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Öğe Cerrahi tedavi uyguladığımız asetabulum kırıklı hastalarımızın fonksiyonel sonuçlarının analizi(Trakya Üniversitesi Tıp Fakültesi, 2015) Erem, Murat; Sarıdoğan, KenanAsetabulum kırığı nedeniyle opere ettiğimiz hastalarımızın, asetabulum kırıklarının radyolojik ve cerrahi tedavi sonuçlarını klinik olarak değerlendirmeyi amaçladık. Çalışmamıza kliniğimizde 2009-2014 yılları arasında asetabulum kırığı sebebiyle opere olan 18 yaş üstü 47 hasta dahil edildi. Hastalarla ilgili tüm bilgiler epikrizlerinden, poliklinik muayene kartlarından sağlandı. Hastalar rutin olarak kontrollere çağırıldı muayeneleri tarafımızca gerçekleştirildi. Hastaların polikliniğimizde yapılan muayenelerinden ve dosya taramalarından demografik verileri (yaş, cinsiyet), travma şekli, Judet ve Letournel sınıflamasına göre asetabulum kırığının tipi, Judet ve Letournel sınıflamasına göre kırığın basit ve kompleks kırık ayrımı görüntü arşivleme ve iletişim sistemi ve kliniğimizdeki film arşivlerinden radyografiler taranarak yapıldı. Travmaya bağlı ek kırık varlığı, travma sonrası ne zaman cerrahi operasyona alındığı, cerrahi operasyon süresi, cerrahi teknik, operasyon sırasında verilen kan ve kan ürünleri, operasyon sonrası komplikasyonlar hasta epikrizlerinden bakılarak kayıt edildi. Hastaları eklem hareket açıklıkları, SF-36 ve Harris Kalça Skorları hasta tam yük verme sonrası ilk poliklinik kontrolünde değerlendirildi. Hastalar preop Judet ve Letournel sınıflamasına göre sınıflanarak en uygun insizyon seçildi ve preop planlama yapılarak cerrahi uygulandı. Tüm hastalara postoperatif 1. günde pasif kalça eklemi eksersizleri başlandı. Eklem hareket açıkları (fleksiyon kaybı, iç rotasyon kaybı, dış rotasyon kaybı, abduksiyon kayıpları) gonyometre yardımıyla hastaların karşı kalça eklemi baz alınarak, derece cinsinden kayıp olarak kayıt edildi. Yaşam kalitesi skorları (SF-36) ve Harris kalça skoru formları hastalar tarafından poliklinikte dolduruldu. Judet ve Letournel sınıflamasını göre yaptığımız insizyon dağılımlarını değerlendirdiğimizde komplike kırıkların yeterli eklem redüksüyonunu ve kırık stabilizyonunun sağlanabilmesi için iki insizyonun gerekliliğinin ortaya çıktığı, iki insizyon yapılan hastaların perop replasman ihtiyaçlarınındaki artışın istatistiksel olarak anlamlı olmasa da miktar olarak daha fazla olduğu, tam yük verme zamanının daha kısa ve cerrahi sürelerinin ise daha uzun olduğu, Hem anterior hem de posterior insizyon uygulanan hastalarda tam yük verme zamanı sadece anterior veya sadece posterior insizyon uygulanan gruplara göre anlamlı derecede daha kısa olduğu bulunurken, bunun da çift insizyon uyguladığımız hastalarda daha güçlü stabilizasyon sağlanarak, erken tam yük vermeye başlandığını göstermekte olduğu bulundu. Sonuç olarak; Eklem içi kırıklar olan asetabulum kırıklarına mümkün olduğunca anatomik redüksiyon uygulanmalı. Cerrahi girişim için gerekli insizyon, kırık tipine ve konumuna göre kırığa hakim olacak şekilde seçilmelidir. Asetabulum kırıklarının cerrahisi ameliyathane koşullarının ve postoperatif bakım olanaklarının yeterli olduğu merkezlerde yapılmalıdır. Asetabulum kırıkları cerrahisinde iyi redüksiyonun iyi fonksiyonel sonuçları her zaman garanti etmediği bilinmekle beraber, cerrahi tespit ve ameliyat sonrası erken rehabilitasyon ile hastaların hayat kalitesinin olumlu yönde etkilendiği başarı oranı yüksek bir cerrahi girişimdir.Öğe Comparison of AO, Schatzker, and three-column classification systems in tibial plateau fractures: Impact on functional outcomes(Turkish Joint Diseases Foundation, 2024) Selcuk, Esref; Erem, Murat; Copuroglu, Cem; Ozcan, Mert; Ciftdemir, MertObjectives: This study aimed to compare the AO, Schatzker, and Three-Column classification systems for tibial plateau fractures, focusing on their prognostic and functional outcome prediction and influence on clinical decisions across different trauma types. Patients and methods: In this retrospective study, we examined 49 patients (36 males, 11 females; mean age: 40.6 +/- 11.8 years; range, 19 to 67 years) with tibial plateau fractures between January 2011 and January 2017. The fractures were classified using the AO, Schatzker, and three-column systems. The main outcome measurements included functional scores (Knee Injury and Osteoarthritis Outcome Score [KOOS], Hospital for Special Surgery [HSS]), range of motion (ROM), duration of hospitalization, thigh atrophy, operation time, and the development of osteoarthritis. The impact of smoking was also assessed. Results: According to the AO classification, type B fractures obtained higher KOOS and HSS scores compared to type C fractures (p=0.013 and p=0.007, respectively). According to the Schatzker classification low-energy fractures achieved higher KOOS and HSS scores than high-energy fractures (p=0.013 and p=0.026, respectively). One-column fractures had higher KOOS and HSS scores compared to two-column and three-column fractures (p=0.007 and p=0.001, respectively). Two-column fractures had a lower ROM compared to other column fractures (p=0.022). Shorter hospital stays were recorded for Schatzker low-energy fractures (p=0.016), whereas higher thigh atrophy was found in Schatzker high-energy fractures (p=0.022) and AO type C fractures (p=0.018). Longer operation times were observed in AO type C fractures (p=0.037) and Schatzker high-energy fractures (p=0.017). According to the Kellgren-Lawrence classification, AO type C fractures and three-column fractures yielded worse outcomes (p=0.039 and p=0.001, respectively). Smoking had a negative impact on functional KOOS and HSS scores across all groups (p=0.022 and p=0.001, respectively). Conclusion: This study highlights the predictive value of the AO, Schatzker, and Three-Column classification systems in determining functional outcomes and clinical data in tibial plateau fractures. Each system provides unique insights into different outcomes, suggesting their concurrent application may yield a more comprehensive prognosis.Öğe Comparison of the functional and radiological results of the conservatively and surgically treated displaced acetabulum fractured patients(Turkish Assoc Trauma Emergency Surgery, 2022) Alpaydin, Eren; Erem, Murat; Copuroglu, CemBACKGROUND: The purpose of the study was to compare the functional and radiological results of the conservatively and surgically treated displaced acetabular fractured patients. METHODS: The study included 61 patients with a displaced acetabulum fracture over the age of 18, who have been treated conservatively or surgically for acetabular fractures, between 2000 and 2014. Patients were divided into two groups according to their treatment type. Group 1 consisted of conservatively treated 31 between 2000 and 2010 patients and Group 2 consisted of surgically treated 30 patients between 2010 and 2014. The fractures were classified according to Judet and Letournel classification. Clinical evaluation of the patients was conducted according to Modified Merle D'Aubigne Score, SF-36, and Harris Hip Score. Radiological evaluation was evaluated according to Matta's Radiological Evaluation Criteria. Kolmogorov-Smirnov, t-test, Mann-Whitney U-test, and two Wilcoxon paired sample tests were used for statistical analysis. The significance limit was chosen as p<0.05. RESULTS: The mean follow-up time was 10 years for the conservative group and 5.5 years for the surgery group. There was no statistically significant difference in functional scores between both groups (p>0.05), Matta's radiological staging score was significantly higher in the operated group (p=0.023). CONCLUSION: Radiological scores are not directly correlated with the functional capacity. We obtained good radiological and functional scores in the surgical group, operative treatment should be considered when absolute indications are there. The outcome of conservatively managed fractures is not bleak. We think that there is an alternative to surgical treatment in displaced acetabular fractures and that similar functional results can be obtained in selected cases.Öğe Does electromagnetic-manual guided distal locking influence rotational alignment in antegrade femoral nailing?(Springer, 2015) Ciftdemir, Mert; Tuncel, Sedat A.; Ozcan, Mert; Copuroglu, Cem; Erem, MuratPurpose The aim of this study was to determine whether distal locking using an electromagnetic-manual guided distal locking decreases the malrotation rate in femur fractures treated with intramedullary nailing. Methods A total of 113 adult patients having unilateral femoral shaft fractures treated using IM nails were evaluated regarding demographic features, injury mechanism, fracture type, interval between trauma and nailing, operation time and number of image intensifier shots during the operation at least one year after nailing. Patients were divided into two groups according to distal locking technique. All patients had also undergone clinical examination for lower extremity alignment and range of motion and filled out the SF-36 questionnaire and undergone ultrasound measurement of femoral anteversion angles to reveal any rotational femoral malalignment. Results Group 1 consisted of 47 patients (41.6 %) with electromagnetic-manual targeting guided distal locking and group 2 consisted of 66 patients (58.4 %) with free-hand distal locking. Both groups were statistically similar regarding demographic features, injury mechanism, fracture type, interval between trauma and nailing, clinical examination and SF-36 results. Operation time and number of image intensifier shots were significantly less in group 1. No statistically significant difference was found between the femoral anteversion angles of injured and uninjured sides of the patients in both groups. Conclusions Although there is no significant effect on malrotation, previously known advantages lead us to state that electromagnetic-manual guided distal interlocking is an advantageous treatment option in femoral shaft fractures.Öğe MIDSHAFT CLAVICLE FRACTURE AND IPSILATERAL DISLOCATİON OF THE ACROMIOCLAVICULAR JOINT: A CASE REPORT(2022) Balkanlı, Bahadır; Copuroglu, Cem; Erem, MuratClavicle fractures are classically defined according to the location of the fracture. Approximately 80% of clavicle fractures are midshaft fractures. Acromioclavicular joint injuries are caused by similar trauma mechanisms such as clavicle fractures. The clavicle shaft fracture associated with the ipsilateral acromioclavicular joint dislocation is a rare type of injury. Acromioclavicular Rockwood type 3 joint injury with midshaft clavicle fracture is only a few cases are available in the literature. In our case revealed that the left clavicle had a middle third clavicle fracture and an ipsilateral type 3 AC joint appearance according to the Rockwood classification. Management of Rockwood type 3 acromioclavicular injuries is controversial. We have chosen a low-profile countered 3.5 mm locking plate and a single Endobutton fixation system (Smith & Nephew) because we provide sufficient stabilization in our case. As a result, 6th month postoperatively, the shoulder range of motions was fully and had no complaints. There are many publications in the literature, the preferred treatment for acromioclavicular joint dislocation is still unclear. We need more cases and longer follow-up to decide on the treatment of rarely combined type injuries.Öğe Symptomatic Deep Vein Thrombosis Following Elective Knee Arthroscopy Over the Age of 40(Sage Publications Inc, 2019) Ozcan, Mert; Erem, Murat; Turan, Fatma NesrinThromboprophylaxis following arthroscopic knee surgery (AKS) is not clear in the literature. The purpose of this study was to present the incidence of symptomatic deep vein thrombosis (DVT) following elective AKS over the age of 40. The secondary purpose was to investigate risk factors associated with venous thromboembolic events (VTEs). Surgical database and outpatient clinic follow-up charts of the patients who underwent AKS for any reason were included in the study. Odds for risk factors such as previous medical history of thrombosis, any family history for clotting disorders, diabetes mellitus (DM), oral contraceptive usage, body mass index, history of malignancy, and smoking were evaluated. The incidence of DVT following AKS significantly increased in the patients older than 40 years who had a previous medical history of VTE, DM, and smoking. A variety of guidelines exist for VTE prophylaxis; however, one should focus on risk factors related to the patient's medical history and current medical conditions. In this study, smoking, DM, and previous history of DVT increased DVT risk significantly, and thromboprophylaxis should be kept in mind for these patients.
