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Öğe A new point of view for mosaicplasty in the treatment of focal cartilage defects of knee joint: honeycomb pattern(Springer International Publishing Ag, 2016) Erol, Mehmet Fatih; Karakoyun, ÖzgürBackground: A focal full thickness cartilage lesion of knee joint is one of the commonly seen intraarticular pathologies among the joint cartilage problems. Osteochondral autograft transfer mosaicplasty is a method which has satisfactory outcomes among the treatment preferences of cartilage defects. In spite of the favorable clinical results there are some pitfalls of mosaicplasty treatment especially in cases of large defects. One of the major problems of the classical OAT mosaicplasty is the gap spaces between the plugs. The objective of the present study is to report the early clinical and radiological outcomes and to evaluate the clinical application of a new hexagonal osteochondral graft system (HOGS) with the hypothesis of improvement of the OAT mosaicplasty method with the use of hexagonally shaped plugs. The study has intended to answer two questions. (1) Does mosaicplasty with the new HOGS has favorable early clinical outcomes? (2) Is it possible to arrange the osteochondral autografts without leaving gap spaces by using hexagonal pattern in OAT mosaicplasty? Patients and methods: We designed a retrospective study to report analysis of early outcomes of the initial case series of OAT mosaicplasty by using a new HOGS. Six male individuals with the diagnosis of osteochondral defect and treated with HOGS and reached sixth month follow-up formed the basis of the study. The clinical status of the patients were evaluated with IKDC score. The radiological evaluations were carried out with direct X-rays and magnetic resonance imaging (MRI) studies. The mosaicplasty procedures were carried out via standard surgical method of classical OAT mosaicplasty by using the HOGS following a diagnostic arthroscopy in the same session. The inclusion criteria was a full thickness osteochondral lesion of femoral condyle between 1.5 and 6 cm(2) and completion of 6 month follow-ups. The patients having deformities around the knee or major ligament lesions were excluded. MOCART scoring system was used for the evaluation of follow-up MRI findings. The clinical status of the patients were evaluated with IKDC scores. Results: The mean age of the patients was 40.8 (+/- 5.2) years and the mean duration of the symptoms on presentation was 16 (+/- 4.3) months. On the initial MRI studies mean defect area was measured 3.7 cm(2) (+/- 0.9) which was compatible with arthroscopic findings. During the surgical procedures it was possible to fill the defect area completely. The mean number of plugs in this series was 4.8 (+/- 1.1). We did not faced with insufficient donor reserve problem in any of the cases. On the sixth month follow-up physical examination there was no limitation of the knee joint range of motion in the cases. All patients were able to bear weight on to their operated extremities without pain. The mean postoperative IKDC score improvement was 70.2 (+/- 3.5) which shows significant improvement compared to preoperative scores. On the control MRI studies the bone integration of the hexagonal plugs were complete the cartilage continuity of the articular surfaces were intact and the grafts were well incorporated in all cases. The mean MOCART score on the 6th month MRI studies was 65.8 (+/- 4.1). Conclusion: The early outcomes of OAT mosaicplasty with HOGS are comparable to studies on the classical mosaicplasty. According to our observations in this study we can say that the gap space left between the cylindrical plugs can be solved by using hexagonal prism shaped plugs.Öğe Conservatively treated isolated capitatum fracture: Case report(2015) Erol, Mehmet Fatih; Karakoyun, ÖzgürKapitatum kırıkları karpal kemik kırıklarının %1'ini oluşturmaktadır. İzole kapitatum kırığı nadir olarak görülür ve literatürde olgu sunumları olarak yer almaktadır. Kapitatum kırıklarının tanısındaki gecikmeler kaynamama, avasküler nekroz ve sekonder artroza neden olabilir. Bu yazımızda tanısında gecikme olan ve konservatif tedavi ettiğimiz bir izole kapitatum kırığının erken dönem sonuçlarını bildirerek nadir görülen bu kırığın tanı ve tedavisinin önemini vurgulamak istedikÖğe Does lengthening after acute correction negatively affect bone healing during distraction osteogenesis?(Turkish Assoc Orthopaedics Traumatology, 2015) Karakoyun, Özgür; Küçükkaya, Metin; Erol, Mehmet FatihObjective: Lengthening after acute correction has a negative effect on bone healing during distraction osteogenesis. In this study, we investigated whether correcting an acute deformity prior to lengthening resulted in a negative effect on bone healing. Methods: Patients with shortened femora were assigned to 3 matched groups. Retrograde femoral nailing after distal metaphyseal-diaphyseal osteotomy was used in all cases. Group 1 (9 femora) included cases of lengthening >4 cm using intramedullary distraction devices after acute correction. Group 2 (16 femora) included pure lengthening cases of >= 4 cm using intramedullary distraction devices. Group 3 (13 femora) included cases of lengthening >= 4 cm with lengthening and the retrograde nailing method (LORN) following acute correction. Results: Healing indices and full weight-bearing times of patients were evaluated. Mean lengthening values were 6.6 (range: 4-14 cm), 5.7 (range: 4-8 cm), and 5.2 cm (range: 4-6.5 cm) in Groups 1-3, respectively, and mean radiographic consolidation index and full weight-bearing times were 31.0+/-8.2, 30.2+/-5.5, and 39.0+/-5.0 day/cm in Groups 1-3, respectively. The consolidation index was significantly better in the Groups 1 and 2 compared to that in Group 3, but no difference was detected between Groups 1 and 2. Conclusion: Acute correction had no negative effect on bone healing after distraction osteogenesis using new-generation intramedullary distraction devices. We suggest that the negative impact on healing and the prolonged consolidation index in patients undergoing LORN may be due to impaired periosteal blood supply due to fixator pins.Öğe Early clinical and radiological results of minimally invasive total hip replacement(Elsevier B.V., 2016) Karakoyun, Özgür; Erol, Mehmet Fatih; Aslan, A.; Karıksız, M.; Günaydın, BurakIntroduction It is critical to achieve both proper component positioning and intact muscle balance if satisfactory results are to be attained after total hip replacement (THR). There have been fewer studies on minimally invasive (MI) THR than standard approaches. The objective of this paper is to present the early clinical and radiological results of posterolateral MI THR. Materials and methods The retrospective analysis of the records of patients undergoing posterolateral MI THR surgery between 2011 and 2014 was the basis of this study. 73 hips of 68 patients were included in the study. The acetabular component and femoral stem positions were measured on plane X-rays. Data on preoperative and postoperative hemoglobin and hematocrit values, as well as transfusion amounts, were also studied. The clinical evaluations were carried out with Harris Hip Scores. Results The mean HHS at the 3rd postoperative month was 87.60 (±7.70). Of the 73 cases, 61 were within the Lewinnek safe zone. The mean PMFA was 88.12 (±7.63°), which is within the normal ranges. The mean postoperative hemoglobin value was 9.7 g/dl (±1.3) and the mean postoperative hematocrit value was 29.8% (±3.8). A nondisplaced proximal femoral fracture line was evident on the early postoperative X-ray of one patient. One patient experienced early dislocation caused by acetabular component malpositioning and an early acetabular cup revision was necessary. Conclusion MI posterior approach for THR is a method in which the prosthetic components can be properly placed. Posterolateral MI approaches are safe when THR is performed, and afford satisfactory results. © 2016 Delhi Orthopedic AssociationÖğe Effect of cable cerclage on regional blood circulation in rabbits: a scintigraphic study(Hong Kong Acad Medicine Press, 2016) Karakoyun, Özgür; Şahin, Ertan; Erol, Mehmet Fatih; Karıksız, Mesut; Küçükkaya, MetinPurpose. To evaluate changes in blood circulation of the femoral cortex in rabbits using scintigraphy before and after cable cerclage alone or combined with an intramedullary Kirschner wire. Method. Ten New Zealand rabbits were used. For the right femur, a 2-mm-thick cable was placed around the mid-diaphyseal region and squeezed with a 400-N force and locked with a clip. For the left femur, a 1.8-mm Kirschner wire was inserted retrogradely into the medullary canal, and a 2-mm-thick cable was applied using the same technique. The blood perfusion ratio of the region of interest (ROI) before and after surgery was evaluated using scintigraphy. Results. For the right femurs, the mean ROI perfusion ratio decreased by 45% from 2.51 to 1.37 after intervention (p=0.001). For the left femurs, the mean ROI perfusion ratio decreased by 56% from 2.12 to 0.92 after intervention (p<0.001). The mean ROI perfusion ratio post-intervention was higher in the right than left femurs (p=0.017). Conclusion. Cable cerclage around the femoral cortex significantly decreased blood circulation in the area.Öğe İntertrokanterik Femur Kırıklarının Tedavisi İçin Proksimal Femur Çivisinin Kullanımı (Veronail İle Tedavi)(Namık Kemal Üniversitesi, Tıp Fakültesi, 2013) Karakoyun, Özgür; Erol, Mehmet Fatih; Küçükkaya, Metin; Demirok, MehmetAmaç Çalışmamızın amacı intertrokanterik femur kırığı olan ve proksimal femur çivisi (Veronail) ile tedavi edilen 59 hastanın sonuçlarını bildirmektir. Materyal ve Metod 2011 ile 2012 yılları arasında intertrokanterik femur kırığı olan 59 hastayı (28 kadın, 31 erkek) proksimal femur çivisi (Veronail) kullanarak tedavi ettik. Hastaların yaş ortalamaları 69,1(+13,3) olarak hesaplandı. Kırıklar AO sınıflandırma sistemine göre sınıflandırıldı. Hastalarımızda en fazla gördüğümüz kırık tipi A3’tü (n=25). Bunu A1 (n=20) ve A2(n=14) tip kırıklar takip etti. Ameliyat sonrası erken dönem radyografiler ve postoperatif üçüncü aya ait radyolojik görünümler değerlendirildi. Bulgular Çalışmamıza dâhil olan 59 olgudan 52’sinde kırıkta tam kaynama başarılı bir şekilde elde edildi. Kötü kaynama görülen bir hasta proksimal femur osteotomisi ile tedavi edildi. 6 olguda ise takip grafilerinde proksimal vidada cutout fenomeni görüldü. Bu hastaların yaş ortalamaları 77 (±7.4) idi. AO sistemine göre bu olgulardan ikisi A1, ikisi A2 ve ikisi A3 tipi kırık olarak sınıflandırılan kırıklardı. Bu 6 olgunun tümü parsiyel kalça protezi ile revize edildi Sonuç Serimizde cut-out fenomeni görülen hastalardan 2’si A1, 2’si A2, 2’si A3 tipi kırığa sahipti. Cut-out görülme sıklığında kırık tipinin belirgin bir rolü olmadığını saptadık. Bu fenomenin görülmesinde belirleyici en majör etkenin yaş arttıkça sıklığı artan osteoporoz olduğunu gördük. Bu bulgular ışığında belirtebiliriz ki; proksimal femur çivisi (Veronail) kırık tipinden bağımsız olarak femur intertrokanterik kırklarında güvenle kullanılabilecek uygun bir materyaldir.Öğe The importance of reaming the posterior femoral cortex before inserting lengthening nails and calculation of the amount of reaming(Bmc, 2016) Küçükkaya, Metin; Karakoyun, Özgür; Erol, Mehmet FatihBackground: Lengthening nails have been used to correct limb length discrepancy caused by different etiologies, as well as for post-traumatic reasons. Two important lengthening nail-related complications are damage to the distraction mechanism and femoral fractures around the nail tip. As a result of the curved anatomy of the femur, straight nails impinge on the anterior cortex. Therefore, proper reshaping of the medullary canal to accommodate straight lengthening nails is crucial for the prevention of this problem. Reaming the dense posterior cortex is important when aiming to insert a lengthening nail without incurring anterior cortex nail tip impingement-related complications. Posterior femoral cortex over-reaming is a solution to this situation. Methods: Sixty patients received lengthening nails during 2008-2013, (ISKD, Fitbone, Precice). Posterior cortex rigid-reaming technique was used successfully in 45 retrograde femoral lengthening cases. The preoperatively planned posterior cortex amount was reamed until the impingement was overcome during the operation under fluoroscopic control for each case. Since the preoperative determination of posterior cortex reaming amount is time consuming and operator dependent, we evaluated the X rays of the patients with computer software and conventional paper-based measurements. The effect of reaming the posterior cortical wall on the inclination of the nail tip to the anterior femoral cortex was detected with measurements on the preoperative and postoperative lateral femoral X-rays by using the CorelDRAW (R) Graphic Suite X6 software package (Corel, Inc., Ottawa, Ontario, Canada) software. On the same software, X-rays and the posterior reaming amount were also calculated. Results: The mean age of the patients was 27 years (11-42), while the mean lengthening was 5.9 cm (2-14). The mean consolidation index was 1.05 (0.75-1.62), and the mean follow-up period was 31 months (range, 18-45 months). The mean distance of the osteotomy site to the intercondylar notch of the femur was 81.2 mm (+/- 16.92). The mean displacement of the nail tip position was 15.42 mm (+/- 4.77) on the measurements on the postoperative X-rays after nail insertion compared to the preoperative simulations on the templates. The mean posterior cortex reaming thickness was 3.68 mm (+/- 1.02). Conclusions: We derived a formula that allows the required amount of optimal posterior cortex reaming to be determined. No impingement-related complications or nail damage were observed.Öğe Treatment of congenital radial head dislocation with a computer-assisted hexapod external fixator: A case report(2015) Karakoyun, Özgür; Erol, Mehmet Fatih; Karıksız, MesutKonjenital radius başı çıkığı (KRBÇ) dirsekte eklem sertliği, atlama, kilitlenme veya ağrıya neden olabilen doğumsal bir anomalidir. Bunun yanında tanı insidental olarak çekilen direkt grafilerle de konulabilmektedir. Tedavide amaç semptomları iyileştirmek ve hareket açıklığı tam olan bir dirsek eklemi elde etmektir. Literatürde çeşitli tedavi yöntemleri bildirilmektedir. Konvansiyonel veya bilgisayar destekli eksternal fiksatör sistemleri ekstremite deformiteleri, eklem kontraktürleri, akut kırıkların tespiti gibi klinik durumlarda kullanılmaktadır. Ancak bilgisayar destekli eksternal fiksatör ile tedavi edilmiş bir KRBÇ olgusuna rastlanmamaktadır. Bu yazımızda adelosan çağına kadar asemptomatik olan ve sonrasında dirsekte kilitlenme ve atlama şikayetleri ile kliniğimize başvuran ve proksimal ulna translasyon ve uzatma osteotomisi ve bilgisayar destekli eksternal fiksatör tatbiki ile başarılı bir şekilde tedavi ettiğimiz KRBÇ olgusunun fonksiyonel klinik ve radyolojik sonuçlarını sunuyoruzÖğe Treatment of neglected elbow dislocations with the help of hinged external fixator: Report of two cases(2014) Karakoyun, Özgür; Erol, Mehmet Fatih; Küçükkaya, MetinDirsek çıkığı hemen tedavi edilmesi gereken acil bir durumdur. Gözden kaçırılmış dirsek çıkıkları nadiren görülür ve tedavileri akut olgulara nazaran daha komplikedir. Bu yazımızda açık redüksiyon ve menteşeli eksternal fiksatör ile tedavi ettiğimiz atlanmış iki dirsek çıkığı olgusunu sunuyoruz1. Olgu: 23 yaşında bayan hasta trafik kazası sonrası ipsilateral humerus diafiz kırığının eşlik ettiği atlanmış bir sol posterior dirsek çıkığı olgusu. Hasta kliniğimize travma sonrası 3. Ayda başvurdu. Çıkık açık olarak redükte edildi ve menteşeli bir eksternal fiksatör ile tespit edildi. Humerus diafiz kırığı da menteşeli fiksatöre ilave edilen parçalar ile eksternal olarak tespit edildi.2. Olgu: 33 yaşında erkek hasta dirsek çevresi geniş yumuşak doku ve kemik defekti olan atlanmış bir sol medial dirsek çıkığı olgusuydu. Yumuşak doku örtüm cerrahileri geçiren hasta kliniğimize 2 aylık bir gecikme ile refere edildi. Hastaya açık redüksiyon uygulandı humerus distalindeki kemik defekti otojen greft ile rekonstrükte edildikten sonra menteşeli eksternal fiksatör ile tespit yapıldı.Sonuç: Atlanmış dirsek çıkığı olgularının tedavisi oldukça zordur. Bu olgularda açık redüksiyon ve eksternal fiksatör tatbiki erken rehabilitasyona da izin vermesi ile tatminkâr sonuçlar vermektedir. Bu yöntem böyle olguların tedavisinde bir seçenek olarak değerlendirilebilir.Öğe Use of a magnetic bone nail for lengthening of the femur and tibia(Hong Kong Acad Medicine Press, 2016) Karakoyun, Özgür; Sokucu, Sami; Erol, Mehmet Fatih; Küçükkaya, Metin; Kabukcuoglu, Yavuz SelimPurpose. To report our experience with the PRECICE nail for limb lengthening in 23 patients. Methods. Records of 15 female and 8 male patients aged 14 to 38 (mean, 23.6) years who underwent lengthening of the tibia (n=6) or femur (n=21) using the PRECICE nail were reviewed. The reasons for lengthening included trauma (n=7), hemihypertrophy (n=2), focal femoral deficiency (n=2), Ellis-van Creveld syndrome (n=1), hip septic arthritis sequelae (n=1), hereditary multiple exostosis (n=1), club foot sequela (n=1), congenital tibial pseudoarthrosis (n=1), fibrous dysplasia (n=1), idiopathic limb length discrepancy (n=7), and cosmetic (n=1). Results. The mean follow-up duration was 20.72 months. The mean lengthening was 48.20 mm, and the mean acute angular correction was 15.5 degrees. The mean time to full weight-bearing was 5.15 months, and the mean consolidation index was 1.12 months / cm. The mean maturation index was 0.78 months / cm. One patient had nail breakage during the consolidation phase. The nail was replaced by an intramedullary nail until consolidation, after which another PRECICE nail was used to treat the residual shortening. Eight patients had over-lengthening and the nails were driven back to the desired length. No patient had infection. Conclusion. The PRECICE nail is a viable option for lengthening of the femur and tibia.
