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Öğe Bonesetter interventions and consequences(Ekin Medical Publishing, 2015) Zehir, Sinan; Zehir, Regayip; Şahin, Ercan; Akgül, Turgut; Zehir, Sultan; Subaşı, MehmetObjective: Delaying the treatment of bone and tendon injuries may cause unmanageable complications. Bonesetters continue to cause delays in treatment. The purpose of this study was to analyze the medical outcomes of delay due to bonesetter intervention and factors affecting patient treatment preference. Methods: Among outpatients treated at our clinic between January 2010-December 2012, bonesetter- intervened patients were included, and patient demographics, clinical outcomes, and possible social factors were retrospectively analyzed. Clinical examinations and radiological screening measurements were used to evaluate outcomes. Results: Of the 162 patients, 97 (59.8%) were male, and mean age was 27.5±9.4 years. Eighty-nine (54.9%) of the patients lived in a rural area, and 108 (66.7%) underwent surgery. Bonesetter preference was dictated primarily by elderly relatives (47.6%) or neighbors (33.3%). Patients with a primary school education and unemployed patients mostly preferred bonesetters (p=0.03 and p<0.01, respectively), the explanation for which was the long treatment period and concern of being disabled (p=0.04). Complication rate among patients who were evaluated at a hospital was 33.9%. Conclusion: Despite being medically unreliable and often times harmful, bonesetting is still accepted as an alternative treatment modality among uneducated patient and thus remains an ongoing problem in Turkey. Improvements in average education level and increased dissemination of accurate information via various media and non-governmental organizations will be effective in the correction and prevention of the afore-mentioned complications regarding bonesetter interventions. © 2015 Turkish Association of Orthopaedics and Traumatology.Öğe Comparison of clinical outcomes with three different intramedullary nailing devices in the treatment of unstable trochanteric fractures(Ulusal Travma ve Acil Cerrahi Derneği, 2015-11) Zehir, Sinan; Şahin, Ercan; Zehir, RegayipBACKGROUND: The aim of this study was toreport our experience regarding the use of three different methods for intramedullary nailing in the treatment of intertrochanteric fractures. METHODS: Patients with A2 and A3 type fractures operated on for unstable trochanteric fractures were included into this retrospective cohort study. Patients were divided into three groups based on the technique used; Talon distal fix nail/lag screw (n=78; mean age, 78.5±6.6), PFNA nail (n=96; mean age, 77.2±6.8) or InterTan nails (n=102; mean age, 76.8±6.7). Harris hip scores were recorded at the last outpatient visit and survival information was obtained by phone interview and civil registry database. RESULTS: Baseline characteristics were similar among groups. Operation time, fluoroscopy time and blood loss were significantly higher in InterTan group. Screw cut-out occurred in eight patients in PFNA group. In-hospital mortality occurred in nine (3.2%) patients. Length of hospital stay and postoperative tip-apex distance was not different among groups. At follow-up, healing time and Harris hip scores were also similar among groups. One-year survival rate was 83.1±4.5% in Talon distal fix nail/lag screw, 84.0±3.8% in PFNA group and 84.4±3.7% in InterTan group (p=0.33). CONCLUSION: New Talon distal fix nail/lag screw was associated with lower cut-out rates than PFNA and shorter operative times than InterTan. Further study is warranted to clearly establish the potential advantages of Talon distal fix over any other technique described herein.Öğe Comparison of novel intramedullary nailing with mini-invasive plating in surgical fixation of displaced midshaft clavicle fractures(Springer Verlag, 2015) Zehir, Sinan; Zehir, Regayip; Şahin, Ercan; Çalbıyık, MuratIntroduction: This prospective randomized pilot study sought to determine whether fixation with Sonoma CRx intramedullary pin is a comparable alternative to minimally invasive plating fixation in patients with displaced clavicle fractures. Materials and methods: A total of 45 consecutive patients (Robinson class B1 or B2) were randomly allocated into two groups; intramedullary pin (IMP) group (n = 24, mean age; 33.17 ± 8.60 years, 14 males 58.3 %) received Sonoma CRx Collarbone pin (Sonoma, USA) whereas locking midshaft superior plating (MIPPO) group (n = 21, 32.38 ± 8.41 years, 12 males) patients received minimally invasive locking midshaft superior plating (Acumed, USA). Patients were followed up with a mean time of 11.82 ± 4.22 and 14.45 ± 6.43 months, respectively. Functional status, as the primary outcome measure, was assessed using quick disability of the arm, shoulder and hand (DASH) scores. Results: Mean time of operation and mean time of fluoroscopy were significantly shorter in the IMP group than those in MIPPO group (p < 0.001 and p = 0.03, respectively). Time of hospital stay was significantly shorter in IMP group (p < 0.001). Complications were rare in the early postoperative period. Time until bony union was significantly shorter in IMP group. Mean quick DASH scores were not significantly different between two groups. Implant failure occurred in one patient from each group. Cosmetic dissatisfaction was more common in MIPPO group. Conclusion: Given the shorter operative times and better cosmetic appearance, Sonoma CRx intramedullary pin may be an alternative to minimally invasive plating. Further safety studies are warranted.Öğe Early surgery is feasible in patients with hip fractures who are on clopidogrel therapy(Ekin Medical Publishing, 2015) Zehir, Sinan; Zehir, Regayip; Sarak, TanerObjective: Timing of surgery in hip fracture patients using antiplatelet agents is a controversial issue. Clopidogrel is an antiplatelet drug widely used in the treatment of many diseases. In this study, we aimed to investigate the outcomes of early surgery in hip fracture patients using clopidogrel. Methods: Elderly patients with femoral neck fractures who underwent open surgery between 2009 and 2014 were evaluated. Two hundred and eleven patients were included in the study. Patients were separated into 3 groups. Group 1 was constituted of patients using clopidogrel who had been operated on within 48 h after admission (n=74), Group 2 was constituted of patients using clopidogrel who had been operated on after the fifth day of admission (n=55), and Group 3 was constituted of patients not using clopidogrel who had been operated on within 48 h after admission (n=83). Length of hospital stay, amount of blood transfusion, rate of complication, and mortality rate were assessed for comparison of groups. Results: Age, sex, preoperative hemoglobin values, and ASA scores were not different between the groups. Amount of blood transfusions was higher in Group 1 (p=0.023). Duration of hospital stay was longer in Group 2 (p<0.01), as was complication rate (25.4%) (p<0.01). Mortality within 30 days and within the first 3 months post-surgery was significantly higher in Group 2 (p=0.031, p<0.01; respectively). Conclusion: Surgery should not be postponed in hip fracture patients using clopidogrel. © 2015 Turkish Association of Orthopaedics and Traumatology.Öğe Eosinophil percentage as a new prognostic marker in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention(Akademiai Kiado Zrt, 2019) Güner, Ahmet; Zehir, Regayip; Kalçık, Macit; Uslu, Abdulkadir; Ösken, Altuğ; Kalkan, Ali Kemal; Gültekin Güner, EzgiBackground: In addition to proinflammatory properties, eosinophils can stimulate platelet activation and enhance prothrombotic pathways. In this study, we aimed to investigate the association between the eosinophil percentage (EOS%) and major adverse cardiac events (MACE) in patients with ST-segment elevation myocardial infarction (STEMI). Methods: This study enrolled a total of 1,909 patients who were diagnosed with STEMI. Ventricular arrhythmia, reinfarction, the need for cardiopulmonary resuscitation, target vessel revascularization, congestive heart failure, and cardiovascular mortality during index hospitalization were defined as MACE. Results: Three hundred and eighty patients (19.7%) reached the combined endpoint with MACE. The rates of inhospital mortality and MACE were significantly higher in low EOS% group as compared to high EOS% group (4% vs. 1.1%, p < 0.01 and 32.8% vs. 11.3%, p < 0.01, respectively). On multivariate logistic regression analyses, EOS% (OR = 0.44, p < 0.01) was found to be one of the independent predictors of MACE. The EOS% lower than 0.60 on admission predicted inhospital MACE with a sensitivity of 68% and a specificity of 72% (AUC: 0.684, p < 0.01). Conclusions: Low EOS% on admission may be associated with high inhospital MACE in STEMI patients. EOS% may be used as a novel biomarker for risk stratification of these patients.Öğe Intramedullary repair device against volar plating in the reconstruction of extra-articular and simple articular distal radius fractures; a randomized pilot study(Springer Verlag, 2014) Zehir, Sinan; Çalbıyık, Murat; Zehir, Regayip; İpek, DenizPurpose: This prospective randomized pilot study reports our institutional experience and early results using Sonoma Wrx (Sonoma Orthopedic Products, Santa Rosa, CA) in the treatment of extra-articular and simple intra-articular distal radius fractures. Material and methods: A total of 64 patients, were enrolled in the study. They were considered eligible if they had; unstable extra-articular distal radius fractures and simple intra-articular distal radius fractures suitable for closed reduction (AO types; A2.2, A2.3, A3.1 C2.1, C2.2). Patients in group I received intramedullary fixation using the Sonoma Wrx® device and patients in group II received standard volar locking plate fixation. Radiographic criteria of acceptable healing were used for evaluation. Results: Two groups were similar in terms of baseline characteristics. Mean time of operation was significantly shorter in Group 1 vs. in group 2 (36.81 ± 7.11 vs. 48.97 ± 5.9 minutes, p = 0.001). Time to healing of the fracture was not different between two groups (5.45 ± 1.09 vs. 5.70 ± 1.04 weeks for Group 1 vs. 2, respectively p = 0.36). Overall complications occurred in 9 patients in group 1 and in 15 patients in group 2 (p = 0.17). Follow-up was completed in all patients with a median time of 12 months and 13 months in group 1 and 2, respectively. On radiographic evaluation radial inclination, radial height and volar tilt were not significantly different between group 1 and 2, respectively. There were no significant differences between two groups in regard to wrist rotational degrees measured in last follow-up visit. Conclusion: Sonoma Wrx Device is reliable and effective in terms of achieving satisfactory outcomes in treatment of distal radius fractures. It may be reasonable to use this device to prevent complications that are related to extensive soft tissue dissection. © 2014 Springer-Verlag.Öğe Platelet-to-lymphocyte ratio predicts contrast-induced nephropathy in acute myocardial infarction(DNT Ortadoğu Yayıncılık A.Ş., 2017) Zehir, Regayip; Sarak, Taner; Zehir, SinanAim: Contrast-induced nephropathy (CIN) is responsible for an increased mortality rate and correlates with increases in hospital stays and the risk of cardiovascular complications. The platelet to lymphocyte ratio (PLR) was introduced as a potential marker to determine the balance between thrombosis and inflammation and was associated with increased cardiovascular morbidity and mortality. We investigated whether PLR on admission is an independent risk factor that predicts the development of CIN in patients with ST-segment elevation myocardial infarction (STEMI) underwent primary percutaneous coronary intervention (pPCI). Material and Methods: 1348 consecutive patients with acute STMI who were admitted to our institution and underwent pPCI were retrospectively evaluated. Data obtained from hospital files and computer records. CIN development was accepted as the endpoint. Results: A total of 127 (9.4%) patients experienced CIN. 16 patients underwent renal replacement theraphy. In-hospital mortality rate was found 2.7% (n = 37). Patients were divided into two groups based on development of CIN. Age (P = 0.001), baseline GFR (P < 0.001), grade 3 and more chronic kidney disease (P < 0.001), baseline creatinin (P < 0.001), EF (P < 0.001), presence of DM (P < 0.001) were different between groups. In multivariate analyses, PLR (odds ratio [OR] 1.012, 95% confidence interval [CI] 1.006-1.017, P < 0.001) was independently predicted CIN development. Conclusion: PLR is easily available, widely used, and relatively cheap biomarker, and is an independent predictor of CIN development in patients with STEMI undergoing pPCI.Öğe Proximal femoral nail antirotation against dynamic hip screw for unstable trochanteric fractures; a prospective randomized comparison(Springer Berlin, 2015) Zehir, Sinan; Zehir, Regayip; Zehir, Sultan; Azboy, İbrahim; Haykır, NahideAim: We sought to determine whether intramedullary fixation with proximal femoral nail antirotation produces comparable outcomes to dynamic hip screw in the treatment of unstable trochanteric fractures. Materials and methods: Patients were randomly allocated to receive proximal femoral nail antirotation (Group 1, n = 96, mean age; 77.22 ± 6.82 years) or dynamic hip screw (Group 2, n = 102, mean age; 76.86 ± 6.74 years). Outcome measures were time of operation and fluoroscopy, amount of blood loss and occurrence of surgery-related complications. Tip–apex distance and femoral neck shortening were also evaluated. Patients were evaluated at the sixth month to assess the recovery of walking ability. Survival information was obtained from a civil registry. Results: Operative and fluoroscopy times were significantly shorter and blood loss was significantly lower in Group 1 than those in Group 2. Complication rates, mean tip–apex indices and recovery of walking ability were similar between groups, whereas independent walking was more common in Group 1 than in Group 2. Until the sixth month, screw cutout occurred in eight (7.8 %) and seven (7.3 %) patients in Group 1 and Group 2, respectively (p = 0.88). Three-year survival rate was 61.6 ± 9.4 vs 57.3 ± 9.7 % in Group 1 and Group 2, respectively (p = 0.50). Conclusion: Proximal femoral nail antirotation technique offers better recovery than dynamic hip screw, whereas both techniques possess the same risk of postoperative complications. © 2014, Springer-Verlag Berlin Heidelberg.Öğe Results of midshaft clavicle fractures treated with expandable, elastic and locking intramedullary nails(Ekin Medical Publishing, 2015) Zehir, Sinan; Akgül, Turgut; Zehir, RegayipObjective: The aim of the study was to present the results of osteosynthesis with elastic expandable intramedullary nail for clavicle fractures. Methods: The study included 17 patients (11 males, 6 females; mean age 36.4 years, range: 21 to 54 years) who underwent surgery for a displaced clavicle fracture and had a shortening of more than 2 cm. The Constant Score and DASH (Disabilities of The Arm, Shoulder and Hand) scoring were used to determine the functional status of the patients. Results: Mean operation time was 30.4 (range: 25 to 42) minutes and mean follow-up period was 10.3 (range: 8 to 19) months. Mean union time was 15.8 (range: 9 to 20) weeks. A superficial infection was treated with wound debridement and antibiotherapy in one patient. No patient suffered from neurovascular compromise, deep infection or implant irritation. Implant fracture developed at 2 months after surgery in one patient treated for Type B1 clavicle fracture and healed without any other intervention. There was no statistically significant shortening (p>0.05). In the final follow-up, the mean Constant Score was 94.3 (range: 86 to 97), and mean DASH score was 11.8 (range: 7.3 to 17.4). Conclusion: Expandable elastic locking intramedullary nail appears to provide minimal complication and high success rate for the surgical treatment of non-comminuted displaced clavicle shaft fractures. Additional studies with large series are necessary for further investigation. © 2015 Turkish Association of Orthopaedics and Traumatology.Öğe Suspensory fixation versus novel transverse crosspin for femoral fixation in anterior cruciate ligament reconstruction(Springer Verlag, 2014) Zehir, Sinan; Zehir, RegayipBackground and aim: There is still no gold standard technique for graft fixation during anterior cruciate ligament reconstruction. We compared the functional outcomes of patients receiving either ToggleLoc with ZipLoop technology or Translig transverse crosspin device for femoral graft fixation.Materials and methods: A total of 118 patients were randomly allocated into two groups to receive either Translig® transverse crosspin (Translig group 1: n = 51, mean age 28.34 ± 7.83 years, age 18–40 years) or ToggleLoc with ZipLoop technology (ToggleLoc group: n = 67, mean age 26.85 ± 8.76, age 16-41 years) for femoral graft fixation. Early and 1-year assessment was made with Lysholm knee scale, International Knee Documentation Committee Scoring, Tegner Activity Level Scale, KT-1000 arthrometer and pivot shift test.Results: Preoperative vs. postoperative functional parameters showed significant improvement in both groups. Two groups were similar in terms of Lysholm knee scale, IKDC and Tegner activity scores (p > 0.05). The KT-1000 arthrometer revealed slightly less anterior sliding in Translig group than that in ToggleLoc group (p > 0.05). ToggleLoc technique allowed a radiographically more horizontal placement of the graft than Translig technique.Conclusion: Two distinct techniques used in this study are likely to be suitable for femoral graft fixation during anterior cruciate ligament reconstruction with the femoral tunnel being created via anteromedial approach. © 2014, Springer-Verlag Berlin Heidelberg.Öğe The relationship between dual antiplatelet treatment (DAPT) score and saphenous venous grafts patency after coronary artery bypass grafting surgery(Taylor & Francis Ltd, 2021) Bayam, Emrah; Öztürkeri, Burak; Yıldırım, Ersin; Kalçık, Macit; Kup, Ayhan; Çakmak, Ender Özgün; Zehir, RegayipBackground Coronary artery bypass grafting (CABG) remains the gold standard treatment for mutivessel and left main coronary artery disease (CAD). Saphenous vein graft (SVG) patency is still a problem in CAD patients after CABG surgery. The Dual Antiplatelet Treatment (DAPT) score is a clinical prediction tool that predicts ischaemic and bleeding risk in CAD patients. The aim of this study is to investigate the relationship between DAPT score and SVG patency in CABG patients. Method This retrospective study enrolled a total of 398 patients (68 female; mean age 65.8 +/- 9.1 years) with a history of CABG surgery. The study population was divided into two subgroups according to SVG patency. The DAPT score was calculated for each patients and compared between the two groups. Results Coronary angiography revealed SVG disease in 212 patients and SVG patency in 186 patients. The rates of diabetes mellitus and hypertension, red cell distribution width values, DAPT Score, time interval after CABG and number of SVGs were significantly higher while LVEF was significantly lower in patients with SVG disease. The presence of diabetes mellitus, high DAPT score, long time interval after CABG and high number of SVGs were found to be independent predictors of SVG patency. DAPT score above 2.5 predicted SVG disease with a sensitivity of 77.1% and a specificity of 87.1% (AUC: 0.873; 95%CI: 0.823-0.924; p < 0.001). Conclusion The DAPT score may provide useful information for SVG patency in CABG patients. Patients with high DAPT score should be followed up closely for SGV occlusion. DAPT score may be useful prior to CABG in determining the duration of dual anti-platelet therapy and in encouraging the use of arterial grafts with better patency.
