Browsing by Author "Gokalp, Mehmet Ata"

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Clinical Results of Decortication With Bone Grafting Method Versus Extracorporeal Shock Wave Treatment in Long-Bone Pseudoarthrosis
(int Scientific information, inc, 2023) Gokalp, Mehmet Ata; Unsal, Seyyid Serif; Guner, Savas; Turkozu, Tulin; Guven, Necip
Background: Despite advanced treatment methods, the treatment of pseudoarthrosis still poses a significant challenge for orthopedists. In this study, we aimed to assess the clinical results of decortication and bone grafting and ex-tracorporeal shock wave treatment (ESWT) in long-bone pseudoarthrosis.Material/Methods: Between 2007 and 2015, 68 fractures of 66 patients treated for long-bone pseudoarthrosis were evaluated retrospectively. ESWT was used in 36 extremities and decortication and iliac bone grafting was used in 32. The treatment results of these patients were evaluated and compared with rates in the literature. Results: The mean patient age was 43.9 years (range, 21-69). The mean interval between the occurrence of the frac-ture and treatment with bone grafting or ESWT was 8.6 months and the mean interval between the procedure and achievement of union was 6.9 months. The patients were followed up for a mean period of 25.2 months. After the mean follow-up period, bone union had occurred in all 32 patients (100%) in the decortication and bone grafting group and in 28 (78%) of the 36 patients in the ESWT group (P=0.023).Conclusions: This study shows that extracorporeal shock wave treatment should be considered the first option in treatment of pseudoarthrosis as it is a non-invasive method and also provides good rates of union. In patients that do not heal with ESWT, decortication and bone grafting remains the criterion standard therapy.
Comparison of Long-Term Clinical and Radiologic Outcomes of Aperfix and Fixed Loop Device Fixation in Anterior Cruciate Ligament Reconstruction: a Retrospective Study
(Lippincott Williams & Wilkins, 2025) Kaya, Sehmuz; Guven, Necip; Unal, Yunus Can; Ozkan, Sezai; Adanas, Cihan; Turkozu, Tulin; Gokalp, Mehmet Ata
Anterior cruciate ligament reconstruction aims to improve knee stability and range of motion. The AperFix system consists of polymer components, and fixed-loop fixation is an established endoscopic technique. Our aim in this study was to compare the long-term clinical and radiological results of AperFix and fixed-loop fixation and to prove that the long-term results of the AperFix fixation method are at least as good as those of the fixed loop device. This retrospective study included 109 patients who underwent primary anterior cruciate ligament reconstruction using single bundled hamstring tendon grafts. Patients under 16 years of age, patients with incomplete follow-up, bilateral or other ligament injuries, inflammatory arthropathy, previous knee surgery, or concurrent meniscal treatment were excluded. Participants were divided into 2 groups according to femoral fixation methods: AperFix fixation (group 1, n = 55) and fixed loop device fixation (group 2, n = 54). All operations were performed by senior surgeons under general or spinal anesthesia. Postoperative rehabilitation started on day 1 and allowed patients to resume normal activities at 6 months. Outcomes were evaluated during follow-up, including knee range of motion, clinical scores [Lysholm, Cincinnati, Tegner, and International Knee Documentation Committee] and radiographic measurements of femoral tunnel width and length. Measurements were performed by 2 orthopedic surgeons to ensure reliability. This study evaluated 109 patients (55 in group 1, 54 in group 2) and found no statistically significant differences in demographic variables such as age, sex, body mass index, follow-up duration, or side distribution. Clinical outcomes, including anterior drawer test, Lachman test results, knee flexion-extension degrees, and Lysholm, Cincinnati, Tegner, and International Knee Documentation Committee scores, were similar between the groups (P > .05). Complications occurred in 8 cases (rerupture, infection, and deep vein thrombosis), with no significant correlation to the fixation method used (P = .506). Radiographic analysis revealed no significant differences in femoral tunnel width or length between the groups (P > .05). In our current study, no meaningful disparity was found between the AperFix and fixed loop device methods in terms of long-term clinical outcomes. As there are no long-term studies on the results of AperFix fixation in the literature, more studies on this subject are needed.
Effect of Zofenopril on Regeneration of Sciatic Nerve Crush Injury in a Rat Model
(Thieme Medical Publ inc, 2009) Kalender, Ali Murat; Dogan, Ali; Bakan, Vedat; Yildiz, Huseyin; Gokalp, Mehmet Ata; Kalender, Mahmut
Background: Zofenopril is an antioxidant agent which has been shown to have beneficial effects in hypertension and heart failure. The aim of this study was to test the effects of Zofenopril on nerve regeneration and scarring in a rat model of peripheral nerve crush injury. Methods: Twenty-one adult Sprague-Dawley rats underwent a surgical procedure involving right sciatic nerve crush injury. 15 mg/kg Zofenopril was administered orally to seven rats in group Z for seven days. Seven rats in group S received saline orally for seven days. Seven rats in the control group C received no drug after crush injury. Fourteenth and 42nd days after injury, functional and electromyography assessments of nerves were performed. Functional recovery was analyzed using a walking track assessment, and quantified using the sciatic functional index (SFI). After these evaluations, all rats were sacrificed and microscopic evaluations were performed. Results: The Sciatic functional Index (SFI) in group Z on 14th day is different significantly from group S and group C (p = 0.037). But on 42nd day there was no difference between groups (p = 0.278). The statistical analyses of electromyelographic (EMG) studies showed that the latency in group Z is significantly different from group S (p = 0.006) and group C (p = 0.045). But on 42nd day there was no difference between groups like SFI (p = 0.147). The amplitude was evaluated better in group Z than others (p < 0.05). In microscopic evaluation, we observed the highest number of nerve regeneration in the group Z and the lowest in the group C. But it was not significant statistically. Conclusion: Our results demonstrate that Zofenopril promotes the regeneration of peripheral nerve injuries in rat models.
Effectiveness of Etofenamate for Treatment of Knee Osteoarthritis: a Randomized Controlled Trial
(Dove Medical Press Ltd, 2016) Guner, Savas; Gokalp, Mehmet Ata; Gozen, A. Bdurrahim; Unsal, Seyyid Serif; Guner, Sukriye Illkay
The intramuscular application of etofenamate in the treatment of knee osteoarthritis was not observed in the existing English language literature. The objectives of this study were to compare the efficacy of etofenamate versus hyaluronic acid ( HA) in reducing joint pain and functional improvement for mild to moderate knee osteoarthritis. The patients were randomly divided into etofenamate ( n=29) and HA ( n=30) groups. Intramuscular etofenamate injection was administered as a series of seven intramuscular injections at intervals of 1 day. Intra-articular HA injection was administered as a series of three intra-articular injections at intervals of 1 week. Clinical evaluation was made before the first injection and again both 6 and 12 months after the last injection. The evaluation consisted of patient-assessed pain on a visual analog scale ( VAS) and on the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC). Statistical significance was found for the etofenamate group when comparing preinjection with 12 months postinjection VAS scores ( P<0.05). Statistical significance was also found for the HA group when comparing preinjection with 12 months postinjection VAS and WOMAC scores ( P<0.05). However, there was no significant difference between the etofenamate and HA groups in terms of VAS or WOMAC scores measured at 12 months after injection ( P>0.05). Results from this study indicated that, etofenamate treatment was not significantly more effective than HA treatment. However, both methods were effective and successful in treating knee osteoarthritis.
Effectiveness of Local Tenoxicam Versus Corticosteroid Injection for Plantar Fasciitis Treatment
(Slack inc, 2013) Guner, Savas; Onder, Haci; Guner, Sukriye Ilkay; Ceylan, Mehmet Fethi; Gokalp, Mehmet Ata; Keskin, Siddik
Plantar fasciitis is one of the most common causes of foot pain in adults. In this prospective study, the outcomes of local tenoxicam injection and corticosteroid therapy for the treatment of plantar fasciitis were compared. Patients were randomly assigned to either the tenoxicam or corticosteroid group. The tenoxicam group (n=31) was treated using a local injection of 1 mL of tenoxicam (20 mg/2 mL) and 1 mL of 2% lidocaine, whereas the steroid group (n=30) was treated with a local 1-mL injection containing 40 mg of methylprednisolone acetate and 1 mL of 2% lidocaine. Clinical evaluations, which were performed before the injection and 6 and 12 months after the injection, consisted of patient-assessed pain using a visual analog scale. In addition, patient satisfaction was measured using the Roles and Maudsley score. Comparison of pre- and posttreatment visual analog scale scores demonstrated a statistically significant difference in both groups (P<.05). Furthermore, no significant difference was found between the steroid and tenoxicam groups in terms of visual analog scale scores measured 12 months after injection (P>.05). The tenoxicam injection was not significantly more effective than the corticosteroid injection. However, both methods were effective and successful in treating patients with plantar fasciitis. Tenoxicam therapy appears to provide pain relief, but its effectiveness in the long term should be explored in additional studies.
Ender Nail Applications in Femoral Diaphysis Fractures
(derman Medical Publ, 2012) Cakan, Albert; Ceylan, Mehmet Fethi; Cuner, Savas; Gokalp, Mehmet Ata; Dogan, Au
Aim: Although the femoral shaft fractures are treated conservatively for up to 6 years in children, surgical treatment should be considered in patients with femoral shaft fractures in school age or in those who have multiple long-bone fracture or organ injury. But it is a controversial issue which surgical treatment is ideal. Material and Method: Twenty-nine femoral fractures of 26 patients whose surgical treatment of femoral shaft fractures were made with Ender nails were prospectively evaluated. Under general anesthesia, 4,5 mm of 2 Ender nails were performed from the metaphysis to all of the patients. The patients were evaluated according to the type of the fracture, duration of the union, the discrepancy of shortening-length, the rotation, limitation of the joint movement, the complications such as refractures and the criterions of Flynn in terms of the clinical outcomes. Results: The mean age of the patients was 9.2 years (4-14). The type of the fracture was Winquist Hansen type 2 and 3. The mean duration of the follow-up was 18 months (13-38). While the etiology of the fractures was the traffic accidents in twenty of the patients, gunshot wounds and falling from height were in the others. The mean duration of the union was 6.5 (5-8) weeks in all patients. The discrepancy of shortening-length was an average of 6 mm (2-20), the difference of the rotation was an average of 3 degree (2-7), and the angulation of varus-valgus was an average of 4 degrees (2-9) in the femurs which were treated in the patients. The limitation of the movement in the knee joint was of an average 5 degrees (3-10) as the flexion and extension. None of the patients developed refractures. Excellent result in 20 fractures, good result in 7 fractures and bad result in 2 fractures were observed according to the criterions of Flynn. Discussion: Ender nail should be considered first for the possibility of early return to school, the low risk of refracture and the price advantage in the surgical treatment of femoral shaft fractures in children aged 5 and above.
Evaluation of Severity Score in Patients With Lower Limb and Pelvic Fractures Injured in Motor Vehicle Front-Impact Collisions
(int Scientific information, inc, 2016) Gokalp, Mehmet Ata; Hekimoglu, Yavuz; Gozen, Abdurrahim; Guner, Savas; Asirdizer, Mahmut
Background: Lower limb and pelvic injuries and fractures occur at a very high incidence in motor vehicle accidents. In this study, the characteristics (e.g., body side, bone location, and fracture severity) of lower limb and pelvic fractures that occurred during front-impact collisions were correlated with the injured patients' sex, age, and position in the vehicle. Material/ Methods: We retrospectively evaluated 191 patients (136 males, 55 females) who were injured in motor vehicle accidents, specifically in frontal collisions. Results: This study revealed that most of lower limb and pelvic fractures occurred in males (71.2%; p=. 000), 19-36 years old (55.5%; p=. 000), small vehicles (86.4%; p=. 000), and rear seat passengers (49.2%; p=. 000). Fractures most commonly occurred in the left side of the body (46.6%; p=. 000) and upper legs (37.7%; p=. 000). Severity scores were higher (2.76) in males than females (2.07). No statistically significant was found in severity scores of patients and other personal characteristics and fracture features of patients with lower limb and pelvic fractures who were injured in a vehicle during front-impact collisions (p> 0.05). Conclusions: The results of this study will be useful for the automobile industry, forensics and criminal scientists, and for trauma research studies.
Ewings Sarcoma of the Finger
(Medknow Publications & Media Pvt Ltd, 2014) Gokalp, Mehmet Ata; Kaplanoglu, Veysel; Unsal, Seyyid Serif; Erten, Remzi
Ewings sarcoma is a mesenchymal cell tumor usually seen in long bones but very rarely seen in the bones of a finger. Swelling and pain are the most common complaints of the affected finger. In radiological imaging, it may be seen as permeative bone destruction accompanied by a soft tissue component or an expansile bone lesion. A 27-year-old right-hand dominant female patient presented with a swelling on the proximal phalanx of her right 3 (rd) finger that had existed for 3 years. However, the mass started to gradually increase in size and the pain worsened over a period of 5 weeks. The mass was excised under regional intravenous anesthesia and Ewings sarcoma was confirmed following a histopathological evaluation. No local recurrence or metastasis was detected 1 year after surgery. Since Ewings sarcoma is rarely seen in the finger, we present this case with its radiological and clinical findings.
Hip Dislocation and Physis Separation Related To the Delayed Diagnosis of Septic Arthritis - Case Re
(derman Medical Publ, 2014) Gokalp, Mehmet Ata; Ceylan, Mehmet Fethi; Guner, Savas; Turktas, Ugur; Ediz, Levent
If the diagnosis of the hip septic arthritis is delayed, serious complications such as the arthrosis in joint, the separation of epiphyseal, osteomyelitis and sepsis can develop. The presence of the accompanying infectious diseases contributes to the delay of the diagnosis. In order to get rid of the late period sequelaes of septic arthritis, the required tests should be asked for the differential diagnosis of this disease in each patient presenting with hip pain. In this paper we presented 13 years old pediatric patient who was treated with the diagnosis of pneumonia developed joint dislocation together with the physis separation of the femoral head because of delayed diagnosis of accompanying hip septic arthritis.
The Impact of Early Weight-Bearing on Results Following Anterior Cruciate Ligament Reconstruction
(Bmc, 2024) Kaya, Sehmuz; Unal, Yunus Can; Guven, Necip; Ozcan, Can; Dundar, Abdulrahim; Turkozu, Tulin; Gokalp, Mehmet Ata
Introduction Anterior cruciate ligament (ACL) ruptures are common injuries that typically affect young, physically active individuals and may require surgical reconstruction. Studies have shown that the long time success of ACL reconstruction depends on the surgical technique and the postoperative rehabilitation strategy. However, there is still no consensus on the content of rehabilitation programs. Hence, additional research is required to elucidate the significance of early weight-bearing in the rehabilitation process following ACL reconstruction. The aim of this article is to examine the impact of weight-bearing on the clinical results of ACL reconstruction.Materials and methods We retrospectively reviewed patient records who had undergone arthroscopic reconstruction using a semitendinosus-gracilis tendon graft for anterior cruciate ligament rupture between January 2018 and December 2020. The study included the data of 110 patients. The patients were split into two groups: Group 1 underwent early weight-bearing, while Group 2 followed a non-weight-bearing regimen for three weeks. We assessed the patients using the anterior drawer test, Lachman test, range of motion, Lysholm knee scale, Cincinnati scale, Tegner scale, International Knee Documentation Committee (IKDC) form and clinical records. Analytical tests were conducted to compare the results.Results The complication rates did not show a significant difference between the groups. Group 1 had higher frequencies of positive anterior drawer and Lachman tests. The Lysholm and Cincinnati knee scores of patients in Group 1 were notably lower than those of patients in Group 2. Additionally, the Tegner activity scores and IKDC scores of patients in Group 1 were also meaningfully lower than those of patients in Group 2. In Group 1 patients, there was no notable relationship observed between body mass index (BMI) and the results of the anterior drawer test (ADT) or Lachman test. However, patients with a BMI of 25 or higher in Group 1 showed a decrease in postoperative IKDC scores. In Group 2 patients, no significant relationship was identified between BMI and either the ADT or the Lachman test outcome.Conclusion Based on current literature and current rehabilitation guidelines following ACL reconstruction, the decision to initiate early weight-bearing is based on a limited number of studies with low levels of evidence. In our study, we found that patients who followed a non-weight-bearing regimen for 3 weeks after surgery had better mid-term results than those who were allowed to bear weight early. It appears that further prospective studies on this topic are needed to update rehabilitation guidelines in the next.
Insall-Salvati Index Is Associated With Anterior Cruciate Ligament Tears in Men: a Case-Controlled Study
(Sage Publications Ltd, 2022) Guven, Necip; Ozkan, Sezai; Turkozu, Tulin; Yokus, Adem; Adanas, Cihan; Gokalp, Mehmet Ata; Tokyay, Abbas
Purpose Many factors in the etiology of anterior cruciate ligament (ACL) tears, predisposing factors related to knee morphology have also been reported. This study aimed to determine whether the Insall-Salvati (IS) index, which measures patella height, is a predisposing risk factor for ACL tears. Methods The IS index, patellar length (PL), and patellar tendon length (PTL) values of patients (study group) that underwent arthroscopic reconstruction for ACL tears obtained by preoperative magnetic resonance imaging (MRI) were compared with the index values in the preoperative MRIs of patients that underwent knee arthroscopy for reasons besides ACL tears. In addition, the anterior tibial translation (ATT) of both groups was also measured and compared on MRI images. The MRI findings of the subjects included in both study groups were arthroscopically confirmed. Results The mean ages of the study group (n = 120) and control group (n = 90) were 29.1 +/- 8.2 years and 31.8 +/- 9.8 years, respectively. There was a statistically significant difference between the study and control groups in terms of the PL and PTL values (p = 0.016 and p = 0.001, respectively). The IS index was statistically significantly higher in the study group with ACL tears (p = 0.009). The ATT was 8.61 +/- 4.68 mm in the study group and 3.80 +/- 1.92 mm in the control group. The ATT results of both groups were evaluated, and it was found that the study group was significantly higher than the control group (p = 0.001) Conclusions As a result of our current study, we observed higher IS index values in patients with ACL tears than in patients without ACL tears. It should be kept in mind that patella alta, which is associated with a high IS index as one of the factors of knee morphology associated with ACL tears, may play a role in the etiology of ACL tears.
Our Ender Nailing Applications in Pediatric Tibial Shaft Fractures
(derman Medical Publ, 2012) Cakar, Albert; Ceylan, Mehmet Fethi; Guner, Savas; Gokalp, Mehmet Ata; Dogan, Ali
Aim: Although tibial shaft fractures in children are mostly treated conservatively. Surgical treatment should be considered in patients in school age with the tibial shaft fracture or with multiple long-bone fracture or who have organ injury. The patients treated their tibia shaft fractures with Ender nail are presented in this article. Material ans Method: Two tibia Ender nails been 3.5 mm in appropriate length were performed under general anesthesia to the 13 fractures of 12 patients, all of whom were children and 9 out of whom were men. Long-leg splint was used for 2 weeks after the surgery. The patients were allowed to go to school after 10 days. Patients were evaluated according to Flynn criteria in terms of the clinical outcome and infection with their follow-up X-rays and examination and the type of the fracture, duration of the union, shortening-length difference, rotation, limitation of the joint motion, refracture. Results: The mean age of the patients was 8,6 years (4-15). The type of the fracture was Winquist type 2 and 3 in all of the patients. The mean duration of the follow-up was 20 months (14-40). Two of the existing-open fractures were type 1 and one of them was type 2 in three patients. In the difference of the length and shortening in treated tibias in patients was an average of 7 mm (2-21), the difference of the rotation was 4 degrees (2-8), and the angulation of varus-valgus was an average of 5 degrees (2-10). None of the patients developed refractures. A perfect result in 5 fractures, a good result in 7 fractures and a bad result in 1 fracture were taken according to the criteria of Flynn. Discussion: Ender nail should first be considered in the surgical treatment of the tibial shaft fractures in children over the age 4 because of the early return to school, low of the refracture risk after the detection and the price advantage.
The Outcomes of Acetabular Fractures Treated Surgically and Factors Affecting the Result The Results of Acetabular Fractures
(derman Medical Publ, 2018) Guven, Necip; Gokalp, Mehmet Ata; Unsal, Seyyid Serif; Turkozu, Tulin; Guner, Savas
Aim: The aim of this study was to evaluate the radiological and clinical outcomes of surgically treated acetabular fractures. Material and Method: A total of 30 patients with acetabular fracture who had presented to the Orthopedics and Traumatology Department of Yuzuncu Yil University Medical Faculty between January 2009 and December 2013 and undergoing surgery were included in the study. The number of males was 25 (83.3%), and the number of females was 5 (16.7%). The ages of the patients varied between 18 and 68 (mean: 40) years. The indications for surgery were: more than 3 mms of dislocation in one of the three X-Rays obtained (antero-posterior, obturator oblique and iliac oblique), intra-articular piece of the fracture and posterior instability. Results: 20 (66.7%) and 10 (33.7%) patients had acetabular fractures in the right and left hips, respectively. The most common cause of trauma was falling from a height. According to the classification of Letournel, 18 patients (60%) had complex and 12 patients (40%) had simple fractures. 13 patients (43.5%) had additional traumatic hip dislocation. Following the surgical intervention, 13 patients (43.3%) had anatomical reduction and 4 (13.3%) had poor reduction. The patients were followed-up for a mean duration of 28 months. According to the radiological criteria of Matta, 13 patients (43.3%) had excellent, 11 (36.6%) had good, 4 (13.3%) had moderate, and 2 (6.6%) had poor outcomes. According to the clinical recovery criteria of Merle d'Aubigne and Postel, 7 patients (23.3%) had very good, 15 (50%) had good, 4 (13.3%) had moderate, and 4 (13.3%) had poor outcomes. Discussion: It was concluded that the quality of reduction affected the clinical and radiological outcomes, and that this effect depended on the simple or complex nature of the fracture. Successful and satisfactory results may be obtained by selecting the correct incision method for the fracture type, advanced surgical experience and careful post-operative patient follow-up.
Serum Antioxidant Enzyme and Oxidative Stress Levels in Patients With Developmental Dysplasia of the Hip: a Preliminary Study
(Parlar Scientific Publications (p S P), 2018) Guner, Savas; Guner, Sukriye Ilkay; Gokalp, Mehmet Ata; Unsal, Seyyid Serif; Demir, Halit
This study was conducted based on the hypothesis that serum antioxidant activity and oxidative stress could be associated with developmental dysplasia of the hip. The purpose of this study was to investigate prospectively the relationship between serum antioxidant levels and developmental dysplasia of the hip. This study included 27 patients with developmental dysplasia of the hip (18 females, 9 males; mean age 24.3 +/- 6.3 months, range 18-36 months) and 26 healthy controls (15 females, 11 males; mean age 23.8 +/- 5.4 months, range 18-36 months) who were free of symptoms. Venous blood samples were taken all of the participants and serum superoxide dismutase, malondialdehyde, glutathione, and catalase levels were evaluated. The serum malondialdehyde level was found to be statistically significantly higher in patients with developmental dysplasia of the hip than controls. Serum superoxide dismutase, glutathione and catalase levels were found to be statistically significantly lower in patients with developmental dysplasia of the hip than controls. Our results may show that serum antioxidant activity and oxidative stress parameters may be adjunctive tools for the diagnosis in patients with developmental dysplasia of the hip. This is a preliminary study, and further prospective randomized clinical studies with larger sample sizes are needed to elucidate whether these alterations are consistent and clinically relevant.
Treatment and Management of Complications in Pediatric Forearm Fractures
(Galenos Publ House, 2021) Tokyay, Abbas; Ozkan, Sezai; Guven, Necip; Turkozu, Tulin; Adanas, Cihan; Gokalp, Mehmet Ata
BACKGROUND/AIMS Forearm diaphyseal fractures are common in children. While closed reduction and casting are sufficient in most patients, surgical treatment is required in some cases. The aim of this study is to determine the possible causes of complications occurring in patients with intramedullary fixation with nail (IMN), as well as to evaluate the management of complications and their final results. MATERIAL and METHODS Between January 2017 and January 2020, 53 children under the age of 16 who had forearm fractures and surgically treated with IMN were included in the study. Demographic data of the patients, type of surgery, surgical technique, postoperative care, complications, and treatment modalities of complications were evaluated. RESULTS The mean age of 53 patients (41 boys and 12 girls) included in this study was 10.5 +/- 2.4 years. The average follow-up period of all our patients was 23.4 months (12-34 months). Complications in our study were seen in 14 (26.4%) patients. These complications included pintrack infection in six (11.3%), refracture in four (7.5%), injury of superficial branch of radial nerve in Iwo (3.7%), extensor pollicis bogus rupture in one (1.8%), and pin migration in one (1.8%) patient. CONCLUSION As a result of the treatment and management of these complications, mild hypesthesia persisted along the superficial branch of the radial nerve in only one case, and all other complications were fully recovered. Successful management of complications can be achieved with close follow-up and appropriate treatment.