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Öğe Amputation for upper extremity ischemia following shoulder dislocation: case report and a review of literature(2015) Songur, Murat; Şahin, Ercan; Kalem, Mahmut; Zehir, SinanInjury of the axillary artery following glenohumeral dislocation is a very rare situation. The mechanisms for arterial injuries are lacerations, rupture, avulsion of main branches or intimal tears and pseudo aneurysm formations. In this report we present an upper extremity ischemia following shoulder dislocation resulting with loss of extremity. Our aim was to highlight the importance of the third part of axillary artery and consequences of underestimation of vascular pathologies following shoulder injuries.Öğe Chondral lesion of the capitellum humeri accompanying a radial head fracture: A case report(Sağlık Araştırmaları ve Stratejileri Derneği, 2015) Songur, Murat; Şahin, Ercan; Kalem, Mahmut; Zehir, SinanIn this case report we present a case of a full thickness chondral lesion of the anterior-distal surface of the capitellum humeri, accompanying an intraarticular radial head fracture. The importance of this case is the resemblance of the chondral injury to a Lorenz-Kocher lesion of the humerus and atypical displacement of chondral fragments. A 32-year-old man was admitted to the emergency room after a fall on his right upper extremity. X-ray and Computed Tomography (CT) scan of the elbow revealed a minimally displaced radial head fracture (Mason type 2), with a 4 mm step (depression) at the joint surface. During the operation, at the anterior surface of the distal humerus, a full thickness chondral lesion was encountered.After removal of chondral fragments from the fractured radial head surface, it was seen that these fragments were of capitellar origin. Following radial head fixation, early active assistive motion was started. At the 6 month visit, the patient was painfree with full participation in activities of daily livingwith a DASH score of 12.5. This injury is important due to demonstration of such an extensile injury in spite of benign looking radiology. Although radial head fractures were described, these type of occult injuries may be responsible for unexplainable and unfavorable outcomes following low energy radial head fractures treated conservatively.Öğe Conventional trans-tibial versus anatomic medial portal technique for femoral tunnel preparation in anterior cruciate ligament reconstruction; Comparison of clinical outcomes(Medknow Publications, 2016) Zehir, Sinan; Şahin, Ercan; Songur, Murat; Kalem, MahmutAim: Method of femoral tunnel preparation in anterior cruciate ligament (ACL) reconstruction is controversial. In this study, we aimed to determine if there is any difference between the clinical outcomes of two most commonly used drilling techniques; which are conventional trans-tibial (TT) drilling of femoral tunnel and anatomic preparation of femoral tunnel through medial portal (MP), in patients who underwent ACL reconstruction. Material and Methods: One hundred and twenty-nine male patients who underwent ACL reconstruction between 2010 and 2012 were included in the study. Single-bundle reconstruction with a quadrupled autologous hamstring graft was performed in all patients. Femoral tunnel was drilled by the conventional TT technique in 58 patients (Group 1) and through MP in 71 patients (Group 2). Functional evaluation was made about 12 months postoperatively. Functional evaluation included the Lysholm Knee Scale, International Knee Documentation Committee Scoring (IKDC), and Tegner Activity Level Scale were used for assessment. The anteroposterior stability was assessed using KT-1000 arthrometer and the pivot shift test for assessment of rotational stability. Results: Interval between injury and surgery was similar between two groups (median 8.0 vs. 10 weeks, for TT vs. MP, respectively). One hundred twenty-five patients attending the final follow-up examination (96.8%) were evaluated. The results of Lysholm, IKDC, and Tegner scales were found to be similar. According to KT-1000 arthrometer results, MP group revealed slightly better results than TT group. Regarding pivot shift, MP group showed significantly better stability than TT group (P < 0.001). Conclusion: The anatomical single-bundle femoral tunnel preparation in the reconstruction of the ACL seems as effective as the conventional technique in terms of functional stability in the midterm. The technique better preserved the rotational stability in non-professional athletes.Öğe Effect of intramuscular botulinum toxin-A in a rat rotator cuff repair model: An experimental study(Ekin Medical Publishing, 2015) Şahin, Ercan; Kalem, Mahmut; Zehir, Sinan; Songur, Murat; Demirtaş, Mehmet A.Objective: Rotator cuff repair is associated with multiple complications, significant morbidity, and reintervention, which could be mitigated by postoperative chemodeneveration with botulinum toxin-A (BTX-A). This study evaluated the antinociceptive and paralytic effects of BTX-A on an experimental supraspinatus repair rat model and its effect on functional outcomes (running performance). Methods: Thirty rats were grouped into the surgical repair group (group A), repair + intramuscular BTX-A group (group B), or control group (group C). At the end of the 3-month follow-up, running performance of the rats on a motorized treadmill was evaluated in four time periods (0-30 min, 30-60 min, 60-90 min, and 90-110 min), and penalty points (i.e., number of shock stimuli per lane) were recorded. Afterwards, the supraspinatus muscles were removed and evaluated histologically. Results: Regarding running performance, group B received significantly fewer penalty points than did group A (p<0.05). The penalty points received were not significantly different between groups B and C in the first three time periods, but were significantly higher in group B at the 90-110-min interval than in group C. On necropsy, all repaired tendons were intact, with no sign of failure at the repair site. Histological evaluation revealed marked degeneration and necrosis of muscles in both repair groups, which was much less evident in group B. Groups A and B had less fatty infiltration than group C. Conclusion: BTX-A injections resulted in a better function based on running performance, probably due to decreased tissue tension at the repair site and less pain. Further studies on humans are needed to demonstrate this effect clinically. © 2015 Turkish Association of Orthopaedics and Traumatology.Öğe Evaluation of short term outcomes of transportal femoral cross pin fixation in anterior cruciate ligament reconstruction(SAGE Publications Ltd, 2014) Zehir, Sinan; Şahin, Ercan; Çalbıyık, Murat; Kalem, Mahmut; İpek, Deniz; Songür, MuratObjectives: Many fixation techniques are currently in use for femoral side graft fixation at ACL reconstruction surgery. Short term success following ACL reconstruction highly depends on fixation strength of the graft. In this study we report short term results of anterior cruciate ligament reconstruction using double hamstring tendon autograft using double cross pin for femoral tunnel fixation. Methods: Between years 2009 and 2013, 51 male adult anterior cruciate ligament injury cases treated surgically, in a single center, with at least one year follow up were investigated. Professional athletes, multi-ligamentous instability cases, cases requiring meniscus repair or further treatment for chondral injuries and cases with concomitant medial and lateral meniscus lesions were not included in the study. Femoral tunnel was prepared anatomically through accessory medial portal, opened medially and distally. Reconstruction was performed using double loop hamstring tendon autograft. Femoral side was fixed using double cross pin, whereas tibial side was secured using single biodegradable interference screw and titanium staple. No external immobilization method such as brace was administered. Patients were encouraged to bear weight as tolerated. Standard physiotherapy was instructed to all patients postoperatively. All cases were evaluated clinically at the end of at least one year follow-up. Clinical and functional evaluation consisted of pivot shift and Lysholm, International Knee Documentation Committee (IKDC) scores and Tegner activity evaluation systems. Results: Mean age was 28.4 (18-39) years. Mean time between the injury and reconstruction was 13 (3-21) weeks. Average duration of surgery was 48 (35-70) minutes. No case of graft failure or posterior cortical fracture was encountered. In two cases, infection was treated successfully with local debridement and antibiotics with retention of the graft. At the end of follow-up period, none of the cases demonstrated positive pivot shift test. Pre-operative and follow-up Lysholm scores were 58.3±6.7 and 87.1±5.3 (p<0.001) respectively. Pre-operative IKDC scores were evaluated as C at 37 cases and D at 14, whereas, follow-up IKDC scores were evaluated as A at 42 cases, B at 8 and C at 1 case. Pre-operative and follow-up Tegner scores were 3.7±0.6 and 6.7±0.4 (p<0.001) respectively. Conclusion: Although fixation strength of transcondylar graft fixation techniques has been questioned over loop systems with cortical fixation, it was reported that transcondylar fixation causes less tunnel widening at long term. Our study revealed successful short term results, with femoral tunnel preparation using accessory medial portal and double cross pin femoral fixation, allowing early weight bearing and rehabilitation without graft and fixation failure. © The Author(s) 2014.Öğe Gluteal compartment syndrome secondary to superior gluteal artery injury following pelvis fracture: a case report and review of literature(Emergency Medicine Association of Turkey, 2016) Songur, Murat; Şahin, Ercan; Zehir, Sinan; Öz, İbrahim İlker; Kalem, MahmutAcute gluteal artery syndrome secondary to superior gluteal artery injury following pelvic fracture is a rare entity with potential for significant morbidity and mortality. In this report we present such a case resulting with a favorable outcome with prompt diagnosis and appropriate treatment. © 2016 The Emergency Medicine Association of Turkey.Öğe Opening wedge high tibial osteotomy using tricalcium phosphate wedge: Preliminary results(SAGE Publications Ltd, 2014) Zehir, Sinan; Çalbıyık, Murat; Şahin, Ercan; Kalem, Mahmut; Songür, Murat; İpek, DenizObjectives: High tibial osteotomy is a standard procedure indicated for early medial sided osteoarthritis in varus knees. In this study, we present the early results of high tibial open wedge osteotomy cases using beta-tricalcium phosphate as a graft substitute and Otis-c plate. Methods: Between years 2010 and 2013, 47 cases of (34F, 13 M) medial compartmental gonarthrosis with genu varum deformity treated with high tibial osteotomy, were evaluated with at least one year follow-up, preoperatively both clinically and radiologically. Clinical evaluation involved functional assessment and pain evaluation using Lysholm and visual analog scale (VAS) scores, including knee range-of-motion. Radiological evaluation included medial joint space measurements on weight bearing knee radiographs with measurements of varus angle and posterior tibial slope. Surgical procedure included standard arthroscopy followed by medial sided opening wedge osteotomy with correction of the varus deformity using ?- tricalcium phosphate graft substitute and fixation of the osteotomy site using Otis-C plate and locking screws. All patients were evaluated at the end of minimum one-year follow-up period. Results: Mean age of the patients was 56,7 (50- 65) years and mean follow-up period was 24,5 (12- 44) months. Mean duration of surgery was 47,4±10.2 minutes. No case of nonunion, delayed union, neurovascular injury or iatrogenic fracture was encountered. Two cases developed deep vein thrombosis and one case developed superficial wound infection managed successfully by local debridement with retention of implants and antibiotics. Mean duration of union was 13,4±2.7 weeks. Mean preoperative and follow-up range-of-motion were measured as 131±8.9 and 129±9.1 respectively with no statistical difference. Preoperative and follow-up VAS scores showed significant difference as 7.6±1.76 and 2.3±1.08 respectively (p=0.001). Also Lysholm scores improved significantly at the end of the follow-up period (43.23±4.01 vs. 76.3±3.7 p<0,001). Radiological evaluation revealed mean correction angle of 10.84±2.70 degrees at follow-up. Mean posterior tibial slope was measured relatively unchanged (8.6±1.70° degrees preoperatively versus 8.2±2.30° follow-up). Medial joint space width measurements showed a significant increase (pre-op 3.7±1.6 mm. versus 4.6±1.32 mm. at the follow-up (p<0.001)). Conclusion: Medial opening wedge osteotomy for treatment of early medial compartment gonarthrosis in varus knees is still a valuable option. Our short term preliminary results using beta-tricalcium phosphate wedge graft substitute and Otis-c plate-screw osteosynthesis revealed satisfactory short term clinical and radiological results with acceptable complication rates. © The Author(s) 2014.Öğe Role of anti-adhesive barriers following rotator cuff repair surgery: An experimental study(Ekin Medical Publishing, 2016) Kalem, Mahmut; Şahin, Ercan; Songür, Murat; Zehir, Sinan; Armangil, Mehmet; Demirtaş, Mehmet A.Objective: This experimental study investigates the effectiveness of expanded polytetrafluoroethylene (Dualmesh®, Gore Medical, Flagstaff, AZ, USA), sodium hyaluronate-carboxymethyl cellulose (Seprafilm ®, Genzyme, Cambridge, MA, USA), and polysiloxane (silicone) as anti-adhesive barriers for inhibition of fibrosis in the subacromial area following rotator cuff repair. Methods: Rabbit rotator cuff tenotomy and repair was conducted on 24 rabbits in 4 groups: control (Group A), Dualmesh® (Group B), Seprafilm® (Group C), and silicone (Group D). Anti-adhesive barrier materials were sutured over the repaired rotator cuff. Macroscopic and histological evaluations were made at the end of the sixth postoperative week. Results: Macroscopic evaluation revealed that minimal adhesion occurred in the control and silicone groups, while the Seprafilm® and Dualmesh® groups showed evidence of fibrosis. Microscopic evaluation revealed diffuse fibrosis and collagen accumulation in the Dualmesh® and Seprafilm® groups, whereas minimal collagen deposition and inflammatory cell reaction was found among the silicone and control groups. Significant differences were found between the silicone and Dualmesh® (p=0.001) and silicone and Seprafilm® groups (p=0.002), as well as between the control and Dualmesh® (p=0.002) and control and Seprafilm® groups (p=0.002). Conclusion: Expanded polytetrafluoroethylene (ePTFE/Dualmesh®) and sodium hyaluronate carboxymethyl cellulose (SH-CMC/Seprafilm®) did not prevent or attenuate postoperative subacromial fibrosis following cuff tear repair. Nor did silicone prevent or attenuate fibrosis. More detailed research is needed for development of an effective anti-adhesive barrier for use after rotator cuff tear surgery. © 2016 Turkish Association of Orthopaedics and Traumatology.Öğe Traction table versus manual traction in the intramedullary nailing of unstable intertrochanteric fractures: A prospective randomized trial(Elsevier Ltd, 2016) Şahin, Ercan; Songür, Murat; Kalem, Mahmut; Zehir, Sinan; Aksekili, Mehmet Atıf Erol; Keser, Selçuk; Bayar, AhmetIntroduction The purpose of this prospective randomized study was to compare traction table with manual traction for the reduction and nailing of unstable intertrochanteric femur fractures. Design Prospective, randomized, two-center trial. Materials and methods 72 elderly patients with AO/OTA 31A2 and 31A3 proximal femur fractures were randomized to undergo surgery with either manual traction (MT) or traction table (TT) facilitated intramedullary nailing. The demographics and fracture characteristics, duration of preparation and surgery, total anaesthesia time, fluoroscopy time, blood loss, number of assistants, early post-operative radiological evaluations and 6th month functional and radiological outcomes were evaluated. Data of 64 patients attending 6th month follow-up examination were evaluated statistically. Results No significant differences were observed between groups regarding demographics and fracture characteristics. In the manual traction group, there was a significant time gain in respect of the positioning and preparation period (18.0 ± 1.6 min in MT group, 29.0 ± 2.4 min in TT group) (p < 0.05). In terms of total anaesthesia time (Preparation + surgery) approximately 6 min of difference was observed in favor of MT group (72.8 ± 14.0 min for MT and 78.6 ± 6.5 min for TT, [p < 0.05]). Median number of assistants needed was significantly lower in TT group (2 assistants [1-3]) in MT group and (1 assistant [1,2]) in TT group [p < 0.05]). There was no significant difference between two groups regarding other surgical and outcome parameters. Conclusions Manual traction reduced the preparation time and total anaesthesia duration, despite an increase in number of surgical assistant. Level of evidence Level II. © 2016 Elsevier Ltd. All rights reserved.
