Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Removal of an Epidural Catheter Without Discontinuation of Dual Antiplatelet Therapy in A Patient with Postoperative Urgent Coronary Stenting(2016) Tuncali, Bahattin; Boya, Hakan; https://orcid.org/0000-0002-7898-2943; https://orcid.org/0000-0001-6110-4004; 26256721; AAJ-7840-2021; W-7391-2019Item Caudal Block Combined with Propofol Infusion Using Laryngeal Mask Airway in A Spontaneously Ventilating Child with Merosin-Positive Occidental Type Congenital Muscular Dystrophy(2016) Tuncali, Bahattin; Boya, Hakan; Arac, Sukru; 0000-0002-7898-2943; 0000-0001-6110-4004; 27290974; AAJ-7840-2021; W-7391-2019Item A Novel Hybrid Type (Custom-Made Plus Off-The-Shelf) Total Femoral PROSTALAC(2016) Arac, Suleyman Sukru; Boya, Hakan; 0000-0001-6110-4004; 27174065; W-7391-2019Introduction: Treatment of periprosthetic joint infection following revision-Total Hip Arthroplasty is more problematic when there is poor bone quality and severe bone loss. Migration of revision prosthesis with a long stem to the knee joint in infected cases makes treatment more complex. In these cases, total femoral replacement is the only treatment option and eradication of infection is mandatory before the replacement. In 2-staged reconstruction treatment, there is a need for a PROSTALAC to replace the whole femur. Methods: We describe here a novel hybrid type (custom-made plus off-the-shelf) total femoral PROSTALAC for cases in need of whole femoral bone and femoral component removal for the treatment of periprosthetic joint infection in total hip arthroplasty. Result: Both sides of the PROSTALAC have anatomical joint surfaces, so the articulation with the acetabulum proximally is expected to be more stable. The off-the-shelf anatomic joint surface of the PROSTALAC distally allows articulation compatible with a proximal tibial off-the-shelf spacer. Conclusions: This simple hybrid-type total femoral PROSTALAC can be adjusted to femoral length, has anatomical joint surfaces that produce a more stable articulation, and can articulate with an off-the-shelf proximal tibial spacer.Item Proximal Tibiofibular Joint Pain Versus Peroneal Nerve Dysfunction: Clinical Results of Closed-Wedge High Tibial Osteotomy Performed with Proximal Tibiofibular Joint Disruption(2017) Ozcan, Ozal; Eroglu, Mehmet; Boya, Hakan; Kaya, Yilmaz; https://orcid.org/0000-0001-6110-4004; 26971107; W-7391-2019Closed-wedge high tibial osteotomy (CW-HTO) requires shortening of the fibula or the fibular head or disruption of the proximal tibiofibular joint (PTFJ). However, no study has evaluated the proximal tibiofibular joint after the osteotomy. The aim of this study was to investigate the fate of the PTFJ after CW-HTO applied with using PTFJ disruption method. This prospective study included 22 knees of 20 patients who underwent CW-HTO. The mean age of the patients was 50 +/- 4 years, and the mean follow-up period was 27.5 +/- 14.3 months (12-46 months). The grade of gonarthrosis (Ahlback's classification), tibiofemoral alignment and tibial slope angles were measured on radiographs pre- and post-operatively. During the surgery, the PTFJ capsule was released meticulously so as not to injure the peroneal nerve. Tenderness over the PTFJ was recorded preoperatively and at the last follow-up. No patient had tenderness or pain over PTFJ preoperatively. On the follow-up examinations, tenderness with compression was detected in nine knees with dorsiflexion, in ten with plantar flexion and in nine with neutral position of the ankle, respectively. None of the patients had peroneal nerve injury (including hypesthesia and mild weakness) post-operatively. However, while 11 knees were pain free in all positions of the ankle, seven knees had tenderness over PTFJ both in dorsiflexion and in plantar flexion. CW-HTO using PTFJ disruption provides good clinical results in terms of medial knee pain and corrects the alignment sufficiently while avoiding peroneal nerve injury. However, the results of this study indicated that this technique might result in painful PTFJs. Thus, the surgeon should consider a possibly painful PTFJ, which can be a cause of chronic lateral knee pain when performing this technique.Item An investigation of consistency between posterior condylar axis+3 degree external rotation line and clinical transepicondylar axis line techniques in primary total knee arthroplasty(2014) Boya, Hakan; Ozcan, Ozai; Maralcan, GokhanObjectives: This study aims to investigate discrepancy between posterior condylar axis (PCA)+3 degree external rotation (ER) line and clinical transepicondylar axis (cTEA) line and consistency between the both techniques in primary total knee arthroplasty. Patients and methods: Thirty-six knees [Bilateral knees were operated simultaneously in 12 patients (50%)] in 24 patients [3 men (12.5%), 21 women (87.5%); average age 67 (59-80 age)] were included in the study. During surgery, PCA+3 degrees ER line and cTEA line were drawn on the distal femoral cutting surface by electrocautery pencil following distal femoral cut. The both lines on distal femur were recorded by digital camera and relationship between lines was ascertained in reference to PCA+3 degrees ER line [parallel, internal rotation (IR), ER]. Statistical analysis was performed by the McNamara chi square test and Kappa (kappa) value. Results: Assessment of the images revealed that cTEA line in comparison to PCA+3 degrees ER line was parallel in 22 knees (61.2%), but not parallel in 14 knees (38.8%) [IR in 10 knees (71.5%), ER in 4 knees (28.5%)]. There was a significant difference (McNamara chi square=12.7 +/- 1; p<0.001) and poor consistency (kappa=0.00055) between both lines and techniques, respectively. Conclusion: For determination of femoral component rotation in surgery setting, different results between cTEA and PCA+3 degrees ER techniques possibly may due to disadvantages of techniques and anatomic variation of distal femur. Thus, using both techniques to check each other's results seems unsafe.Item Hand injury with a nail gun: a case report with literature review(2015) Boya, Hakan; Uzun, Belkan; 26200416The nail gun was introduced in the late 1950s to increase the ease of driving nails, studs, bolts, or staples into various hard surfaces. The nail gun is a potentially dangerous device that is still commonly used in the construction industry. Since its introduction, an increasing number of studies have reported injuries associated with nail guns. Nail gun-related injuries-such as to the head, neck, and chest-can be devastating, and in some cases, even fatal. Extremity injuries, notably in the hand, can cause loss of function, missed work, and long-term health effects. This case report describes a nail-gun injury of the hand along with a discussion of the unique features of and treatment strategies for nail gun injuries.Item Clinical utilization of arterial occlusion pressure estimation method in lower limb surgery: effectiveness of tourniquet pressures(2016) Tuncali, Bahattin; Boya, Hakan; Kayhan, Zeynep; Arac, Sukru; Camurdan, Mehmet Ali Koray; 26969952Objective: The effectiveness of the arterial occlusion pressure (AOP) estimation method to set tourniquet inflation pressures was assessed in patients undergoing lower limb surgery. Methods: One hundred ninety-eight operations were performed in 224 lower extremities of 193 patients. Tourniquet inflation pressures were set using the AOP estimation formula and adding 20 mmHg of safety margin to AOP value. Primary outcome measures were the amount of tourniquet pressure and its effectiveness. The quality of the surgical field and complications were assessed by the surgical team in a blinded fashion. Secondary measures included the time required to set the tourniquet pressure and complications. Results: The initial and maximal tourniquet pressures used were 168.4 +/- 14.5 and 173.3 +/- 15.6 mmHg, respectively. The performance of the tourniquets was assessed as "excellent" and "good" in all stages of the procedure in 97.76% of cases. The time required to measure AOP and set the tourniquet cuff pressure was 19.0 +/- 2.6 sec. No complications occurred during or after surgery until discharge. Conclusion: Clinical utilization of the AOP estimation formula is a practical and effective way of setting tourniquet pressures for lower limb surgery. Its usage allows achievement of a bloodless field with inflation pressures lower than those previously recommended in the literature for lower limb tourniquets.Item Practice of tourniquet use in Turkey: a pilot study(2016) Boya, Hakan; Tuncali, Bahattin; Ozcan, Ozal; Arac, Sukru; Tuncay, Cengiz; 26969951Objective: The aim of the present pilot study was to evaluate patterns in the current practice of tourniquet use in Turkey. The results of this study can provide detailed information regarding tourniquet use and evaluate the need for guidelines on tourniquet use in Turkey. Methods: The questionnaire was sent to orthopedic residents and surgeons by either giving printed questionnaires directly or by establishing preliminary communication with surgeons and then sending questionnaires by e-mail. Participating staff consisted of 3 groups: Group 1: orthopedic surgeons; Group 2: orthopedic residents; and Group 3: orthopedic academic staff. Statistical differences in tourniquet use were analyzed among the groups. Results: Use of mechanical tourniquet was significantly higher in Group 1. Plain cuffs were used in orthopedic surgical practice more frequently. Assistant and orthopedic theatre personnel were commonly reported by participants as the tourniquet applicant. Periodic educational practice was not routine. The number of reported complications was higher in Group 3. Cuff padding was generally routine practice. Scientifically valid options at lowest inflation pressure were not observed among the results at the expected rates. Conclusion: The results of this pilot study indicate that there is wide variation in some aspects of tourniquet practice in Turkey. The differences are not acceptable because of the potential for significant complications with some practices. There is a need to provide and ensure adequate education to provide the best patient care. Furthermore, protocols should be developed for acceptable standards of tourniquet use.Item A rare complication of total knee arthroplasty: Type l complex regional pain syndrome of the foot and ankl(2016) Soylev, Gozde Ozcan; Boya, Hakan; 0000-0001-6110-4004; 0000-0001-8742-5543; 27726920; W-7391-2019; AAJ-4917-2021Complex regional pain syndrome (CRPS) is a painful and disabling disorder that usually affects the extremities. This complication may affect the knee joint after total knee arthroplasty (TKA). We report a unique case of CRPS of the foot and ankle, which was an unusual involvement site for CRPS after TKA. (C) 2016 Publishing services by Elsevier B.V. on behalf of Turkish Association of Orthopaedics and Traumatology.Item Does severe osteoarthritis in knees with varus deformity alter the adductor ratio?(2017) Boya, Hakan; Arac, Suleyma Sukru; 0000-0001-6110-4004; 29029868; W-7391-2019Objective: In our retrospective study, we aimed to investigate the differences between the adductor ratio (AR) in knees with and without osteoarthritis, and its validity in determining the articular level. Methods: Data from 80 knees of 80 patients were retrospectively evaluated. Anteroposterior weight bearing knee radiographs of the patients with and without osteoarthritis (40 knees in each group) were obtained. The adductor ratio was determined using the following formula: ATJL/FW (adductor tubercle-joint line distance/femoral width). All radiographs were evaluated at the baseline and at one-month intervals afterwards. Intraobserver reliability of the two measurements was assessed using interclass correlations (ICC). Pearson's correlation test was used to evaluate the correlation between the ATJL and the FW. The differences between the adductor ratios of the two groups were evaluated by the independent samples two-tailed t-test. Results: Most of the ICC values were well above 0.95, indicating a very high intraobserver reliability. The adductor ratio was significantly greater in Group 2 in comparison to Group 1 (Mean AR in Group 2: 0.522 +/- 0.031 and Mean AR in Group 1: 0.502 +/- 0.032; p = 0.005). There was a significant correlation between the ATJL and FW in the groups when assessed both separately and combined. Conclusion: In conclusion, we can assert that if the AR is used to determine the articular level in revision arthroplasty cases, it may be sensible to measure the FW intraoperatively rather than measuring it on primary or contralateral radiographs of arthritic patients. (c) 2017 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V.