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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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    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, Nahide
    Aim: 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.