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  • Küçük Resim
    Öğe
    Biomechanical comparison of fixation of two-part osteoporotic neck fracture of the proximal humerus using uni-planar and multi-planar Kirschner wire
    (2009) Esen, Erdinç; Doğramacı, Yunus; Kömürcü, Mahmut; Kanatlı, Ulunay; Bölükbaşı, Selçuk; Atahan, Ali Osman
    Objectives: The stability and effectiveness of uni-planar Kirschner wire (K-wires) was compared to multi-planar K-wires osteosynthesis combined with tension band wiring for fixation of two-part osteoporotic surgical neck fracture of the proximal humerus. Materials and methods: Two groups each with eight cadaveric elderly (mean age 72.6; range 70 to 80 year) frozen human humeri were used in the study. Transverse osteotomy of the proximal humerus was performed using a thin oscillating saw. The first group (group A) was fixed using two anterograde smooth K-wires, sent from lateral cortex, combined with tension band wiring. The second group (group B) was fixed using multi-planar (anterograde and retrograde) four smooth K-wires combined with tension band wiring on the lateral cortex. Biomechanical tensile properties for 3 mm displacement (gap load) and maximum load were assessed. Results: The mean value for the gap load was 1045.0±45.4 N (Newton) for group A and 1238.1±115.8 N for group B. Gap load values of groups were similar (p=0.01). The maximum load was 1261.8±52.4 N in group A and 1471.1±107.3 N in group B. The maximum load values were statistically higher in the multiplanar fixation technique (group B) when compared to that of the uniplanar fixation technique (group A), (p=0.004). Conclusion: Fixation in osteoporotic two-part surgical neck fractures of the proximal humerus using multiplanar K-wires combined with tension band wire provides substantially more effective stability compared to that of uniplanar fixation.
  • Küçük Resim
    Öğe
    Çocuklarda suprakondiler humerus kırıklarının açık-kapalı redüksiyon ve internal tespitle tedavisinde radyasyon sürelerinin karşılaştırılması
    (2009) Esen, Erdinç; Doğramacı, Yunus; Gültekin, Serap; Görmeli, Gökay; Yıldırım, Ahmet; Kanatlı, Ulunay; Bölükbaşı, Selçuk
    Amaç: Çocuklarda yer değiştirmiş suprakondiler humerus kırıklarında uyguladığımız K-teli ile yapılan iki tedavi yöntemi (Açık redüksiyon internal tespit-ARİF, Kapalı redüksiyon internal tespit, KRİF), ameliyat süresi ve radyasyona maruz kalma süresi açısından karşılaştırıldı. Çalışma planı: Yer değiştirmiş suprakondiler humerus kırığı (Gartland tip 3) tanısıyla cerrahi tedavi uygulanan 124 hasta (76 erkek, 48 kız) geriye dönük olarak incelendi. Elli iki hastaya (ort. yaş 7.5±2.8) ARİF, 72 hastaya (ort. yaş 6.1±2.5) KRİF uygulandı. İki gruptaki ameliyat süresi ve floroskopi uygulama süresi kaydedildi. Hastalar son takiplerde, eklem hareket açıklığı, varus-valgus açılanma derecesi, damar sinir muayenesi ve kozmetik görünüm açısından değerlendirildi. Fonksiyonel ve kozmetik sonuçların değerlendirilmesinde Flynn ve ark.nın ölçütleri kullanıldı. Ortalama takip süresi ARİF grubunda 49.3±18.6 ay, KRİF grubunda 50.4±17.9 ay idi. Sonuçlar: Tüm olgularda altıncı hafta sonunda radyografik kaynama görüldü. Kozmetik ve fonksiyonel açıdan iki grup arasında anlamlı fark saptanmadı (p>0.05). Mükemmel ve iyi sonuç oranı KRİF grubunda %90.3, ARİF grubunda %86.6 bulundu. Ortalama ameliyat süresi, KRİF grubunda 44.2±12.6 dk, ARİF grubunda 28.3±8.2 dk bulundu. Ortalama floroskopi uygulama süresi, KRİF grubunda 36.0±15.3 sn, ARİF grubunda 11.7±4.5 sn idi. Ameliyat süresi ve floroskopi süresinin KRİF grubunda anlamlı derecede uzun olduğu görüldü (p=0.000). Çıkarımlar: Uzamış skopi kullanımı radyasyona maruz kalmayı artırdığından, yer değiştirmiş suprakondiler humerus kırıklarında ARİF yönteminin tercih edilmesini öneriyoruz.
  • Küçük Resim
    Öğe
    Double plate osteosynthesis provides better biomechanical stabilization than double tension band technique in distal humerus fractures
    (2010) Doğramacı, Yunus; Esen, Erdinç; Kürklü, Mustafa; Kırıcı, Yalçın; Atahan, Ali Osman; Kömürcü, Mahmut
    Objectives: In this study we evaluated the stability and effectiveness of the double tension band osteosynthesis technique compared to the double plate osteosynthesis technique used for fixation of distal humerus fractures. Materials and methods: The study was performed on two groups, and in each group eight cadaveric, elderly (mean age 70-80) human humeri was used. An osteotomy was performed in the supracondylar region using a manual saw. The first group (group 1) was fixed with double 3.5 mm reconstruction plates, while the second group (group 2) was fixed with the double tension band technique, using crossing Kirschner wires. The osteotomy was designed so that the distal fragment would allow only a single screw per plate. The constructs were evaluated using a material testing machine. A linear non-cyclic load was applied until the failure of the constructs. The force which produced a 3 mm gap (3 mm gap strength), as detected visually with the aid of operating loupes, and the maximum load prior to failure of the fixation (maximum force) were measured from all tests. Results: The mean value for the 3 mm gap strength was 1356.29±226.97 N for group 1 and 882.63±305.21 N for group 2. The mean value of the maximum load strength was 1487.13±298 N for group 1 and 1232±107.62 N for group 2. There were significant differences in 3 mm gap strengths of the two groups (p=0.005). There was also a significant difference in the maximum load between the two groups (p=0.016). Conclusion: Double plate osteosynthesis technique is superior to double tension band osteosynthesis for the fixation of distal humerus fractures.