Person: AKGÜLLE, AHMET HAMDİ
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AKGÜLLE
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AHMET HAMDİ
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Publication Open Access Effect of rotational deformities after pediatric femoral fracture on clinical outcome(2022-03-01) AKGÜLLE, AHMET HAMDİ; KESİMER, MEHMET DENİZ; Igrek S., AKGÜLLE A. H., KESİMER M. D.Femoral shaft fractures are the most common pediatric injuries that require hospitalization. Early closed reduction and spica casting are one of the most popular treatment options. One of the significant complications of spica casting is rotational deformities of the fracture. The present study aimed to determine the potential effects of rotational deformities in pediatric patients who underwent early spica casting after a femoral shaft fracture. Pediatric patients who underwent early spica casting following femoral shaft fractures were screened retrospectively. Radiological measurements were made on the patients\" initial postop radiographs who could be measured rotationally according to the defined radiological method. Twenty-three patients with more than 10 degrees of rotation in their measurements were included in the study. Differences in leg length and rotation between both legs were calculated with clinical examination methods for all patients in the study. The gaits of the patients were observed; patient and family complaints were obtained. We found a strong and positive correlation between the rotational measurement made on the X-ray and the clinical measurement (R: 0.634, P: 0.001). For measurements made on X-ray, the mean rotational value was calculated as 27.2 +/- 6.9 degrees. After the patients\" clinical examination, an average of 3.0 +/- 1.7 degrees rotational difference was found between the broken limb and the healthy limb. No patient or family complained of trauma. Early spica casting, according to the age of the patient, is an effective treatment method. There may still be certain degrees of deformity after treatment, but patients well tolerate them even at high degrees. Accordingly, it was concluded that the rotational deformities less than 30 degrees would not cause clinical problems on children under 4 years of age which may require postoperative revisions or the use of various costly imaging techniques and include radiation.Publication Open Access Immobilization after pediatric supracondylar humerus fracture surgery: Cast or splint(2022-01-01) ŞİRİN, EVRİM; POLAT, MURAT; ŞAHBAT, YAVUZ; EROL, BÜLENT; AKGÜLLE, AHMET HAMDİ; AKGÜLLE A. H., ŞİRİN E., Baysalo O., POLAT M., Sahbat Y., EROL B.Objective: While surgical treatment is the most accepted treatment method for displaced supracondylar humerus fractures in children, there is little data about immobilization method after surgery. The aim of the study is to determine whether there is any difference in preventing loss of reduction between long-arm cast and long-arm splint following pediatric supracondylar humerus fracture surgery. Patients and Methods: We conducted a retrospective analysis of pediatric patients with supracondylar humerus fractures treated operatively between 2012 and 2019 at a university hospital. According to Skaggs criteria, early postoperative and 3rd-week follow-up X-rays were evaluated for the loss of reduction (LOR). Postoperative immobilization method; splint or cast was compared in the context of LOR. Results: Cast immobilization was found to be superior in preventing LOR in the first three weeks postoperatively (p˂0.05). There was no significant difference for other factors like fracture configuration, patient age and surgical technique. Conclusion: Cast immobilization is superior to splint immobilization in preventing radiologic LOR after pediatric supracondylar humerus fracture surgery however, clinical relevance of this conclusion is yet to be proved.Publication Open Access Does ultrasound imaging of the spastic muscle have an additive effect on clinical examination tools in patients with cerebral palsy?: A pilot study(2022-01-01) AKBAŞ, FIRAT; YAĞCI, İLKER; AKGÜLLE, AHMET HAMDİ; KARADAĞ SAYGI, NAİME EVRİM; Atalay K. G., Saygi E. K., AKBAŞ F., Coskun O. K., AKGÜLLE A. H., YAĞCI İ.OBJECTIVE: The Modified Ashworth Scale, the Modified Tardieu Scale, and measuring the passive range of motion is commonly preferred examination tools for spasticity in cerebral palsy (CP). Ultrasonography has become increasingly used to provide relevant insight into spastic muscle morphology and structure recently. It was aimed to reveal associations between the clinical and ultrasonographic parameters of gastrocnemius medialis (GM) and lateralis muscles in this population. METHODS: Thirty-four children with spastic CP aged between 4 and 12 years who did not have botulinum neurotoxin A intervention within 6 months or had no previous history of any orthopedic or neurological surgery were included. The spasticity of GM and lateralis was evaluated firstly by the Modified Ashworth Scale, Modified Tardieu Scale, and ankle passive range of motion. Then, the cross-sectional area (CSA), muscle thickness (MT), qualitative and quantitative echo intensity (EI) values of both muscles were measured from their ultrasonographic images. RESULTS: The CSA of GM, and qualitative EI of both muscles were found to be mild-to-moderately correlated to all clinical examination tools (p<0.01), whereas the CSA of gastrocnemius lateralis was mildly related to Modified Ashworth Scale (p=0.009). The MT and quantitative EI of both muscles were not associated with any of the clinical tools (p>0.05). CONCLUSION: Ultrasonographic measurements of GM and lateralis partially reflect ankle spasticity in children with CP. Ultrasonography can be used as an alternative tool in this patient population where the clinical evaluation can not perform ideally.Publication Open Access Supracondylar humerus fractures in ınfants and early toddlers; characteristics, clinical and radiological outcomes compared with older children(2022-09-01) AKGÜLLE, AHMET HAMDİ; ŞAHBAT, YAVUZ; EROL, BÜLENT; AKGÜLLE A. H. , Sahbat Y., Baysal O., Kart H., EROL B.Background Supracondylar humerus fractures (SCHF) are rarely seen in the youngest age groups (1-3 years). Although there is no difference in the context of treatment options, it has been shown that younger age groups have different characteristics. Few studies have examined toddlers, which have notably different characteristics. This study is the first to report the characteristics, diagnosis, treatment and functional results of SCHF in infants and early toddlers. Methods A retrospective analysis was made of the data of patients younger than 30 months old, who were operated on in our clinic for SCHF between 2012 and 2020 with at least 2 years of follow-up. Patient demographic and surgical data, and the functional and radiological results were documented. Results Evaluation was made of a total of 52 patients comprising 30 females (58%) and 22 males (42%), with a mean age of 20.75 +/- 5.4 months (range, 6-30 months). The injury was in the right elbow in 24 (46%) patients. The mechanism of injury was a fall from an object at home (table, chair, bed, etc.) in 41 (79%) patients. Patients who fell from a height of more than 4 meters had additional injuries (liver laceration, vertebral fracture, etc.). Only 1 patient had anterior interosseous nerve (AIN) damage before the operation, but the final follow-up neurovascular examinations for all patients were normal. The median follow-up period was 4 years (range, 2-7 years). Flynn outcome scores were (88.5%) excellent and variant Hospital for Special Surgery scores were (82.7%) excellent. Conclusions With appropriate treatment of SCHF, the clinical outcomes in infants and early toddlers are excellent. Using a medial pin to achieve and protect stability in this age group does not increase the risk of iatrogenic ulnar nerve damage. Patients younger than 20 months tend to have more varus malalignment but similar functional results.