Browsing by Author "Köse A."

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Comparison of low-profile plate-screw and Kirschner-wire osteosynthesis outcomes in extra-articular unstable proximal phalangeal fractures
(2019-04-09) Köse A.; Topal M.; Engin M.Ç.; Şencan A.; Dinçer R.; Baran T.
Background: We aimed to present the radiological and clinical results of Kirschner-wire (K-wire) fixation and low-profile plate-screw fixation applied to unstable proximal phalangeal fractures without extension to the joint. Methods: Clinical and radiological data of 22 patients who underwent fixation with open reduction and low-profile 1.5-mm titanium mini plate and unlocked screws and 18 patients who underwent fixation with K-wire due to closed, unstable extra-articular proximal phalangeal fractures were retrospectively examined. All evaluation and statistical analyses were based on sixth postoperative month evaluation parameters. Active and passive metacarpophalangeal joint and interphalangeal joint range of motions, total joint range of motion, measurement of grip strength for fractured and healthy hands, visual analog scoring, disabilities of the arm, shoulder, and hand scores, measurement of distance between the pulpa and palmar curve in the operated finger, Belsky score, reoperation, and complications were evaluated. Results: Radiological union was achieved in all patients in a mean duration of 4.2 (3–6) weeks. When the functional results of the patients were evaluated, the mean active metacarpophalangeal joint flexion was 87.3° (75°–90°), mean proximal interphalangeal joint flexion was 94.3° (65°–100°), mean distal interphalangeal joint flexion was 77.6° (75°–80°), and mean total range of motion was 259° (210°–270°). The grip strength of the fractured hand was 52.7 (40–58) kgW, whereas that of the healthy hand was 54.4 (42–60) kgW. The mean value of visual analog score was 0.8 (0–2), mean score for disabilities of the arm, shoulder, and hand was 7 (2–27), and mean distance between the finger pulpa and finger curve was 3 (0–8) mm. Conclusion: Plate-screw osteosynthesis in the extra-articular, unstable fractures of the proximal phalanx, which is “small” compared with the body but has a “major function” for the hand and upper extremity, allows for rigid fixation, short immobilization, and early motion in spiral/oblique-fragmented fractures. K-wire fixation, an alternative treatment modality, applied to selected fracture patterns with appropriate indications can achieve good–excellent results radiologically and functionally.
Surgical management of displaced adolescent tillaux fractures with the mini-open technique
(2021-01-01) Ayas M.S.; Köse A.; Terzi E.; Dincer R.; Topal M.; Uymur E.Y.; Şahin A.
BACKGROUND: There is no consensus on the optimal treatment of Tillaux-Chaput fractures. The results of our cases treated with mini-open surgery (open reduction and internal fixation) concerning efficacy and complications, we aim to compare other procedures (open, percutaneous, and arthroscopy-assisted) with the literature data and to look for an answer to the question of whether the primary treatment can be mini-open surgery. METHODS: Between the years 2014 and 2017, 22 of 30 patients with Tillaux-Chaput fractures were treated using mini-open sur-gery, open reduction and internal fixation with one cannulated screw. These cases were retrospectively examined concerning age, sex, side, surgery duration, complications, and American Orthopedic Foot and Ankle Score (AOFAS). Functional results were statistically evaluated 12 months after the injury. Follow-up included a clinical examination, imaging and AOFAS. RESULTS: Of the patients, 14 were male (63.6%) and eight were female (36.4%). The mean age of the patients was 13.8 years. The mean surgery duration was 21 minutes. All fractures healed after an average of 14 weeks. No complications were observed in any of the cases. The mean follow-up time was 24.7 months. The mean preoperative AOFAS score was 53.3 and the mean postoperative AOFAS score was 93.6, which was a statistically significant difference. At the last follow-up, the AOFAS score was perfect for all cases. CONCLUSION: Contrary to what is stated in the literature, the mini-open surgical procedure has many advantages. The operation is very short and the risk of nerve injury is very low. This study showed that Tillaux-Chaput fractures could be safely and efficiently treated with mini-open surgery. We recommend mini-open surgery, complete anatomical reduction, and internal fixation for successful results.
Surgical management of Rockwood type 3 acromioclavicular joint injuries: a retrospective comparison of outcomes of suture anchor fixation and double-button fixation techniques
(2020-05-22) Topal M.; Köse A.
The treatment of type 3 acromioclavicular joint injuries has still controversial issues. In this retrospective study, we aimed to compare the radiological and functional outcomes of the suture anchor and double-button fixation methods for the treatment of type 3 acromioclavicular joint injuries.This study included 20 patients who underwent suture anchor (9 patients) and double-button fixations (11 patients) for isolated type 3 acromioclavicular dislocation. Injuries were classified according to the Rockwood Classification System. Coracoclavicular(CC) distances and anterior translation have been measured pre-operatively and at the 12th month follow-up. Functional evaluation was performed using the DASH, and Constant-Murley scores of the patients were recorded at the12th-month follow-up.The mean age of the patients was 37 (22-50) years in Group 1(double-button group) and 39 (24-56) years in Group 2(suture anchor group). All of the patients were male. There was no statistically significant difference between the DASH and Constant-Murley scores of the 2 groups (P > .05). The mean DASH score of the patients evaluated at the postoperative 12th month was 6.65 (0-38.3) in Group 1 and 2.48 (0-4.2) in Group 2. The mean Constant-Murley score of the patients evaluated at the postoperative 12th month was 89,6 (50-98) in Group 1 and 93,6 (90-98) in Group 2. Comparison of the pre- and post-operative CC distances and pre- and post-operative anterior translation distances of both groups revealed that there was no statistically significant difference between groups regarding postoperative CC distances and anterior translation distances (P > .05).Suture anchor and double-button techniques are reliable treatment methods that are not superior to one another and can yield excellent functional outcomes.
Surgical treatment of pediatric forearm fractures with intramedullary nails: Is it a disadvantage to leave the tip exposed?
(2020-03-01) Dinçer R.; Köse A.; Topal M.; Öztürk I.A.; Engin M.C.
Elastic intramedullary nailing is the main treatment method in the surgical treatment of pediatric forearm fractures. In this study, we compared the clinical outcomes of intramedullary nailing of forearm fractures with leaving the tips exposed and with placing the tip of the nails under the skin. We aimed to present the clinical outcomes of intramedullary nailing and determine the advantages and disadvantages of leaving the tips of the nails exposed. One hundred and ninety-two children with both-bone forearm fracture who were treated with titanium elastic nailing (TEN) in the Department of Orthopedics at Erzurum Regional Training and Research Hospital between January 2009 and December 2016 were included in the study. All cases had been followed up for at least 1 year. The tips of the TENs were left exposed in 74 and buried subcutaneously in 118 children. Union was achieved in all cases. Delayed union was observed in just one case. Skin irritation was observed in 11 (5.7%) of the exposed TEN cases. Superficial infection developed in two (1%) cases with exposed TEN tips. Migration developed during the follow-up of 11 (5.7%) cases with buried tips. The mean time to removal of TEN was 7.9 weeks in cases with exposed and 26.2 weeks in cases with buried cases. Refracture was observed in six buried (3.1%) cases and four exposed TEN (2.1%) cases in the first year after the removal of the nails. Perfect outcomes were achieved in 146 (76%) cases and good outcomes in 36 (19%) cases in our study. On comparing the rate of complications and clinicaloutcomes, leaving the TEN exposed seems to be safe.