Browsing by Author "Turkozu, Tulin"

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Can Pirfenidone Prevent Tendon Adhesions? an Experimental Study in Rats
(Turkish Joint Diseases Foundation, 2023) Turkozu, Tulin; Guven, Necip; Altindag, Fikret; Tokyay, Abbas; Gokalp, M. Ata; Ismailov, Ulan; Akkol, Suna
Objectives: In this experimental study, we aimed to investigate the effectiveness of oral pirfenidone (PFD) treatment on preventing tendon adhesion and tendon healing in rats. Materials and methods: A total of 21 rats were assigned into three groups including seven rats in each group. In Group 1 (sham group), no surgical procedure was performed. In Group 2 (control group), tendon repair was performed following right achillotomy. In Group 3 (treatment group), the rats also underwent tendon repair after right achillotomy. Additionally, 30 mg/kg of oral PFD was initiated from the postoperative Day 1 and administered via gavage for 28 days. At the end of the study, tendon healing and fibrosis levels in the tendon repair site were compared macroscopically, histopathologically, and immunohistochemically among the groups. Results: Macroscopically, moderate and severe adhesions were observed in four and three rats, respectively in the control group, while no adhesion was found in four rats and filmy adhesions were observed in three rats in the treatment group (p<0.01). Microscopically, there was moderate adhesions in three rats and severe adhesions in four rats in the control group, while three rats had no adhesions and four rats had slight adhesions in the treatment group (p<0.01). Microscopically, tendon healing was good in six rats and fair in one rat in the control group, while five rats showed excellent tendon healing and two rats showed good tendon healing in the treatment group (p<0.01). Immunohistochemically, expressions of collagen I (p<0.01), collagen III (p<0.001), vascular endothelial growth factor (VEGF) (p<0.001), and proliferating cell nuclear antigen (PCNA) (p<0.001) significantly decreased in the treatment group compared to the control group. Conclusion: Our study results indicated that PFD decreased collagen synthesis and prevented the formation of peritendinous adhesion in rats; however, it did not impair tendon healing.
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.
Does Epinephrine Use Reduce Perioperative Blood Loss During Combined Surgery of the Patients With Developmental Dysplasia of the Hip
(Turkish Joint Diseases Foundation, 2023) Turkozu, Tulin
Objectives: In this study, we aimed to investigate whether the use of epinephrine solution-impregnated gauzes and irrigation fluid with epinephrine could reduce perioperative blood loss during the combined surgical treatment of developmental dysplasia of the hip (DDH) patients. Patients and methods: Between January 2018 and June 2023, a total of 68 pediatric patients (8 males, 60 females; mean age: 32.4 +/- 13.2 months; range, 18 to 98 months) who underwent combined surgery for DDH were retrospectively analyzed. The patients were divided into two groups as those who used topical epinephrine in the surgical sites during combined surgical treatment (n=34) and those who did not (n=34). Demographic and clinical characteristics and pre-, intra-, and postoperative data were recorded. To avoid transfusion complications, blood transfusion was performed in only symptomatic patients in the postoperative period. Results: Age, sex, weight, and surgical duration were similar between the two groups (p>0.05). No statistically significant difference was found between the groups in terms of preoperative hemoglobin and hematocrit levels (p>0.05) There were statistically significantly differences between the groups in terms of postoperative hemoglobin and hematocrit levels, perioperative amount of blood loss, and postoperative length of hospital stay (p<0.001). No significant difference was found between the groups in terms of intraoperative hemodynamic parameters (p> 0.05). The differences in perioperative and estimated intraoperative blood loss amounts and length of hospital stay were statistically significant between the groups (p<0.001). There was a significant relationship between the groups in terms of perioperative and estimated intraoperative blood loss, and transfusion of blood products (p<0.01). Blood transfusion was administered to five patients in the no epinephrine group. No local complications were observed in any group; however, one patient had transfusion-related fever and one patient had allergic skin lesions in the no epinephrine group. Conclusion: The intraoperative topical use of epinephrine irrigation solution and epinephrine solution-impregnated gauze dressings is effective and safe in reducing blood loss in DDH patients.
The Effect of Theranekron on Femur Fracture Healing in an Experimental Rat Model
(Turkish Joint Diseases Foundation, 2022) Guven, Necip; Ozkan, Sezai; Turkozu, Tulin; Koc, Serap; Keles, Omer Faruk; Yener, Zabit; Karasu, Abdullah
Objectives: The aim of this study was to investigate the radiological, biomechanical, histopathological and immunohistochemical effects of Theranekron on fracture healing in an experimental rat model. Materials and methods: Forty-eight male albino Wistar rats were used. Four groups were formed, with 12 rats in each of Theranekron groups 1 and 2, and control groups 1 and 2. After a fracture was created in the right femur of the rats included in the study, fixation was performed with an intramedullary Kirschner wire. Theranekron was administered subcutaneously to Theranekron groups 1 and 2 at a dose of 0.3 mg/kg on days 0, 5 and 10. After radiographic analysis of the femurs of Theranekron group 1 and control group 1 rats at four weeks of the study was performed, both groups were divided into two equal subgroups (six femurs in each group). Histopathological and immunohistochemical examinations were performed in one subgroup and biomechanical examination in the other subgroup. At the end of six weeks, the rats in Theranekron group 2 and control group 2 were evaluated after applying the same procedure as in the fourth week. Results: When the mean radiological scores of the Theranekron and control groups were compared, a statistically significant difference was found in favor of the Theranekron group at four and six weeks (p=0.028 and p=0.006, respectively). At four weeks, statistically significant higher biomechanical forces were obtained in the Theranekron group compared to the control group (p=0.030). In the histopathological evaluation, the inflammation value of the control group at four weeks was statistically significantly higher than the Theranekron group (p=0.027). The angiogenesis, osteoblast proliferation, and bone formation values of the Theranekron group were significantly higher than the control group (p=0.014, p=0.014, and p=0.005, respectively). At six weeks, the bone formation values of the Theranekron group were statistically significantly higher than the control group (p=0.021). The difference between the Theranekron group and the control group scores of the immunohistochemical evaluation were statistically significantly different at four and six weeks (p=0.006 and p=0.011, respectively). Conclusion: Theranekron may play a role in accelerating fracture healing by reducing acute inflammation process in the early period of fracture union, increasing fracture strength, angiogenesis, osteoblast proliferation, and bone formation.
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.
Obituary: Colonel Dr. Zeynep Karaosmanoglu: a Trailblazer in Turkish Orthopedics and Traumatology
(Turkish Assoc Orthopaedics Traumatology, 2025) Gonen, Emel; Turkozu, Tulin
One-Stage Combined Surgical Treatment of Developmental Dysplasia of the Hip in the Children Aged Over 18 Months
(Galenos Publ House, 2023) Turkozu, Tulin
BACKGROUND/AIMS: This retrospective study aimed to evaluate the early-term radiological and functional outcomes of one-stage combined surgical treatment in children aged over 18 months with developmental dysplasia of the hip (DDH).MATERIALS AND METHODS: Thirty-two (32) patients (44 hips) with DDH were included in the study. The T & ouml;nnis classification system was used to assess the pre-operative dysplasia grade of the hips. The acetabular index (AI) was measured on AP pelvic radiographs performed preoperatively and at the last control examination. Radiological evaluation was performed according to Severin's criteria, whereas modified McKay's criteria were applied for clinical evaluation. Kalamchi and MacEwen's criteria were preferred for the evaluation of avascular necrosis (AVN).RESULTS: The mean preoperative AI value of the hips was 44.7 +/- 5.0 degrees, whereas that value at the last control AI was 23.5 +/- 3.7 degrees (p<0.001). According to T & ouml;nnis classification, 10 hips were type II, 11 hips were type III, and 23 hips were type IV among 44 hips. According to the modified McKay criteria, excellent clinical results were obtained in 39 (88.7%) hips, good in 4 (9%) hips, and fair in 1 (2.3%) hip. According to Severin's criteria, class 1 radiological results were obtained in 29 (66%) hips, class 2 in 13 (29.5%) hips, and class 3 in 2 (4.5%) hips. The evaluation based on Kalamchi and MacEwen's criteria revealed AVN in 8 (18.2%) hips.CONCLUSION: Combined surgical procedures involving pelvic and femoral osteotomy with open reduction are effective in the management of DDH in children over 18 months of age. In addition, femoral derotation osteotomy is necessary for stable reduction in children after walking age.
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.
A Simple, Safe and Painless Method for Acute Anterior Glenohumeral Joint Dislocations: "the Forward Elevation Maneuver
(Springer, 2013) Guner, Savas; Guner, Sukriye Ilkay; Gormeli, Gokay; Turkozu, Tulin; Gormeli, Cemile Ayse; Bora, Aydin
The glenohumeral joint is the most frequently dislocated joint in the body. Numerous techniques for reducing an acute anterior dislocation of the glenohumeral joint have been described. The goal of this study was to assess the efficacy of Janecki's forward elevation maneuver for reducing a traumatic acute anterior glenohumeral joint dislocation. Between May 2010 and November 2011, the forward elevation maneuver was applied to 27 patients who presented to the emergency department of Yuzuncu Yil University Medical School with a traumatic anterior glenohumeral joint dislocation. For each patient, the forward elevation maneuver was used to reduce the anterior glenohumeral joint dislocation. The type of dislocation, the effectiveness of the procedure in achieving reduction, the need for premedication, the ease of performing the reduction and complications (if present) were noted. Janecki's forward elevation maneuver was successful for 25 patients (92.6 %) on the first attempt. Premedication was not used for 22 patients, and reduction was successful for 20 of them. The method was not successful in two cases. Twenty-three of the patients (85.2 %) experienced no pain or mild pain. Complications referred to the reduction technique were not found in any patient. This paper concludes that Janecki's forward elevation maneuver is a simple, safe, painless, and effective reduction method. Consequently, the forward elevation maneuver seems to be a good method for reducing anterior glenohumeral joint dislocation.
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.