Person: ÖZYALÇIN, ALİ
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Publication Primary treatment of complex proximal humerus fractures using humelock cementless reversible shoulder arthroplasty in the elderly(Turkish Assoc Trauma Emergency Surgery, 2021-07-01) ; Atici, Teoman; ATICI, TEOMAN; Ermutlu, Cenk; ERMUTLU, CENK; Yerebakan, Selcan; Özyalcin, Ali; ÖZYALÇIN, ALİ; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anestezi ve Reanimasyon Anabilim Dalı.; 0000-0002-3396-3407; AEQ-5464-2022BACKGROUND: Proximal humerus fractures are quite common, constituting 5% of all fractures. Plate osteosynthesis of comminuted fractures in the elderly with osteoporotic bones is prone to complications, including loss of reduction, intraarticular protrusion of screws, avascular necrosis and non-union. Hemiarthroplasty may be preferred to achieve a stable fixation, which permits early shoulder motion. Prerequisites for the successful functional outcome of this surgical technique are to have an intact rotator cuff, which is often torn, and achieve proper soft tissue balance, which is technically demanding. In RSA design, deltoid muscle replaces the function of the supraspinatus, compensating for a dysfunctional rotator cuff or a displaced tuberculum. We designed a retrospective study to evaluate the results of proximal humerus fractures treated with reverse shoulder arthroplasty using Humelock II reversible prosthesis in elderly patients.METHODS: Thirty-one patients (25 females, six males) above 65 years old who underwent reverse shoulder arthroplasty between 2014 and 2019 for Neer 3-4 part fractures or head split injuries were included in this study. Patients with a previous internal fixation attempt, cases with neurological deficit or previous upper extremity fractures, patients who presented later than three weeks after the trauma, cases with less than six months follow-up and patients with additional fractures were excluded. Twenty-eight patients were available for final analysis. Fracture mechanism, time from trauma till surgery, hospital stay and preoperative ASA scores were noted. Humelock II Reversible (FX Solutions) implants were used in all cases. Patients' shoulder range of motion and functional outcome using UCLA, DASH and Constant scores at minimum six months follow-up were evaluated.RESULTS: The mean age was 72.2 (65-95) years, and mean follow-up time was 15.5 (6-48) months. The mean UCLA, Constant and Dash scores at the last follow-up were 27.6 (14-35), 67.9 (38-80) and 30.8 (9.9-79.2), respectively. Mean shoulder flexion, abduction, internal and external rotation were 130 (110-160), 100 (70-140), 40 (15-60) and 39 (15-75) degrees, respectively.CONCLUSION: RSA is a very reliable treatment for proximal humerus fractures in patients over 65 years old. Early active and passive shoulder exercises can be started postoperatively, and good functional outcome and wide ROM can be achieved with this age group. Although stable fixation of the tuberculum is not required for shoulder abduction, it facilitates external rotation and should be attempted in all cases. Clinical outcomes of patients who underwent RSA due to proximal humerus fracture are as good as the outcomes of patients with different etiologies.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(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; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı; Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı; 0000-0002-3396-3407; 0000-0002-6503-8232; AEQ-5464-2022; A-7994-2018; ELR-9087-2022; JHR-5447-2023Objective: 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 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 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.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.