vulnerable to open fractures due to its relative inadequacy of soft tissue coverage. The optimal treatment method of open tibial fractures is still controversial. External fixators are widely used as a definitive treatment method for open fractures. The aim of the current study was to evaluate the outcomes of external fixators applied for open tibial shaft fractures. All open tibial fractures treated with external fixators between December 1999 and October 2008 were reviewed retrospectively. 48 limbs of 47 patients were included in this study. Fractures were classified as Type I in 4 (8.3%), Type II in 18 (37.5%), and Type III in 26 (54.2%) according to Gustilo-Anderson classification. The mean follow-up period was 58.3 months. 28 patients (29 limbs) underwent unilateral external fixation, and 19 patients received Ilizarov ring fixator. Fracture healing rates were 100% in Type I fractures, 88.9% in Type II fractures, 81.8% in Type IIIA fractures, 28.6% in Type IIIB fractures, and 62% in Type IIIC fractures. The mean time for removal of the external fixator was 24.06±12.44 weeks. The mean time to fracture union was 27.27±13.19 weeks. According to Karlstrom and Olerud criteria, the mean functional score was 31.04±3.77. Functional results were excellent in 6 limbs (12.5 %), good in 16 limbs (33.3 %), acceptable in 8 limbs (16.7%), moderate in 10 limbs (20.8%), and poor in 8 limbs (16.7%). Deep tissue infection developed in 5 limbs (10.4%). Osteomyelitis developed in 4 limbs (8.3%). The findings of our study suggest that satisfactory results can be obtained by using external fixators for the treatment of open tibial shaft fractures.Öğe Vascular pedicled iliac bone grafting is effective in patients with an early stage of femoral head avascular necrosis(Turkish Joint Diseases Foundation, 2014) Elmali, Nurzat; Ertem, Kadir; Karakaplan, Mustafa; Pepele, Demet; Daggez, Cihat; Topgul, HaldunObjectives: This study aims to evaluate clinical and radiological findings of a series of patients with avascular necrosis of the femur head (ANFH) treated by core decompression and vascular pedicled iliac crest grafting. Patients and methods: This retrospective study included 26 hips of 22 patients (14 males, 8 females; mean age 36 years; range 16 to 48 years) with ANFH using the vascularized iliac bone grafting between March 2003 and July 2010 in our clinic. The main predisposing factor was steroid use in 13 patients. All patients were assessed clinically according to the Harris hip score and by radiographs by the Association Internationale de Recherche sur la Circulation Osseuse (ARCO) staging system. Results: The mean follow-up was 36 (range 14 to 62) months. Eleven hips (42%) had stage II and 15 hips (58%) had stage III ANFH. The mean Harris scores increased from 52 (range 31 to 63) to 82.8 (range 62 to 90) after surgery. Based on clinical outcomes, 18 hips (69%) were presented as excellent and good, while eight hips presented fair and poor. According to the ARCO staging system, satisfactory results were provided in 17 (65%) of the 26 hips. Two of four hips at preoperatively stage II progressed to stage III, two other hips to stage IV. Five hips at stage III preoperatively progressed to stage IV and these hips had to undergo hip replacement. Conclusion: Our results suggest that core decompression and the vascular pedicled iliac bone grafting are effective in early stages of ANFH.
