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    Electrochemical corrosion properties of metal alloys used in orthopaedic implants
    (2009) Songür, Murat; Çelikkan, Hüseyin; Gökmeşe, Faruk; Şimşek, S. Aykin; Altun, N. Şükrü; Aksu, Mehmet Levent
    This study concerns an investigation of the corrosion behavior of 316 stainless steel, CoCrMo and Ti6Al4V alloys in simulated body conditions (ringer lactate) at 37 °C by the use of Tafel plots, mixed potential and electrochemical impedance spectroscopy (EIS). Ti6Al4V alloy has the highest corrosion resistance followed by CoCr alloy. Ti6Al4V-CoCrMO was the best couple for galvanic corrosion with the minimum galvanic potential and current values according to mixed potential theory and Tafel method. It was concluded that Ti6Al4V was the most suitable material for implant applications in the human body. © 2009 Springer Science+Business Media B.V.
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    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, Murat
    Objectives: 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.
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    Irreducible dorsal distal radius fracture-dislocation with accompanying dorsal displacement of flexor tendons and median nerve: A rare type of injury
    (Elsevier Ltd, 2014) Songür, Murat; Şahin, Ercan; Zehir, Sinan; Kalem, Murat
    INTRODUCTION High energy distal radius fractures may cause significant soft tissue injuries. Dorsal displacement of median nerve and flexor tendons to dorsal compartment between distal radioulnar joint was an unreported type of soft tissue injury.PRESENTATION OF CASE 35-Year male admitted following fall from height diagnosed as closed distal radius fracture with dorsal displacement. The patient had no flexion and extension of all fingers with loss of sensation. Radial artery pulse was not palpable. Radiography and CT imaging revealed distal radius fracture with dorsal displacement with dorsal carpal dislocation. After failure of closed reduction, operative treatment was performed. At surgery, flexor tendons and median nerve was found to be placed at dorsal compartment. Reduction of the soft tissues was facilitated by distraction of distal radioulnar joint.DISCUSSION Dorsal displacement of volar structures as the result of fracture dislocation was found to be an unreported type of injury. Difficulty during reduction of dorsally displaced structures is an important feature of the case.CONCLUSION For severely displaced and deformed distal radial fractures and fracture dislocations, threshold for operative treatment should be kept low. © 2014 The Authors. Published by Elsevier Ltd.
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    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, Deniz
    Objectives: 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.
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    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.
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    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, Ahmet
    Introduction 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.