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    Amputation for upper extremity ischemia following shoulder dislocation: case report and a review of literature
    (2015) Songur, Murat; Şahin, Ercan; Kalem, Mahmut; Zehir, Sinan
    Injury 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.
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    Bilateral acute tibial osteomyelitis in a patient without an underlying disease: a case report
    (BioMed Central Ltd., 2014) Sipahioğlu, Serkan; Askar, Hüseyin; Zehir, Sinan
    Introduction: The simultaneous presentation of osteomyelitis in more than one bone is rare and is commonly accompanied by a chronic disease. Even in such cases, other conditions that arise commonly in the long bones of children - such as chronic recurrent multifocal osteomyelitis and Ewing's sarcoma - must be ruled out. Case presentation: We present the case of a 5-year-old boy with bilateral acute tibial osteomyelitis without an underlying chronic disease who was treated with surgical debridement. We also review the pertinent literature. Conclusion: Early diagnosis, appropriate antibiotic therapy, and timely surgical intervention - including proactive efforts to prevent fractures - all increase the chance of a successful outcome for these patients. © 2014 Sipahioglu et al.; licensee BioMed Central Ltd.
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    Bonesetter interventions and consequences
    (Ekin Medical Publishing, 2015) Zehir, Sinan; Zehir, Regayip; Şahin, Ercan; Akgül, Turgut; Zehir, Sultan; Subaşı, Mehmet
    Objective: 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.
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    Can developmental dysplasia of the hip be identified in the prenatal period? A pilot study: Ultrasonographic evaluation and postnatal follow-up results of fetal hips in the third trimester
    (2021) Komut, Erdal; Zehir, Sinan
    Objective: This study aimed to determine the predictability of developmental dysplasia of the hip (DDH) in the prenatal period by means of evaluating fetal hips using the Graf method on obstetric ultrasonography (US) after the 34th week of gestation. Methods: A total of 84 pregnant women (mean age = 27.04; age range = 19-46 years), who were referred to our radiology clinic for an obstetric US examination in the third trimester, and their fetuses were included in this study. In the obstetric US, alpha angles of both hips of the fetuses were measured based on Graf’s method, and each case was assessed ultrasonographically by a second physician at 6-10 postnatal weeks. Prenatal and postnatal hips were then classified according to alpha angles as ? 60° or < 60°. The kappa coefficients between the diagnoses based on prenatal and postnatal alpha angles were calculated. Results: According to the postnatal alpha angle, 77 fetuses were diagnosed to have type 1 right hip and 7 fetuses had type 2A right hip. The prenatal alpha angle provided the same results (77 type 1 and 7 type 2A right hips). Similarly, the postnatal alpha angle revealed type 1 left hip in 82 fetuses and type 2A left hip in 2 fetuses, which was the same as the diagnoses based on the prenatal alpha angles. There was a complete agreement between prenatal and postnatal alpha measurements for both the left and right hips (kappa = 1.00, P < 0.001). Conclusion: Evidence from this study has revealed that DDH can be identified by obstetric ultrasonographic examinations in the prenatal period. Level of Evidence: Level II, Diagnostic Study
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    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, Sinan
    In 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.
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    Clinical and Radiological Results of Patients Treated with Talon Distalfix Femoral Intramedullary Nail for Femoral Shaft Fractures
    (Hitit University, 2023) Dündar, Abdulrahim; İpek, Deniz; Zehir, Sinan; Kaya, Şehmuz
    Objective: Talon distalfix intramedullary nails have been developed as a solution to the technical difficulties experienced during the placement of locking screws. We aimed to evaluate the radiological and clinical results of retractable talon distal fix for the treatment of femoral shaft fractures. Material and Method: Between January 2017 and January 2022, 28 patients with femoral shaft AO type 32-A and B fractures were treated with Talon distalfix nails. AO Type 32-A and B fractures were included in the study. Demographic characteristics, follow-up times, ASA of Anesthesiologists classification and fracture type were recorded. The duration of the operation, intraoperative blood loss, fluoroscopy time (in min), and time to bone union were recorded. General and technical complications (nonunion, malunion, malrotation, and shortening) were evaluated. Clinical functional outcomes were evaluated using the Knee Injury and the Osteoarthritis Outcome Score Physical Function Shortform (KOOS-PS), Hip Injury and Osteoarthritis Outcome Score Physical Function Shortform (HOOS-PS) and Thoresen criteria. Results: A total of 28 patients (11 female and 17 male) were included in the study. The mean age was 46.8 years and the mean follow-up was 23.7 months. The mean time to bone union was 22.6 weeks. No nonunion was observed in any of the patients. The mean hospital stay was 3.4 days and the mean Body Mass Index was 24.2. The mean operation time was 40.3±3.4 minutes and the mean scope time was 26.9 seconds. The mean KOOS-PS score and HOOS-PS were 83.4 and 85.6, respectively. Conclusion: Talon distalfix nails can be safely used in AO type A-B fractures of the midshaft femur. Talon distalfix nail application provides advantages including shorter operation times, less radiation exposure, fewer surgical incisions, and less blood loss. In addition, it should be emphasized that the union time is prolonged compared with that of conventional nails
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    Comparision of the expandable nail with locked nail in the treatment of closed diaphyseal fractures of femur
    (Medknow Publications, 2017) Sipahioğlu, Serkan; Zehir, Sinan; Sarıkaya, Baran; Işıkan, Uğur Erdem
    Background: Expandable nails achieve stability only by hydraulic expansion; therefore suggest less radiation exposure and operation time. In this study, we aimed to compare the results of expandable femoral nails with locked intramedullary nails in the treatment of diaphyseal fractures of femur. Materials and Methods: Isolated closed AO = Arbeitsgemeinschaft für Osteosynthesefragen type 32.A or 32.B unilateral femoral shaft fractures operated with expandable or locked nail were evaluated retrospectively. We match patients who undergone expandable nail fixation with patients of the same-sex, age, and fracture type who undergone locked nailing. A match was done for 31 expandable nail. At follow up, healing was assessed radiologically and clinically. Outcome measures included duration of hospital stay, time taken to achieve bony union, and participation in full activities. Results: The average duration of surgery in the expandable group was 60.9 min and in the locked group was 82.4 min. In the expandable group, the average clinical healing time was 15.5 weeks and radiographic healing time was 21.7 weeks. In the locked IMN group, the average clinical healing time was 18.4 weeks and the average radiographic healing time was 24.1 weeks. We observed seven (22.6%) non-union in expandable group and four (12.9%) non-union in locked group. In the expandable group, type of the fracture was AO 32.B in all of the non-union patients. We achieved union in all of non-unions of the locked group only with dynamization. In the expandable IMN group, five (16.1%) patients required major surgery, in the locked group none of the patients required major surgery. Conclusion: Non-union rate of the expandable nail is higher than that of the locked nail for femoral diaphyseal fractures. It may be a treatment option in simple fractures like AO 32.A and in patients where rapid fixation is demanded. It has advantages of reduced operative time and less radiation exposure in comparison with reported series of conventional nails.
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    Comparison between locked intramedullary nailing and anatomical locking plating in the treatment of displaced clavicular midshaft fractures
    (Ekin Medical Publishing, 2016) Zehir, Sinan; Çalbıyık, Murat; Şahin, Ercan; İpek, Deniz
    Objective: The aim of this study was to compare the results of expandable flexible locked intramedullary nailing and anatomical locking plating in clavicular midshaft fractures. Methods: Thirty-three patients (21 male, 12 female) who had displaced fractures and at least 2-cm shortening fixed with expandable flexible locked intramedullary nailing and 38 patients (24 male, 14 female) who underwent anatomical locking plating were recruited. Duration of surgery, incision size, duration of hospital stay, union time, and early and late complications were compared between the groups. Functional results were compared with Constant scoring system. Results: Mean duration of surgery was 32.4±9.1 minutes (range: 20-42 minutes) in the nailing group and 54.1±11.9 minutes (range: 42-70 minutes) in the plating group. The incision was 4.1±0.9 cm (range: 3-5 cm) in the nailing group and 9.5±1.7 cm (range: 7-12 cm) in the plating group. Mean union time was 14.8 weeks (range: 10-24 weeks) in the nailing group and 21.3 weeks (range: 12-33 weeks) in the plating group. Mean duration of hospital stay was 3.6±1.1 days (range: 2-4 days) in the plating group, whereas it was 2.3±0.8 days (range: 1-3 days) in the nailing group. In the plating group, an average of 2.7-mm (range: 0-7 mm) shortening was determined in the clavicles that underwent surgery as compared to the intact clavicles, whereas shortening was 2.3 mm (range: 0-6 mm) in the nailing group. Conclusion: Expandable flexible locked intramedullary nailing can provide more successful outcomes than plating in displaced clavicular midshaft fractures, due to advantages such as shorter union time, lower complication rate, and better cosmetic outcomes. © 2016 Turkish Association of Orthopaedics and Traumatology.
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    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, Regayip
    BACKGROUND: 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.
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    Comparison of medial and posterior surgical approaches in pediatric supracondylar humerus fractures
    (Medknow Publications, 2017) Şahin, Ercan; Zehir, Sinan; Sipahioğlu, Serkan
    Objectives: The aim of the current study was to compare the clinical results of pediatric supracondylar humerus fracture cases requiring open reduction through medial approach with posterior approach. Patients and Methods: Retrospective cohort of 67 cases of pediatric supracondylar fractures was reviewed. Thirty-three patients (20 males, 13 female, average age: 8.3 ± 3.131) were treated with medial approach were compared with 34 patients (19 males, 15 females, average age: 7.5 ± 3.146) treated with posterior exposure. Median follow-up period of the first group was 35.04 months (range: 17-76 months) and of the second group was 36.04 (range: 16-65 months). Radiological evaluation included Baumann angle, carrying angles, and lateral humero-capitellar angles. Functional and cosmetic evaluation was assessed with range-of-motion measurements and the criteria defined by Flynn et al. Results: No differences between groups were noted regarding gender, age, and follow-up periods. Operative time was significantly shorter in medial approach group [60.0 ± 14.5 vs. 75.8 ± 17.6 min (P = 0.002)]. Radiological measurements (Baumann, humero-capitellar, and carrying angles) were also similar between groups. When evaluated patients according to Flynn's criteria, for medial group, 31 cases (93.9%) had good-perfect result regarding ROM loss, whereas for posterior group 33 cases (97%) had good-perfect result. Regarding carrying angle change and posterior group were slightly better than medial group (perfect result observed in 91.1% vs 81.8%, respectively). The differences did not show statistical significance. Conclusion: In the treatment of supracondylar humerus fractures in children, both surgical approaches revealed similar functional and radiological outcomes with shorter operative time when medial approach was utilized.
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    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, Murat
    Introduction: 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.
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    Comparison of radiological and functional results in osteoporotic distal femur fractures operated with single plating, lateral incision, and double plating, anterior paramedial incision: A retrospective study
    (LIPPINCOTT WILLIAMS & WILKINS, 2024) Çalbıyık, Murat; Zehir, Sinan; Demirezen, Murat Okan
    Treatment of osteoporotic distal femur fractures is often complicated by a high rate of nonunion and varus collapse. For such fractures, lateral plating with lateral incision and double plating with anterior paramedial incision have shown promising results in the recent literature. The hypothesis of this study was that bilateral plating of comminuted distal femur fractures in osteoporotic patients would result in higher union rates and lower revision rates compared to an isolated lateral locking plate. The study included 56 patients (23 males, 33 females) with supracondylar femur fracture. According to the OA/OTA classification, 9 were type A3, 8 were A2, 13 were C1, 16 were C2, and 10 were C3. The mean follow-up period was 12 months, with 29 patients treated using lateral mini-incision, lateral locking plate, and 27 patients treated with anterior paramedial incision, dual plating. The clinical and radiological results were evaluated. The mean duration of radiological union in the studied population was 15 +/- 2.1 months (range, 11-21 months) in the single plate group (Group A), and 13.5 +/- 2.6 months (range, 9-19 months) in the double plate group (Group B). Mean ROM was 112.3 degrees and flexion contracture 4 degrees in Group A, and ROM 108.3 degrees and flexion contracture 6.7 degrees in Group B. (P = .15). The average Western Ontario and McMaster Universities Arthritis Index (WOMAC) score was 85.6 points in Group A and 83.5 points in Group B (P = .2278). The postoperative anteversion measurement in the operated extremity ranged from -15 to 19 in Group A, and from 5 to 18 in Group B. When the anteversion degrees were compared between the injured and uninjured extremities in the postoperative period, a significant difference was observed within Group A (P = .0018), but no significant difference was observed in Group B (P = .2492). Dual plate fixation using the anterior paramedial approach is an effective operative method for osteoporotic distal femur fractures. This has many advantages such as precise exposure, easy manipulation, anatomic reduction, and stable fixation. However, for surgical indications and medial bone defects > 1 cm, grafting should be performed.
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    Comparison of Unilateral Knee Arthroplasty with High Tibial Osteotomy in Surgical Treatment of Medial Knee Osteoarthritis
    (ACAD MEDICAL SCIENCES I R IRAN, 2022) Zehir, Sinan; Şahin, Ercan
    Background: High tibial osteotomy (HTO) and unicondylar knee arthroplasty (UKA) are two procedures of choice in moderate medial-sided knee osteoarthritis. In this study, we aimed to compare the outcomes of patients undergoing either unilateral knee arthroplasty or open-wedge HTO both clinically and radiologically. Methods: Clinical records of 105 patients treated surgically with either medial unilateral knee arthroplasty or high tibial osteotomies were reviewed. Fifty-one cases of HTO (group 1) and 54 cases of unicompartmental knee arthroplasty (group 2) were reviewed. Radiographic follow-up data included Kellgren Lawrence index and mechanical alignment measurements using the PACS system. Clinical and functional follow-up data included range of motion degrees and functional assessment scores (Tegner, Lysholm, Knee Society Score and VAS). Results: Mean time of follow-up was 66.10±8.14 months and 65.27±6.95 months for groups 1 and 2, respectively. The HTO group had better radiographic improvement and greater range of motion than the unicompartmental knee arthroplasty group. Despite a significant difference in Lysholm Knee Score and a slight difference in VAS score in favor of HTO, both groups were similar with regard to functional outcomes. Conclusion: Both techniques are satisfactory in terms of functional outcomes about five years after the operation and may be considered in cases of middle-aged medial-sided gonarthrosis (
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    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, Mahmut
    Aim: 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.
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    Early surgery is feasible in patients with hip fractures who are on clopidogrel therapy
    (Ekin Medical Publishing, 2015) Zehir, Sinan; Zehir, Regayip; Sarak, Taner
    Objective: 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.
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    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.
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    Eklem içi distal radius kırıklarının volar kilitli plakla tedavi sonuçları
    (2014) Azboy, İbrahim; Demirtaş, Abdullah; Alemdar, Celil; Zehir, Sinan; Çakır, İdris Ahmet; Şahin, İlhami; Arslan, Arslan Kağan
    Amaç: Çalışmamızda eklem içi distal radius kırıklarında volar kilitli plakla tespitin fonksiyonel ve radyolojik sonuçlarının değerlendirilmesi amaçlandı. Yöntemler: Eklem içi distal radius kırığı tanısıyla volar kilitli plakla tedavi edilen 28 hasta (ort. yaş 44.6; dağılım 19- 74) çalışmaya alındı. Kırıklar AO/ASIF sınıflamasına göre sınıflandırıldı. Buna göre 18 hasta B ve 10 hasta C tipi kırık idi. Ortalama takip süresi 19 ay (dağılım 12-28) idi. Hastalar MAYO el bileği skoru ve DASH (Disabilities of the Arm, Shoulder and Hand) anketi ile değerlendirildi. Radyolojik incelemede radial kısalma, radial ve palmar eğimler ölçüldü. Klinik ve radyolojik karşılaştırma için sağlam el bileği kullanıldı. Bulgular: Tüm kırıklarda kaynama elde edildi. Ameliyat sonrası MAYO skorlamasında 6 hastada mükemmel, 7 hastada iyi, 14 hastada yeterli ve bir hastada kötü sonuç alındı. Ortalama DASH skoru 16.4 (dağılım 0-76) olarak bulundu. Sağlam tarafla karşılaştırıldığında radial eğimde ortalama 0.9 derecelik ve palmar eğimde ortalama 6.9 derecelik kayıp saptandı. Ortalama aktif fleksiyon 56.3°, ekstansiyon 52.5°, supinasyon 74.2° ve pronasyon 70.7° ölçüldü. Dört hastada ekstansör tendon tenosinoviti, iki hastada fleksör pollisis longus tenosinoviti, iki hastada karpal tünel sendromu, bir hastada yüzeyel enfeksiyon ve bir hastada refleks sempatik distrofi görüldü. Sonuçlar: Volar kilitli plaklar, eklem içi distal radius kırıklarının tedavisinde yeterli tespit ve tatmin edici fonksiyonel sonuçlar sağlamaktadır. Bununla birlikte, fleksör ve ekstansör tendon sorunları, median sinir tuzaklanması ve refleks sempatik distrofi ile karşılaşılabileceği akılda tutulmalıdır. Tenosinovit semptomlarının gözlendiği olgularda, kaynama sağlanmışsa vakit kaybetmeksizin implantlar çıkarılmalıdır
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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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    Femur boyun kırıklarına parsiyel protez uygulamasında anterior ve posterior kapsüler açılımın sonuçları
    (2013) Zehir, Sinan; Şahin, Ercan; Sipahioğlu, Serkan; Azboy, İbrahim; Yar, Ümit
    AMAÇ: Çalışmamızda anterior veya posterior cerrahi yaklaşımla bipolar protez uygulanan femur boyun kırıklı hastaların fonksiyonel durumları ve ortaya çıkan komplikasyonlar geriye dönük olarak değerlendirildi. GEREÇ VE YÖNTEM: Kasım 2007-Şubat 2011 tarihleri arasında femur boyun kırığı nedeni ile bipolar parsiyel protez uygulanan, takip süresi en az bir yıl olan 224 hasta (96 erkek, 128 kadın) değerlendirildi. Cerrahi yaklaşıma göre iki grup oluşturuldu. Kalça eklem kapsülü anteriordan açılan (grup 1) grupta 92 (46 erkek, 46 kadın; ortalama yaş 78.4 yıl dağılım 70-97) hasta, kapsülün posteriordan açıldığı (grup 2) grupta ise 132 (50 erkek, 82 kadın ortalama yaş 77.9 dağılım 70-96) hasta vardı. Grup 1’deki hastaların ortalama takip süresi 16.4 ay (12-34), grup 2’deki hastaların ortalama takip süresi 18.9 ay (12-39) idi. BULGULAR: Ortalama Harris puanı grup 1’de 81.7±7.6 grup 2’de ise 79.2±6.9 olarak bulundu. Grup 1’de 19 hastada çok iyi, 52 hastada iyi, 15 hastada orta ve 6 hastada yetersiz sonuç, grup 2’de ise 29 hastada çok iyi, 74 hastada iyi, 21 hastada orta ve 8 hastada yetersiz sonuç elde edildi. Grup 2’de daha fazla çıkık (%3.78) ve enfeksiyon (%3.03) görülsede; iki grup arasında fonksiyonel puanlama ve komplikasyonlar açısından anlamlı fark bulunmadı (p>0.05). SONUÇ: Kalça eklemine parsiyel protez uygulamasında cerrahi yaklaşım fonksiyonel sonuçları etkilememektedir. Kalça eklemine parsiyel protez uygulamasında kapsülün anterior açılımı çıkık ve enfeksiyon açısından daha güvenli olabilir.
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    Gelişimsel kalça displazisi tedavisinde Salter osteotomisi
    (2014) Sipahioğlu, Serkan; Aşkar, Hüseyin; Zehir, Sinan; Işıkan, Uğur Erdem
    Amaç. Gelişimsel kalça displazisi bulunan olgularda Salter pelvik osteotomi uygulaması sonrası erken dönem sonuçlarını radyolojik ve klinik olarak değerlendirmek. Yöntem. Kliniğimize 2002- 2008 yılları arasında başvuran ve daha önce herhangi bir tedavi uygulanmamış GKD tanısı konmuş, açık redüksiyon ve Salter İnnominate osteotomi ile tedavi edilmiş 51 kalça (44 hasta,12 erkek, 32 kız, ortalama yaş 30,7 ay) ortalama 25 aylık takip sonucunda retrospektif olarak değerlendirildi. Olgular klinik olarak McKay sınıflamasına, radyolojik olarak Severinin kriterlerine ve avasküler nekroz (AVN) varlığı ise Kalamchi-MacEwen kriterlerine göre değerlendirildi. Bulgular. Preoperatif asetabular indeksi ortalama 37,4 (29-50) derece olan hastaların en son takibi sırasında alınan postoperatif asetabular indeks değerleri ortalama 24,1 (12- 32) derece bulundu. MacKay ın klinik değerlendirme sistemine göre 51 kalçanın 43’ü (%84) mükemmel, 7’si (%13,7) iyi, 1’i (%2) orta idi. Severinin radyolojik sınıflamasına göre 26 kalça (%51) çok iyi, 15 kalça (%29,4) iyi, 8 kalça (%15,7) orta ve 2 kalça (%3,9) kötü olarak değerlendirildi Postoperatif AVN oranı yaklaşık %17,6 (9 kalça) idi. Sonuç. Onsekiz ay sonrası GKD tedavisinde Salter innominate osteotomisi etkin bir yöntem olarak pelvis osteotomisi seçenekleri arasında değerlendirilebilir. İleri yaşlarda artan komplikasyon riskini düşürmek için osteotomi tekniğine uygun yapılmalıdır.