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Öğe Comparison of Surgical Treatment and Conservative Approach for Type III Acromioclavicular Dislocations(Ortadogu Ad Pres & Publ Co, 2011) Esen, Erdinc; Ozturk, Akif Muhtar; Dogramaci, Yunus; Kanatli, Ulunay; Bolukbasi, SelcukObjective: In this study, we aimed to compare the effectiveness and the results of surgical (modified Weaver-Dunn) and conservative treatment techniques for Rockwood type III acromioclavicular dislocation. Material and Methods: Thirty four patients with acromioclavicular dislocation were included in this study. The mean age was 43.6 +/- 10.2 years (range 21-60). Modified Weaver-Dunn technique was performed on 17 patients. The mean operation time after the trauma was 12 +/- 6.9 days (range 3-24 days). The remaining 17 patients were treated conservatively with an acromioclavicular bandage. The range of motion and strengthening of the shoulder muscles started during the sixth week of treatment in both groups. The mean follow up period of both groups was 32.8 +/- 12.1 months (range 12-72). Results: No complication occurred in either groups. According to Poigenfurst's criteria, the results were classified as good or excellent in both groups. No statistically significant difference was found between the results of the groups according to Poigenfurst's criteria (p> 0.05). Conclusion: Treatment modalities of type III acromioclavicular dislocation remain controversial. Satisfactory results have been reported when Modified Weaver-Dunn techniques were performed initially to young, active, laborer and athletes with acromioclavicular dislocation of the dominant extremity. In this study, we did not find a significant difference between surgical treatment and conservative approach in terms of measurements of functional outcomes. We concluded that the treatment of stage III dislocation can be modified according to the personal characteristics and the expectations of the patient. Current data indicates that both treatment modalities can be satisfactory.Öğe Does strand configuration and number of purchase points affect the biomechanical behavior of a tendon repair? A biomechanical evaluation using different Kessler methods of flexor tendon repair(2008) Dogramaci, Yunus; Kalacı, Aydıner; Sevinç, Teoman Toni; Esen, Erdinc; Komurcu, Mahmut; Yanat, Ahmet NedimThis study compares the mechanical properties of modified Kessler and double-modified Kessler flexor tendon repair techniques and evaluates simple modifications on both methods. Forty fresh sheep flexor tendons were divided equally into four groups. A transverse sharp cut was done in the middle of each tendon and then repaired with modified Kessler technique, modified Kessler with additional purchase point in the midpoint of each longitudinal strand, double-modified Kessler technique, or a combination of outer Kessler and inner cruciate configuration based on double-modified Kessler technique. The tendons were tested in a tensile testing machine to assess the mechanical performance of the repairs. Outcome measures included gap formation and ultimate forces. The gap strengths of the double-modified Kessler technique (30.85 N, SD 1.90) and double-modified Kessler technique with inner cruciate configuration (33.60 N, SD 4.64) were statistically significantly greater than that of the two-strand modified Kessler (22.56 N, SD 3.44) and modified Kessler with additional purchase configuration (21.75 N, SD 4.03; Tukey honestly significant difference test, P < 0.000). There were statistically significant differences in failure strengths of the all groups (analysis of variance, P < 0.000). With an identical number of strands, the gap formation and ultimate forces of the repairs were not changed by additional locking purchase point in modified Kessler repair or changing the inner strand configuration in double-modified Kessler repair. The results of this study show that the number of strands across the repair site together with the number of locking loops clearly affects the strength of the repair; meanwhile, the longitudinal strand orientation and number of purchase points in a single loop did not affect its strength. © American Association for Hand Surgery 2008.Öğe Effects of a Single Application of Extractum Cepae on the Peritendinous Adhesion An Experimental Study in Rabbits(Lippincott Williams & Wilkins, 2010) Dogramaci, Yunus; Kalacı, Aydıner; Atik, Esin; Esen, Erdinc; Altug, Muhammet Enes; Onel, Ercument; Koc, AhmetPeritendinous adhesion is an important cause of poor functional outcome after flexor tendon repair. The objective of this study was to investigate the effect of a single intraoperative application of extractum cepae, an extract of dietary onion, on the peritendinous adhesion, using a rabbit model of flexor tendon injury. The first, second, and third digits of the right hind paw of 18 rabbits were used for tendon operations. A standard partial division of the synovial sheath and flexor tendon was done at zone II to stimulate the adhesion formation. In the treatment group (n = 9 rabbits, 27 tendons), the flexor tendon sheath was treated with 50 mg/mL of extractum cepae which was applied locally and allowed to infiltrate for 5 minutes, the skin was sutured without suturing the sheath and the tendons. The same operation was done for the control group (n = 9 rabbits, 27 tendons) and 1 mL of normal saline solution was applied locally. Biomechanical and histologic evaluations of the specimens were done after 3 weeks. Tendons from the first toes were used for biomechanical studies. The second and third toe tendons were used for histopathologic evaluation. We have compared the peritendinous adhesions and the ultimate forces in the control and treated tendons. There were no statistically significant differences between the 2 groups with respect to the ultimate loads. Adhesion formation was absent in 1 tendon (5.5%), slight in 8 (44.4%), moderate in 6 (33.3), and severe in 3 tendons (16.7%) in the extractum cepae treated group (n = 18); while in the control group (n = 18), it was absent in 1 tendon (5.5%), slight in 1 tendon (5.5%), moderate in 3 (16.6%), and severe in 13 (72.4%) tendons. There was a significant reduction (P = 0.01) in the peritendinous adhesion in the treated group comparing to the control group. The problem of adhesion formation may be minimized using a single intraoperative application of extractum cepae.Öğe Factors affecting results of patients with humeral proximal end fractures undergoing primary hemiarthroplasty: A retrospective study in 42 patients(Elsevier Sci Ltd, 2009) Esen, Erdinc; Dogramaci, Yunus; Gultekin, Serap; Deveci, Mehmet Ali; Suluova, Fatih; Kanatli, Ulunay; Bolukbasi, SelcukAim: Our study reports long-term results and factors related to patient satisfaction in the case of primary hemiarthroplasty for humeral proximal end fractures. Patients and methods: We retrospectively evaluated 42 patients with humeral proximal end fractures who underwent primary hemiarthroplasty in our clinic from February 1994 to March 2004. Of the 42 patients, 14 (33%) were male and 28 (67%) female. The mean age was 68.9 +/- 5.57 years (age range: 59-81 years). The mean follow-up period was 78.8 +/- 26.6 months (range: 48-118 months). We evaluated the following parameters: fracture type according to the Neer classification, the time interval between the fracture and the operation, postoperative radiological examination, the Neer outcome assessment criteria for patient satisfaction and functions, according to the Constant and Murley Scoring (CMS) system. Results: We found good-to-excel lent outcomes in 36 (85.7%) and poor outcome in six (14.3%) patients according to the Neer criteria. The average values for CMS score, anterior elevation and external rotation were 73.59 +/- 17.95 (25-94), 121.30 +/- 42.99 degrees (range: 30-170 degrees) and 30 degrees (range: 0-80 degrees), respectively. The patients who had been operated in the early period (within 2 weeks) had better functional outcomes (p < 0.001) and had significant pain relief. There was a strong positive correlation between the humeral offset (distance between the head and the tuberosities) and the degree of elevation (r = 0.872, p < 0.001). There was a strong negative correlation between the height of the humeral head and the degree of elevation (r = -0.853, p < 0.001). Conclusion: In humeral proximal end fractures, primary hemiarthroplasty in the early period with the anatomic reconstruction of bone and soft tissues of the shoulder joint and long-term regular rehabilitation programme are important factors contributing to increased patient satisfaction. (C) 2009 Elsevier Ltd. All rights reserved.Öğe Guyon's Canal Syndrome Secondary to Ulnar Artery Stenosis Caused by a Constricting Fibrous Band; a Rare Cause of Ulnar Nerve Compression(Ortadogu Ad Pres & Publ Co, 2011) Dogramaci, Yunus; Kalacı, Aydıner; Esen, Erdinc; Sevinc, Teoman T.; Emir, Anil; Yanat, Ahmet NedimGuyon's canal is not a common site of ulnar nerve compression at the wrist. Ganglia, lipoma, anomalous tendons and muscles, trauma related to an occupation, arthritis, and carpal bone fractures can cause ulnar nerve compression at the wrist. Ulnar nerve compression at Guyon's canal secondary to pathologic conditions involving the ulnar artery is also rare. Ulnar artery aneurysm, tortuous ulnar artery, hemangioma, and thrombosis have been reported in the literature as vascular lesions. However, ulnar nerve compression at Guyon's canal by a constricting fibrous band has not been reported. The authors experienced a case of ulnar nerve compression at Guyon's canal by a constricting fibrous band and the patient's symptoms improved after surgical resection. This report is, to the best of our knowledge, the first on ulnar neuropathy in the Guyon's canal caused by a constricting fibrous band of the ulnar artery. We can not easily predict constricting fibrous band as a cause of ulnar nerve compression at Guyon's canal. However, if there is not an obvious etiology, we should consider a constricting fibrous band as another possible etiology.Öğe Lipoma Arborescens of the Peroneus Longus and Peroneus Brevis Tendon Sheath Case Report(Amer Podiatric Med Assoc, 2009) Dogramaci, Yunus; Kalacı, Aydıner; Sevinc, Teoman Toni; Atik, Esin; Esen, Erdinc; Yanat, Ahmet NedimLipoma arborescens is an uncommon pseudotumoral synovial lesion usually located in the suprapatellar pouch of the knee. Lipoma arborescens involving the synovial sheaths of the tendons is exceedingly rare. This diagnosis should be considered, particularly in patients with chronic joint effusion. We report a case with lipoma arborescens affecting the synovial sheaths of the peroneal tendons without involvement of the adjacent ankle joint. To our knowledge, this is the second reported case of lipoma arborescens involving tenosynovial sheaths of tendons arround the ankle joint without ankle joint involvment. (J Am Podiatr Med Assoc 99(2): 153-156, 2009)Öğe The Prevalence of the Palmaris Longus Agenesis: A Study in Afghan Population(Ortadogu Ad Pres & Publ Co, 2010) Dogramaci, Yunus; Kalacı, Aydıner; Savas, Nazan; Esen, Erdinc; Ucar, Edip; Duman, I. Gokhan; Kanatli, UlunayObjective: Palmaris longus (PL) is a structure often used in reconstructive surgery mainly in the setting of tendon grafting. The palmaris longus agenesis varies depending on the race/ethnicity. Awareness of the prevalence in the treated population or ethnic group is important. The prevalence of palmaris longus agenesis has, to the best of the authors' knowledge, not been reported in Afghan population. Material and Methods: Four-hundred and thirty healthy Afghan subjects (215 males and 215 females) were clinically examined for the presence or absence of palmaris longus. The examination entailed observation of the volar aspect of the wrist, looking for the palmaris longus tendon using Schaeffer's test and Mishra's second test. Results: PL tendon was found to be absent unilaterally in 7.7% and bilaterally in 14.2% of study participants. The overall prevalence of absence of PL (unilateral or bilateral) was 21.9%. Bilateral absence of PL was statistically more frequent than the unilateral absence. The prevalence of absence of PL was statistically similar between the genders and the sites. Conclusion: The prevalence of the palmaris longus agenesis in the Afghan subjects was found to be much higher than the reported average prevalence in the Asian population.Öğe Severe allergic reactions to prilocaine during intravenous regional anesthesia(John Libbey Eurotext Ltd, 2008) Dogramaci, Yunus; Dogramaci, Asena Cigdem; Esen, Erdinc; Korkmaz, Tulay[Abstract Not Available]Öğe Validation of the VISA-A questionnaire for Turkish language: the VISA-A-Tr study(B M J Publishing Group, 2011) Dogramaci, Yunus; Kalacı, Aydıner; Kucukkubas, Nigar; Inandi, Taceddin; Esen, Erdinc; Yanat, A. NedimObjectives To evaluate the validity and reliability of the Turkish version of the Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire for patients with Achilles tendinopathy. Design Fifty-five patients with a diagnosis of Achilles tendinopathy and 55 healthy subjects were included in the study. VISA-A questionnaires were translated and culturally adapted into Turkish. The final Turkish version (VISA-A-Tr) was tested for reliability on healthy individuals and patients. Tests for internal consistency, validity and structure were performed on 55 patients. Results The VISA-A-Tr showed good test-retest reliability (Pearson's r=0.99, p < 0.001). The patients with Achilles tendinopathy had a significantly lower score (p < 0.001) than the healthy individuals. The VISA-A-Tr score correlated significantly with the Stanish tendon grading system (Spearman's r=-0.86; p < 0.001). Conclusion The VISA-A-Tr is a valid and reliable tool for evaluating the severity of Achilles tendinopathy.
