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Yayın Comparison of Outcomes of Anterior Cruciate Ligament Reconstructions Using Patellar Tendon or Hamstring Tendon Autografts with Femoral Cross-pin Fixation(2020) Ünal, Ömer Kays; Dağtaş, Mirza Zafer; Demirag, Burak; Unal, Ulku SurAim: In this study, we aimed to compare outcomes of anterior cruciate ligament (ACL) reconstructions using bone–patellar tendon–bone graft (BPTG) or hamstring tendon graft (HTG) with cross-pin fixation at the femoral side. Materials and Methods: The retrospective observational study included records of 100 patients who underwent ACL reconstruction with femoral cross-pin fixation between May 2008 and August 2012. The patients were di- vided into two groups according to the graft type used: the BPTG group and the HTG group. The preoperative and postoperative 6th-month Tegner Lysholm Knee Scoring Scale (TLKS) scores, International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC-SKF) scores, and Lachman test results were compared. The effects of meniscus lesion presence on the outcomes were also investigated. Results: Of the 100 patients, 93 were male and 7 female. The HTG and BPTG groups consisted of 62 and 38 patients, respectively. The mean age was 24.1±4.9 (18–38) years for the HTG group and 32.1±6.8 (21–54) years for the BPTG group. The mean pre- and postoperative TLKS scores were respectively 50.5 and 94.3 in the BPTG group, and 49.9 and 95.2 in the HTG group. The mean pre- and postoperative IKDC-SKF scores were 51.3 and 95.6 in the BPTG group, and 51.8 and 95.6 in the HTG group. The postoperative score improvement was statistically significant in all patients (p<0.05), but there was no significant difference between the two groups. The postop- erative improvement in knee stability was statistically significant in all patients (p<0.05). The postoperative score improvement was less in patients with meniscal injury (p<0.05). Discussion and Conclusion: We found no significant difference between the two groups in terms of functional knee scores. However, the presence of meniscus lesions negatively affects the postoperative outcomes.Yayın Deltoid Ligament Repair in Addition to Syndesmotic Fixation in Distal Fibula Fractures is Associated with Better Clinical Results in Midand- Long-term Follow-up: A Comparative Study(2021) Dağtaş, Mirza Zafer; Ünal, Ömer KaysObjective: To evaluate mid to long term effects of adding deltoid ligament repair (DLR) to syndesmotic screw fixation (SSF) in the treatment of distal fibula fractures -in terms of functional and radiographic results and quality of life. Method: Seventy-eight patients who underwent SSF or SSF+DLR with the diagnosis of distal fibula fracture in the Maltepe University Hospital, Department of Orthopedics and Traumatology were included in the study retrospectively. Results: 71.8% of the cases were male. The mean age was 39.24±11.95 years. The radiographic and functional results and quality of life were better in the SSF+DLR group compared to the SSF group. Additionally, the operation time was longer in the SSF+DLR group. Conclusion: Performing DLR in appropriate cases of distal fibula fracture may contribute to better clinical outcomes in the mid to long term. Keywords: Ankle, deltoid ligament repair, distal fibula fractures, syndesmosisYayın The effects of proximal fibular osteotomy on the knee and ankle joints: a finite element analysis(Czech Society for Orthopaedics and Traumatology, Slovak Society for Orthopaedics and Traumatology and Publishing House Galen, 2021) Ünal, Ömer Kays; Dağtaş, Mirza Zafer; Demir, C.; Nacefov, Turan; Üğütmen, EnderPURPOSE OF THE STUDY In this study, our aim is to examine the effect of proximal fibular osteotomy on knee and ankle kinematics with finite element analysis method. MATERIAL AND METHODS One 62-year-old, female volunteer’s radiologic images were used for creating lower limb model. Osteotomized model (OM) which was created according to definition of PFO and non-osteotomized model (NOM) were created. To obtain a stress distribution comparison between the two models, 350 N of axial force was applied to the femoral heads of the models. RESULTS After PFO, the average contact pressure decreased 26.1% at the medial tibial cartilage and increased 42.4% at the lateral tibial cartilage. The Von Mises stresses decreased 57.1% at the femoral cartilage and decreased 79.1% at tibial cartilage. The stress on the tibial cartilage increased 44.6%, and stress on the talar cartilage increased 7.1% at the ankle joint. CONCLUSIONS FEA revealed that main loading at the knee joint shifted from medial tibial cartilage to the lateral tibial cartilage after PFO. Additionally, the stresses on each cartilage were redistributed across a wider and more peripheral area. FEA also demonstrated that the Von Mises stresses of the tibial and talar cartilages of the ankle joint increased after PFO.Yayın Evaluation of axillary nerve integrity and shoulder functions in patients who underwent lateral deltoid splitting approach(SelSistem, 2020) Ünal, Ömer Kays; Ateş, Miruna Florentina; Dağtaş, Mirza Zafer; Üğütmen, EnderAim: The most common complication of the Lateral deltoid splitting approach (LDSA), which is used in the shoulder area, especially for posterior extension fractures and other soft tissue pathologies, is axillary nerve injury. Determining the frequency of nerve injuries that may occur after LDSA is decisive for the applicability of this approach. Therefore, in our study, we aimed to evaluate the axillary nerve integrity and shoulder functions in patients who underwent LDSA. Methods: In this prospective cohort study, 55 patients who were operated with LDSA for proximal humerus fractures between February 2015 and July 2018 were evaluated. Among these patients, 35 were selected and included in the study. Six months later Electrophysiological tests (Electroneuromyelography – ENMG) and Constant Shoulder Score (CSS) were used for evaluation of each operated and non-operated shoulder. CSS difference between the operated and non-operated sides was graded as mild (11-20 point), moderate (21-30) and severe (>30). Results: Mean age of the group was 66 (9) years. Twenty-five patients were female and 10 were male. Mean follow-up time was 4 (1) years. Mean latencies of axillary nerve were 4.6 (1.8) msn, 3.7 (0.54) msn and mean amplitudes of axillary nerve were 6.6 (2.21) mV, 8.4 (2.80) mV in the operated and non-operated shoulders, respectively. There was no statically significant difference between the operated and non-operated sides according to latency and amplitude (latency P=0.25, amplitude P=0.16). Mean CSS of the patients were 28.7. CSS of 12 patients were severe (mean: 39.08), 18 patients, moderate (mean 25.4) and 5 patients, mild (mean 16). There was no statically significant correlation between CSS and axillary nerve latency / amplitude (P= 0.62, r=0.267 / P=0.98, r=-0.339). Fracture type and CSS showed a statically significant correlation (P=0.032, r= 0.829). Conclusion: This study revealed that LDSA provides wide and versatile fracture control without compromising the deltoid muscle functions and axillary nerve, especially in fractures extending to the posterior part of the proximal humerus.Yayın İNTERTROKANTERİK FEMUR KIRIKLARININ TEDAVİSİNDE KULLANILAN İKİ FARKLI PROKSİMAL FEMUR ÇİVİSİNİN KLİNİK VE RADYOLOJİK SONUÇLARI(2021) Ünal, Ömer Kays; Dağtaş, Mirza ZaferBu çalışmanın amacı iki farklı tipte proksimal femur çivisi (PFÇ) kullanılarak internal fiksasyon uygulanan intertrokanterik femur kırığı (İTK) olgularında fonksiyonel ve radyolojik sonuçların karşılaştırılmasıdır.Bu çalışmada 1 Ocak 2012 – 31 Aralık 2018 tarihleri arasında kliniğimizde İTK nedeniyle ameliyat edilen hastaların dosyaları retrospektif olarak incelendi. Olgular uygulanan PFÇ tipine göre Profin ve İnterTan olmak üzere iki gruba ayrıldı.78 olgunun 41’i Profin, 37’si İnterTAN grubundaydı. Olguların %47,4’ü erkek, yaş ortalaması 74,12 ± 8,91’di. İnterTan grubu ile karşılaştırıldığında, Profin grubunda skopi süresi ve mobilizasyona kadar geçen süre istatistiksel olarak anlamlı düzeyde daha fazlaydı (sırasıyla, p = 0,002, p = 0,037). Profin grubu ile karşılaştırıldığında, İnterTan grubunda hastanede yatış süresi istatistiksel olarak anlamlı düzeyde daha fazlaydı (p =0,001). Operasyondan bir yıl sonra değerlendirilen femur boyun açısı İnterTan grubunda istatistiksel olarak anlamlı düzeyde daha fazlaydı (p <0.001). İnterTan grubu ile karşılaştırıldığında, Profin grubunda varus deformitesi sıklığı istatistiksel olarak anlamlı düzeyde daha fazlaydı (%8,11’e karşın %61,0, p <0.001).Gruplar arasında Harris kalça skoru bakımında istatistiksel olarak anlamlı bir fark yoktu (p = 0,630). Harris kalça skorunu etkileyen faktörleri belirlemek amacıylayapılan çoklu doğrusal regresyon analizi sonucunda, komplikasyon gelişen (p<0,001) ve revizyon yapılan hastalarda (p<0,001) Harris kalça skorunun diğerlerine göre daha düşük olduğu saptandı.Varus deformitesi Profin uygulanan olgularda daha fazla sıklıkta gelişmiş olsa da, gruplar arasında fonksiyonel sonuçlar, kırık kaynama süresi, komplikasyon ve revizyon sıklığı açısından anlamlı fark yoktu. İTK olgularında redüksiyon ve kırık tespiti iyi düzeyde yapılırsa, seçilen implant tipinin çok önemli olmadığı söylenebilir.Yayın İntramedüller Çivi Uygulaması Sonrası Kırık Kaynama Problemi Olan Tibia Kırığı Vakalarında Uygulanan Farklı Dinamizasyon Tekniklerinin Karşılaştırılması(2020) Ünal, Ömer Kays; Dağtaş, Mirza ZaferÇalışmamızda intramedüller çivi (İMÇ) uygulanan tibia kırığı vakalarında dinamik kilitleme ve kaynama gecikmesi nedeniyle ikincil dinamizasyon uygulanan vakaları kaynama süreleri yönünden karşılaştırmak amaçlanmıştır. Mayıs 2002 ile Eylül 2019 tarihleri arasında tibiakırığı nedeniyle İMÇ kullanılarak kapalı redüksiyon internal fiksasyon uygulanan 95 hasta çalışmaya alındı. Hastalar dinamizasyon tekniklerine göre 3 gruba ayrıldı. Birinci grup dinamik kilitleme yapılan hastalar, ikinci grup dinamizasyon amacıyla sadece statik vida çıkarılanhastalar, 3. grup dinamizasyon amacıyla dinamik ve statik tüm vidalar çıkarılan hastalardı. Gruplar; demografik bilgiler, sigara kullanımı,kırık tipi ve kaynama süresi açısından karşılaştırmalı olarak değerlendirildi. Çalışmaya dahil edilen 95 hastanın 61’i erkek, 34’ü kadındı.Hastaların yaş ortalaması 35 (19 – 63) idi. Hastaların ortalama takip süresi 21,3 (12 – 30) hafta idi. Grup 2’de kaynama süresinin diğergruplara göre daha uzun olduğu görüldü. Tüm hastalar ve ayrı ayrı gruplar arasında yaş ve cinsiyet ile kırık kaynama süresi arasında anlamlıistatistiksel bir ilişki saptanmamıştır (p>0.05). Tüm gruplar için sigara kullanan hastalarda kırık kaynama süresinin daha uzun olduğu saptanmıştır (p<0.05). Kırık tipine göre kırık kaynama süreleri arasında istatistiksel olarak anlamlı bir fark saptanmadı (p>0.05). Gruplar, 12.haftadan tam kaynama gerçekleşene kadar geçen süreler açısından incelendiğinde grup 2’de istatistiksel olarak grup 3’ten daha uzun birkaynama süresi olduğu saptandı (p<0.05). Çalışmamızın sonucunda; İMÇ uygulanan ve kaynama problemi olan vakalarda en etkili dinamizasyonun, kırık hattına uzak olan noktadan tüm vidaların çıkarılarak çivinin aksiyel yönde hareketine izin vererek sağlandığı görülmüştür.Yayın The Maltepe combination: Novel parasacral interfascial plane block and lumbar erector spinae plane block for surgical anesthesia intransfemoral knee amputation(Elsevier, 2019) Tulgar, Serkan; Selvi, Onur; Şentürk, Özgür; Özer, Zeliha; Ünal, Ömer Kays; Thomas, David TerenceThe Maltepe combination: Novel parasacral interfascial plane block and lumbar erector spinae plane block for surgical anesthesia intransfemoral knee amputation. For patients undergoing transfemoral (above knee) amputation, anesthesia options are generally limited due to concomitant complex medical problems of the patients. In patients undergoing transfemoral amputation, regional anesthesia techniques may be life-saving when it is necessary to avoid general or neuraxial anesthesia. The blockage of lumbar and sacral plexus or their components are generally applied for thispurpose.Yayın Morphological and biomechanical effects of vitamin K2 on fracture healing: An animal study on the rat tibia fracture model(Turkish Assoc Orthopaedics Traumatology, 2023) Ünal, Ömer Kays; Dağtaş, Mirza Zafer; Ipek, Belkiz Ongen; Sitar, Mustafa Erinc; Ugutmen, EnderObjective: The aim of this study was to evaluate the effects of vitamin K2 on fracture healing.Methods: Twenty-four 6-week-old male Wistar albino rats that had open tibia fractures induced were included in this study. They were divided into 2 groups of 12, a group that had vitamin K2 administered over 30 consecutive days and a control group. After 30 days, the rats were sacrificed, and from each group, 6 tibiae were selected for biomechanical testing to examine the mechanical strength of the callus tissue using the Instron 3-point bending test and 6 tibiae were selected for histological analysis to examine the density and organization of callus tissue using Allen's grading system and Huo et al's grading system. Furthermore, weekly x-rays were taken to evaluate bone union described by Lane and Sandhu, and osteocalcin, procollagen I N-terminal propeptide, and procollagen I C-terminal propeptide were examined in blood samples taken by intracardiac puncture during sacrification.Results: Breaking force (P = .047), breaking time (P = .019), stiffness (P = .039), fracture strength (P = .041), and Young's modulus (P = .032) showed a statistically significant increase in the K2 group. Procollagen I C-terminal propeptide (P = .024), procollagen I N-terminal propep -tide (.047), and osteocalcin (.048) levels were significantly higher in the K2 group compared to the control group. Furthermore, 3rd-week x-rays showed higher bone union scores according to the Lane and Sandhu method in the K2 group (P = .014). However, the histological grading systems of Allen and Huo et al did not show statistically significant differences between groups (P = .086, P = .07, respectively).Conclusion: In light of these findings, it could be concluded that vitamin K2 has a significant positive effect on fracture healing.Yayın Novel lateral support system increases stability and reduces angular error in total hip arthroplasty: A case control study(SelSistem, 2022) Dağtaş, Mirza Zafer; Ünal, Ömer Kays; Nacefov, Turan; Üğütmen, EnderBackground/Aim: Intraoperative changes in patient position or other changes that would disrupt the decisive position during preoperative preparation would directly have a negative impact on acetabular cup orientation in patients undergoing total hip arthroplasty. This study aimed to compare the standard support system and a novel lateral support system (Maltepe), which ensures stable lateral decubitus positioning during the perioperative period, in patients undergoing total hip arthroplasty with the posterolateral approach. Methods: Patients operated in our department for osteoarthritis of the hip between 2012 - 2019 were included in this case-control study retrospectively. 46 and 41 patients were prepared for surgery in lateral decubitus position using the classical (Group 1) and novel (Group 2) lateral support systems, respectively. The groups were compared in terms of demographic characteristics, duration of preparation, anteversion and inclination, and Harris Hip scores. Results: Mean patient age was 66.89 (7.53). There was no significant difference between the two groups in terms of age (P=0.546), gender (P=1.00), body mass index (P=0.302) and the operative side (P=0.724). Duration of preparation and absolute deviation values from 15 degrees and 45 degrees were significantly better in group 2 compared to group 1 (P<0.01). There was no significant difference between the Harris Hip Scores of two groups. Conclusion: We demonstrated that the novel support system we developed provided more successful outcomes than the classical system in terms of acetabular cup orientation.Yayın Novel lateral support system increases stability and reduces angular error in total hip arthroplasty: a case control study(JOSAM, 2022) Dağtaş, Mirza Zafer; Ünal, Ömer Kays; Najafov, Turan; Ugutmen, EnderBackground/Aim: Intraoperative changes in patient position or other changes that would disrupt the decisive position during preoperative preparation would directly have a negative impact on acetabular cup orientation in patients undergoing total hip arthroplasty. This study aimed to compare the standard support system and a novel lateral support system (Maltepe), which ensures stable lateral decubitus positioning during the perioperative period, in patients undergoing total hip arthroplasty with the posterolateral approach. Methods: Patients operated in our department for osteoarthritis of the hip between 2012 - 2019 were included in this case-control study retrospectively. 46 and 41 patients were prepared for surgery in lateral decubitus position using the classical (Group 1) and novel (Group 2) lateral support systems, respectively. The groups were compared in terms of demographic characteristics, duration of preparation, anteversion and inclination, and Harris Hip scores. Results: Mean patient age was 66.89 (7.53). There was no significant difference between the two groups in terms of age (P=0.546), gender (P=1.00), body mass index (P=0.302) and the operative side (P=0.724). Duration of preparation and absolute deviation values from 15 degrees and 45 degrees were significantly better in group 2 compared to group 1 (P<0.01). There was no significant difference between the Harris Hip Scores of two groups. Conclusion: We demonstrated that the novel support system we developed provided more successful outcomes than the classical system in terms of acetabular cup orientation.Yayın Radius Distal İntraartiküler Kırıklarında El Bileği FiksatörüYapılan Hastalar ile Açık Redüksiyon ve Plak Vida YapılanHastaların Orta Dönem Sonuçların Karşılaştırılması(2021) Dağtaş, Mirza Zafer; Ünal, Ömer KaysBu çalışmanın amacı, distal radius kırık cerrahi tedavisinde eksternal fiksatör ve volarplak uygulanan hastaların klinik özelliklerinin ve orta dönem sonuçlarınınkarşılaştırılmasıdır. Gereç ve Yöntem: Çalışma Mayıs 2014-Aralık 2019 tarihleri arasında MaltepeÜniversitesi Tıp Fakültesi ortopedi kliniğinde distal radius eklem içi parçalı kırıknedeniyle eksternal fiksatör veya volar plak uygulanan olguların dosyalarının retrospektifolarak incelenmesi ile gerçekleştirildi. Olguların demografik verileri, kırık sınıflaması,ameliyat süresi, hastanede yatış süresi, takip süresi, gelişen komplikasyonlar, revizyonsayısı ve MAYO el bileği skoru kaydedilmiş ve uygulanan cerrahi tekniğe göre sonuçlarkarşılaştırıldı. Bulgular: Çalışmada değerlendirilen 60 olgunun 32’si volar plak, 28’i eksternal fiksatörgrubundaydı. Olguların takip süre ortalaması 28.08±4.64 ay, yaş ortalaması50.20±14.69’du. Eksternal fiksasyon grubu ile karşılaştırıldığında, volar plak grubununoperasyon süresi (P<0.001) ve hastanede yatış süresi istatistiksel olarak anlamlıdüzeyde daha uzundu (P=0.002). MAYO el bileği skoru volar plak grubunun tamamındamükemmel/iyi düzeydeyken (88.94±3.13), eksternal fiksasyon grubunun %57.1’indemükemmel/iyi düzeydeydi (80.43±6,12). Volar plak uygulanan olguların MAYO el bileğiskoru istatistiksel olarak anlamlı düzeyde daha iyi seviyedeydi (P<0.001).Sonuç: Distal intraartiküler radius kırıklarında eksternal fiksasyon ile karşılaştırıldığında,volar plak ile internal fiksasyon yaklaşımında cerrahi operasyon süresi ve hastanedekalış süresi daha uzun olsa da orta dönem takip sonuçları daha başarılıydı.Yayın Severe gonarthrosis without pain and disability: A case report(Maltepe Üniversitesi, 2021) Sur Ünal, Ülkü; Ünal, Ömer KaysDiz Osteoartriti (gonartroz), diz bölgesindeki kronik ağrının en yaygın nedenlerinden biridir. Gonartrozda tip II kollajenin bozulması, kıkırdak yıkımı, sinovit ve kemik iliği lezyonları tipik olarak belirgin ağrıya sebep olur. Diz eklemindeki bu değişiklikler, zaman içinde eklem hareket açıklığında önemli kısıtlılıklara ve yürüme bozukluklarına yol açmaktadır. Bu semptomların zamanla ilerlemesi ile hastanın yaşam kalitesi giderek düşmekte ve ileri gonartroz vakalarında hastalar bakıma muhtaç hale gelebilmektedir. Bu yazıda diz bölgesinde ağrısız ve hareket kısıtlılığı olmayan ileri evre gonartroz olgusu sunulmaktadır.
