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Öğe Adding intrathecal morphine to unilateral spinal anesthesia results in better pain relief following knee arthroscopy(Springer Tokyo, 2008) Demiraran, Yavuz; Yücel, İstemi; Akçalı, Gülgün Elif; Değirmenci, Erdem; Sezen, Gülbin; İskender, AbdülkadirIntrathecal morphine is administered to provide profound and prolonged analgesia, and to treat acute postoperative pain. We compared the effectiveness of hyperbaric bupivacaine alone and in combination with morphine for unilateral spinal anesthesia in patients undergoing knee arthroscopy. Sixty patients were randomly allocated to two groups to receive either 1.2 ml (6 mg) of 0.5% hyperbaric bupivacaine (group B; n = 30) or 1.2 ml of 0.5% hyperbaric bupivacaine containing 0.16 mg of morphine (group BM; n = 30). Spinal block was assessed by pinprick and a modified Bromage scale and compared between the operated and nonoperated sides. Visual analog scale (VAS) values, duration of analgesia, and total analgesic requirement of patients were recorded. Patients in group BM had significantly lower VAS values on movement at 30 min and at 2, 4, 6, and 12 h postoperatively (P < 0.05 and P < 0.001, P < 0.001, P < 0.001, and P < 0.05, respectively). The total analgesic requirement in the first 24 h after surgery was significantly higher in group B (P < 0.001). Patients in group BM had a significantly longer duration of analgesia in the first 24 h postoperatively (P < 0.001). Motor blockade of the operated limb in group BM was similar to that in group B (P > 0.05), and motor blockade of the nonoperated limb in group BM was also similar to that in group B (P > 0.05). We conclude that unilateral spinal anesthesia with hyperbaric bupivacaine plus 0.16 mg morphine is preferable to hyperbaric bupivacaine alone with respect to analgesic requirement, duration of analgesia, and VAS values.Öğe Asymmetric bilateral hip dislocations and unilateral femoral head fracture: A CASE report(Elsevier Ltd, 2018) Değirmenci, Erdem; Kaya, Yasin Emre; Özturan, Kutay EnginHip is a stabilized joint due to the surrounding ligaments, and muscles, which can dislocate as a result of high energy trauma, high-level falls, and motor vehicle accidents. Traumatic hip dislocations can either be isolated or simultaneously with acetabular and proximal femur fractures. At the same time injury of sciatic, femoral or obturator nerves can be seen. However, avascular necrosis of femoral head, posttraumatic osteoarthritis, and heterotopic ossifications can be seen as prolonged complications. The period prior to the reduction, severity of the trauma, and performing open or close reductions are the major contributors of the prognosis. As an extremely rare entity, bilateral asymmetrical hip dislocations are reported as the 0.01–0.02% of all joint dislocations. Accompanying proximal femoral fractures are pointed out 17%, one of them is femoral head fractures which are orthopedic emergencies that need to be fixed with surgery. However, high incidence of AVN is reported at the end of 2 years even if following early reductions. In our article, traumatic bilateral asymmetric hip dislocations and femoral head fracture is described in the context of a diagnosis, treatment and follow-up. © 2018 The AuthorsÖğe BECK Açısının Erişkin Patellar Yükseklik Ölçümünde Kullanımı(2019) Değirmenci, ErdemAmaç: Patella yükseklik ölçümünün özellikle diz çevresi patolojilerinin endikasyon ve cerrahi çeşitliliğin artmasısonucu önemi artmıştır. Literatürde tarif edilen metotlar bulunmasına rağmen, günümüzde altın standart bir yöntemmevcut değildir. Özellikle pediatrik yaş grubunda referans noktalarının tam belirlenememesi nedeni ile ölçümsonuçlarının güvenirliğinde sorunlar yaşanmaktadır. Jennifer J. Beck ve arkadaşları Blumensaat-EpiphysealContainment of the Knee Angle (BECK) yöntemini tanımlamış ve pediatrik hasta grubunda kolay ve klinik alandauygulanabilen güvenilir bir yöntem olduğunu belirtmişlerdir. Biz çalışmamızda bu yöntemin erişkinlerdekullanılabilirliğini araştırdık.Gereç ve Yöntemler: Çalışmamıza dahil edilen çocuk hastaların lateral diz grafileri ölçümlerinden elde edilen BECKaçıları kullanılarak sağlıklı erişkin aile bireylerinde patellar yükseklik ölçümü yapıldı. Aynı kişilerde bu ölçümleriInsall- Salvati ve Blumensaat yöntemleri kullanarak tekrarlandı ve bu 3 yöntemin ölçüm sonuçları karşılaştırıldı.Bulgular: Çalışmaya katılan çocuk hastanın %54,7’ si (n=29) erkek, %45,3’ü (n=24) kız ortalama yaşı 14,9±1,3 (13-18) idi. %28,3’ü (n=15) erkek %71,7’si (n=38) kadın ve ortalama yaşları 49,3±7,7 (37-68) idi. Çocuk hastalardakiortalama BECK açısı 46,58° (42,0°- 53,0°) ± 2,3°) idi. Ortalama değer ile erişkinlerde yapılan ölçümlerde en az %50patellar kapsama oranı %88,7 (n=47) idi. Bireysel açı değerleri ile yapılan ölçümlerde bu oran %90,5 (n=48) olaraktespit edildi. Insall-Salvati yöntemi ile normal değer ölçüm oranı %77,3 (41/53), anormal ölçüm %22,6 (12) olaraksaptandı. Blumensaat yöntemi ile %62,2 (33/53) oranında normal, %37,7 (20/53) anormal aralıkta saptandı.Sonuç: Erişkin patellar yükseklik ölçümlerinin basit, anlaşılabilir, efektif bir yöntem ile yapılabilmesi klinikuygulamalarda büyük kolaylık sağlar. BECK yöntemi bu ölçümlerde uygulanabilecek alternatif bir yöntem olarakdüşünülebilir.Öğe Biomechanical and histological effects of intra-articular hyaluronic acid on anterior cruciate ligament in rats(Elsevier Sci Ltd, 2009) Yücel, İstemi; Karaca, Erkut; Özturan, Kutay; Yıldırım, Ümran; Duman, Seçkin; Değirmenci, ErdemBackground: The histologic and biomechanical effects of intra-articular hyaluronic acid on the anterior cruciate ligaments of rats were investigated. Methods: Thirty rats were divided into three groups, i.e., the hyaluronic acid group, saline group, and control group. The hyaluronic acid and saline groups received a total of four intra-articular injections, whereas no injection was administered to the control group. The hyaluronic acid group was injected with 50 mu g (0.05 cc) hyaluronic acid, and the saline group was injected with 50 mu l (0.05 cc) of 0.9% sodium chloride solution. All of the rats were sacrificed on day 29 and the femur-anterior cruciate ligament-tibia complexes from the right knees were prepared, tested mechanically, and evaluated histologically. Findings: The mode of failure involved the midsubstance of the anterior cruciate ligament in all the specimens. There were no statistically significant differences in the stiffness and ultimate load to failure values between the three groups (P > 0.05). The energy to failure values were evaluated and there was no statistically significant difference between the groups (P = 0.064, chi-square = 3.43). In the histologic analyses, there was a significant difference in the hyalinization values between the hyaluronic acid and saline groups (P = 0.029) and between the hyaluronic acid group and control groups (P = 0.029). Interpretation: The present study shows that intra-articularly delivered hyaluronic acid has no statistically significant effect on the tensile strength of the rat anterior cruciate ligament. Although hyalinization was increased, no difference was found on the other markers for degenerative changes. We conclude that intra-articular hyaluronic acid injections can be performed safely, although the use of a precise injection technique is recommended. (C) 2009 Elsevier Ltd. All rights reserved.Öğe Comparison of High-Dose Extracorporeal Shockwave Therapy and Intralesional Corticosteroid Injection in the Treatment of Plantar Fasciitis(Amer Podiatric Med Assoc, 2010) Yücel, İstemi; Özturan, Kutay Engin; Demiraran, Yavuz; Değirmenci, Erdem; Kaynak, GürselBackground: The aim of this study was to evaluate the results of high-dose extracorporeal shockwave therapy applied with an ankle block and corticosteroid injection in patients with plantar fasciitis whose symptoms persisted for more than 6 months. Methods: Sixty patients were assessed clinically at presentation and at 3-month follow-up with a patient-assessed 100-mm visual analog scale of pain and a physician-assessed heel tenderness index. A therapeutic response rate was evaluated. A decrease of at least 50% from baseline to 3 months in visual analog scale or heel tenderness index scores was accepted as a successful result. Results: Extracorporeal shockwave therapy and corticosteroid injection provided significant improvements in visual analog scale and heel tenderness index scores, but between the two groups there was no significant difference in the visual analog scale score change 3 months after treatment (P > .05). Twenty-seven of 33 patients (82%) in the extracorporeal shockwave therapy group and 23 of 27 (85%) in the corticosteroid injection group had a successful therapeutic response after 3 months. Conclusions: Corticosteroid injection and extracorporeal shockwave therapy are successful treatment modalities for plantar fasciitis. Corticosteroid injection treatment is cost effective compared with extracorporeal shockwave therapy, and corticosteroid injection may be the first treatment choice according to these results. (J Am Podiatr Med Assoc 100(2): 105-110, 2010)Öğe A Comparison of the Modified Bosworth and Endobutton Techniques in the Surgical Treatment of Rockwood Type III Acromioclavicular Joint Dislocations(2020) Karaduman, Zekeriya Okan; Orhan, Zafer; Turhan, Yalçın; Arıcan, Mehmet; Değirmenci, Erdem; Turhal, OzanAim: In this study, we aimed to retrospectively compare the long-term clinical and radiological outcomesobtained with the modified Bosworth technique and Endobutton technique in surgical treatment of type IIIacromioclavicular dislocations.Materials and Methods: Thirty-two patients (26 males, 6 females) (mean age 37, range 15–78 years) weretreated surgically for acromioclavicular joint (ACJ) dislocation. All patients had type III dislocation. Twentytwo patients had right ACJ dislocation and 10 patients had left ACJ dislocation. Of the dislocations, 18 occurred due to falls; 9, sports injuries; and 5, traffic accidents. Of the patients, 18 were operated on with theEndobutton technique and 14 with the modified Endobutton technique. Patients were evaluated postoperatively in terms of functional Constant, DASH, and VAS scores and radiologically with coracoclavicular distance(CCD) assessment. The mean follow-up was 52 (37–66) months.Results: The alignment of the acromioclavicular joint was normal in all patients. No joint degeneration wasobserved in any patient. Shoulder movements were painless and complete in all patients. The mean postoperative 3rd, 12th, and 24th month Constant scores were found significantly higher for the Endobutton group thanfor the modified Bosworth group (p=0.001). The mean postoperative 3rd, 12th, and 24th month DASH scoreswere significantly lower for the Endobutton Group than for the modified Bosworth group (p=0.003). Themean postoperative 3rd, 12th, and 24th month VAS scores were significantly lower for the Endobutton groupthan for the modified Bosworth group (p=0.001). However, no statistically significant difference was foundbetween the mean preoperative and postoperative CCD values of the two groups (p=0.104).Discussion and Conclusion: The Endobutton technique is a good alternative to the modified Bosworthtechnique in the surgical treatment of acromioclavicular dislocations.Öğe Comparison of ultrasound-, palpation-, and scintigraphy-guided steroid injections in the treatment of plantar fasciitis(Springer, 2009) Yücel, İstemi; Yazıcı, Burhan; Değirmenci, Erdem; Erdoğmuş, Beşir; Doğan, SemihThe aim of the study was to compare the efficacies of steroid injections guided by scintigraphy, ultrasonography, and palpation in plantar fasciitis. A total of 35 heels of 27 patients were randomly assigned to three steroid injection groups: palpation-guided (pg), ultrasound-guided (ug), and scintigraphy-guided (sg). Patients were evaluated for pain intensity before the injections and at the last follow-up of 25.3 months with a 100-mm visual analog scale (VAS). There were significant improvements in plantar fascia thickness, fat pad thickness, and VAS. Among the three groups of ug-pg, ug-sg, and pg-sg there were no statistically significant differences after treatment (P = 0.017, MWU = 36.5; P = 0.023, MWU = 29.5; and P = 0.006, MWU = 13, respectively). The ug, pg, and sg injections were effective in the conservative treatment of plantar fasciitis. We are of the opinion that steroid injections should be performed, preferably with palpation or ultrasonographic guidance.Öğe Complex regional pain syndrome type I: Efficacy of stellate ganglion blockade(2009) Yücel, İstemi; Demiraran, Yavuz; Özturan, Kutay; Değirmenci, ErdemBackground: This study was performed to evaluate the treatment of complex regional pain syndrome (CRPS) type I with stellate ganglion blockade. Materials and methods: We performed three blockades at weekly intervals in 22 patients with CRPS type I in one hand. The patients were divided into two groups depending on the time between symptom onset and treatment initiation. Group 1and 2 patients had short and long symptom-onset-to-treatment intervals, respectively. Pain intensity, using a visual analog score (VAS), and range of motion (ROM) for the wrist joint were assessed before and 2 weeks after treatment and were compared using nonparametric statistical analysis. Results: Treatment produced a statistically significant difference in wrist ROM for all patients (P < 0.001). VAS values showed an overall decrease from 8 ± 1 to 1 ± 1 following treatment, and there was a significant difference in VAS value between groups 1 and 2 (P < 0.05). Conclusions: We concluded that stellate ganglion blockade successfully decreased VAS and increased ROM of wrist joints in patients with CRPS type I. Further, the duration between symptom onset and therapy initiation was a major factor affecting blockade success. © 2009 Springer-Verlag.Öğe Diffuse-type giant cell tumor: Pigmented villonodular synovitis of patellar fat pad(Wolters Kluwer Medknow Publications, 2022) Değirmenci, Erdem; Şahin, Abdullah Alper; Bulum, Yunus Emre; Gamsızkan, Mehmet; Orhan, ZaferPigmented villonodular synovitis (PVNS) is a rare, relatively benign intra-articular lesion characterized by slowly progressing proliferation of the synovial tissue. It is most commonly observed in the knee joint. Localized and diffuse types are two types of PVNS depending on the synovial involvement. Arthroscopic and excisional resections are recommended as the treatment methods for the PVNS. Radiotherapy or chemotherapy can be adjuvant therapeutic options for the widespread masses. In this study, we presented a case of diffuse PVNS originating from the patellar fat pad.Öğe Effect of extracorporeal shock wave therapy on fracture healing in rat femural fractures with intact and excised periosteum(Turkish Joint Diseases Foundation, 2014) Oktaş, Birhan; Orhan, Zafer; Erbil, Barış; Değirmenci, Erdem; Üstündağ, NilObjectives: The aim of this study is to compare the effect of extracorporeal shock wave therapy (ESWT) on fractures with intact periosteum and excised periosteum. Materials and methods: Thirty-seven Wistar albino rats were randomized into four groups. Osteotomy and intramedullary Kirschner wire fixation were performed on all right femurs under ketamin anesthesia. The first group (n=10) was identified as control group. In the second group (n=10), periosteum located at the osteotomy site was excised circumferentially during surgery. In the third group (n=9), periosteum was left intact and ESWT was applied. In the forth group (n=8), periosteums of all rats were excised and ESWT was applied. All fracture lines were evaluated radiographically each two weeks and histologically at the sixth week. Results were evaluated statistically. Results: In periosteum excised group which represents a model of open fractures with soft tissue defect, ESWT application had a significantly positive histologic effect on bone healing. However, radiological evaluation did not reveal any statistically significant difference between groups with intact and excised periosteums. Conclusion: According to our findings, ESWT can be used to improve fracture healing and prevent pseudoarthrosis in the treatment of open fractures with accompanying soft tissue and periosteum damage. However, further clinical studies are required to include ESWT in routine practice.Öğe Effects of tranexamic acid on the recovery of osteochondral defects treated by microfracture and acellular matrix scaffold: an experimental study(Bmc, 2019) Değirmenci, Erdem; Özturan, Kutay Engin; Şahin, Abdullah Alper; Yılmaz, Fahri; Kaya, Yasin EmreBackground: Microfracture and scaffold application in the treatment of osteochondral defects is still one of the most frequently used methods in the clinic. The most important step in this treatment method is the stabilization of fibrin clot Tranexamic acid (TA) is an antifibrinolytic agent commonly used in orthopedic surgery in recent years. This study evaluated the effect of local TA application on healing of experimentally induced osteochondral defects on rabbits. Methods: This paper contains an animal in vivo data and histological outcomes on the effect of TA. Eighteen New Zealand white rabbits were treated unilaterally and cylindrical defects having a width of 4 mm and depth of 5 mm were created in the weight-bearing surfaces of the medial and lateral condyles of the right femur. They were divided into two groups, as group 1 study and group 2 control groups, respectively. One milliliter (ml) of TA was injected into the knee joints of the subjects in group 1. All animals were sacrificed for the extraction of the femur condyles for histologic study at the fourth and eighth weeks after surgery. Histological evaluations were performed by Brittberg and O'Driscoll scores to all samples. Data were organized in a Standard Statistical Package System v.22 software package (SPSS/PC Inc., Chicago, IL) and reported as mean and median (min-max). Repeated measures ANOVA test was used to compare groups and condyle effects together for each week. p values below 0.05 were considered as statistically significant. Results: Samples were taken in the fourth and eighth weeks. The regularity of the surface in group 1 was smoother, and the tissue stability was more robust. Mean Brittberg scores in both weeks were statistically higher in group 1 when compared with group 2. In the microscopic evaluation, it was observed that the regeneration of subchondral and cartilage tissues were more rapid and organized in group 1, and the mean O' Driscoll scores in both weeks were statistically higher in group 1. Conclusions: Application of TA improves the healing time and tissue stability in osteochondral defects which are implanted a-cellular scaffold after microfracture and should be applicable to humans for the treatment of osteochondral defects.Öğe Efficacy of Intramedullar Locking Plate in Mild to Moderate Hallux Valgus Deformity: Early Outcomes(2019) Değirmenci, Erdem; German, Ali Berat; Yücel, İstemiAim: Hallux valgus is a complex deformity of the first metatarsophalangeal joint characterizedby varus deformity of the first metatarsal bone, valgus deformity of the big toe, and lateraldeviation of the extensor tendons and sesamoid bones. Several surgical methods have beendescribed for correction of the deformity. Distal metatarsal osteotomy is a commonly usedprocedure in mild-to moderate hallux valgus. Different materials have been used for thefixation of osteotomy. The aim of this study was to evaluate radiological and clinical efficacyof intramedullar locking plate in hallux valgus surgery.Material and Methods: Postoperative 6th month data of patients with mild-to moderate halluxvalgus deformity who underwent distal metatarsal osteotomy using an intramedullary lockingplate between 2012 and 2014 were evaluated retrospectively. The surgical procedure wasapplied by Mitchell technique. Clinical and radiological features of the patients were analyzed.Results: Thirty-six (29 female, 7 male) patients whit a mean age of 51.00±12.96 years wereenrolled the study. Eight patients underwent bilateral surgery. There were statisticallysignificant improvement in hallux valgus angle, distal metatarsal articular angles, andAmerican Orthopaedic Foot and Ankle Society hallux valgus scores in the postoperative 6thmonth (all p values <0.001). No statistically significant difference were found between thepreoperative and postoperative 6th month inter-metatarsal angle values (p=0.058).Conclusion: The intramedullar locking plate usage in surgery of mild-to moderate halluxvalgus deformity is an effective method providing strong fixation and quick recovery that ledpatients to gain an early improvement in the daily life activities.Öğe Ekstrakorporeal şok dalga tedavisinin periostu sağlam olan ve periostu eksize edilmişsıçan femurlarında kırık iyileşmesine etkisi(2014) Oktaş, Birhan; Orhan, Zafer; Erbil, Barış; Değirmenci, Erdem; Üstündağ, NilAmaç: Bu çalışmada ekstrakorporeal şok dalga tedavisinin (ESWT) periostu sağlam olan ve periostu eksize edilmiş olan kırıklar üzerine etkisi karşılaştırıldı.Gereç ve yöntemler: Otuz yedi Wistar albino sıçan dört gruba randomize edildi. Ketamin anestezisi altında tüm sağ femurlara osteotomi ve intramedüller olarak Kirschnerteli tespiti uygulandı. İlk grup (n10) kontrol grubu olarak tanımlandı. İkinci grupta (n10), osteotomi hattındaki periost cerrahi sırasında çevresel olarak eksize edildi. Üçüncü grupta (n9), periost sağlam bırakılarak ESWT uygulandı. Dördüncü grupta (n8), tüm sıçanların periostları eksize edildi ve ESWT uygulandı. Tüm kırık hatları iki haftada bir radyolojik olarak ve altıncı haftada histolojik olarak değerlendirildi. Sonuçlar istatistiksel olarak değerlendirildi.Bulgular: Yumuşak doku defektli açık kırık modelini temsil eden, periostu eksize edilen grupta, ESWT uygulaması kırık iyileşmesi üzerinde anlamlı şekilde olumlu bir histolojik etkiye sahipti. Ancak radyolojik değerlendirme periostu sağlam olan ve eksize edilen gruplar arasında istatistiksel olarak anlamlı bir fark göstermedi.Sonuç: Bulgularımıza göre, yumuşak doku ve periost hasarının eşlik ettiği açık kırık tedavisinde, kırık iyileşmesini hızlandırmak ve psödoartroz oluşumunu engellemek amacıyla ESWT kullanılabilir. Ancak ESWT'nin rutin uygulamaya dahil edilebilmesi için daha fazla klinik çalışma gereklidir.Öğe Evaluation of the age and gender related changes in the Blumensaat line(Springer-Verlag France, 2019) Değirmenci, Erdem; Yücel, İstemi; Özturan, Kutay; Karaduman, Zekeriya Okan; Karaca, ErkutPurpose: The position of the patella according to the femur is very important in the evaluation of patella-femoral joint disorders. In 1938, Blumensaat (BS) described the BS line to evaluate the patella femoral congruence. This method is still valuable in clinical use. There is a limited number of studies demonstrating the accuracy of BS method as well as the affected variables. The aim of this study was to evaluate o the age and gender-related changes in the BS line. Methods: Standard lateral knee radiography was performed to all patients at 30° flexion. The relationship between the BS line and the patella inferior pole was examined and the variability of the measurements according to gender and age groups was investigated by statistical methods. Results: Ninety-five patients (43 men and 52 women) were enrolled in the study. Mean age of the patients were 43.7 ± 14.1 years (48.2 ± 11.7, 37.9 ± 14.8 in women and men, respectively). The BS line was passed through the inferior pole of the patella in only 2 (2.1%) of 95 patients. There was a statistically significant difference (p = 0.041) between BS measurement and gender which was found to be higher in females than males. There was no statistically significant correlation with this distance between the age groups (r = ? 0.216, p = 0.427). Conclusion: In our study, it was concluded that BS measurement differs according to gender but did not have any difference between different age groups. © 2019, Springer-Verlag France SAS, part of Springer Nature.Öğe Hamstring tendon otogrefti ile ön çapraz bağ rekonstrüksiyonu(2010) Değirmenci, Erdem; Yücel, İstemi; Özturan, KutayAmaç: Bu çalışmada semptomatik kronik ön çapraz bağ yırtığının dört katlı otojen Hamstring tendon grefti kullanılarak yapılan artroskopik rekonstruksiyonunun erken dönem sonuçları incelenmiştir. Gereç ve Yöntem: Ön çapraz bağ yırtığı bulunan 64 hasta otojen Hamstring tendon grefti kullanılarak artroskopik yöntemle opere edildi. Proksimal tespitte çapraz pin sistemi (Transfix, Arthrex) ve tibial tespitte ise interferans vidası kullanıldı. Tüm hastalar ortalama 16.36.4 ay sonunda fonksiyonel olarak Lysholm diz skorlaması, IKDC (International Knee Documentation Committee) skorlaması ve Tegner aktivite skorlaması ile klinik olarak diz eklem hareket açıklığı, stabilite testleri, uyluk çevresi ölçümü ve kişisel memnuniyet ile radyolojik olarak Kellgren ve Fairbank sınışaması ile değerlendirildi. Bulgular: Kontrol IKDC skorlamasına göre 56 hasta (%87.5) A veya B grubunda 8 hasta (%12.5) ise C veya D grubunda yer almıştır. Kontrol Lysholm skoru ve Tegner aktivite skoru ameliyat öncesi değerlerle karşılaştırıldığında istatistiksel açıdan ileri derecede anlamlı farklılık bulunmuştur (p0.001). Anterior tibial sublüksasyonda %91’lik bir azalma belirlenmiştir. Hastaların kişisel memnuniyet değerlendirme ortalaması ise 7.62.7 (0–10 arası 0 - hiç memnun değil, 10 - çok memnun) olarak tespit edilmiştir. İzlem sonunda radyolojik değerlendirmelerde Kellgren sınışamasına göre 52 hastada (%81) Fairbank sınışamasına göre ise 50 hastada (%78) osteoartrit bulgularında değişiklik olmadığı tespit edilmiştir. Sonuç: Ön çapraz bağ yırtıklarının, dört katlı otojen Hamstring tendon grefti kullanılarak yapılan artroskopik rekonstrüksiyonlarında hem fonksiyonel olarak düzelme hem de hastalarda yüksek memnuniyet oranları tespit edilmiştir.Öğe Hoffa fracture: A case report(2008) Yücel, İstemi; Değirmenci, Erdem; Özturan, KutayUnicondylar fractures of the femur that occur in the coronal plane (Hoffa fractures) are uncommon and most often affect the lateral condyle. Conservative treatment generally yields poor results, but rigid internal fixation allows early functional rehabilitation and decreases the incidence of malunion, nonunion, and stability loss. This case report describes open reduction and internal fixation in the treatment of a young man with a Hoffa fracture. The fragment was reduced and fixed with a cannulated corticocancellous screw. At 16-month follow-up, the fracture was completely healed and he was able to achieve a normal range of movement, with 145º flexion of the knee and full extension. To achieve favorable long-term results in coronal plane fractures of femoral condyles, open reduction, stable fixation and early mobilization are mandatory. Physical rehabilitation should be initiated as soon as possible to minimize joint contractures.Öğe Improved Clinical Outcomes After Arthroscopic Microfracture in Isolated Medial Talar Osteochondral Lesions with a Single Injection of High Molecular Weight Hyaluronic Acid(2019) Arıcan, Mehmet; Değirmenci, ErdemObjective: To investigate the effectiveness of a single intra-articular injection of high molecular weight hyaluronic acid (HMW-HA) for treating isolated medial osteochondral lesions (OCLs) of the talus following arthroscopic microfracture. Methods: A total of 39 patients, treated between 2014–2017 for medial OCLs of the talus, were enrolled in the study. Patients were split into two groups: group 1, consisting of 18 patients who received a single injection of 4 ml of HMW-HA (22 mg/ml) injection following microfracture; and group 2, consisting of 21 patients who underwent microfracture but did not receive an injection. Clinical results were assessed at baseline, 6 months, and at a final follow-up using a visual analogue scale (VAS) and the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS). Results: The mean AOFAS score increased in groups 1 and 2, from 45.61±14.71 to 95.11±5.02 (p=0.0001) and 41.81±13.83 to 90.29±7.43 (p=0.0001), respectively. Similarly, the average VAS score decreased in groups 1 and 2 from 8.72±1.23 to 2.11±1.45 (p=0.0001) and 9.05±0.80 to 3.67±2.22 (p=0.0001), respectively. In addition, the average AOFAS score in group 1 was higher than in group 2 (p=0.025) at the final follow-up, and the average VAS score in group 1 was lower than that of group 2 (p=0.0001, p=0.015, respectively) at 6 months postoperatively and the final follow-up. Conclusions: Although both treatments for isolated medial OCL of the talus were associated with successful results, single-dose HMW-HA injection following arthroscopic microfracture was significantly more effective.Öğe Ratlarda deneysel, implant ilişkili, metisilin dirençli stafilokokus aureus osteomiyelit modelinde tigesiklin ve teikoplanin antibiyotiklerinin etkinliklerinin karşılaştırılması(Düzce Üniversitesi, 2008) Değirmenci, Erdem; Orhan, ZaferGiriş: Akut ve kronik ortopedik enfeksiyonlarının tedavisi zordur ve genellikle uzun süreli antibiyoterapi uygulanımı ve cerrahi tedavi gerektirir. Özellikle MRSA etkenli ve implant ilişkili osteomyelit enfeksiyonlarının medikal tedavisinde kullanılabilecek ajanlar sınırlıdır.Amaç: Çalışmamızda deneysel rat modellerinde, MRSA etkenli, implant ilişkili osteomiyelit tedavisinde tigesiklin ve teikoplanin antibiyotiklerinin etkinliklerinin karşılaştırılması amaçlanmıştır.Gereç ve Yöntemler: Çalışmamızda 60 adet erişkin dişi Wistar Albino cinsi rat kullanıldı. Tüm ratlar 10'arlı 6 gruba ayrılarak, sağ tibia metafizlerinde MRSA etkenli, imlant ilişkili, osteomyelit geliştirildi. 3. hafta sonunda 3 gruptan imlantlar çıkarıldı, 1 implantlı 1 implantsız 2 grup tedavisiz bırakılarak geri kalan 4 gruba 4 hafta süreyle 2 farklı antibiyotik tedavisi verilerek sonuçlar karşılaştırıldı.Bulgular: Antibiyotik uygulanan gruplarda kolonize olan mikroorganizma sayısının kontrol grubuna göre anlamlı derecede düşük olduğu bulunurken, tigesiklin uygulanan grupların implantlı ve implantsız gruplarda teikoplanin uygulanan gruplar ile aralarında anlamlı bir fark saptanmamıştır.Sonuç: Yeni nesil antibiyotiklerden olan tigesiklinin deneysel osteomyelit tedavisinde teikoplanine karşı üstünlüğünün saptanmamasına karşın klinik uygulamalarda teikoplanine alternatif olabileceği düşünülmektedir. Bununla birlikte özellikle implant ilişkili osteomyelitin medikal olarak daha etkin tedavi edilebilmesi için yeni çalışmalara ihtiyaç vardır
