Browsing by Author "Beyaz, Salih"

Now showing 1 - 13 of 13

Artroskopik tek band ve çift band ön çapraz bağ rekonstrükyonu sonrası tibial ve femoral tünel genişlemesi ve izokinetik kas gücüne etkisi : prospektif, randomize çalışma
(Başkent Üniversitesi Tıp Fakültesi, 2008) Beyaz, Salih; Özkoç, Gürkan
Bu çalısmada tek band ve çift band ön çapraz bağ (ÖÇB) rekonstrüksyonu yapılan hastaların erken postoperatif dönemde tünel genislemesi ve bu genislemenin izokinetik kas gücü üzerine etkinliğini arastırıldı. Çalısmaya 1 Kasım 2007 ile 30 Mart 2008 arasında Baskent Üniversitesi Adana Uygulama ve Arastırma Merkezinde ortopedi polikliniğinde ÖÇB yırtığı tanısı konulan, daha önce diz cerrahisi geçirmemis ve cerrahi endikasyonu olan, çalısmaya katılmayı kabul eden ve takiplerinde sorun yasanmayan, ortalama yası 28.6 (19-40 arası ) 34 hasta (33 erkek (ort. yası 28.7) bir bayan (yası 24) ) dahil edildi. Hastaya yapılacak ameliyatın sekline operasyondan önce kura yoluyla karar verildi. Tüm hastaların ameliyat öncesi karsılastırmalı olarak Biodex 3 (Biodex Medical System NY USA) cihazı ile her iki diz 60o/sn, 120o/sn ve 180o/sn açısal hızlarda hamstring ve kuadriseps izokinetik kas gücü değerlendirmesi yapıldı. Ortalama yası 27.25 (yas aralığı 19-35) olan 18 hastaya artroskopik tek band bağ rekonstrükyonu (17 erkek, 1 bayan) ortalama yası 30.1 (yas aralığı 20-40) olan 16 hastaya artroskopik çift band bağ rekonstrüksyonu yapıldı. Hastalara ameliyat sonrası 2. ve 3. ay’da sadece üç boyutlu diz eklem tomografisi çekildi. Altıncı aydaki kontolleri sırasında 3 boyutlu diz eklem tomografisi ve izokinetik değerlendirme tekrarlandı. Her tünel 6 esit parçaya bölünerek (L1-L6) dijital ortamda sagittal ve koronal planda tünel genislik ölçümü, aksiyal planda ise aynı noktalardan tünel alan ölçümü yapıldı. Hem tek band hemde çift band bağ rekonstrüksyonu yapılan hastaların ameliyat öncesi ve sonrasında yapılan izokinetik kas değerleri arasında bir farklılık saptanmadı. Yine 2., 3. ve 6. ayda çekilen tomografiler üzerinde yapılan çap ve alan ölçümleri arasında istatistiksel olarak anlamlı genisleme bulunmadı. Çift band ÖÇB cerrahisi tek bandla kıyaslandığında teorik olarak normal fizyolojiye daha yakın davrandığı iddia edilse de erken postoperatif dönemde tünel genislemesinin izokinetik kas gücü üzerine etkinliği açısından bu iki yöntem arasında herhangi bir fark bulunmamaktadır. The purpose of this study is to compare the early postoperative tunnel enlargement and it’s effect on isokinetic muscle force in patients who were treated with either single bundle or double bundle anterior cruciate ligament (ACL) reconstruction Between November 2007 and March 2008, patients who had a diagnosis of ACL rupture and who had surgical indication with no prior knee surgery history with regular clinical follow-up were enrolled for this study at Baskent University Adana Research and Training Center. A total of 34 patients (33 males (avarege age 28.7) and 1 female (age 24) with an avarege age of 28.6 (range:19-40) were included for the final analysis. The study group were randomized in two groups and isokinetic mucle testing for quadriceps strenght with 60o/sc, 120o/sc ve 180o/sc velocities were performed and compared with the unaffected knee by Biodex 3 (Biodex Medical System NY USA) dynomometer. Eighteen patients (17 male, 1 female) with an avarage of 27.25 (range: 19-35) were undergone single bundle reconstruction and 16 patients with an avarage age of 30.1 (range:20-40) were undergone double bundle reconstruction. In the postoperative second and third months, only 3-d computed tomography scans were performed. In the sixth month postoperatively, 3-d computed tomography and isokinetic muscle testing were repeated. Each tunnel was divided into 6 equal pieces (L1-L6) and tunnel width was evaluated at coronal and sagittal plans and tunnel area was evaluated by the same areas at the aixal plans. There were no significant difference between isokinetic muscle testing for single bundle and double bundle reconstructions in the preoperative and postoperative period. Đn addition, no statistically significant difference was found for the width and area examinations of the tunnels between second, third and sixth months of 3-d computed tomography scans. Although double bundle reconstrucion had a more normal phsyology than single bundle reconstruction, surgeon must consider the need for a double bundle surgery in the preoperative period.
A brief history of artificial intelligence and robotic surgery in orthopedics & traumatology and future expectations
(2020) Beyaz, Salih; 0000-0002-5788-5116; 32962606; K-8820-2019
Recently. the rate of the production and renewal of information makes it almost impossible to be updated. It is quite difficult to process and interpret large amounts of data by human beings. Unlimited memory capacities. learning abilities, artificial intelligence (AI) applications, and robotic surgery techniques cause orthopedic surgeons to be concerned about losing their jobs. The idea of AI. which was first introduced in 1956. has evolved over time by revealing deep learning and evolutionary plexus that can mimic the human neuron cell. Image processing is the leading improvement in developed algorithms. Theoretically. these algorithms appear to be quite successful in interpreting medical images and orthopedic decision support systems for preoperative evaluation. Robotic surgeons have emerged as significant competitors in carrying out the taken decisions. The first robotic applications of orthopedic surgery started in 1992 with the ROBODOC system. Applications started with hip arthroplasty continued with knee arthroplasty. Publications indicate that problems such as blood loss and infection caused by the long operation time in the early stages have been overcome in time with the help of learning systems. Comparative studies conducted with humans indicate that robots are better than humans in providing limb lengthening, patient satisfaction, and cost. As in all new technologies, the developments in both AI applications and robotics surgery indicate that technology is in favor in terms of cost/benefit analyses. Although studies indicate that new technologies are more successful than humans, the replacement of technology with experience and long-term results with traditional methods will not be observed in the near future.
Comparison of Different Machine Learning Approaches to Detect Femoral Neck Fractures in X-Ray Images
(2021) Acici, Koray; Sumer, Emre; Beyaz, Salih; 0000-0002-3821-6419; 0000-0001-8502-9184; 0000-0002-5788-5116; AGA-5711-2022; K-8820-2019
Femoral neck fractures are a serious health problem, especially in the elderly population. Misdiagnosis leads to improper treatment and adversely affects the quality of life of the patients. On the other hand, when looking from the perspective of orthopedic surgeons, their workload increases during the pandemic, and the rates of correct diagnosis may decrease with fatigue. Therefore, it becomes essential to help healthcare professionals diagnose correctly and facilitate treatment planning. The main purpose of this study is to develop a framework to detect fractured femoral necks in PXRs (Pelvic X-ray, Pelvic Radiographs) while also researching how different machine learning approaches affect different data distributions. Conventional, LBP (Local Binary Patterns), and HOG (Histogram of Gradients) features were extracted manually from gray-level images to feed the canonical machine learning classifiers. Gray-level and three-channel images were used as inputs to extract the features automatically by CNNs (Convolutional Neural Network). LSTMs (Long Short-Term Memory) and BILSTMs (Bidirectional Long Short-Term Memory) were fed by automatically extracted features. Metaheuristic optimization algorithms, GA (Genetic Algorithm) and PSO (Particle Swarm Optimization), were utilized to optimize hyper-parameters such as the number of the feature maps and the size of the filters in the convolutional layers of the CNN architecture. The majority voting was applied to the results of the different classifiers. For the imbalanced dataset, the best performance was achieved by the 2-layer LSTM architecture that used features extracted from the fifth max-pooling layer of the CNN architecture optimized by GA. For the balanced dataset, the best performance was obtained by the CNN architecture optimized by PSO in terms of the Kappa evaluation metric. Although metaheuristic optimization algorithms such as GA and PSO do not guarantee the optimal solution, they can improve the performance on a not extremely imbalanced dataset especially in terms of sensitivity and Kappa evaluation metrics. On the other hand, for a balanced dataset, more reliable results can be obtained without using metaheuristic optimization algorithms but including them can result in an acceptable agreement in terms of the Kappa metric.
Comparison Of Efficacy Of Oral Versus Intra-Articular Corticosteroid Application In The Treatment Of Frozen Shoulder: An Experimental Study In Rats
(2022) Cinar, Bekir Murat; Battal, Vahit Erdal; Bal, Nebil; Guler, Umit Ozgur; Beyaz, Salih; 35234132
Objective: The aim of this study was to compare clinical and histopathological effects of oral versus intraarticular corticosteroid application in a rat model of frozen shoulder. Methods: In this study, eighty adult Sprague-Dawley rats were used. The animals were divided into 5 equal groups. The frozen shoulder model was created by immobilizing animals' shoulders with internal fixation with sutures for 8 weeks. At the 8th week, sham(n: 16) and control (n: 16) groups were sacrificed to collect data for healthy and affected shoulders. Also, at the 8th week, 50 mg/kg methylprednisolone was started for the oral treatment group, and a single dose of 0.5mg/kg triamcinolone acetonide was injected for the intraarticular treatment group. The effect of additional steroid treatment was expected for 2 weeks, then all remaining treatment and natural course groups were sacrificed on the 10th week. Results: After sacrification, specimens taken as "en bloc" scapulothoracic disarticulation were randomly divided into two groups for a range of motion measurement and histopathological examination. The control (frozen shoulder model) group's shoulder range of motion in all directions was lower than the sham (healthy) group (P < 0.01). Natural course and intraarticular steroid groups, compared to the frozen shoulder model showed a significant increase in the direction of abduction (P < 0.05). Also, it was found for treatment groups that in all directions the range of motion was not as good as the healthy values (P < 0.01). The intraarticular treatment group showed higher degrees of abduction compared to the natural course and oral steroid treatment groups (P < 0.01). Oral steroid treatment group's range of motion was not significantly better than the disease model and had no superiority to the natural course group (P > 0.05). Histopathologically, no statistically significant difference was observed between the groups for signs of frozen shoulder which was found in the immobilized group (P > 0.05). Histopathologically, immobilization was found to cause thickening of the capsule that cannot be resolved by treatment. (P < 0.05). Conclusion: In frozen shoulder disease, intraarticular steroid injection seems to be superior in increasing the range of motion than oral steroid treatment.
Do diabetic patients who undergo transtibial amputation receive adequate treatment?
(2019) Beyaz, Salih; 0000-0002-5788-5116; 30946028; M-2609-2013
AIMS: To determine if patients who undergo below-knee amputation (BKA) for intractable wounds caused by diabetes complications receive adequate treatment before surgery. MATERIALS AND METHODS: The study included a total of 528 patients who underwent transtibial amputation for diabetic foot. All patients were assessed on the basis of duration of preoperative treatment, HbO therapy, negative wound pressure therapy (NPWT), peripheral vascular angioplasty (PVA) treatment, wound cultures, antibiotic medications, consultations with plastic and vascular surgeons, need for hemodialysis treatment, use of anticoagulant treatment as an inpatient, and assessment of blood sugar regulation by an endocrinologist. HbA1c, BUN, Creatinine, ESR, and CRP values attained for preoperative assessment were noted. RESULTS: Eighteen patients (3.5%) received HbO therapy, 35 (67%) NPWT therapy and 347 (65.7%) anticoagulant treatment. Wound cultures were taken in 317 patients (60.5%) and 390 (73.9%) received preoperative antibiotic treatment. 45 (8.6%) patients were assessed by plastic surgeon with 22 (4.2%) subsequently undergoing surgery by the plastic surgeon. Vascular surgeons assessed 163 patients (30.9%) and performed procedures on 45 patients (8.6%). Endocrinologists assessed 316 patients (59.8%) and implemented blood sugar regulation. PVA treatment was performed in 246 patients (466%). Patients who were managed medically for more than 7 days after the initial assessment received more HbO therapy (p=0.037), anticoagulant treatment (p=0.015), IV antibiotics (0.001), blood sugar regulation attempts (p=0.001), and PVA therapy (0.001) and had more cultures taken (p=0.001). These patients also received overall more diagnostic and treatment modalities than those that received definitive surgical intervention within 7 days. CONCLUSIONS: The duration of time patients with diabetes-related foot problems who see orthopedic surgeons for longer periods of time receive more treatment modalities and are referred more often to specialists before transtibial amputation surgery. We believe that delayed presentation is one of the main obstacles prohibiting adequate treatment for these patients.
Early period hospital mortality after orthopedic surgery and affecting factors By:Beyaz, S (Beyaz, Salih)[ 1 ]
(2019) Beyaz, Salih; 000-0002-5788-5116; M-2609-2013
Purpose: The aim of this study was to determine the factors affecting the mortality and the orthopedic surgical procedure with the highest hospital mortality. Materials and Methods: 19,727 patients who had undergone orthopedic surgery between 1998-2016 were included in the study. Of these patients, 370 patients who died in the hospital within the first 30 days were screened. Surgical procedures for patients with a higher than average mortality, age, gender, presence of malignancy, history of coronary artery disease, diabetes, hemodialysis, cerebrovascular event history, presence of hypertension, The American Society of Anesthesiologists (ASA) assessment score and anesthesia patterns were recorded. Results: Of 19,727 patients undergoing orthopedic surgery, 237 (1.23%) patients died early in the hospital after surgery. 4 surgical procedures with the highest mortality rate; It was found 6.35% in amputation surgery, 5.2% in femoral neck fracture, 4.2% in intertrochanteric hip fracture and 2.6% in vertabra surgery. Factors affecting the mortality were age, male gender, hypertension, having general anesthesia, having amputation surgery and having hemodialysis. ASA score was statistically significant in mortality all surgical types. Conclusion: Amputation is the most deadly orthopedic surgery in the early period. comorbid chronic diseases are the most important factors affecting mortality in orthopedic surgery.
The effect of a new universal laser aiming device in C-arm fluoroscopy on the technician's accuracy
(2020) Beyaz, Salih; Kurtuldu, Huseyin; 0000-0002-5788-5116; 32160486; K-8820-2019
Objectives: This study aims to introduce a new low-cost universal laser aiming device (LAD) that can be used in existing C-arm fluoroscopy devices, independent of brand and model. and to determine whether this new universal LAD improves technician accuracy in locating the desired region at the midpoint of the fluoroscopic image. Materials and methods: A low-priced universal LAD that is compatible with existing 12-inch C-arm fluoroscopy devices was designed. Eight radiology technicians with varied levels of experience in C-arm fluoroscopy participated in the study. A 12mm cortical screw with a diameter of 3.5 mm was placed on proximal, diaphyseal. and distal points of femur, tibia, and humerus bones in the anteroposterior plane on L3 vertebrae and the left pubis arm in the pelvis bone model. Technicians were asked to align each screw in the image center 10 times from a distance of 30 cm in the anterolateral plane, first without the LAD and then with the LAD. The distance of the screw head to the center point was measured from the 3,520 images with the help of medical viewer software based on the X- and Y-axis. Results: Each fluoroscopic image was divided into 48 equal parts and the length of a part was taken as one unit for distance measurements. The compliance between technicians without the LAD was 0.347 (95% confidence interval [CI]: 0.208-0.47, p=0.001) and with the LAD was 0.687 (95% CI: 0.621-0.741, p=0.001). The distance between the screw head and the center of the image without the LAD was 19.0=9.8 for technicians with more than 10 years of experience and 28.0 +/- 12.9 for those with less than 10 years of experience. This difference was statistically significant (p=0.001). When the LAD was used, the difference between the less experienced (3.1 +/- 1.5) and more experienced (3.3 +/- 2.0) technicians was statistically reduced, along with the distance (p=0.033). Conclusion: The use of the LAD with C-arm fluoroscopy appears to be successful in helping technicians capture the desired point in the center of the fluoroscopic image. The use of the LAD reduces the experience gap between technicians.
The Effect of Chronic Renal Failure on Survival After Nontraumatic Lower Extremity Amputation
(2023) Beyaz, Salih; 0000-0002-5788-5116; 37395354; K-8820-2019; M-2609-2013
Effects of Orthopedic Instruments Breakage During Surgery: A Minimum Five-Year Follow-Up
(2021) Haberal, Bahtiyar; Beyaz, Salih; 0000-0002-1668-6997; 0000-0002-5788-5116; W-9080-2019; K-8820-2019
Aim: The present study aims to investigate the the long-term effect of metallic orthopedic instruments that were broken and not removed during surgery on the health status of patients. Material and Methods: Radiographs of 12,601 patients (5765 females and 6836 males; mean age: 48.9 years; range: 0-105) who underwent orthopedic surgery in our clinic between January 2009 and January 2015 were screened. Thirty-six patients (13 females and 23 males; mean age: 45.3 years; range: 12-82) with metallic instruments, broken and not removed during surgery, were included in the study and minimum five-year follow-up radiographs of the patients were examined. Results: The rate of orthopedic instrument breakage during surgery was 0.28%. This was 0.64% in trauma cases and 0.08% in elective surgery cases. The broken instrument was a Kirschner wire (K-wire) in 16 (44.4%) cases, a screw in 14 (38.9%), and a drill bit in 6 (16.6%). The rate of instrument breakage was 7.44 times higher in trauma cases than in elective surgery cases, which was statistically significant (p = 0.001). Only 1 patient required reoperation for the broken instrument 7 years later. No surgical notes regarding broken implants were identified in patient files. Discussion: Instruments that are broken and not removed during surgery do not cause any complication if they are entirely within the bone. Nevertheless, any instance of instrument breakage should be documented, and the patient should be informed about the condition and followed closely.
Factors affecting lifespan following below-knee amputation in diabetic patients
(2017) Beyaz, Salih; Guler, Umit Ozgur; Bagir, Gulay Simsek; 0000-0002-5788-5116; 0000-0002-5375-635X; 0000-0002-5375-635X; 28865844; K-8820-2019; O-7590-2017; AAJ-4844-2021
Introduction: Untreatable foot problems in diabetics may require lower extremity amputation, which has a high level of patient mortality. This high mortality rate is worse than most malignancies. The present study aimed to identify parameters that can be used to estimate survival in DM patients undergoing below-knee amputations for diabetic foot problems. Materials and methods: A total of 470 patients (299 males, 171 females) with a mean age of 64.32 years who underwent below-knee amputation for diabetic foot problems between 2004 and 2014 were enrolled in the study. The length of time from the operation to time of death was recorded in days. Patient details were obtained, including age during surgery, BMI, oral antidiabetic and insulin usage, dialysis therapy history, lower extremity endovascular intervention, previous amputation at the same extremity, the need for stump revision surgery during follow-up, and above-knee amputation at the same site. Biochemical test results of pre-operative HbAl c, ESR, and levels of CRP, BUN, and creatinine were also obtained. Results: A total of 333 patients (70.9%) died and 137 (29.1%) survived post-surgery. Survival rates were 90% in the first 7 days, 84% in the first 30 days, and 64% after the first year. Patient median life expectancy post-surgery was 930 106 days. Hemodialysis treatment (p = 0.001), endovascular intervention (p = 0.04), sex (p = 0.004), age (p = 0.001), BUN level (p = 0.001), and duration of insulin use (p = 0.003) were shown to be effective predictors of mortality. Conclusions: Life expectancy is low (<3 years) in DM patients requiring below-knee amputations for untreatable foot problems. Survival could be predicted by duration of insulin use, age, sex, and renal insufficiency. Level of evidence: Level IV, Therapeutic study. (C) 2017 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V.
Femoral neck fracture detection in X-ray images using deep learning and genetic algorithm approaches
(2020) Beyaz, Salih; Acici, Koray; Sumer, Emre; 0000-0002-5788-5116; 32584712; K-8820-2019
Objectives: This study aims to detect frontal pelvic radiograph femoral neck fracture using deep learning techniques. Patients and methods: This retrospective study was conducted between January 2013 and January 2018. A total of 234 frontal pelvic X-ray images collected from 65 patients (32 males, 33 females; mean age 74.9 years; range, 33 to 89 years) were augmented to 2106 images to achieve a satisfactory dataset. A total of 1,341 images were fractured femoral necks while 765 were non-fractured ones. The proposed convolutional neural network (CNN) architecture contained five blocks, each containing a convolutional layer, batch normalization layer, rectified linear unit, and maximum pooling layer. After the last block, a dropout layer existed with a probability of 0.5. The last three layers of the architecture were a fully connected layer of two classes, a softmax layer and a classification layer that computes cross entropy loss. The training process was terminated after 50 epochs and an Adam Optimizer was used. Learning rate was dropped by a factor of 0.5 on every five epochs. To reduce overfitting, regularization term was added to the weights of the loss function. The training process was repeated for pixel sizes 50x50, 100x100, 200x200, and 400x400. The genetic algorithm (GA) approach was employed to optimize the hyperparameters of the CNN architecture and to minimize the error after testing the model created by the CNN architecture in the training phase. Results: Performance in terms of sensitivity, specificity, accuracy, F1 score, and Cohen's kappa coefficient were evaluated using five-fold cross validation tests. Best performance was obtained when cropped images were rescaled to 50x50 pixels. The kappa metric showed more reliable classifier performance when 50x50 pixels image size was used to feed the CNN. The classifier performance was more reliable according to other image sizes. Sensitivity and specificity rates were computed to be 83% and 73%, respectively. With the inclusion of the GA, this rate increased by 1.6%. The detection rate of fractured bones was found to be 83%. A kappa coefficient of 55% was obtained, indicating an acceptable agreement. Conclusion: This experimental study utilized deep learning techniques in the detection of bone fractures in radiography. Although the dataset was unbalanced, the results can be considered promising. It was observed that use of smaller image size decreases computational cost and provides better results according to evaluation metrics.
Intractable pain following core decompression caused by salmonella septic arthritis
(2016) Beyaz, Salih; Guler, Umit Ozgr; Cinar, Bekir Murat; Bolat, Filiz Aka; 0000-0002-7906-5039; 0000-0002-5375-635X; 0000-0002-5788-5116; 0000-0002-5788-5116; AAL-4474-2021; O-7590-2017; K-8820-2019; M-2609-2013
Glucocorticoids (GC), often used in the treatment of diseases caused by autoimmune mechanisms, are the most common nontraumatic causative factor of femoral head avascular necrosis (FHAN). FHAN is, in turn, the most common cause leading to orthopedic surgery in patients using GCs. As GCs suppress the immune system, patients experience increased susceptibility to infections, including FHAN, which has a similar clinical manifestation with septic arthritis. In rare cases, septic arthritis may be caused by salmonella in patients using GCs. Core decompression is the gold standard in the treatment of early stage FHAN. We report a 28-year-old male patient with multiple sclerosis (MS) presenting with the complaints of hip pain. The patient had been treated with two megadoses of steroids. FHAN was considered due to X-ray and MRI findings. The patient underwent core decompression (CD) and salmonella bacteria growth was found in the hip puncture culture. Avascular necrosis associated with septic arthritis was determined. The patient was re-operated and irrigation and debridement for synovial tissues were performed two days following the first operation. While the association of septic arthritis with causative Salmonella and FHAN is rare except in sickle cell patients, septic arthritis must be considered and ruled out in patients who have previously undergone CD and did not show expected relief in early stage FHAN.
Kronik böbrek hastalığı olan ratlarda teriparatid kullanımının kırık iyileşmesi üzerine etkisi
(Başkent Üniversitesi Tıp Fakültesi, 2018) Ajdin, Elfida; Beyaz, Salih
Kronik böbrek hastalığı (KBH), tüm dünyada olduğu gibi ülkemizde de görülme sıklığı gittikçe artan önemli bir sağlık sorunudur. Kronik böbrek hastalığında başlatan neden ne olursa olsun en önemli sorun son dönem böbrek yetmezliğine ilerleme ve böbrek fonksiyon kaybına bağlı gelişen komplikasyonlar sağlık sektöründe diyaliz ihtiyacının artmasının yanı sıra daha birçok alanda sorunlar ortaya çıkarmakta ve tedavi gereksinimi artmaktadır. Kronik böbrek hastalığında ileri evrelerde ve yetmezlik gelişen hastalarda özellikle kemik mineral metabolizması bozuklukları Ortopedi ve Travmatoloji kliniğinde önemli komplikasyonlarla karşımıza çıkmaktadır. KBH olan hastalarda kemiklerdeki kemik mineralizasyonunun azalmasına ve kemik yapımı ve yıkımındaki dengenin bozulmasına bağlı olarak adinamik kemik hastalığı, tekrarlayan kemik kırıkları, kırık kaynamasında komlikasyonlar gibi birçok sorun uzun uğraşlar gerektirmekte ve eş zamanlı olarak gerek hasta gerekse hekim açısından zaman ve maddi kayba neden olmaktadır. Bu çalışma ülkemizde ve özellikle merkezimizde takip edilen çok sayıda KBH’lı hasta göz önünde bulundurularak, yukarıda saydığımız sorunlara bağlı gelişebilecek komplikasyonlar sonucu oluşan kayıpları en aza indirmek amacıyla yürütülmüştür. Bu amaçla çalışmamızda 32 adet Sprague- Dawley cinsi erkek sıçan, Grup I, Grup II, Grup III ve Grup IV olmak üzere ve her grupta eşit sayıda (8 adet) sıçan olacak şekilde dört gruba ayrıldı. Grup II ve Grup IV’teki sıçanlara KBH oluşturmak amacıyla 5/6 nefrektomi uygulandı. Gruplardaki tüm sıçanlara tur motoru ile sağ femur diafiz kırığı oluşturuldu. Kırık oluşturulmasını takiben tüm sıçanların sağ femurlarına k-telleri ile intramedüller fiksasyon uygulandı. Grup I’deki sıçanlar osteotomi oluşturulan kontrol grubu olarak, Grup II’deki sıçanlar KBH oluşturularak ilaç tedavisi almadan takip edilecek KBH’lı kontrol grubu olarak belirlendi. Grup III sıçanlar KBH oluşturulmayan ancak ilaç kullanılarak kırık iyileşmesi takip edilen, Grup IV sıçanlar ise KBH oluşturularak ilaç kullanılacak çalışmadaki temel grup olarak belirlendi. Sıçanların KBH tanısı ve takibi amacıyla 4 haftalık süreler ile ağırlık ölçümü ve 0.gün, 4.hafta ve 8.haftalarda (sakrifikasyon öncesinde) kan hemoglobin, üre ve kreatinin seviyeleri ölçüldü. Kemik iyileşmesi ve kallus oluşumu; radyolojik olarak direkt grafi, histopatolojik olarak ise Hematoksilen Eosin boyama ile değerlendirildi.Morfolojik olarak kallus dokusu miktarı ve kemiğin düzgün iyileşme bulguları sırası ile: Grup III> Grup I> Grup IV> Grup II olarak bulundu. Kemik iyileşmesinin takibi radyolojik olarak direk garfilerde kallus dokusunun ölçümü ile rakamsal olarak belirlendi. Medüller kanalın en dış kısmından başlanarak kortikal kısım ve kallusun en dış kısmına kadar olan kalınlık ölçüldü. Kallus kalınlıkları rakamsal olarak belirlendi. Kallusun en dış noktasına olan kalınlıklarının ölçülmesi sonucu ortalama kallus kalınlıkları; Grup I (1.538 ±0.7763), Grup II (0.738 ±0.6781), Grup III (1.775 ±0.7126), Grup IV (1.500 ±0.3464) olarak ölçüldü. Kemik iyileşmesi skorlama sistemi sonuçları ile ölçülen kallus kalınlıklarının karşılaştırılmasında; skorlama sistemi ile kallus kalınlıkları arasında anlamlı korelasyon gözlendi. 0. gün, 4. hafta, ve 8.haftada alınan kan örneklerinde BUN, kreatinin seviyelerinde yükselme ve hemoglobin seviyelerindeki düşme anlamlı bulundu. Histopatolojik değerlendirmede kemik dokunun iyileşme skorlaması (Allen skorlaması) sonuçları Grup I (3.38 ±1.302), Grup II (3.88 ±1.458), Grup III (2.5 ±1.609), Grup IV (3.0 ±1.927) olarak bulundu. Bu çalışmada KBH’nın kemik iyileşmesi üzerindeki olumsuz etkilerinin PTH analoğu olan ve düşük dozlarda ve aralıklı uygulamalarda anabolik etkisi olduğu birçok makalede gösterilmiş olan Teriparatid tedavisi araştırıldı. Radyolojik olarak kırık kaynamasında kallus oluşumunu arttırdığı gözlenirken, yapılan birçok çalışmanın aksine histopatolojik olarak kaynama açısından anlamlı fark olmadığı ancak yine histopatolojik olarak kırık iyileşmesi sırasında kemik dokudaki nekrozu önlemede anlamlı fark olduğu gözlendi. Çalışmamızda KBH’lı hastalarda radyolojik olarak kallus kalınlığının ilaç kullanılmayan gruba göre daha fazla olacağı ve iyileşme esnasında oluşabilecek nekrozun ve bu nekrozun uzun dönemde kırık iyileşmesinde oluşturacağı olumsuz etkilerinin önlenebileceği kanaatindeyiz. Chronic kidney disease (CKD) is an important health problem that has been seen to increase globally and in our country as well. No matter the cause leading to chronic kidney disease, most importantly is its progression to late stage kidney failure and complications due to kidney disfunction. As a result, apart from the need for dialysis in the health sector, problems in quite a number or areas ensue and also an increased need for treatment. Patients who have advanced chronic kidney disease and kidney failure develope especially disorders of bone and mineral metabolism presenting with important complications to the Orthopaedic Surgery and Traumatology clinic. Decreased bone mineralization and impaired balance between bone formation and bone resorption in CKD patients lead to many problems like adynamic bone disease, recurrent bone fractures and complications in bone union that require long term management and at the same time costs both the patient and the doctor time and money. This study has been caried out taking into consideration the number of CKD patients in our country and especially in our clinic and with the aim of reducing to the minimum the complications that would ensue as a result of the above mentioned problems. In this study 32 Sprague-Dawley male rats were divided into 4 groups each with equal numbers (8 rats). Single session 5/6 nephrectomy model described by Seth et al. was applied to the rats in Group II and Group IV with the aim of inducing CKD. Right femur diaphysis fracture was created using a rotating bar in all the rats in all the groups. Intramedullary fixation of the right femur with k-wire was then done on all the rats after the fracture. The rats in Group I were designated to be a control group with osteotomies and the rats in Group II were designated to be a CKD control group with induced CKD and would be followed up with no treatment. Group III rats would not be induced to have CKD however they would be administered medicine to treat fractures, whereas Group IV rats were the main group that would be induced to develope CKD and administered medicine. To be able to diagnose and follow up CKD induced in the rats, weight measurements were taken for a period of 4 weeks and hemoglobin, urea and creatinin levels measured at the beginning, on the 4th week and on the 8th week (before sacrification). Bone healing and callus formation was evaluated radiologically using x-ray and histopathologically using hematoxylin and eosin staining.Morphologically the amount of callus tissue and signs of bone healing were determined to be in this order; Grup III> Grup I> Grup IV> Grup II. Bone healing was monitored radiolojically using x-ray whereas measurement of callus tissue was done numerically. The thickness from medullary canal’s outer most part to the cortical part and the outer most part of callus was measured. The thickness of callus was determined numerically. Callus thickness that was measured upto the outer most point was determined and the average thicknesses was as follows; Grup I (1.538 ±0.7763), Grup II (0.738 ±0.6781), Grup III (1.775 ±0.7126), Grup IV (1.500 ±0.3464). The results of bone healing scoring system were compared to measurements of callus thickness and a significant correlation observed. Blood samples taken at the beginning, on the 4th week and 8th week showed levels of BUN and creatinin to have significantly increased and levels of hemoglobin to have significantly decreased. With histopathologic evaluation the results of bone healing scoring (Allen scoring system) were as follows; Grup I (3.38 ±1.302), Grup II (3.88 ±1.458), Grup III (2.5 ±1.609), Grup IV (3.0 ±1.927). In this study the therapeutic effect of Teriparatide on bone healing affected by CKD has been investigated. Teriparatide is a PTH analogue that has been shown in a number of articles to have an anabolic effect when applied intermittent. Radiologically it has been observed that callus formation increases in fracture union whereas unlike many studies carried out, there was no significant difference in terms of fracture union histopathologically. However there was a significant difference in the prevention of necrosis in bone tissue while the fracture is healing. In our study radiologically callus thickness in CKD patients would be greater compared to the group that medicine was not used and we believe that necrosis that ocurs during healing and its long term impact on the healing of fracture would be prevented.