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    Comparison of dynamic compression system versus multiple cancellous screws in the treatment of femoral neck fractures in young adults
    (Bmc, 2024) Aljasim, Omar; Yener, Can; Ozkayin, Nadir
    Introduction Femoral neck fractures have posed a significant global healthcare challenge and had notable impacts on the quality of life. Current treatment strategies for femoral neck fractures in young individuals have varied, emphasizing the need for optimal fixation methods. This study compared the clinical and radiological outcomes of the dynamic compression system (DCS) and multiple cancellous screws (MCS) methods. Methods This retrospective study included a total of 275 young adults with fresh femoral neck fractures treated with DCS and MCS. A matching analysis with a 1:1 ratio based on age, gender, fracture classification, and reduction quality was conducted. Demographic data were recorded, and comparisons were made according to follow-up time (FUT), hospitalization period, operation duration, femoral neck shortening, caput-collum-diaphysis (CCD) angle, Harris Hip Score (HHS), and post-operative complications. Results A total of 42 fractures were matched with a median age of 42 years (range, 22-48). In the DCS group, vertical neck shortening (median 1.92) was significantly lower than that in the MCS group (median 4.53) (P < 0.05). In the DCS group, horizontal femoral neck shortening, resultant femoral neck shortening, the amount of change in CCD angle, and HHS were 0.57 mm (0.43, 4.74 mm), 1.82 mm (0.40, 3.53 mm), 0.13 degrees (-0.78 degrees, 1.80 degrees), and 91 (85-93), respectively. They were all non-significant than 1.00 mm (0.56, 6.23 mm), 2.74 mm (1.59, 6.71 mm), -0.18 degrees (-1.11 degrees,1.85 degrees), and 91 (75, 93) in the MCS group, respectively (P > 0.05). There was no statistical difference in FUT, hospitalization period, operation time, and post-operative complications at the latest follow-up (P > 0.05). There were no complications such as pulmonary embolism, deep vein thrombosis, and incision infection reported. Conclusion DCS and MCS demonstrated effectiveness in treating femoral neck fractures in young adults. The DCS implant provides additional stability in the vertical axis. A prospective randomized controlled study with a large sample size was needed to validate these findings.
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    An investigation into the frequency and risk factors of low back pain following surgical treatment of isolated calcaneal fractures
    (Turkish Assoc Orthopaedics Traumatology, 2024) Bayraktar, Dilek; Ozgurbuz, Cengizhan; Ozturk, Anil Murat; Aktuglu, Salih Kemal; Ozkayin, Nadir
    Objective: This study aimed to determine the frequency of low back pain after calcaneal fractures treated with open reduction internal fixation (ORIF) and the risk factors that cause this condition. Methods: Thirty-one patients (27 males and 4 females) who underwent surgery for a unilateral calcaneal fracture between 2016 and 2020 and had no complaints of low back pain before fracture surgery were included in the study. The patients were divided into 2 groups: those who developed low back pain after the operation and those who did not. Patients were evaluated with the Life Quality Short Form SF -36, the Oswestry Disability Index (ODI), and American Orthopedic Foot -Ankle Association Score (AOFAS). Sanders' fracture type, joint range of motion (ROM) measurements of injured and uninjured limbs, maximal isometric muscle strength measurements, balance on 1 leg with pedobarographic measurements, and walking time were evaluated. The obtained data were compared among the 2 groups. Results: Low back pain was observed in 71% of the patients and was detected after an average of 6 months from the operation. In ODI, 59.1% of the patients reported that low back pain limited their lives slightly. Patients with low back pain have lower AOFAS scores and worse SF -36 physical functionality than those without low back pain (P < .001, P = .016). Balance time on 1 foot in pedobarographic measurements, foot in ROM, ankle in ankle active, passive plantar flexion, inversion, active hip, passive internal, external rotation, muscle is the foot eversion force. In these measurements, the values of the injured side are intact. It was statistically significantly lower than the other side (interaction P < .1). Conclusion: Low back pain may occur after unilateral calcaneal fractures treated by ORIF. This may be caused by decreased angles of ankle dorsi and plantar flexion, foot inversion, hip abduction, and internal and external rotation. In the rehabilitation program, not only the ankle region but also the hip joint of the affected side should be included, and the kinetic chain that describes the interaction mechanism of the human body should not be forgotten.
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    Is interferential current effective in the management of pain, range of motion, and edema following total knee arthroplasty surgery? A randomized double-blind controlled trial
    (Sage Publications Ltd, 2019) Kadi, Mehmet Resul; Hepguler, Simin; Atamaz, Funda Calis; Dede, Emine; Aydogdu, Semih; Aktuglu, Kemal; Ozkayin, Nadir; Ozturk, Cihat
    Objective: To investigate the effectiveness of interferential current implementation following total knee arthroplasty surgery. Design: Double-blind randomized controlled study. Setting: Orthopedics and traumatology in-patient clinic. Participants: From an initial enrollment of 132 patients, 113 who met the study inclusion criteria were randomly separated into two groups: the interferential current group (n = 57) and the sham current group (n = 56). A total of 98 patients completed the study: 49 in the interferential current group and 49 in the sham group. Intervention: Patients in the interferential current group received interferential current treatment for 30 minutes, twice a day for five days postoperatively. For the patients in the sham interferential current treatment group, the same pads were applied to the patients for the same time periods but no electrical stimulation was applied. Main outcome measures: Patients were assessed in respect of pain, range of motion (ROM), edema, and the amount of paracetamol used at baseline and on the 5th and 30th days after surgery. Results: No significant difference was determined between the groups in respect of pain, ROM, and edema at days 0, 5, and 30. At the end of the 5th day, the amount of paracetamol used was significantly lower in the interferential current group (P < 0.05). Conclusion: In this study, both groups showed significant improvements in pain, ROM, and edema with no significant difference between the groups. Although there was a significant difference in paracetamol intake of the two groups, this cannot be argued as showing the effectiveness of interferential current.
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    Simultaneous sequential anterolateral thigh free flaps with interposition comitant vein graft for one-stage lower extremity reconstruction: A case report
    (Wiley, 2023) Gur, Ersin; Tiftikcioglu, Yigit Ozer; Ozkayin, Nadir
    Developments in the microsurgery have made perforator fasciocutaneous free flaps more popular in lower extremity reconstructions. They have acceptable donor site morbidities when compared to traditional methods. However; there are some possible limitations with these flaps such as anatomical variations and insufficiency to cover large and/or complex defects with a single flap. Anterolateral thigh flap (ALT), which has proven its advantages in the reconstruction of many regions of the body, is one of the versatile perforator fasciocutaneous flap options. We present our experience of using sequential double ALTs for complex lower extremity reconstruction. A 44-year-old patient, who had a history of multiple traumas as a result of a traffic accident, had interconnected anterior tibial (6 x 4 cm) and bimalleolar defects (4 x 4 cm, 4 x 5 cm) in his left lower extremity. Double ALT flaps (16 x 9 cm, 17 x 10 cm) were used to reconstruct three individual defects. The posterior tibial artery was the only uninjured artery perfusing the lower extremity, so the already occluded anterior tibial artery was chosen as the recipient to avoid disturbing the posterior tibial vessels. The dominant comitant vein of one of the flaps was leaving the pedicle too early and following an aberrant path with increased diameter. As it was understood that the other comitant vein had poor drainage, it was taken as an interposition vein graft to lengthen the dominant aberrant vein. The two flaps were customized as one by flow-through anastomoses on the operating table. The anterior tibial artery was washed and debrided distal to proximal until arterial spurting was seen. At the distance of 8 cm superior, the artery was found as feasible and anastomoses were performed. The proximal flap was inset vertically and the distal flap was inset on the horizontal axis to reach the bilateral malleolar defect. No complications were observed in both flaps. The patient was followed-up for 8 months. Despite the successful reconstruction, the patient is still unable to walk unaided due to multiple traumas and the rehabilitation process continues. We believe that the use of sequential double ALT may be a useful alternative to reconstruct large lower extremity defects with minimal donor site morbidity when a suitable single recipient vessel is available.
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    Treatment of the four-part proxsimal humerus fractures in elderly patients with hemiarthroplasty
    (Turkish Joint Diseases Foundation, 2008) Ozkayin, Nadir; Alktuglu, Kemal
    Objectives In this study, elderly patients treated by hemiarthroplasty for the four-part proximal humerus fractures were retrospectively evaluated. Patients and methods Twenty-eight patients 60 years of age and above who underwent hemiarthroplasty for the four-part humerus proximal shaft fractures between years 1991-2005 were evaluated. The mean age was 67.7 years (61-82). Nine patients were male and 19 patients were female. Cause of fracture in 11 cases was traffic accidents (39.3 %) and in 17 cases it was a simple fall (60.7 %). Results The mean follow-up time was 54.5 (26-153) months. Rehabilitation started at the end of the first week of surgery. All the cases were evaluated according to the Neer Scoring System. The mean Neer score was 77.1 (32-92). Results were excellent in 14.3%, adequate in 46.4%, inadequate in 28.6% and unsuccessful in 10.7% of the cases. Conclusion Primary shoulder hemiarthroplasty is a preferred treatment method in elderly patients having four-part humerus proximal fractures despite limited excellent results. Presence of osteoporosis, high osteonecrosis risk and difficulties in internal fixation amend the outcome.
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    Which Implant Is Better for Treating Reverse Obliquity Fractures of the Proximal Femur: A Standard or Long Nail?
    (Springer, 2013) Okcu, Guvenir; Ozkayin, Nadir; Okta, Cemil; Topcu, Ismet; Aktuglu, Kemal
    Reverse obliquity fractures of the proximal femur have biomechanical characteristics distinct from other intertrochanteric fractures and high implant failure rate when treated with sliding hip screws. Intramedullary hip nailing for these fractures reportedly has less potential for cut-out of the lag screw because of their loadbearing capacity when compared with extramedullary implants. However, it is unclear whether nail length influences healing. We compared standard and long types of intramedullary hip nails in terms of (1) reoperation (fixation failure), (2) 1-year mortality rate, (3) function and mobility, and (4) union rate. We conducted a pilot prospective randomized controlled trial comparing standard versus long (a parts per thousand yen 34 cm) intramedullary hip nails for reverse obliquity fractures of the proximal femur from January 2009 to December 2009. There were 15 patients with standard nails and 18 with long nails. Mean age was 79 years (range, 67-95 years). We determined 1-year mortality rates, reoperation rates, Parker-Palmer mobility and Harris hip scores, and radiographic findings (fracture union, blade cut-out, tip-apex distance, implant failure). Minimum followup was 12 months (mean, 14 months; range, 12-20 months). We found no difference in reoperation rates between groups. Two patients (both from the long-nail group) underwent revision surgery because of implant failure in one and deep infection in the other. There was no difference between the standard- and long-nail groups in mortality rate (17% versus 18%), Parker-Palmer mobility score (five versus six), Harris hip score (74 versus 79), union rate (100% in both groups), blade cut-out (zero versus one), and tip-apex distance (22 versus 24 mm). Our preliminary data suggest reverse obliquity fractures of the trochanteric region of the femur can be treated with either standard or long intramedullary nails.