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Öğe The Biocompatibility of Nitinol in Knee Joint Spaces and Femoral Tunnels: An Experimental Study in Rats(Journal Hard Tissue Biology, 2014) Kalacı, Aydıner; Uruc, Vedat; Ozden, Raif; Duman, Ibrahim Gokhan; Dogramaci, Yunus; Karapinar, Serhat; Yaldiz, MehmetCurrently the most common method of reconstructing a ruptured anterior cruciate ligament (ACL) is by using bone-patellar tendon-bone (BPTB) or semitendinosus, gracilis tendon autografts. Although good results are reported, donor morbidity continues to be a problem. To overcome these complications, synthetic grafts have been investigated. However, to date no prosthetic graft has been developed as an alternative to patellar or hamstring tendon autografts. The aim of the present study was to assess the biocompatibility of nitinol in rat knee joint spaces and distal femoral bones. Ten male, healthy Wistar albino rats, weighing between 300-350 g, were used. The right knee joint of each rat was reached by medial longitudinal parapatellar dissection. The femur distal was penetrated by a size 0.5 mm of Kirshner wires. Twenty nitinol wires were placed in the bone tunnel (0.125 mm in diameter and 5 mm long). In addition one nitinol wire was placed in the joint space. Following hemostasis, the layers were closed with interrupted sutures. The same procedure was repeated for the left side without placing any nitinol wire. The rats were allowed unrestricted weight bearing. Two animals died of unknown reasons during follow-up. The remaining rats were sacrificed 8 weeks after surgery. The knees were removed by careful dissection and the nitinol wires were removed. The sections taken from these specimens were stained with Standard hematoxylin and eosin and with Mason trichrome and examined under the light microscope. The bone tunnels were filled with osteocytes and chondrocytes. In two specimens of the nitinol group, moderate synovitis was detected. The synovitis rate in the study group was found to be statistically insignificant. In conclusion, the short term biocompatibility of nitinol in the rat knee joint space and femoral tunnel was found to be within acceptable limits.Öğe The comparison of macroscopic and histologic healing of side-to-side (SS) tenorrhaphy technique and primer tendon repair in a rabbit model(Springer, 2014) Dogramaci, Yunus; Uruc, Vedat; Ozden, Raif; Duman, Ibrahim Gokhan; Kalacı, Aydıner; Altug, Muhammed Enes; Isler, Cafer TayarThe side-to-side (SS) tenorrhaphy technique has been used in tendon transfer surgery. The mechanical properties of SS tendon suture have been studied previously. However, the histo-pathological healing of the SS tenorrhaphy of the tendons is unknown. The aim of this study was to assess the gross and histological effects of SS tenorrhaphy in a rabbit model. Twenty New Zealand rabbits were used. The extensor hallucis longus and tibialis anterior tendon were sewed SS at the level distal to the ankle joint. The patellar tendon (PT) at the same side was used as control group. A unilateral midline incision was made and repaired with a single suture. The animals were killed at the 12th week postoperatively. The histological sections were obtained from the side of surgery from each group. Each sample was stained with hematoxylene and eosin (H&E). Gross and microscopic healing was compared between the two groups. Gross examination of the control group showed complete healing with a thin peri-tendinous sheath formation around the suture site, whereas in the study group, a thick peri-tendinous sheath was formed around the area of the tendon-tendon anastomosis. In the control group, at the 12th week after surgery, the healing was almost completed in all samples. In the study group, a thick fibro vascular sheath has formed around the side of anastomosis. In all specimens few inter-digitations were observed between the tendons;however, the trough was still present. The result of the current study showed that histological healing and union of SS tenorrhaphy differ from that in primary tendon injury and healing. Further studies are required to clarify the healing stages at the tenorrhaphy site.Öğe THE COMPARISON OF VACUUM ASSISTED CLOSURE AND CONVENTIONAL COTTON GAUZE DRESSING IN THE TREATMENT OF DEFECTIVE LOWER EXTREMITY INJURIES(Carbone Editore, 2014) Ozden, Raif; Duman, Ibrahim Gokhan; Uruc, Vedat; Dogramaci, Yunus; Kalacı, Aydıner; Komurcu, ErkamWe performed a retrospective analysis to compare the efficacy of the vacuum assisted closure (VAC) therapy and conventional cotton gauze dressing of wounds. From July 2011 to August 2013, 40 patients were included in the study. All patients were reconstructed with split thickness skin graft after the granulation tissue was sufficient Two groups of 20 patients Were compared retrospectively. Data were collected for gender, age, time needed for sufficient granulation tissue for split thickness skin grafts, length of stay in hospital and. number of debridement for wound VAC application, and conventional cotton gauze dressing methods. Demographic data were the Same. for two groups. Time needed to have a good granulation tissue that was sufficient for split thickness skin graft, length of stay in hospital, and number of debridement were significantly less in VAC treatment group (P<0,05). No major complication occurred that was directly attributable to treament. VAC therapy appears to be a good adjunct for the treatment of musculoskeletal injuries and found to facilitate the rapid formation of healthy granulation tissue on wounds in the lower limb and shortens the length of stay in hospital.Öğe The comparison of vacuum assisted closure and conventional cotton gauze dressing in the treatment of defective lower extremity injuries(Acta Medica Mediterranea, 2014) Ozden, Raif; Duman, Ibrahim Gokhan; Uruc, Vedat; Dogramaci, Yunus; Kalacı, Aydıner; Komurcu, ErkamWe performed a retrospective analysis to compare the efficacy of the vacuum assisted closure (VAC) therapy and conventional cotton gauze dressing of wounds. From July 2011 to August 2013, 40 patients were included in the study. All patients were reconstructed with split thickness skin graft after the granulation tissue was sufficient. Two groups of 20 patients were compared retrospectively. Data were collected for gender, age, time needed for sufficient granulation tissue for split thickness skin grafts, length of stay in hospital and number of debridement for wound VAC application, and conventional cotton gauze dressing methods. Demographic data were the same for two groups. Time needed to have a good granulation tissue that was sufficient for split thickness skin graft, length of stay in hospital, and number of debridement were significantly less in VAC treatment group (P < 0.05). No major complication occurred that was directly attributable to treatment. VAC therapy appears to be a good adjunct for the treatment of musculoskeletal injuries and found to facilitate the rapid formation of healthy granulation tissue on wounds in the lower limb and shortens the length of stay in hospital.Öğe The Effect of Cape on Steroid Induced Osteonecrosis of the Femoral Head in Rat Model Hide(Journal Hard Tissue Biology, 2018) Uruc, Vedat; Duman, Ibrahim Gokhan; Davul, Serkan; Ozden, Raif; Gonenci, Ramazan; Gokce, Hasan; Dokuyucu, RecepThe aim of this experimental study was to examine the effect of Caffeic acid phenethyl ester (CAPE) on steroid-induced osteonecrosis of femoral head (ONFH) in rats. Thirty-one male Wistar albino rats were divided into 4 groups: control group (7 rats), methylprednisolone treatment group (MPS, 8 rats), CAPE treatment group (8 rats) and MPS+CAPE administered group (8 rats). The rats of group MPS and CAPE+MPS, On days 2, 3 and 4 were treated with 20 mg/kg/day methylprednisolone (MPS; Pfizer Pharmaceutical, Puurs, Belgium) intramuscularly. 10 mu mol/kg/day CAPE was intraperitoneally injected to the rats of group CAPE from 13 weeks of age for 4 weeks. The control group was fed and housed under identical conditions without any treatment. All rats were sacrificed at 17 weeks of age by taking blood from the heart. Both proximal femoral parts were taken for histopathological and immunohistochemical analysis . Total oxidant status, total antioxidant status, and oxidative stress index (OSI), lipid parameters, coagulation parameters were assessed in blood specimens. Much lesser amount of osteonecrosis lesions were observed in the MPS+CAPE group compared to MPS group. In immunhisochemical analysis, oxidative stress was found significantly decreased in CAPE+MPS group compared to MPS group. OSI levels were significantly decreased in CAPE+MPS group compared to MPS group (p<0.001). In CAPE+MPS group lipid and coagulation parameters were found positively affected compared to MPS group. In conclusion, CAPE has strong protective effect against the steroid induced femoral head osteonecrosis in rats.Öğe Effects of a Single Application of Adcon Gel on Peritendinous Adhesion: An Experimental Study in Rabbits(Journal Hard Tissue Biology, 2014) Ozden, Raif; Uruc, Vedat; Duman, Ibrahim Gokhan; Dogramaci, Yunus; Kalacı, Aydıner; Komurcu, Erkam; Ozsoy, Sule YurdagulPeritendinous adhesions are serious complications after surgical repair of tendons and can lead to poor functional outcome. In the present study, the tensile strength of repaired tendons was measured biomechanically in two groups using a rabbit Achilles tendon model, and the effects of Adcon gel on peritendinous adhesions and tendon healing were examined by means of histological and mechanical analyses. In the treatment group, the Achilles tendon was transected, followed by a primary repair using a modified Kessler technique, and Adcon gel was injected between the tendon and skin of the right leg. The same operation was done for the control group, and 1 mL of normal saline solution was applied locally in a similar fashion. The experimental protocols were approved by the local animal ethics committee. Microscopic evidence of the formation of adhesions and of inflammation was less in the treatment group than in the control group. There was no significant difference in the tensile load necessary to rupture the repaired tendons between the two groups. Adcon gel reduced the peritendinous adhesions histologically without impairing tendon healing, as determined with mechanical analyses. The use of Adcon gel may provide a simple means of preventing of postoperative peritendinous adhesions, thereby offering a beneficial effect on tendon repair.Öğe Effects of Gaseous Ozone Treatment on Bone Regeneration in Femoral Defect Model in Rats(Journal Hard Tissue Biology, 2017) Duman, Ibrahim Gokhan; Davul, Serkan; Gokce, Hasan; Gonenci, Ramazan; Ozden, Raif; Uruc, VedatThe purpose of this study was to investigate the effect of ozone therapy in rat femoral fractures. Following the right open femoral fractures and intramedullary Kirschner wire fixation of the fracture in 60 male Wistar albino rats, the animals were divided into two groups of 30 animals each: ozone therapy group (n=30); non-treatment (control) group (n=30). Ozone was administered by rectal insufflation. After the rats were sacrified fracture healing was assessed by biomechanical and histopathologic evaluation. Histological and mechanical findings indicated that the ozone therapy had a significantly positive effect on bone healing.Öğe Five cases of early dissociation between the bipolar hip endoprosthesis cup components; either spontaneously or during reduction maneuvers(Turkish Assoc Orthopaedics Traumatology, 2017) Uruc, Vedat; Ozden, Raif; Duman, Ibrahim Gokhan; Kalacı, AydınerBipolar hemiarthroplasty is frequently used in the treatment of intracapsular hip fractures. Dissociation of the bipolar components can happen during the hip dislocation, the reduction maneuvers, or spontaneously without any dislocation. Here we report early dissociation between bipolar components in two cases during the attempt of closed reduction maneuvers and three cases with spontaneous dissociation without any trauma. To prevent or minimize this complication; the reduction of dislocated hips must be achieved very gently under general anesthesia with fluoroscopic control. During the initial operation the surgeons must be sure that the bipolar components are locked to each other and after final reduction, especially in osteoarthritic acetabulums, that the cup position is not in varus position. (C) 2017 Publishing services by Elsevier B.V. on behalf of Turkish Association of Orthopaedics and Traumatology.Öğe MAJOR MUSCULOSKELETAL INJURIES AND APPLIED TREATMENTS IN THE CURRENT CONFLICTS IN SYRIA(Carbone Editore, 2014) Uruc, Vedat; Ozden, Raif; Duman, Ibrahim Gokhan; Dogramaci, Yunus; Yengil, Erhan; Karapinar, Serhat; Karakus, AliAims: The aim of this study was to document the types of musculoskeletal injuries, mechanism of injuries and applied treatments during the Syrian civil war. Materials and methods: 579 (520 male, 59 female) Syrian civilian war victims who were treated in our clinic from December 16,2011 till August 17,2013. The mean age was 30 years (range: 1-90 years). Anatomic distribution and mechanism of injuries, and applied treatments were the main outcomes. Results: 449 subjects were wounded by gunshot, 44 by blast injuries and 86 by other causes. 668 open fractures and 98 closed fractures were treated. 514 grade 3a open fractures which were relatively clean and early-admitted were treated as immediate aggressive debridement and internal fixation. Early infection rate was 2.7% (n=14). Eight subjects had 10 grade 3b open fractures. Seventy patients presented with 99 grade 3c open fractures. Totally 84 external fixations were applied. 138 major amputations were done in 69 subjects. Wound infections were seen in 77 patients (13.2%). 29 of them were previously operated under non-sterile conditions in Syria. Debridenzent & irrigation (D&I) was the most commonly applied treatment. Conclusion: In conclusion gunshot was the main wounding agent in the recent Syrian conflicts, D&I was the most commonly applied treatment. In the treatment of relatively clear and early arrived grade 3a open fractures, internal fixation, after aggressive debridement and irrigation, resulted with low infection rates and it can be considered as a good choice of treatment. Prior interventions under non-sterile conditions were associated with 63% of resistant infections and extend the duration of hospital stay. Early evacuation and thorough debridement will result in lower infection rates.Öğe Prevalence of household meat grinder-induced severe hand injuries: A retrospective clinical study(Turkish Assoc Trauma Emergency Surgery, 2022) Duman, Ibrahim GokhanBACKGROUND: The aim of the study was to evaluate patients with household meat grinder-related hand injuries who presented to our hospital between 2009 and 2020, investigate the causes of these injuries, and discuss prevention methods. METHODS: Sixty-four patients injured by a meat grinder were retrospectively screened. The patients aged one to 18 years were evaluated in the pediatric group and those over 18 years were evaluated in the adult group. The relationships between age, gender, location of injury (right hand, left hand, wrist, and fingers), and amputation level were analyzed. RESULTS: Twenty-two of the patients were children, of whom 13 were boys and nine were girls, with a mean age of 11 (range 1-18) years. There were 42 adult patients comprising 15 males and 27 females, and their mean age was 42 (range 19-74) years. In the pediatric group, the rate of amputations at the metacarpophalangeal (MP) and wrist joint levels were significantly higher compared to the adults (p<0.005). In the adult group, the rate of amputations at the third finger distal interphalangeal (DIP) joint was significantly higher compared to the pediatric group (p=0.007). There was no statistically significant difference between the pediatric and adult groups regarding the rate of amputations at the thumb and little finger levels. CONCLUSION: There seems to be a lack of research to guide the development of strategies to prevent household meat grinderrelated injuries, and this type of injury remains a national health problem. To prevent such injuries, occupational safety should be considered not only in workplaces but also at home, and information should be provided to raise the awareness of the society.Öğe Reinforcement of the Flexor Tendon Repair Using Human Amniotic Membrane: A Biomechanical Evaluation Using the Modified Kessler Method of Tendon Repair(Amer Podiatric Med Assoc, 2016) Dogramaci, Yunus; Duman, Ibrahim GokhanBackground: Human amniotic membrane is used to prevent peritendinous adhesions after tendon injuries. This study compares the mechanical properties of modified Kessler repairs and modified Kessler repairs strengthened using multiple layers of human amniotic membrane. Methods: Twenty flexor digitorum profundus tendons of sheep forelimbs were sutured by the two-strand modified Kessler technique (group A) and by the two-strand modified Kessler repair reinforced with multiple layers of human amniotic membrane (group B). To assess the mechanical performance of the repairs, tendons were subjected to a linear noncyclic load-to-failure test using a material testing machine. Outcome measures included ultimate forces and the mode of failure. Results: The mean +/- SD value of the failure strength was 34.6 +/- 1.64 N for group A and 50.6 +/- 5.60 N for group B. The reinforced repair provided a significantly higher ultimate load compared with the nonreinforced group (P < .001). All of the specimens failed due to suture breakage at the repair site. Conclusions: The results of this study show that the modified Kessler repair can be reinforced effectively with human amniotic membrane.Öğe Spontaneous atraumatic extensor pollicis longus rupture in healthy individuals due to steroid injection: Two case reports(Medi+World Int, 2014) Ozden, Raif; Uruc, Vedat; Duman, Ibrahim Gokhan; Dogramaci, Yunus; Kalacı, Aydıner; Komurcu, ErkamIntroduction: Local steroid injection is believed to be associated with risk of spontaneous tendon rupture. Spontaneous rupture of the extensor pollicis longus (EPL) tendon at the wrist is infrequent and essentially described after fracture of the distal radius. Rough bone ends, rheumatoid arthritis, lupus erythematosus, synovitis or tenosynovitis both contribute to this process. The aim of this study is to define rupture of the EPL tendon with review of the literature in two cases after receiving local steroid injections. Case presentation: The operative records for two patients undergoing EPL reconstruction by an author were criticized. All 2 patients had exposure to local steroids but this exposure was not into the ruptured tendon. It is administered about 2 cm away from the tendon. We identified 2 patients who presented with spontaneous EPL tendon rupture owing to steroid injection. These patients reported no risk factors or inciting event other than steroid injection. EPL were operatively repaired in two cases. At the 2-year follow-up, patients could completely extend the thumb. The cases were from the Eastern Mediterranean region of Turkey. Conclusion: In patients with unexpected loss of extension of the thumb interphalangeal joint, with a history of steroid injection, rupture of EPL tendon should be considered even if it was administered to remote location.Öğe Treatment of secondary hip arthritis from shell fragment and gunshot injury in the Syrian civil war(Bmc, 2020) Ozden, Raif; Davut, Serkan; Dogramaci, Yunus; Kalacı, Aydıner; Duman, Ibrahim Gokhan; Uruc, VedatBackground In gunshot and shell fragment injuries to the hip joint, orthopedic intervention includes wound assessment and care, osteosynthesis of fractures, and avoiding of infection and osteoarthritis. Individuals injured in the Syrian civil war were frequently transferred to the authors' institution in neighboring city. Orthopedic trauma exposures were determined in approximately 30% of these patients. The aim of this study was to evaluate the outcomes of the patients with secondary hip arthritis due to prior gunshot and shell fragment (shrapnel) injuries who underwent primary total hip arthroplasty. Methods This retrospective study reviewed 26 patients (24 males, 2 females) who underwent hip arthroplasty due to prior gunshot and shell fragment injuries from November 2013 to January 2019. For all patients, the Harris Hip Score (HHS) was evaluated preoperatively and after surgery. Results Mean age was 31.5 (range, 19-48) years. The mean preoperative HHS was 52.95 points, and the mean postoperative HHS was 79.92 points at the final follow-up after surgery. Patients with shell fragment injuries to the hip joint had higher infection rates, but it is not statistically significant. Conclusions An anatomic reduction of the fracture may not be possible in these cases as a result of significant bone and/or cartilage loss. Total hip arthroplasty can be done after gunshot- and shell fragment-related posttraumatic arthritis. It is an effective treatment choice to reduce pain and improve function, but the surgeon must be very careful because of high rate of infection.Öğe Urotensin II (U-II), a novel cyclic peptide, possibly associated with the pathophysiology of osteoarthritis(Elsevier Science Inc, 2014) Gogebakan, Bulent; Uruc, Vedat; Ozden, Raif; Duman, Ibrahim Gokhan; Yagiz, Abdullah Erman; Okuyan, Hamza Malik; Aldemir, OzgurSynovial fibrosis is one of the main outcomes of osteoarthritis. Some authors have reported that urotensinII (U-II) may cause pathologic fibrosis in cardiovascular system, lung and liver. However there are no previous reports available in the literature about its relationship with the synovial fibrosis in osteoarthritis. The aim of this study was to compare the U-II levels in knee synovial fluids obtained from osteoarthritic and non-osteoarthritic patients. Two groups were created, the osteoarthritis group and non-osteoarthritic control group. The control group was consisted of patients who underwent arthroscopic surgery for other reasons than cartilage disorders. In the osteoarthritis group all patients had grade 4 primer degenerative osteoarthritis and were treated with total knee arthroplasty. Minimum 1 mL knee synovial fluids were obtained during operation. Levels of U-II were measured by using ELISA kit U-II levels were significantly higher in the osteoarthritic group than that in the control group. No correlation was found between U-II levels and age. In conclusion, the significantly high U-II levels in the knee synovial fluid of osteoarthritic patients supported our hypothesis that U-II may be associated with the synovial fibrosis in osteoarthritis.(c) 2014 Elsevier Inc. All rights reserved.
