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TOPKAR, OSMAN MERT

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Author: AKGÜLLE, AHMET HAMDİ ×

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    Pediatrik radius diafiz kırıklarının intramedüller tel ile fiksasyonunda, dorsal veya lateral giriş yeri fonksiyonel sonuçları ve komplikasyon oranını değiştirir mi
    (2019-11-22) AKGÜLLE, AHMET HAMDİ; TOPKAR, OSMAN MERT; ŞİRİN, EVRİM; AKGÜLLE A. H., ONAY T., İĞREK S., KESİMER M. D., TOPKAR O. M., ŞİRİN E.
    Amaç: Çocuk radius diafiz kırıkları cerrahi tedavisinde intrameduller tel ile fiksasyon en sık kullanılan yöntemdir. Tel girişi dorsal ve lateralden yapılabilmektedir. Çalışmanın amacı, pediatrik radius diafiz kırıklarında dorsal giriş ya da lateral girişli intrameduller fiksasyon yapılmış olguları fonksiyonel sonuç ve komplikasyon oranları açısından karşılaştırmaktı. Yöntem: 2014-2018 yılları arasında tek bir merkezde pediatrik radius diafiz kırığı nedeniyle cerrahi uygulanmış olan hastalar retrospektif olarak incelendi. İntramedüller yöntemle tedavi edilmemiş, dosya ve takipleri yetersiz ve patolojik kırığı olan hastalar çalışmadan çıkarıldı. Dorsal giriş yapılan 19 (Grup A), lateral giriş yapılan (Grup B) 18, toplam 37 hasta çalışmaya alındı. Hastaların; yaş, kırıktan ameliyata kadar geçen süre, kaynama (pin çıkarma) süreleri, açık veya kapalı cerrahi uygulanması, perop ve geç postop komplikasyonları ile fonksiyonel skorları kaydedildi. Radius alt uçta kırık gelişmesi major komplikasyon, el bilekte hafif ağrı ve hareket kısıtlılığı minör komplikasyon olarak kabul edildi. Fonksiyonel değerlendirmede Childrens Hospital of Philadelphia Önkol Kırık Fonksiyon Sınıflaması kullanıldı. Veriler istatistiksel olarak analiz edildi. Bulgular: Hastaların ortalama yaşı 10,5 yıl ve ortalama takip süresi 37 ay olarak bulundu. Tüm kırıklar ortalama 47 günde kaynadı. Grup A’da 2, Grup B’de 1 hastada giriş sırasında radius alt uçta kırık oluştu. Grup A’da 1 hastada, Grup B’de 3 hastada minör komplikasyon tespit edildi. 30 hastada (%81,1) mükemmel, 4 hastada (%10,8) orta ve 3 hastada (%8,1) kötü sonuç elde edildi. İki grup arasında, komplikasyon gelişimi ve fonksiyonel skor açısından istatistiksel anlamlı fark saptanmadı (p>0.05). Çıkarımlar: Pediatrik radius diafiz kırıklarının intramedüller fiksasyonunda, tel giriş yeri ile komplikasyonlar ve fonksiyonel sonuç arasında bir ilişki bulunamamıştır. Her iki giriş noktasında benzer sonuçlar elde edilebilmektedir. Geniş serilerle prospektif olarak yapılacak çalışmalar daha yol gösterici olacaktır.
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    Dorsal or Lateral Approach for Intramedullary Nailing Using Kirschner Wire in Pediatric Radius Diaphyseal Fractures: Does it really matter?
    (SPRINGER HEIDELBERG, 2021) AKGÜLLE, AHMET HAMDİ; Akgulle, Ahmet Hamdi; Onay, Tolga; Igrek, Servet; Kesimer, Mehmet Deniz; Topkar, Osman Mert; Sirin, Evrim
    Background Intramedullary nailing is the most preferred fixation method for diaphyseal radius and ulna fractures in the young age group. The aim of this study was to compare the dorsal and lateral entry points in the context of entry site-related complications, fracture union and functional results. Methods This retrospective comparative study included pediatric patients who underwent surgery for isolated diaphyseal radius or both bone forearm fractures with intramedullary nailing using Kirschner wire between January 2013 and January 2019. K-wire was introduced from the distal radius through dorsal entry (Group A) in 19 patients and lateral entry (Group B) in 18 patients. The mean follow-up was 37 months. Complications were noted and functional outcomes were evaluated according to the CHOP criteria. Results All fractures were healed. The functional results were determined to be excellent for 30, fair for 4, and poor for 3 patients. The overall complication rate was 18.9%, including distal radius fracture, mild pain in the wrist, and minor loss in ROM. No statistically significant differences were determined between the groups in respect of functional results and complication rates. Conclusion Good functional results and similar complication rates can be obtained with both dorsal and lateral entry approaches. Stainless steel K-wire is an inexpensive intramedullary fixation implant option, which provides strong stabilization. Distal radius fracture is a newly reported complication for forearm intramedullary nailing. Leaving the implant out of the skin seems safe with the benefit of avoiding a further surgical intervention to extract the implant.
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    Experiences with total femur replacement for malignant bone and soft tissue tumors
    (2018-04-14) EROL, BÜLENT; TOPKAR, OSMAN MERT; AKGÜLLE, AHMET HAMDİ; EROL B., TOPKAR O. M., YONGA Ö., AKGÜLLE A. H., BAYSAL Ö., BAYKAN S. E.
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    Mid-term results of intralesional extended curettage, cauterization, and polymethylmethacrylate cementation in the treatment of giant cell tumor of bone: A retrospective case series
    (TURKISH ASSOC ORTHOPAEDICS TRAUMATOLOGY, 2020-10-30) AKGÜLLE, AHMET HAMDİ; Sirin, Evrim; Akgulle, Ahmet Hamdi; Topkar, Osman Mert; Sofulu, Omer; Baykan, Said Erkam; Erol, Bulent
    Objective: The aim of this study was to present the mid-term functional outcomes and recurrence rate in patients with giant cell tumor of bone (GCTB) treated by intralesional extended curettage, electrocauterization, and polymethylmethacrylate (PMMA) cementation. Methods: In this retrospective observational study, 79 consecutive patients (41 females, 38 males; mean age=39 years; age range=19-62 years) who were diagnosed and treated for GCTB between 2005 and 2017 were identified from hospital medical records. All patients were treated by intralesional extended curettage using high-speed burr, electrocauterization of the cavity, and filling the defect with PMMA. No additional local adjuvants were used. The mean follow-up period was 47 months (range=24-96). The tumors were graded according to the radiological classification system described by Campanacci. Functional outcomes were evaluated using the Musculoskeletal Tumor Society Score (MSTS) preoperatively, one year postoperatively, and at the final follow-up. Postoperative complications and recurrence rates were recorded. Results: Twenty-nine tumors were located in the distal femur, 23 in the proximal tibia, nine in the distal radius, five in the proximal humerus, five in the pelvis, three in the proximal fibula, two in the distal ulna, two in the distal tibia, and one in the second metatarsal. According to Campanacci classification, 37 tumors were grade III, 32 grade II, and 10 grade I. The mean MSTS score was 46.1% (range 40.2 to 71.4%) preoperatively, 91.7% (range 73.3% to 100%) one year postoperatively, and 86.3 % (range 66.2% to 96,1%) at the final follow-up. The overall complication rate was 7.6%; which included local tumor recurrence in four patients, superficial wound infection in one, and deep wound infection in another. The recurrence rate was 5.1% (4 patients). Recurrent tumors were located at the distal femur in three patients and proximal tibia in one. Conclusion: With satisfactory functional results and low recurrence rates at the mid-term follow-up, GCTB can be treated effectively with intralesional extended curettage, electrocauterization, and PMMA cementation.