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Öğe Characteristics of femoral neck fractures in osteogenesis imperfecta: Series of four-teen consecutive hips in twelve patients(Elsevier Sci Ltd, 2024) Vahabi, Arman; Kaya, Huseyin; Cagiran, Zeynep; Sozbilen, Murat Celal; Kurt, Cengizhan; Gunay, HuseyinIntroduction: While long bone fractures are commonly seen in individuals with Osteogenesis Imperfecta (OI), femoral neck fractures (FNF) are exceedingly rare. There is a lack of comprehensive data regarding the etiology of FNFs, their characteristics, and the treatment protocols. Our aim was to determine the characteristics of femoral neck fractures in children with OI. Materials and methods: This study was conducted as retrospective series covering period of January 2011December 2022. Total of 14 femoral neck fractures in 12 patients were included into final analysis. Age, gender, fracture location, ambulation level, injury mechanism, Sillence type, pre-fracture collo-diaphyseal angle, presence of previous implants and applied treatments were noted. Results: The mean age was 9.3 (range: 3 -16), 8 out of 12 patients were males. Sillence type 3 OI was most common (50 %) type. Among 12 patients, 2 (16.6 %) were restricted ambulatory while 5 (41.6 %) were nonambulatory. Seven patients had prior femoral implants. Six fractures were managed non-operatively, while others underwent surgery, with cannulated screws (42.8 %) or plate osteosynthesis (7.1 %). All eight cases (100 %) with minor trauma or unknown origin were Sillence type 3 -4, displaying varus deformity. FNFs that occured in mobile patients required higher-energy traumas. Conclusion: Femoral neck fractures in OI showed differing trauma mechanisms in ambulatory vs. non-ambulatory patients. Non-surgical treatment may be considered with in patients with high-risk anesthesia concerns, requiring higher level clinical studies.Öğe Comparison of the Effects of Extracorporeal Irradiation and Liquid Nitrogen on Nerve Recovery in a Rat Model(Taylor & Francis Inc, 2019) Kaya, Huseyin; Sabah, Dundar; Kececi, Burcin; Kucuk, Levent; Erbas, Oytun; Oltulu, Fatih; Taskiran, DilekAim of the study: Biologic reconstruction using tumor-bearing bone autografts devitalized by liquid nitrogen or extracorporeal irradiation (oncological sterilization) is a safe and effective method in musculoskeletal surgery. the purpose of this study was to examine the effects of these two oncological sterilization methods on nerve recovery. Methods: A total of 48 rats were randomly divided into 3 groups as autograft, irradiation and liquid nitrogen groups. A nerve defect created in the right sciatic nerve was reconstructed with an autograft obtained from the nerve itself. Group I underwent reconstruction with standard nerve autograft. Group II and Group III underwent reconstruction with devitalized nerve autograft treated through extracorporeal irradiation and liquid nitrogen, respectively. the left sciatic nerves of the rats served as control. Electromyography, motor function test and histomorphological analysis were performed to assess the nerve recovery on the 3rd (early stage) and 4th months (late stage). Results: Electrophysiological assessment revealed better results in irradiation group compared with liquid nitrogen group in terms of myelinization and axonal regeneration. Motor performance of the autograft group was slightly better than the other groups. Histologically, autograft group demonstrated better results compared with other groups. Late-stage assessments revealed high rates of myelinization in the graft segment in liquid nitrogen group and in the segment distal to the graft in irradiation group. Conclusions: This study has demonstrated that nerve autografts treated by oncological sterilization methods may be used for nerve reconstruction in limb salvage surgery. However, further studies are needed to clarify the applicability of these methods.Öğe Comparison of the Effects of Extracorporeal Irradiation and Liquid Nitrogen on Nerve Recovery in a Rat Model(Taylor & Francis Inc, 2021) Kaya, Huseyin; Sabah, Dundar; Kececi, Burcin; Kucuk, Levent; Erbas, Oytun; Oltulu, Fatih; Yigitturk, GurkanAim of the study: Biologic reconstruction using tumor-bearing bone autografts devitalized by liquid nitrogen or extracorporeal irradiation (oncological sterilization) is a safe and effective method in musculoskeletal surgery. The purpose of this study was to examine the effects of these two oncological sterilization methods on nerve recovery. Methods: A total of 48 rats were randomly divided into 3 groups as autograft, irradiation and liquid nitrogen groups. A nerve defect created in the right sciatic nerve was reconstructed with an autograft obtained from the nerve itself. Group I underwent reconstruction with standard nerve autograft. Group II and Group III underwent reconstruction with devitalized nerve autograft treated through extracorporeal irradiation and liquid nitrogen, respectively. The left sciatic nerves of the rats served as control. Electromyography, motor function test and histomorphological analysis were performed to assess the nerve recovery on the 3rd (early stage) and 4th months (late stage). Results: Electrophysiological assessment revealed better results in irradiation group compared with liquid nitrogen group in terms of myelinization and axonal regeneration. Motor performance of the autograft group was slightly better than the other groups. Histologically, autograft group demonstrated better results compared with other groups. Late-stage assessments revealed high rates of myelinization in the graft segment in liquid nitrogen group and in the segment distal to the graft in irradiation group. Conclusions: This study has demonstrated that nerve autografts treated by oncological sterilization methods may be used for nerve reconstruction in limb salvage surgery. However, further studies are needed to clarify the applicability of these methods.Öğe Composite Reconstruction With Irradiated Autograft Plus Total Hip Replacement After Type II Pelvic Resections for Tumors Is Feasible but Fraught With Complications(Lippincott Williams & Wilkins, 2024) Vahabi, Arman; Tosyali, Hakan Koray; Kececi, Burcin; Sabah, Dundar; Kaya, HuseyinBackgroundMalignancies involving the pelvic ring present numerous challenges, especially in the periacetabular area. Extensive resection of the pelvic region without reconstruction can lead to severe functional impairment. Numerous reconstructive options exist, but all have drawbacks. Extracorporeally irradiated autografts are one option for reconstruction after periacetabular resections; they offer the potential advantages of eliminating the risk of allogeneic reactions associated with allografts and preserving local anatomy. However, little is known about the durability and risks of this approach in pelvic reconstruction.Questions/purposes(1) What are the survival rates of the autograft used, and if there is graft loss, what is the extent of this loss? (2) What are the functional outcomes after the implementation of this method? (3) What is the rate and nature of complications associated with this approach?MethodsThis is a retrospective case series from one subspecialty tumor unit that evaluated patients treated between January 2005 to January 2022. During that time, three surgeons treated 48 patients with Type II resections (defined as resection of periacetabular area). Patients treated with isolated Type II resections were eligible, as were those treated either with Type I+II resections, Type II+III resections, Type I+II+III resections, and Type I+II+III+IV resections. Of those, 21% (10 of 48) were treated primarily with a cone prosthesis, 13% (6 of 48) were treated without femoral reconstruction, 10% (5 of 48) were treated with resection without reconstruction, and 6% (3 of 48) had a THA on the sacrum, leaving 50% (24 of 48) of patients who were treated with femoral and acetabular reconstruction using extracorporeally irradiated autograft and total hip replacement; those patients were potentially eligible for this study. During that time span, we used this approach in all Type II pelvic resection procedures, when a part of the hemipelvis could be preserved without resection (other than Type I+II+III+IV) and where we predicted that there would be sufficient bone stock after tumor removal. Of those, 21% (5 of 24) were lost to follow-up before 2 years, and 13% (3 of 24) died within 2 years with the reconstruction intact and without any reoperation or graft loss, leaving 67% (16 of 24) for analysis here. Demographic characteristics, type of tumor, tumor origin site, type of applied resection, and extent of applied surgical procedure were noted. Of 16 patients, 12 were male, with a mean age of 38 +/- 21 years. Tumor types included chondrosarcoma in eight patients, malignant mesenchymal tumor in four patients, osteosarcoma in two patients, and Ewing sarcoma in two patients. Among these, 10 patients had tumors originating from the pelvis, whereas six patients had tumors originating from the proximal femur. We used a Kaplan-Meier estimator to calculate survivorship free from total or partial graft removal at 72 months. To measure functional results, the Musculoskeletal Tumor Society (MSTS) scoring system was utilized at most recent follow-up so as to be able to evaluate the impact of complications (if any) on the ultimate result. The MSTS score ranges from a minimum of 0 points to a maximum of 30 points, where a higher score reflects lower pain and higher functional and emotional capacity. Related complications, time of complications, secondary interventions, and mortality rates were also ascertained from chart review. ResultsGraft survival rate at 72 months after initial reconstruction, free from partial or total graft removal, was 50% (95% CI 26% to 75%). Kaplan-Meier analyses revealed estimated mean time of graft removal as 43 months (95% CI 28 to 58). The graft was protected in eight patients on their final follow-up radiographs. The median (range) MSTS score was 18 (6 to 25) of 30 points at most-recent follow-up (these scores include patients who have had their grafts removed). In all, 15 of 16 patients had 17 complications; 16 were major complications (defined as those substantial enough to result in further surgery or a life- or limb-threatening event). A total of 14 of those 15 patients underwent one or more secondary procedures (a total of 21 unplanned additional procedures were performed in those patients). Deep infection was the most common complication, occurring in eight patients. Prosthesis dislocation occurred in four patients. Three patients developed aseptic acetabular component loosening, two had graft fractures, and one patient developed heterotopic ossification.ConclusionComposite reconstruction with extracorporeal irradiated autografts plus total hip replacement is a feasible reconstruction technique after Type II pelvic resections, although complications and reoperations were common. Although no reconstruction technique has been proven superior to other alternatives, the high risk of complications and reoperations associated with this technique should be considered when selecting from among possible alternative reconstruction methods.Level of EvidenceLevel IV, therapeutic study.Öğe Dexpanthenol reduces fibrosis and aids repair following nerve laceration and neurorrhaphy(Spandidos Publ Ltd, 2021) Karahan, Gokhan; Kaya, Huseyin; Eyceyurt, Recep Selcuk; Erdogan, Mumin Alper; Yigitturk, Gurkan; Erbas, OytunThe aim of the present study was to investigate the effect of dexpanthenol on nerve healing following neurorrhaphy in lacerated peripheral nerves. A total of 30 mature Sprague Dawley rats were used. Surgical sciatic nerve dissection and repair was performed on an experimental group of 20 rats. The remaining 10 rats were designated as the control group. The experimental group was divided into 2 subgroups. The surgery + saline group (SSLE; n=10) was given 1 ml/kg 0.9% sodium chloride saline intraperitoneally. The surgery + dexpanthenol group (SDPL; n=10) rats were given 500 mg/kg/day dexpanthenol intraperitoneally. Histological evaluation of the sciatic nerve tissue revealed that the fibrosis score was significantly lower in the SDPL group than in the SSLE group (P<0.001). Electrophysiological evaluation of compound muscle action potential (CMAP) indicated that the CMAP level in the SDPL group was significantly higher than that of the SSLE group (P<0.001), and the CMAP latency period was lower in the SDPL group compared with the SSLE group (P<0.001). in addition, the SDPL group malondialdehyde level was significantly lower than that of the SSLE group (P<0.001). Functional evaluation with an inclined plane test revealed a significant difference between the SSLE (39.6 +/- 5.5 degrees) and SDPL (79.1 +/- 6.93 degrees) groups (P<0.001). Dexpanthenol was observed to have a positive effect on nerve tissue repaired with neurorrhaphy in a rat sciatic model of laceration-type injuries similar to those frequently encountered in the clinic.Öğe Impact of the unplanned excision on the oncological outcomes of patients with soft tissue sarcomas: a single-center retrospective review of 490 patients(Turkish Assoc Orthopaedics Traumatology, 2022) Alsina, Andac Celasun; Sacchetti, Federico; Kaya, Huseyin; Yaman, Banu; Tamsel, Ipek; Sabah, DundarObjective: This study aimed to (1) compare the oncological results of patients who underwent re-excision after unplanned excision with those who underwent planned excision and (2) analyze the impact of local recurrences on oncological outcomes. Methods: Patients with soft tissue sarcoma who had been treated in our center between 2000 and 2018 were retrospectively reviewed. Patients were divided into two groups: Group PE (Planned excision; n=345) and group UE (Unplanned excision; n=145). Two groups were compared in terms of local recurrence-free survival (LRFS), metastasis-free survival (MFS), and overall survival (OS). Local recurrences effects over MFS and OS were also analyzed. Results: There were 26 (17.9%) local recurrences in the UE group and 30 (8.7%) local recurrences in the PE group (P=0.005). There was no difference in MFS and OS between study groups (P=0.278 and P=0.848, respectively). Five years MFS rates of UE and PE groups were 76.4% and 73.6%, and five-year OS rates of UE and PE groups were 70.3% and 73.9%, respectively (P=0.417, P=0.656). Patients with local recurrence had a 1.96 times higher risk of metastasis than patients without local recurrence (P=0.008). Patients with local recurrence had 1.65 times higher risk of mortality than patients without local recurrence (P=0.047). Conclusion: Although local recurrence is much more common in the UE group, this outcome does not seem to affect MFS or OS. These results indicate that similar outcomes can be achieved if UE patients are referred and appropriately treated with wide re-resections.Öğe Intra-articular ganglion cyst of cruciate ligaments of knee : arthroscopic and conservative treatment(Acta Medica Belgica, 2021) Karahan, Gokhan; Gok, Murat; Kaya, Huseyin; Kayali, Cemil; Yamak, KamilAnterior and posterior cruciate ligaments associated ganglion cysts of knee are rare conditions. These cysts are generally symptomatic; painfull and activity limiting. MRI is commonly used for diagnosis of cruciate ligaments associated ganglion cyst, relation to anatomical structures and preoperative assesment. In this study, we present 8 cases with ganglion cysts in the cruciat ligaments detected with MRI and treated conservatively or arthroscopically. Three of these cases were treated conservatively and five of cases were treated arthroscopically. One of the patients treated conservatively had moderate pain and seven patients had no pain or any other symptoms.Öğe Is Hydatid Cyst with Musculoskeletal Involvement a Problem that Causes Morbidity? Long-Term Follow-Up and Functional Results(Springer Heidelberg, 2022) Kaya, Huseyin; Karahan, Gokhan; Sabah, DundarBackground The aim of study is to evaluate the involvement characteristics of hydatid cysts, which are rarely involved the musculoskeletal system, and the results of recurrence, morbidity, and functional and mental scoring. Methods We retrospectively investigated 18 patients with skeletal hydatid disease. Patients were categorized as those with bone or skeletal muscle involvement. Pre- and post-operative physical component scores (PCS) and mental component scores (MCS) on the functional Short Form 12-item Survey were recorded in these patients.We compared the functional scores, number of recurrences, and lesion volumes between patients with hydatid cyst of bone (HCOB) and those with hydatid cyst of soft tissue (HCOST). Results This study included 11 women and 7 men with bone hydatid cysts. Patients' mean age was 38 years (range 22-70 years). Patients were followed up for a mean of 118.16 months (range 49-230 months). The mean lesion volume was 447.39 cm(3) (36-1260 cm(3)). The 12th and 48th month PCS, the PCS was lower in the HCOB group during both periods (p = 0.04 and p = 0.001, respectively). The 48th month MCS was lower in the HCOB group (p = 0.04). Postoperative residual cysts were detected in five patients who underwent surgical treatment for bone c; all residual lesions were located in the pelvis. Conclusions Bone hydatid cysts are associated with high recurrence rates, and treatment is challenging. In view of the low functional results and high infection and recurrence rates observed in patients over long-term follow-up, particularly in those with pelvic hydatid cysts, we conclude that this disease is associated with significant morbidity.Öğe Management of Chondroblastoma in Pediatric Patients: 21 Years of Single-Center Experience(Mdpi, 2024) Tosyali, Hakan Koray; Kaya, Huseyin; Kececi, Burcin; Sabah, DundarBackground: Chondroblastoma (CB), a rare benign bone tumor that produces chondrocytes, often develops in the epiphysis or apophysis of children and young adults. The treatment of these rare tumors is complex. The standard treatment protocol involves curettage with local adjuvants and bone graft or cement application. The authors examined 38 CBs to determine risk factors for local recurrence, complications, and functional outcomes following epiphyseal curettage. Methods: Twenty-two girls and sixteen boys aged 10 to 17 years with histologically confirmed chondroblastoma who arrived at our hospital between January 2000 and June 2021 were reviewed retrospectively. Clinical data, radiographic images, histological results, treatment, functional outcomes, and the local recurrence rate were examined-surgical treatment involved total tumor curettage, followed by bone grafting and adjuvant techniques. Local recurrences have also been reported. Results: The most frequently affected site was the proximal femur. Sites of involvement included the proximal femur in 10 (26.3%) cases, the proximal tibia in 8 (20.8%), the humerus in 5 cases (13.2%), the distal tibia in 4 cases (10.5%), the distal femur in 3 cases (7.9%), the supracetabular region in 3 cases (7.9%), the talus in 1 case (2.6%), the calcaneus in 1 case (2.6%), the scapula in 1 case (2.6%), the lumbar spine in 1 case (2.6%), and the iliac bone in 1 (2.6%) patient. The mean follow-up was 144.2 months (24 to 276). The local recurrence rate was 7.9%. The mean Musculoskeletal Tumor Society (MSTS) score was 28.3 points (17 to 30). The mean duration of symptoms at presentation was 5.8 (range, 1 to 28) months. Conclusion: Aggressive curettage and bone grafting resulted in local control and good outcomes in most pediatric patients. In a relatively small proportion of cases, long-term complications and recurrence can occur due to growth plate damage and late diagnosis. In patients admitted to the pediatric clinic with pain, which is often accompanied by localized edema and joint effusion, early detection via advanced radiological scans (X-ray, CT, or MRI) may prevent delays in diagnosis.Öğe Posteromedial Open-Wedge High Tibial Osteotomy to Avoid Posterior Tibial Slope Increase(W B Saunders Co-Elsevier Inc, 2020) Kaya, Huseyin; Dastan, Ali Engin; Bicer, Elcil Kaya; Taskiran, EminPurpose: the primary aim was to evaluate the influence of the surgical modification on posterior tibial slope (PTS) and patellar height in open-wedge high tibial osteotomy (OWHTO). the secondary aim was to evaluate the influence of preoperative mechanical axis deviations (MA) on PTS Methods: Between January 2014 and February 2016, patients with a diagnosis of medial-compartment osteoarthritis who had undergone OWHTO with posteromedial osteotomy technique with a minimum follow-up of 3 months were included in this retrospective study. Preoperative and postoperative PTS angles with 3 different methods and patellar heights with respect to the InsalleSalvati and CatoneDeschamps indices were measured on lateral radiographs by 2 observers. Patients were grouped according to preoperative MA (either <10 degrees or >= 10 degrees). PTS changes were compared between groups Results: Thirty consecutive knees of 28 patients were evaluated. Preoperative mean PTS angles were 9.50 degrees +/- 4.47 degrees (posterior tibial cortex referenced), 11.51 degrees +/- 4.50 degrees (tibial anatomical axis referenced), and 10.80 degrees +/- 4.58 degrees (posterior fibular cortex referenced); postoperative angles were 6.10 degrees +/- 4.23 degrees, 8.78 degrees +/- 4.57 degrees, and 8.11 degrees +/- 4.55 degrees, respectively. PTS was significantly decreased postoperatively with respect to all 3 methods (P <.0001). Mean preoperative and postoperative InsalleSalvati indices were 1.04 +/- 0.16 and 1.07 +/- 0.17, respectively (P 1/4 .088). Mean preoperative and postoperative CatoneDeschamps indices were 0.87 +/- 0.18 and 0.78 +/- 0.18, respectively (P = .017). PTS changes were not statistically significant between groups with respect to MA (P values.861,.723, and.727, respectively) Conclusions:Öğe Preoperative radiotherapy with concomitant chemotherapy in extremity soft tissue sarcomas: long-term results of a single center(Springer Heidelberg, 2023) Yilmaz, Ugur; Kamer, Serra; Kaya, Huseyin; Sabah, Dundar; Sanli, Ulus Ali; Tamsel, Ipek; Yaman, BanuPurposeTo assess oncological outcomes of patients receiving neoadjuvant radiochemotherapy (RCT) for soft tissue sarcoma (STS) of the extremities.MethodsPatients who were treated with preoperative radiotherapy and concomitant chemotherapy-3 cycles of mitomycin/doxorubicin/cisplatin (MAP) or 2-4 cycles of doxorubicin/cisplatin (AP)-followed by surgery were analyzed retrospectively. Survival rates were estimated, and prognostic factors were identified.ResultsBetween 1994 and 2017, a total of 108 patients were included. Median ages were 43 years and 51 years for patients receiving MAP and AP, respectively. The 5-year local relapse-free survival (LRFS), disease-free survival (DFS), disease-specific survival (DSS), and overall survival (OS) were 94.1, 63.6, 75.3, and 71.9%, respectively. In the multivariate analysis, significant predictors were identified as follows: de novo or R1/R2 resected tumor on admission before RCT (p = 0.017; hazard ratio [HR] 0.112, 95% confidence interval [CI] 0.019-0.675) and R0 resection after RCT (p = 0.010; HR 0.121, 95% CI 0.024-0.598) for LRFS; female gender (p = 0.042; HR 0.569, 95% CI 0.330-0.979) and liposarcoma histology (p = 0.014; HR 0.436, 95% CI 0.224-0.845) for DFS; liposarcoma histology (p = 0.003; HR 0.114, 95% CI 0.027-0.478) and AP regimen (p = 0.017; HR 0.371, 95% CI 0.165-0.836) for DSS; age <= 45 years (p = 0.043; HR 0.537, 95% CI 0.294-0.980) and liposarcoma histology (p = 0.006; HR 0.318, 95% CI 0.141-0.716) for OS, respectively.ConclusionAn increased risk for local failure seems to exist for patients with relapsed tumor on admission and having positive surgical margins after neoadjuvant RCT. Intensity of chemotherapy influenced DSS but not OS, which could be due to younger patients receiving MAP.Öğe Stress radiography findings in medial meniscus posterior root tears(Elsevier, 2020) Argin, Mehmet; Dastan, Ali Engin; Bicer, Elcil Kaya; Kaya, Huseyin; Taskiran, EminBackground: The present study aimed to evaluate stress radiography and magnetic resonance imaging (MRI) findings in medial meniscus posterior root tears (MMPRTs). Methods: The study included 27 patients (26 females, mean age, 53.52 years) who underwent high tibial osteotomy and in whom medial menisci were concurrently examined arthroscopically. Preoperative stress radiographs and MR1 series in 14 cases with root tears (MMPRT group, detected arthroscopically) and in 13 cases without tears (control group) were evaluated. Joint spaces measured on the stress radiographs were compared between the operated and opposite knees in each group. Results: on the varus stress radiographs, the mean lateral joint space of the operated knees was significantly wider than that of the opposite knees in the MMPRT group (P - 0.007). Upon MRI studies, meniscal extrusion was significantly more common in the MMPRT group than in the control group. Moreover, the amount of meniscal extrusion was correlated with the tear size. Conclusions: Widening of the lateral joint space on the varus stress radiography was higher in the cases with root tears. Therefore, we propose that stress radiographs can be helpful in the diagnosis of MMPRT. (C) 2020 Elsevier B.V. All rights reserved.Öğe Surgical Site Infection in Sarcoma Patients Treated with Extracorporeal Irradiated Bone Autograft: A 18-Year Cohort Analysis(Bilimsel Tıp Yayınevi, 2023) Kaya, Huseyin; Vahabi, Arman; Vahabi, Merve Mert; Kamer, Serra; Sabah, Dündar; Taşbakan, MeltemIntroduction: Biological reconstruction techniques in sarcoma surgery are employed selectively within limb-sparing procedures. The utilization of extracorporeal irradiated bone autografts stands as a secure, cost-efficient, and efficacious therapeutic approach. Surgical site infection in such cases is associated with graft failure, necessitating further surgical intervention, consequently raising the morbidity rate.Materials and Methods: This study adopted a retrospective cohort design, encompassing the timeline from January 2002 to December 2020. Data on demographic charateristics, structural attributes of the graft employed, infection-related complications, culture results, instances of secondary surgical intervention, and occurrences of graft loss were noted. Infections are classified as superficial or deep, and instances of graft loss are categorized as partial or complete.Results: Surgical site infections occurred in 39 out of 180 patients (21.6%). The pelvis (n= 19, 48.7%) and tibia (n= 9, 23%) constituted the most frequent locations for these occurrences. Among 29 culture growths, Acinetobacter baumannii (n= 8, 27.5%) and Escherichia coli (n= 6, 20.7%) were the predominant isolates. Among the infected cases, complete graft loss was observed in 18 (46.1%), while partial graft loss occurred in eight (20.5%). Conclusion: To the best of our knowledge, this data is one of the largest patient series reported in the literature. Intraoperative and postoperative variables need to be optimized in these patients to reduce graft loss and morbidity. Postoperative surgical site-related complications should be addressed promptly with early debridement and appropriate antibiotic therapy.Öğe Surgical treatment of displaced radial neck fractures in children with metaizeau technique: Late-term results Metaizeau technique : Late term results(Bayrakol Medical Publisher, 2022) Tosyali, Hakan Koray; Hancioglu, Sertan; Kaya, Huseyin; Okcu, Guvenir; Aktuglu, KemalAim: in this study, we aimed to analyze the functional and radiological outcomes of displaced radial neck fractures in children treated with the Metaizeau technique . Material and Methods: This was a retrospective study, and data were collected prospectively. Thirty-eight patients with grade III and grade IV radial neck fractures according to the classification of Judet et al were managed surgically by Metaizeau technique. All patients were surgically treated with percutaneous k-wire leverage reduction and retrograde transphyseal k-wire fixation. The functional results were evaluated using the Metaizeau functional scoring system. Clinical evaluation and results were performed using the Mayo elbow performance score (MEPS), ROM of the elbow (flexion, extension) and forearm (supination, pronation) was measured with a goniometer. Complications were also evaluated. Results: The average follow-up time was 64.9 months (28 -120 months), there were no patients with nonunion, avascular necrosis, infection, posterior interosseous nerve (PIN) injury, heterotopic ossification or radioulnar synostosis. There were 31 (88.5 %) excellent or good results and 4 (11.5 %) fair results according to the Metaizeau classification. The final X-rays showed fracture healing in all patients. No patient developed complications. Discussion: Intramedullary pinning, as described by Metaizeau, is a reliable and reproducible surgical method to treat radial neck fractures in children, which provides excellent or good results and has a low risk of complications.Öğe What has changed in the last 25 years in osteosarcoma treatment? A single center experience(Turkish J Pediatrics, 2023) Ataseven, Eda; Goktepe, Sebnem Onen; Kaya, Huseyin; Tamsel, Ipek; Kececi, Burcin; Argin, Mehmet; Doganavsargil, BasakBackground. Osteosarcoma is the most common type of primary malignant bone tumor in the extremities. The main purpose of this study was to determine clinical features, prognostic factors, and treatment results of patients with osteosarcoma at our center.Methods. We retrospectively analyzed the medical records of children with osteosarcoma between the years 1994-2020.Results. 79 patients were identified (54.4% male, 45.6% female). The most common primary site was the femur (62%). Twenty-six of them (32.9%) had lung metastasis at diagnosis. The patients were treated between 1995-2013 according to the Mayo Pilot II Study protocol, while the others were treated with the EURAMOS protocol between the years 2013-2020. Sixty-nine patients underwent limb salvage surgery as a local treatment, whereas seven underwent amputation. The median follow-up time was 53 months (2.5-265 months). The event-free survival (EFS) and overall survival (OS) rates at 5 years were 52.1% and 61.5%. The 5-year EFS and OS rates were 69.4% and 80% in females; 37.1% and 45.5% in males (p=0.008/p=0.001). The 5-year EFS and OS rates of the patients without metastasis were 63.2% and 66.3%; with metastasis 28.8% and 51.8% (p=0.002/p=0.05). For good-responders, the 5-year EFS and OS rates were 80.2% and 89.1%; while for poor-responders, 35% and 46.7% (p=0.001). Mifamurtide was used in addition to chemotherapy as of the year 2016 (n=16). The 5-year EFS and OS rates were 78.8% and 91.7%, respectively for the mifamurtide group; 55.1% and 45.9%, respectively for the non-mifamurtide group (p=0.015, p=0.027).Conclusions. Metastasis at diagnosis and poor response to preoperative chemotherapy were the most important predictors of survival. Females had a better outcome than males. In our study group, the mifamurtide group's survival rates were significantly higher. Further large studies are needed to validate the efficacy of mifamurtide.
