Browsing by Author "Ermutlu, Cenk"
Now showing 1 - 20 of 26
- Results Per Page
- Sort Options
Item Approach to supracondylar humerus fractures with neurovascular compromise in children(Türk Ortopedi Travmatoloji Derneği, 2013-04-03) Aksakal, Murat; Ermutlu, Cenk; Sarısözen, Bartu; Akesen, Burak; Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı.; AAH-9833-2021; ABI-7283-2020; 55890736200; 23102160500Objective: The aim of this study was to evaluate neurovascular compromise in childhood Gartland Type 3 supracondylar humerus fractures (SHFs), identify the factors correlated with increased need of open reduction and compare the clinical outcome of anterior open reduction with that of closed reduction. Methods: The study included 65 patients (46 male, 19 female; mean age: 7.03 years, range: 1 to 14 years) treated surgically for SCH fracture between January 2002 and June 2008. Fractures underwent closed reduction with percutaneous pinning when possible. Open reduction was performed when adequate reduction via the closed technique failed or vascular compromise were indications for open reduction. Patient demographics, physical examination findings, adequacy of reduction, functional and cosmetic outcomes were assessed. Results: During the antecubital approach, vascular pathology was noted in all patients with signs of vascular compromise at physical examination. Half of these patients underwent vascular intervention. Closed reduction failed in 93% of patients with concomitant edema, ecchymosis and dimple sign. Of these, the median nerve was trapped between the bone fragments in 4 patients with normal neurological examinations. Functional and cosmetic results of open reduction were similar to closed reduction (p>0.05). Conclusion: Closed reduction should not be forced in cases with marked edema, ecchymosis, dimple sign, and absence of radial pulse. The anterior approach is the surgical approach of choice due to direct visualization of neurovascular bundle and availability of neurovascular intervention by extending the same approach.Item Artritli çocuk olguların değerlendirilmesi: 9 yıllık retrospektif çalışma(Bursa Uludağ Üniversitesi, 2020-06-06) Yeşil, Edanur; Çelebi, Solmaz; Özcan, Nur; Özer, Arife; Turan, Cansu; Bülbül, Beyhan; Ermutlu, Cenk; Sarısözen, Bartu; Hacımustafaoğlu, Bartu; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı/Çocuk Enfeksiyon Bilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı.; 0000-0002-8926-9959; 0000-0002-3536- 0263; 0000-0001-6093-6263; 0000-0001-9232- 0084; 0000-0003-3146-6391; 0000-0002- 5720-1212; 0000-0001-8259-3695; 0000- 0003-4071-8052; 0000-0003-4646-660XBu çalışmada, kliniğimize septik artrit öntanısı ile başvuran olguların klinik ve laboratuvar bulgularının ve tedavi yanıtlarının değerlendirilmesi amaçlandı. Ocak 2010-Ocak 2019 tarihleri arasında artrit öntanısıyla yatmış olan 111 çocuk (0-18 yaş) hasta kayıtları retrospektif incelendi. Olguların klinik, laboratuvar bulgularının değerlendirilmesi, tedavi ve prognostik özelliklerinin incelenmesi planlandı. Çalışmaya alınan toplam 111 hastanın %66’sı erkek olup ortalama yaşları 91±56 (medyan 83,1-215 aralığı) ay idi. Olguların çoğunluğunu (n=62,%56) 3-10 yaş aralığındaki hastalar oluşturdu. Olguların %60’ına (n=67) septik artrit tanısı konuldu. Bu tanıyı reaktif artrit (%10), juvenil idiopatik artrit (%10), toksik/geçici sinovit (%5) ve diğer artritler takip etti. Başvuruda olguların %96’sında ağrı, %63’ünde eklem şişliği, %21’inde kızarıklık, %41’inde eklemde ısı artışı, %64’ünde hareket kısıtlılığı, %38’inde yürüyememe yakınması vardı. Sıklıkla tutulan eklemler diz (%51) ve kalçaydı (%35). Ateş yüksekliği olan olgularda septik artrit olasılığı yüksek saptandı (p=0,0001). Septik artrit dışı artritlerde ibuprofene yanıt daha fazlaydı (p=0,0001). Olguların %55’ine (n=61) ponksiyon yapıldı, %34’ü (n=38) eklem içi debridman operasyonu geçirdi. Eklem sıvı kültüründe en sık üreyen mikroorganizmalar Staphylococcus aureus ve Streptococcus pyogenes idi. Septik artrit ile septik artrit dışı olgular karşılaştırıldığında, ultrasonografi ile ölçülen efüzyon miktarı, ponksiyonla alınan sıvı miktarı septik artrit grubunda istatistiksel olarak anlamlı oranda daha fazla, CRP ve lökosit sayısı ise septik artrit grubunda daha yüksek bulundu (sırasıyla p=0,001;p=0,025;p=0,018;p=0,032). Olguların %19’unda (n=21) osteomyelit saptanıp hepsi septik artrit grubundaydı Bu çalışmada ateşi olan, lökosit sayısı >12100/mm3 , CRP>3 mg/dl üzerinde olan olgularda, ultrasonografi ile 8,5 mm ve üzerinde efüzyon ölçülen olgularda septik artrit olma olasılığı istatistiksel anlamlı bulundu. Septik artrit dışı artritlerde ibuprofen yanıtı daha fazlaydı.Publication Association of clinical characteristics with decision making in patients with severe lower extremity trauma(Mre Press, 2021-01-01) Durak, Vahide Aslıhan; Ermutlu, Cenk; Atıcı, Teoman; DURAK, VAHİDE ASLIHAN; ERMUTLU, CENK; ATICI, TEOMAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Bölümü; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi Bölümü ve Travmatoloji; 0000-0003-0836-7862; 0000-0002-3396-3407; AAE-9483-2021; AEQ-5464-2022; A-5095-2018Severe lower limb trauma represents a challenge for both the emergency department physicians and the surgeons. These injuries are associated with significant incidence of limb loss and it is not uncommon for the treating physician to make the hard decision between limb salvage, amputation or stump closure for a patient in critical condition. Our aim was to evaluate the epidemiology of traumatic lower extremity amputations and to analyze the factors which may have effect on patient resuscitation, limb salvage and efficient patient management. Patients who were admitted to our institution's emergency department for traumatic lower extremity amputation over an 8 years' period (2012 to 2020) were retrospectively analyzed. Patient files with the possibility of severe lower limb trauma and mangled extremity were retrieved and analyzed using ICD codes recorded/registered during the emergency department admission. Mean time from emergency admission to transfer to operating theater was 184,5 minutes. Replantation of the amputate was performed in 4 patients (19%). 25% of the amputations at the ankle level (1 out of 4) and 37.5% of the transtibial amputates (3 out of 8) were replanted. A multidisciplinary approach is necessary in every aspect of patient management; however, this does not justify a delay in treatment. Time spent during conclusion of necessary consultations does not have negative effects on patient outcome as long as patient is closely monitored and resuscitated in the emergency department.Publication Augmenting posterolateral fusion with transforaminal lumbar interbody fusion cage improves clinical outcome, but not fusion rate, of posterior decompression(Sage Publications, 2020-04-01) Atıcı, Teoman; Yerebakan, Selcan; Ermutlu, Cenk; Özyalçın, Ali; ATICI, TEOMAN; Yerebakan, Selcan; ERMUTLU, CENK; ÖZYALÇIN, ALİ; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Yoğun Bakım Anabilim Dalı.; 0000-0002-9518-541X; 0000-0001-8259-3695; 0000-0003-3772-1699; AAB-2795-2021; EGQ-9946-2022 ; A-5095-2018; JHR-5447-2023ObjectiveThis study was performed to compare fusion rates and clinical outcomes of posterior decompression by posterolateral fusion (PLF) versus transforaminal lumbar interbody fusion (TLIF) for treatment of lumbar spinal stenosis.MethodsThis retrospective cohort study involved 157 patients with lumbar spinal stenosis treated with instrumented PLF alone or instrumented PLF combined with TLIF from 2010 to 2018. The patients were divided into two groups: the PLF group (Group A), in which posterior decompression with instrumented PLF was performed, and the cage-augmented group (Group B), in which TLIF was added to the procedures described for the PLF group. Patient outcomes (Oswestry Disability Index, visual analog scale score, and 36-Item Short-Form Health Survey scores) and fusion rates were compared.ResultsThe fusion rate was similar between the two groups. Among patients with two- and three-level fusion, improvements in the clinical outcome scores were significantly greater in Group B than Group A.ConclusionCombining TLIF with PLF provides better clinical outcomes than PLF alone when multilevel fusion is indicated. TLIF augmentation does not improve the fusion rates in either single- or multi-level surgery.Publication Bone loss following cementless hemiarthroplasty for the treatment of femoral neck fracture(Springer Heidelberg, 2020-01-31) Murat, Mert; Ermutlu, Cenk; Ünkar, Ethem Ayhan; Topalhafızoğlu, Sertaç; Şenel, Ahmet; Öztürkmen, Yusuf; ERMUTLU, CENK; Uludağ Üniversite/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı.; AAB-2795-2021Background With the advances in medicine, an increasing number of the ageing population are a public health concern in terms of age-related complications. Among them, displaced neck fractures often require surgical intervention or arthroplasty to achieve the mobilization of the elderly and good life quality. The aim of the study is to monitor the changes in bone mineral density (BMD) around the femoral stem and the effects on functional outcomes in patients treated with cementless hemiarthroplasty following femoral neck fracture. Materials and Methods Seventy-one patients aged 70 years or older who were treated with cementless hemiarthroplasty for a displaced femoral neck fracture were prospectively followed for 2 years. The percent change in the periprosthetic BMD in each Gruen zone was compared to the baseline using dual-energy X-ray absorptiometry (DEXA). Demographic factors [age, body mass index (BMI), and sex] that could possibly influence BMD and the clinical outcome were evaluated. Results Fifty-one patients were available for the final follow-up. The mean age was 76.5 (range 70-89) years. The mean BMI was 28.9 (range 22.7-37.2). The mean Harris hip score at the final follow-up was 84.3 (range 72-93). There was a significant decrease in BMD in all Gruen zones (p < 0.001), except in zone 3 (R3, p = 0.547). The reduction in BMD was highest in the calcar and the greater trochanter region. The femur diaphysis was relatively spared, with zone 3 showing no significant bone mineral loss. The age and BMI of the patients were not correlated with the postoperative change in BMD in any of the Gruen zones. The degree of reduction in bone density was not correlated with the clinical outcome. Conclusions Cementless hemiarthroplasty for the treatment of femoral neck fracture in elderly patients achieves a good clinical outcome despite significant bone loss around the femoral stem. The reduction in BMD is more pronounced in the metaphyseal region.Item A comparison of clinical outcome of augmentation and standard reconstruction techniques for partial anterior cruciate ligament tears(Türk Eklem Hastalıkları Vakfı, 2012) Demirağ, Burak; Ermutlu, Cenk; Aydemir, Fatih; Durak, Kemal; Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı.; 0000-0001-8259-3695; AAB-2795-2021; 56019156900; 54392665300; 22633641900; 6602850051Objectives: This study aims to compare the clinical outcome and possible complications of augmentation technique and standard reconstruction for the treatment of partial anterior cruciate ligament (ACL) tears. Patients and methods: Forty patients (36 males, 4 females; mean age 30 years; range 19 to 40 years) who underwent surgery due to ACL tear were included in this prospective randomized study. The patients were randomly divided into two groups, including 20 patients in each group. The patients in the group I underwent standard single bundle ACL reconstruction with hamstring tendon autografts, while those in the group 2 underwent augmentation where the remaining remnant ACL was not sacrificed, but instead augmented with hamstring tendon autograft as in the standard reconstruction technique. The mean follow-up was 24.3 months (range; 21-28 months). Clinical outcomes were evaluated using International Knee Documentation Committee (IKDC), Lysholm scores, physical instability tests and patient satisfaction questionnaires. The complication rates of both groups were compared. Tibial and femoral tunnel widening were assessed using lateral and anteroposterior radiographs. Results: No significant differences were found between the groups in terms of IKDC, Lysholm scores, physical instability tests, patient satisfaction questionnaires and incidences of Cyclops lesions and arthrofibrosis. Tibial and femoral tunnel widening was less in the augmentation group. This difference was more significant on the tibial side. Conclusion: In the repair of partial ACL tears, augmentation technique is as effective as the standard technique, leading to, less tunnel widening evidently in the tibial tunnel, particularly.Publication Comparison of efficacy between the genicular nerve block and the popliteal artery and the capsule of the posterior knee (IPACK) block for total knee replacement surgery: A prospective randomized controlled study(Türkiye Ortopedi Travmatoloji, 2021-03-01) Akesen, Selcan; Akesen, Burak; Atıcı, Teoman; Gurbet, Alp; Ermutlu, Cenk; Özyalçın, Ali; AKESEN, SELCAN; AKESEN, BURAK; ATICI, TEOMAN; GURBET, ALP; ERMUTLU, CENK; ÖZYALÇIN, ALİ; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı; 0000-0002-3396-3407; 0000-0002-6503-8232; JHR-5447-2023; AEQ-5464-2022; ELR-9087-2022; AAH-9833-2021; A-5095-2018; A-7994-2018Objective: The aim of this study was to compare the efficacy of popliteal artery and the capsule of the posterior knee (IPACK) block and genicular nerve block on postoperative pain scores, the need for rescue analgesics, range of motion (ROM), walking distance, and perioperative monitorization variables in patients undergoing total knee replacement (TKR) surgery.Methods: Sixty American Society of Anesthesiologists (ASA) physical status I-III patients were enrolled in this study and then were randomly assigned into three groups: the IPACK block group (17 female, 3 male; mean age=67.5 +/- 1.4 years), genicular nerve block (16 female, 4 male; mean age=68 +/- 1.76 years), and the control group (13 female, 7 male; mean age=63 +/- 1.67years). All the patients underwent TKR under spinal anesthesia. The visual analog scale (VAS) score, mobility, pre- and intra-operative monitorization of systolic and diastolic holding area, non-invasive blood pressure, heart rate, and SPO 2 were compared between the groups.Results: Patients in the IPACK and genicular block groups had a significantly lower visual analogous scale (VAS) at postoperative 4 hours (p<0.01), 8h (p<0.01), 12h (p<0.01), and 24h (p<0.05). VAS score was significantly lower in the genicular block group at the postoperative 4h (5.5 +/- 0.55) and 8h (5.0 +/- 0.53) in the mobile state compared to the IPACK (8.0 +/- 0.47 and 8.0 +/- 0.43, respectively) and the control group (9.5 +/- 0.20; 10 +/- 0.28, respectively) (p<0.01). The use of patient-controlled-analgesia (PCA) devices and button push count for analgesics demand were significantly lower in the genicular block group on the immediate postoperative period (p<0.01 at the postoperative 0 to 4 h). The total consumption of morphine equivalents on the postoperative day 0 was significantly lower in the genicular block group (p<0.01, and p<0.001 for IPACK and control groups, respectively). The degree of flexion was significantly higher in the genicular block group at the postoperative 12h compared to the IPACK and the control group (p<0.001). The length of hospital stay was significantly lower in the genicular block group compared to the IPACK and the control group (p<0.05 for both variables).Conclusion: IPACK and genicular blocks both are effective in improving patient comfort during and after TKR surgery and reducing the potential need for systemic analgesic and opioids. The genicular block seems to be a promising technique that can offer improved pain management in the immediate and early postoperative period without adverse effects on systemic and motor variables.Publication Comparison of radiofrequency ablation and curettage in osteoid osteoma in children(Atha Comunicacao & Editora, 2019-03-01) Göksel, Ferdi; Aycan, Aye; Ermutlu, Cenk; ERMUTLU, CENK; Gölge, Umut Hatay; Sarısözen, Bartu; SARISÖZEN, MEHMET BARTU; 0000-0002-9730-5454; 0000-0001-8259-3695; 0000-0003-4071-8052; ABI-7283-2020; AAB-2795-2021Objective: Osteoid osteoma, which is observed in the adolescent and young adult population as benign bone tumors, appears as a single nidus with a diameter < 2 cm and is treated with open surgery. However, technological advances in medicine have made it possible to apply less invasive procedures in surgery. Methods: Between 2006-2014, 24 patients < 18 years of age were treated for osteoid osteoma. Patient demographic data, surgical data, complications, and recurrences were noted. Results: Twenty-four patients (mean age, 11 [2-18] years) were treated and followed up for a mean 3.58 (range, 1-9) years. Mean patient age in the curettage group was 12.1 (range, 3-18) years. Mean operation length was 69.5 (range, 60-120) minutes. Mean hospital stay was 1.3 (range, 0-2) days. Mean patient age in the radiofrequency ablation (RFA) group was 10.7 (range, 2-17) years. Five patients were female and 8 were male. Mean operation length was 49.6 (range, 20-90) minutes. Mean hospital stay was 0.3 (range, 0-1) days. Mean follow-up time was 1.76 (range, 1-4) years. Mean operation length, hospital stay, and follow-up were significantly shorter in the RFA group. Conclusions: Considering reduced costs due to shorter hospitalization periods and the ability to reach anatomically difficult locations, percutaneous procedures are likely to replace the conventional open approach.Item Effect of low-dose irradiation on structural and mechanical properties of hyaline cartilage-like fibrocartilage(Turkish Assoc Orthopaedics Traumatology, 2013) Öncan, Tevfik; Ermutlu, Cenk; Demrag, Burak; Yalçınkaya, Ulviye; Özkan, Lütfü; Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Patoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Radyasyon Onkolojisi Anabilim Dalı.; AAH-8924-2021; EVT-6166-2022; JLK-0331-2023; 55801460800; 6508300295; 55915679500Objective: The aim of this study was to analyze the effect of low-dose irradiation on fibrous cartilage and to obtain a hyaline cartilage-like fibrocartilage (HCLF) with similar structural and mechanical properties to hyaline cartilage.Methods: An osteochondral defect was created in 40 knees of 20 rabbits. At the 7th postoperative day, a single knee of each rabbit was irradiated with a total dose of 5.0 Gy in 1.0 Gy fractions for 5 days (radiotherapy group), while the other knee was not irradiated (control group). Rabbits were then divided into four groups of 5 rabbits each. The first three groups were sacrificed at the 4th, 8th and the 12th postoperative weeks and cartilage defects were macroscopically and microscopically evaluated. The remaining group of 5 rabbits was sacrificed at the 12th week and biomechanical compression tests were performed on the cartilage defects.Results: There was no significant biomechanical difference between the radiotherapy and the control group (p=0.686). There was no significant macroscopic and microscopic difference between groups (p=0.300). Chondrocyte clustering was observed in the irradiated group.Conclusion: Low-dose irradiation does not affect the mechanical properties of HCLF in vivo. However, structural changes such as chondrocyte clustering were observed.Publication Efficacy of single-dose radiotherapy in preventing posttraumatic tendon adhesion(Springernature, 2020-06-02) Ermutlu, Cenk; ERMUTLU, CENK; Kaleli, Tufan; KALELİ, HÜSEYİN TUFAN; Yalçınkaya, Ulviye; YALÇINKAYA, ÜLVİYE; Çetintaş, Sibel; ÇETİNTAŞ, SİBEL; Atıcı, Teoman; ATICI, TEOMAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Patoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyasyon Onkolijisi Anabilim Dalı.; 0000-0001-8259-3695; 0000-0003-1109-8958; 0000-0002-3396-3407; AAH-8924-2021; AAB-6136-2022; A-5095-2018; AAB-2795-2021Background and AimPosttraumatic peritendinous adhesion is the greatest obstacle to achieve normal tendon function following lacerations of extrinsic flexor tendons of the hand. In this study, we aimed to evaluate whether single-dose radiotherapy (RT) has the potential to modulate intrasynovial tendon adhesions.Materials and MethodsA total of 80 tendons from the third to fourth flexor profundus of both hind paws of 20 adult New Zealand rabbits were used in this study. Rabbits in the RT group received 3 Gy of X-irradiation in a single fraction. Histopathological evaluation of longitudinal sections of tendons was made using the Tang grading system for peritendinous adhesions. Intratendinous quality of the healing tissue in the laceration zone was assessed using a modified Movin scale.ResultsAdhesion and inflammatory response were greater in the RT group (p(<)0.001). Tendon healing in the radiation group was found to he more uniform and organized compared with the control group. However, this difference was not statistically significant. The nuclei of the tenocytes in the radiation group showed a closer resemblance to normal tendon tissue when compared with the control group (p=0.007).ConclusionsDespite RT's certain advantages such as extracorporeal use, anti-inflammatory effect, and homogenous tissue penetration, 3-Gy X-irradiation resulted in increased peritendinous posttraumatic adhesion, possibly due to dose imbalance. Increased roundness in the tenocyte nuclei was present in the RT group. Studies with different dosing regimens and a higher number of subjects are necessary to establish an ideal dose suppressing the synovial response without compromising tendon healing.Publication Evaluation of children with arthritis: 9 years retrospectif study(Galenos Yayınevi, 2020-08-01) Yeşil, Edanur; Çelebi, Solmaz; Özcan, Nur; Özer, Arife; Turan, Cansu; Bülbül, Beyhan; Ermutlu, Cenk; Sarısözen, Bartu; Hacımustafaoğlu, Mustafa; YEŞİL, EDANUR; ÇELEBİ, SOLMAZ; Özcan, Nur; Özer, Arife; TURAN, CANSU; BÜLBÜL, BEYHAN; ERMUTLU, CENK; SARISÖZEN, MEHMET BARTU; HACIMUSTAFAOĞLU, MUSTAFA KEMAL; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı/Çocuk Enfeksiyon Bilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı.; 0000-0002-8926-9959; 0000-0003-3146-6391; 0000-0002-5720-1212; 0000-0003-4071-8052; 0000-0003-4646-660X; GSO-3630-2022; AEQ-5464-2022; JCD-9679-2023; ENK-4130-2022; JRU-9977-2023; DLB-3888-2022; IVB-4013-2023; GAX-3172-2022; ABI-7283-2020; CTG-5805-2022INTRODUCTION: The aim of this study was to evaluate the clinical and laboratory findings and treatment responses of patients with arthritis.MATERIALS and METHODS: The medical records of 111 children (0-18 years) were evaluated who were hospitalized with the diagnosis of arthritis between January 2010 and January 2019 retrospectively. The aim of this study was to evaluate the clinical and laboratory findings and to investigate the treatment and prognostic features of the patients.RESULTS: : A total of 111 patients, 66% were male and the mean age was 91+56 (median 83,1-215) months. The most of the patients (n=62,56%) were between 3-10 years of age. Septic arthritis was diagnosed in 60% (n=67) of the patients. This diagnosis was followed by reactive arthritis (10%), juvenile idiopathic arthritis (10%), toxic/transient synovitis (5%) and other arthritis. On admission, there were pain in 96%, joint swelling in 63%, redness in 21%, increased temperature of the joint in 41%, decreased range of motion in 64%, and inability to walk in 38% of the patients. The most frequently involved joints were knee (51%) and hip (35%). The possibility of septic arthritis was significantly higher in patients with high fever (p=0,0001). The response to ibuprofen was higher in non-septic arthritis (p=0,0001). Arthrocentesis was performed in 55% (n=61) of the cases and 34% (n=38) of the patients had underwent intra-articular debridement surgery. Staphylococcus aureus and Streptococcus pyogenes were the most common microorganisms growth in joint fluid culture. When septic arthritis and other arthritis cases were compared, the effusion amount, the amount of fluid taken by puncture were significantly higher and the level of CRP and leukocytes were higher in septic arthritis group (p=0,001;p=0,025;p=0,018;p=0,032,respectively). Osteomyelitis was observed in 19%(n=21) of the cases.CONCLUSIONS: In this study, the probability of septic arthritis was found to be statistically significant in patients with fever, leukocyte>12100/mm(3), CRP>3 mg/dl, and effusion measured 8.5 mm or more by ultrasonography. Also, ibuprofen response was higher in non-septic arthritis group.Publication Evaluation of titanium release from titanium alloy implants in patients with spinal instrumentation(Sage Publications Ltd, 2021-01-01) Ulusaloğlu, Armağan Can; Atıcı, Teoman; Ermutlu, Cenk; Akesen, Selcan; ATICI, TEOMAN; ERMUTLU, CENK; AKESEN, SELCAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Yoğun Bakım Anabilim Dalı; 0000-0002-3396-3407; AEQ-5464-2022; A-5095-2018; ELR-9087-2022ObjectiveThis study was performed to investigate the baseline serum titanium levels in patients with short-segment titanium alloy posterior instrumentation and to assess patient-, implant-, and surgery-related factors that might affect the serum titanium level.MethodTwo groups of patients were included in the study. The study group comprised 39 patients who had undergone short-segment posterior instrumentation from January 2013 to June 2016. The control group comprised 11 randomly selected patients who presented to the outpatient clinic with no history of orthopedic surgery. The serum titanium levels and inter-group differences were analyzed.ResultsThe mean serum titanium level was significantly higher in the study group than in the control group. No significant difference was observed between patients with different etiologies, implants used for fusion, numbers of instrumented segments, or postoperative durations.ConclusionThe serum titanium levels of patients with posterior lumbar spinal instrumentation are significantly higher than those of the normal population even after achievement of solid fusion. These levels are not affected by the use of transverse connectors, the use of cages, the operated segments, or the duration of implants.Publication Forearm compartment pressure change in children operated for supracondylar humerus fracture(Lippincott Williams & Wilkins, 2022-10-01) Togaç, Soner; ERMUTLU, CENK; Ermutlu, Cenk; SARISÖZEN, MEHMET BARTU; Sarısözen, Bartu; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı.; 0000-0003-4071-8052; ABE-9918-2021; AEQ-5464-2022; ABI-7283-2020Background: The aim of this study is to examine the preoperative and postoperative forearm compartment pressures in patients treated operatively for Gartland type III extension type supracondyler humerus fractures and understand the course of these values over postoperative period. Methods: Deep volar compartment pressure of 31 patients were measured in the proximal one third of the forearm preoperatively, and measurements were continued every 4 hours for the first 24 hours after the operation with a catheter. Type of the reduction technique (open reduction vs. closed reduction), duration of surgery, the time from the injury to surgery were all evaluated. Results: In the measurements made immediately after the operation (0 h), a sudden increase in the compartment pressure was detected in all patients (15.0 +/- 5.9 to 27.9 +/- 7.5 mm Hg) independent of the reduction technique and gradually decreased over time. The mean compartment pressure at the 12th hour postoperatively was higher in the open reduction group than in the CR group (24.5 +/- 3.4, 20.7 +/- 6.7 mm Hg, respectively) (P=0.044). The mean preoperative compartment pressure was 17.7 +/- 5.8 mm Hg in patients with a time from injury to surgery longer than 12 hours, and 12.4 +/- 4.8 mm Hg in patients with 12 hours or less (P=0.006). The postoperative 0-, 12-, and 20-hour pressure values were higher in the >1 hour operation time group than in the <= 1 hour group and the differences were statistically significant (P=0.046, 0.016, and 0.032, respectively). Conclusions: In pediatric supracondylar humeral fractures, those who underwent open reduction had higher preoperative and postoperative compartment pressures. The reduction attempt was found to be a factor that increased the compartment pressure and after the operation, the compartment pressure values decrease gradually. Prolonged operative time (>1 h) and increased time from injury to operative fixation (>12 h) were associated with higher compartment pressures.Publication High-dose short-course oral corticosteroid protocol for treatment of primary frozen shoulder: A retrospective cohort study(Sage Publications Ltd, 2021-07-01) Atıcı, Teoman; Ermutlu, Cenk; Akesen, Selcan; Özyalçın, Ali; ATICI, TEOMAN; ERMUTLU, CENK; AKESEN, SELCAN; ÖZYALÇIN, ALİ; Uludağ Üniversitesi/Tıp Fakültesi/Travmatoloji Anabilim Dalı; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Yoğun Bakım Bölümü; 0000-0002-3396-3407; AEQ-5464-2022; A-5095-2018; ELR-9087-2022; FPA-5997-2022Objective To evaluate the effect of high-dose prednisolone on the functional outcome of patients with early-stage primary frozen shoulder. Methods Eighteen patients treated with oral prednisolone at an initial dose of 1 mg/kg/day for primary frozen shoulder were retrospectively evaluated. The patients' range of motion, Disabilities of the Arm, Shoulder, and Hand (DASH) score, Constant-Murley score, American Shoulder and Elbow Surgeons (ASES) score, and visual analog scale score were recorded at baseline and at 4 weeks and 6 months after treatment. Results Rapid recovery of shoulder motion was noted at 4 weeks with the exception of abduction, which was maintained at 6 months. Significant improvement in pain perception and the Constant-Murley score was evident at 4 weeks and extended to 6 months. The DASH and ASES scores did not show significant improvement in the first 4 weeks but were significantly improved at 6 months. Conclusion High-dose oral prednisolone treatment provides rapid symptom resolution that persists long after drug discontinuation. The early treatment period is characterized by marked reduction in pain and rapid recovery of shoulder motion. Improvements in functional outcomes and disability indices tend to be more subtle in the early period but significantly improve during late treatment.Item Incidence of meniscal and osteochondral lesions in patients undergoing delayed anterior cruciate ligament reconstruction(Türk Ortopedi ve Travmatoloji Derneği, 2011) Demiraǧ, Burak; Aydemir, Fatih; Daniş, Mutlu; Ermutlu, Cenk; Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı.; 0000-0001-8259-3695; AAB-2795-2021; 56019156900; 22633641900; 54392610000; 54392665300Objective: Unreconstructed anterior cruciate ligament (ACL) tears cause repeated incidences of giving-way and rotational-translational instability. The aim of this study was to test our hypothesis that delayed surgical treatment of patients with ACL tears, especially those with high Tegner activity levels, results in more severe and complicated meniscal and osteochondral lesions with potential affect on the outcome. Methods: This study included 385 patients who underwent arthroscopic ACL reconstruction between 2001 and 2009. Patients' arthroscopic video records or MRI scans and patient files at the time of surgery were analyzed. We defined severe meniscal and osteochondral lesions which could negatively affect the outcome and labeled them meniscal lesions affecting outcome (MLAO) and osteochondral lesions affecting outcome (OLAO). The relation between MLAO, OLAO, time since injury and Tegner activity levels were statistically analyzed. Results: The incidences of MLAO and OLAO grew statistically higher as time elapsed between the injury and surgery increased (p=0.001, p<0.05; p=0.001, p<0.05). The relation between the Tegner activity score, MLAO and OLAO risk were found to be statistically insignificant (p=0.317, p=0.184, p>005). Conclusion: Delays in ACL reconstruction surgery result in an increase in the incidence of meniscal and osteochondral lesions which have the potential to negatively affect the surgical outcome.Publication Less malunion and shorter bone union time with titanium elastic nail treatment for isolated femoral shaft fractures in three- to six-year-old children(Springernature, 2022-02-18) Eken, Gökay; EKEN, GÖKAY; Ermutlu, Cenk; ERMUTLU, CENK; Sarısözen, Bartu; SARISÖZEN, MEHMET BARTU; Atıcı, Teoman; ATICI, TEOMAN; Çakar, Adnan; DURAK, KEMAL; ÇAKAR, ADNAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı.; 0000-0003-4071-8052; 0000-0002-3396-3407; AEQ-5464-2022; ABE-9918-2021Purpose Titanium elastic nail (TEN) is a good option for femoral shaft fractures in school-age children, whereas a spica cast is favored for younger patients. We aimed to compare these treatment modalities in a group of children aged three to six years. Methods 34 patients aged 3-6 years with an isolated closed femoral shaft fracture treated with TEN or one-leg spica cast immobilization were retrospectively assessed. Age, gender, weight, mechanism of injury, hospital stay time, bone union time, radiographic shortening, malunion, and complications were compared between the treatment groups. Results 16 (47.1%) patients who were treated with TEN (Group T) and 18 (52.9%) patients with spica casting (Group S) were included with a mean of 51 (24-94) months follow-up. The mean age was 4.98 years and statistically similar between both groups (mean, 5.2 vs. 4.8 years; p = 0.234). The patients in Group T were heavier (mean, 19.3 vs. 17.2 kg; p < 0.001) and were more likely to have a higher-energy mechanism of injury (p = 0.006). The mean late femoral shortening of Group S patient's was 6.5 +/- 3.5 mm and significantly higher than Group T, which was 2.0 +/- 2.9 (p = 0.050). However, effective late femoral shortening rates were not statistically different between groups (p = 0.347). Malunion was seen in six (33.3%) patients in Group S, whereas none of the patients in Group T had malunion at the last follow-up examination and were statistically different (p = 0.011). Conclusion Our study identified radiographic evidence favoring TEN over spica cast immobilization in treating preschool-age children with an isolated femoral shaft fracture in terms of malunion.Item Lornoxicam injection is inferior to betamethasone in the treatment of subacromial impingement syndrome: A prospective randomized study of functional outcomes(Springer, 2017-02) Aksakal, Murat; Ermutlu, Cenk; Özkan, Yüksel; Özkaya, Güven; Uludağ Üniversitesi/Tıp Fakültesi/İstatistik Anabilim Dalı.; 0000-0003-0297-846X; A-4421-2016; 16316866500Subacromial impingement syndrome (SIS) is one of the most frequent shoulder pathologies. Initial treatment is conservative. Subacromial injection of drugs achieves a high concentration at the pathologic site with less drug use and fewer systemic side effects. Glucocorticoids are most frequently injected. One concern with steroid use is the wide array of potential systemic and local complications. Nonsteroidal anti-inflammatory drugs (NSAIDs) are also peripherally acting and can be used locally. Although intraarticular (IA) use of NSAIDs is common in orthopedic practice, it is mostly restricted to the knee joint. Reports of local NSAID for joint pathologies are relatively rare. This study compared the efficacy of single-dose subacromial injections of betamethasone and lornoxicam for treatment of SIS. Subacromial injections of either 7.0 mg betamethasone or 8 mg lornoxicam were received by 70 patients with mean age 53 (46-68) years. Treatment outcome was assessed with Constant-Murley and UCLA questionnaires before injection and at 2aEuro, 4aEuro, and 6aEuroweek follow-ups. The change in outcome scores compared to pretreatment was higher in the steroid group at all follow-ups (p < 0.001). Patients in the steroid group showed a significant improvement at all follow-ups compared to pretreatment (p < 0.001) and previous follow-ups (p < 0.05) at all times. Patients in the lornoxicam group showed a significant functional improvement in week 2 (p < 0.001), which was not evident in the following weeks (p > 0.05). Although functional recovery halted after week 2, outcome scores remained significantly higher than the pretreatment values at all weeks (p < 0.001). Although a single subacromial lornoxicam injection provides rapid functional recovery, which partially extends into the intermediate term, its results are inferior to betamethasone and it may be an alternative only in patients where corticosteroids are contraindicated.Publication Management of distal radius fractures: Comparison of three methods(Springernature, 2020-08-19) Mert, Murat; Kovalak, Emrah; Kanay, Enes; Obut, Abdullah; Ozturkmen, Yusuf; Ermutlu, Cenk; ERMUTLU, CENK; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi Anabilim Dalı.; AAB-2795-2021IntroductionDistal radius fractures are the most common type of all extremity fractures. It is generally accepted that fractures with more than 2 mm step-off in the radiocarpal joint and greater than 10 degrees dorsal tilt should he treated surgically. However, the ideal technique for surgical management is still a point of debate. We performed cross-sectional data analysis to compare the results of three treatments methods - volar locking plate (VLP), external fixation (EF), Kirschner wire (K-wire) - in patients with distal radius fractures, and compared the clinical, functional, and radiological resultsMaterials and methodsForty-four patients with distal radius fractures who underwent fixation with VLP, K-wire or EF between 2011 and 2013 were included in the study. All fractures were classified according to the Miiller's Arbeitsgemeinschaft fur Osteosynthesefragen (AO) and Frykman's classifications. Routine radiographs were taken at the postoperative three weeks, six weeks, and three months. Radial inclination, volar tilt, radial length and ulnar variance were assessed on the follow-up visits and additionally at the follow -up for the study. The patient-based Disabilities of the Arm, Shoulder and Hand (DASH) score system and the physician-based MAYO scale were used to evaluate functional outcomes. Radiological and functional outcomes between three surgical modalities were compared and statistically analyzed.ResultsThe average age at the time of surgery was 52 years (range = 35-69 years). Of a total of 44 patients, 28 were operated with VLP, 11 were with K-wire and five with EF. Satisfactory reduction was achieved in all fractures, and all of the fractures healed. DASH and MAYO scores were similar in all groups. Regarding radiographic parameters, there was no significant difference in radial inclination, volar tilt, radial length and ulnar variance between the treatment modality groups. When evaluated based on fracture geometry, the DASH score was significantly higher in the patients with AO23A type fracture compared to the patients with AO23B and AO23C type fractures. As for MAYO score, all AO23 groups had similar outcomes.ConclusionsSurgical treatment options VLP, EF, and K-wire provide adequate fixation, satisfactory radiological, and functional results for the management of distal radius fractures of various severities. The optimal treatment approach depends on individual features, and the choice for an internal fixation or closed reduction method for the restoration of wrist function should be evaluated thoroughly by the operating surgeon considering the patient-related variations.Item Minimally invasive plate osteosynthesis for short oblique diaphyseal tibia fractures: Does fracture site affect the outcomes?(Sage Publications, 2020-10-22) Eken, Gökay; Ermutlu, Cenk; Durak, Kemal; Atıcı, Teoman; Sarısözen, Bartu; Çakar, Adnan; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı.; ABI-7283-2020; AAB-2795-2021; A-5095-2018; 57195109967; 54392665300; 6602850051; 7801647288; 55890736200; 57219550849Objective To report the results of patients with short oblique diaphyseal tibia fractures treated with minimally invasive plate osteosynthesis (MIPO). The secondary aim was to understand the effect of fracture location (midshaft or distal 1/3) on outcomes. Methods Twenty-eight patients with short oblique (>30 degrees) tibial shaft fractures (AO/OTA 42A2) treated with plate and MIPO technique between 2015 and 2019 were retrospectively assessed. Age, gender, follow-up time, fracture type (open or closed), operation time, postoperative infection rate, union time, ankle joint range of motion, and complications were analyzed. Patients' radiographs at a minimum 1-year follow-up were evaluated for malunion, nonunion, and implant-related complications. Results Mean age and follow-up time were 47.0 +/- 15.7 years and 18.3 +/- 12.1 months, respectively. Mean bone union time was 3.66 +/- 1.04 months in middle 1/3 diaphysis and 4.23 +/- 1.48 months in distal 1/3 tibia fractures. Seven (25%) patients developed superficial infections. Mean union time, malunion rate, coronal and sagittal angulation, operation length, and infection rate were similar between the groups. Conclusion MIPO is an effective method for treatment of short oblique diaphyseal tibia fractures, and results in few complications. Both distal and midshaft fractures have similar union and malunion rates.Item Posttravmatik tendon yapışıklıklarını önlemede tek doz radyoterapinin etkinliği(Uludağ Üniversitesi, 2011) Ermutlu, Cenk; Kaleli, Tufan; Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı.Yüzeyel yerleşimleri sebebi ile elin ekstrinsik tendonlarının yaralanmalarına sık rastlanmaktadır. Tendon yaralanmaları sonrası iyileşme bölgesi ile çevre dokular arasında meydana gelen yapışıklık tendonun normal fonksiyonuna kavuşmasının önündeki en büyük engeldir. Bu çalışmanın amacı, düşük doz radyoterapinin travma sonrası sinovyal kılıf içindeki fleksör tendon adezyonunu modüle edecek potansiyele sahip olduğunu göstermektir.Bu çalışma 20 adet erişkin, 2400-3800 gr ağırlığında New Zealand cinsi tavşan üzerinde gerçekleştirildi. Her bir deneğin her iki arka 3. ve 4. ayak parmak fleksör profundus tendonları kullanılarak toplamda 80 tendon üzerinde çalışıldı. A1 ve A3 makaraları arasında fleksör profundusa yarım kat perkutan tenotomi uygulandı. Denekler Kontrol ve Radyoterapi grubu olarak ikiye ayrıldı. . Hayvanların her iki ayağı toplamda 3 Gray dozunda X ışını alacak şekilde tek seferde ışınlandı. Ameliyat sonrası 10. günde denekler sakrifiye edildi. Longitudinal planda alınan kesitler Tang ve arkadaşlarının tanımladığı histolojik evreleme kriterleri kullanılarak peritendinöz alandaki adezyonlar yönünden değerlendirildi.Çalışmanın analizleri kontrol grubundaki 8 tavşana ait 23 ve radyoterapi grubundan 7 tavşana ait 26 adet histolojik incelemeye uygun kalitede preparat üzerinde yapıldı. Radyasyon grubunda adezyonun ve enflamatuar cevabın kontrol grubuna oranla artmış olduğu görüldü. (p?0.001)Çalışmamızda radyoterapinin enflamatuar cevabı adezyonu arttıracak şekilde modüle ettiği görülmüştür. Bu durum dozun az ya da fazla gelmesine bağlı olabilir. Peritendinöz adezyonu azaltacak şekilde sinovyal cevabı modüle edilecek doz aralığının bulunması için daha yüksek denek sayıları ile farklı dozlarda çalışmak gerekmektedir. Radyoterapi ekstrakorporal kullanımı, peroperatif uygulanma zorunluluğu olmaması ve enflamasyon üzerine etkinliği sebebi ile tendon yaralanmaları sonrası adezyonu önlemede umut vadeden bir yöntemdir.