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AKGÜLLE, AHMET HAMDİ

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AKGÜLLE

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AHMET HAMDİ

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    Staged management of infection with adjustable spacers after megaprosthesis implantation in primary sarcoma patients
    (2023-03-01) ŞİRİN, EVRİM; AKGÜLLE, AHMET HAMDİ; EROL, BÜLENT; ŞİRİN E., Sofulu O., Baysal O., AKGÜLLE A. H., EROL B.
    BackgroundWhile periprosthetic joint infection has always been a significant concern for orthopaedic surgeons, the rate of infection is five to ten times higher after tumor prosthesis implantation. With the growing use of mega-implants, the number of these infections has also increased. We aimed to investigate the results of our patients with a primary malignant musculoskeletal tumor, who underwent two-stage revision surgery for an infected mega-prosthesis. We also presented the emerging complicatons and required soft tissue reconstruction procedures.MethodsThe study included 32 primary bone and soft tissue sarcoma patients who underwent a two-stage revision procedure for infection. After a rigorous bone and soft tissue debridement procedure at the first stage, antibiotic-loaded bone cement was wrapped around a cloverleaf type intramedullary nail and inserted into the forming gap. After a minimum of 6 weeks of antibiotic therapy, depending on patients\" clinical signs and serum infection markers, the reimplantation stage was undertaken.ResultsThe mean oncologic follow-up period was 28 months (range 5-96 months). During this period, 11 patients died because of non-infection related causes, 12 patients were alive with their disease, whereas 9 patients were totally free of their oncologic condition. The infection was eradicated in all survivors except one patient, where a high-level transfemoral amputation became necessary.ConclusionPeriprosthetic infection after tumor proshesis implantation in cancer patients can be managed with same principles as conventional arthroplaty procedures, taking care that they are immunocompromised and vulnerable patients and their bone stock loss is significant which makes surgical options more challenging.
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    Factors influencing study outcomes in recent literatüre on distal radial fracture treatments
    (2023-11-01) AKGÜLLE, AHMET HAMDİ; BEKİROĞLU, GÜLNAZ NURAL; Akgülle A. H., Uysal D., Bekiroğlu G. N.
    The main tools used by an orthopaedic surgeon for managing distal radial fracture treatment are recent literature and treatment guidelines. The aim of the present study was to find which factors within the study design influence study outcomes the most. Trials in three major databases (PubMed, Scopus, Embase) comparing surgical and non-surgical treatment options for adolescent and adult distal radial fractures with their original data, between 2013 and 2021, were included. The selected 47 studies were classified according to their outcomes. The relationship between study characteristics and outcomes was statistically analysed. It was more likely to find no difference in outcomes between volar locking plate and less invasive treatments when the sample size was above 100, follow-up was more than 1 year and functional assessments were used. A small sample size and short follow-up time affect study outcomes in favour of a volar locking plate. Readers should focus on the design criteria and read the full text of the studies before making any conclusions.Level of evidence:III.Keywords:Adult; distal radius; fracture; study bias; treatment.