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    Consultation of traditional bone setters instead of doctors: Is it a sociocultural and educational or social insurance problem?
    (Sage Publications Inc, 2015) Golge, Umut Hatay; Kaymaz, Burak; Komurcu, Erkam; Eroglu, Mehmet; Goksel, Ferdi; Nusran, Gurdal
    Background Patients consulting bone setters is common in the eastern and south-eastern regions of Turkey. The reasons for consulting bone setters instead of qualified doctors remains unclear. We investigated the characteristics of such patients who consult traditional bone setters after trauma prior to admission to hospital. Methods In the study, 3,422 of 14,080 patients were investigated admitted to hospital between January 2012 and February 2013 with trauma or sequelae of such who were previously treated by bone setters. The characteristics of these patients and the main reasons for consultation of bone setters instead of doctors were recorded. Results Most of the patients consulting bone setters were found to be young adults or children. Generally speaking, the poorly educated prefer bone setters despite having social insurance. The most common reason (29.3%) was a general preference and secondarily (27.1%) the fear of being disabled after medical treatment. However, the most common cause of patients' consultation at hospital subsequently was due to complications of treatment (46.8%); indeed the complication rate after bone setters' intervention was found to be 54.8%. Conclusion Although improvements have occurred in the access to and utilisation of healthcare services, consultation by patients of bone setters seems to be a sociocultural and educational issue rather than a problem of lack of medical insurance.
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    Effect of systemic carnitine therapy on serum fibronectin level in diabetic rats
    (Academic Press Inc Elsevier Science, 2014) Komurcu, Erkam; Ozkan, Omer Faruk; Kemik, Ahu Sarbay; Nusran, Gurdal; Asik, Mehmet; Arslan, Emrah
    Background: L-carnitine has been shown to enhance wound healing. There has, however, not been sufficient research on the effect carnitine has on diabetic wound healing. We investigated the relationship between the viability of full thickness skin grafts (FTSGs) and fibronectin (FN) serum levels in diabetic rats that were administered carnitine. Materials and methods: A total of 40 rats were divided into four groups of 10 rats each and operated on. The FTSG model was 10 x 3 cm, with the dorsal flap extending from the tip of the scapula to the hip joint. After surgery, group 1 (nondiabetic control, n = 10) and group 2 (diabetic control, n = 10) were given a sterile saline solution at 0.9% with a dose of 100 mg/kg/d intraperitoneally for 7 d after the surgery. Group 3 (diabetic sham, n = 10) contained diabetic rats and did not receive any agent after the surgery. The diabetic rats in group 4 ( carnitine study diabetic, n 10) were given carnitine with a dose of 100 mg/kg/d intraperitoneally for 7 d after the surgery. Results: The percentages of viable areas in groups 1-4 were 70.38 +/- 6.10%, 62.66 +/- 1.55%, 62.59 +/- 2.94%, and 73.48 +/- 4.43%, respectively. The mean levels of FN, measured in milligram per deciliter, in groupse4 were 23.57 +/- 3.27 mg/dL, 21.58 +/- 2.35 mg/dL, 22.04 +/- 2.71 mg/dL, and 27.11 +/- 2.79 mg/dL, respectively. Furthermore, we found that there was a strong positive correlation (R = 0.509; P = 0.001) between FN and the viability of the FTSG. Conclusions: We demonstrated that administering carnitine leads to an increase in diabetic wound healing. Further increasing the levels of the FNserum might have a role in this process. Crown Copyright (c) 2014 Published by Elsevier Inc. All rights reserved.
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    Musculoskeletal System Injuries Due to Motorcycle Accidents in Aksaray
    (Elsevier, 2013) Komurcu, Erkam; Arik, Kasim; Golge, Umut Hatay; Nusran, Gurdal; Kurt, Tolga
    Objectives An increase in motorcycle accidents and injuries has been observed in recent years due to the rising number of motorcyclists. The purpose of our study was to evaluate musculoskeletal system injuries due to motorcycle accidents. Methods The files of 189 patients who presented at the Aksaray State Hospital Emergency Service with injuries due to motorcycle accidents were investigated retrospectively. Age, gender, and current trauma were recorded for each patient. Cases with musculoskeletal system injuries were evaluated according to site of injury, and subsequent morbidity and mortality were documented. Results Of the 189 patients, 168 were male (89.9%), and 21 were female (11.1%). Locomotor system injuries were present in 147 patients (77.8%). The number of patients presenting with multiple extremity injuries versus isolated extremity injuries were 26 (17.69%) and 70 (47.62%), respectively. Soft tissue trauma was present in only 51 patients (34.69%). The distribution of fractures and dislocations was as follows: 74 (54.81%), lower extremity; 48 (35.56%), upper extremity; 9 (6.67%), pelvic; and 4 (2.96%), vertebral injuries. Of the extremity injuries, injuries to the femur (27.41%) and tibia (19.26) were most prevalent, followed by hand and wrist (9.63%) injuries. Seven patients with multiple organ injuries died, while permanent disability due to extremity function loss occurred in 22 patients. Pulmonary embolism and osteomyelitis complications occurred in two patients and one patient, respectively. Injuries were reported most frequently in July between 23: 00 and 03:00 and 04:00 and 07:00. According to the records, 48 (32.79%) of the patients with musculoskeletal injuries were drunk. Conclusions Musculoskeletal system injuries due to motorcycle accidents cause lifelong disabilities. To reduce the frequency of accidents, social awareness should be increased, and training programs in motorcycle usage should be more effective and widespread.
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    No Decrease in Infection Rate with the Use of Local Vancomycin Powder After Partial Hip Replacement in Elderly Patients with Comorbidities
    (Springernature, 2020) Erken, H. Yener; Nusran, Gurdal; Karaguven, Dogac; Yilmaz, Onur; Kuru, Tolgahan
    Introduction The goal of this study was to evaluate the effects of local intra-wound vancomycin powder (VP) administration to decrease surgical site infections (SSIs), particularly in elderly patients with comorbidities, after having undergone partial hip replacement in the treatment of intertrochanteric (ITF) or femoral neck fractures (FNF). Methods We retrospectively reviewed patients who underwent partial hip replacement in the treatment of ITF or FNF in one year. We divided the patients into two groups. The non vancomycin-treated group received standard systemic prophylaxis only (1 gr cefazolin IV), while the vancomycin-treated group received 1 gr of VP in the surgical wound just before surgical closure in addition to the systemic prophylaxis. We included patients of 64 years or older who also had one or more comorbidities. We compared the post-operative SSI rates between the non vancomycin-treated group and the vancomycin-treated group. Results A total of 93 patients were included in the study. We detected post-operative wound infection in six patients (6.4%). The rate of SSI was found to be 5.7% in the vancomycin-treated group and 6.9% in the non vancomycin-treated group respectively, which showed no statistically significant difference (p:0.498). The incidence of SSI was statistically higher in the patients who had a follow-up in the post-operative intensive care unit than the patients who had not any follow-up in the intensive care unit. Conclusion Local application of VP in the surgical wound was found to be ineffective in reducing the incidence of SSI after partial hip replacement in elderly patients with comorbidities.
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    No Sedation, No Traction, and No Need for Assistance: Analysis of New Prakash's Method of Shoulder Reduction
    (Hindawi Ltd, 2020) Kuru, Tolgahan; Olcar, Haci Ali; Bilge, Ali; Nusran, Gurdal; Ozkilic, Recai; Akman, Canan; Prakash, Lakshmanan
    Background and Objective. Shoulder dislocations, which often occur anterior, account for about half of all dislocations. There are numerous reduction methods reported for the conservative treatment of acute anterior dislocations. However, there is still an ongoing search for an optimal method given the procedure time, possible complications, success rates, and need for sedation/analgesia in existing methods. This study seeks to explore the effectiveness and safety of Prakash's method in the treatment of acute shoulder dislocations, which is a novel method in the treatment of anterior shoulder dislocations. Materials and Methods. A total of 19 patients who were admitted to the emergency department with the diagnosis of anterior shoulder dislocation participated in this study. The diagnosis of shoulder dislocation was established in the emergency department with physical examination and anteroposterior shoulder radiography. The method was applied only once to the patients in the sitting position by the same physician without using any help, traction, anesthesia, analgesia, and myorelaxant. Results. The mean age of the patients was 37.3 +/- 13.1 years. Among them, 36.8% n=4 of the patients. The success rate of the method was 94.7% n=18. No complication was noted in the patients. The mean procedure time was 243 +/- 38 seconds. Conclusion. Prakash's method is a safe method for anterior shoulder dislocations that can be quickly performed with no need for sedation, assistance, and traction and has a high success rate.
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    Preventive effects of coenzyme Q10 (CoQ10) on steroid-induced osteonecrosis in rats
    (Turkish Assoc Orthopaedics Traumatology, 2014) Komurcu, Erkam; Oktay, Murat; Kaymaz, Burak; Hatay Golge, Umut; Goksel, Ferdi; Nusran, Gurdal
    Objective: The aim of this study was to examine the role of coenzyme Q(10) (CoQ(10)) in the prevention of steroid-induced osteonecrosis of the femoral head (ONFH) in rats. Methods: The study included 20 Sprague-Dawley rats injected once with 20 mg/kg of methylprednisolone acetate into the right gluteus medius muscle to induce osteonecrosis. Animals were divided into two equal groups; Group 1 received no prophylaxis (control group) and the Group 2 received CoQ(10). Hematological examinations were performed before steroid injection (0 weeks) and at 4 weeks after steroid injection. Femoral heads were examined histologically to evaluate osteonecrosis. Results: Changes in blood glutathione (GSH) and malondialdehyde (MDA) concentrations were less significant in the CoQ(10) group. The incidence of histologic changes consistent with early osteonecrosis was lower in the CoQ(10) group (2 of 10; 20%) than the control group (7 of 10; 70%). Conclusion: Coenzyme Q(10) may be useful as a preventing agent in steroid-induced ONFH. Inhibited oxidative stress is a possible mechanism for this effect.
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    Relationship between serum fibronectin levels and carnitine administration: an experimental study in rats
    (Wiley, 2014) Ozkan, Omer F.; Komurcu, Erkam; Arik, Muhammet K.; Kemik, Ahu S.; Tas, Sukru; Nusran, Gurdal
    We aimed to investigate the relationship between dorsal flap viability and serum fibronectin levels in carnitine-administered rats. A total of 24 rats were equally divided into three groups and operated on. Group 1 (sham group n = 8): following surgery, no agent was given. Group 2 (control group, n = 8): following surgery, sterile saline solution at 09% with a dose of 100 mg/kg per day for 7 days was administered intraperitoneally. Group 3 (study group, n = 8): following surgery, carnitine with a dose of 100 mg/kg per day for 7 days was administered intraperitoneally. The flap model used was a 10 x 3 cm dorsal flap extending from the tip of the scapula to the hip joint. This was elevated, and then sutured back to its original site. At the end of postoperative day 8, the animals were anaesthetised and blood samples were collected from intracardiac space. Then, the animals were euthanised. Flap viability was then evaluated measuring the surviving area, using a transparent graph paper. Finally, excised tissue was examined histopathologically. The percentages of viable areas in groups 1, 2 and 3 were 6468 +/- 337%, 6735 +/- 582% and 7515 +/- 356%, respectively. The mean value of fibronectin levels in groups 1, 2 and 3 were 223 +/- 35, 231 +/- 35 and 31 +/- 68 mg/dl, respectively. The results of this study demonstrated that 100 mg/kg carnitine administration led to an increase in flap viability, and increased serum fibronectin levels might have a role in this process.
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    Safety of bioabsorbable implants in vitro
    (Biomed Central Ltd, 2015) Isyar, Mehmet; Yilmaz, Ibrahim; Nusran, Gurdal; Guler, Olcay; Yalcin, Sercan; Mahirogullari, Mahir
    Background: The aim of the present study was to investigate the safety of bioabsorbable plates and screws in humans. Methods: For this purpose, an implant system based on [poly(lactic-co-glycolic acids)(85: 15)] was designed. The system was tested for pH, temperature, and swelling and then its surface morphology was analyzed for surface porosity using environmental electron microscopy. Then, the effects of this bioabsorbable system on the viability and profileration of osteocytes were examined on a molecular level via in vitro experiments. A [poly(lactic-co-glycolic acids)(90:10)] bioabsorbable implant, which is commercially available and used in orthopedic surgery, was used as control group. For the statistical evaluation of the data obtained in the present study, the groups were compared by Tukey HSD test following ANOVA. The significance level was set as p < 0.05. Results: It was observed that the osteocytes cultivated on the PLGA system designed in the present study included more live cells and allowed more proliferation compared to the control. Conclusion: One of the criteria in the selection of implants for orthopedic surgery is that a good implant should not need removal and thus a second surgery. In the present study, a bioabsorbable implant was designed considering this criterion. The present study is the first step to prove the safety of this new design by in vitro toxicity and viability experiments.
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    The critical role of computed tomography in the differential diagnosis of acute calcific tendinitis of longus colli muscle: A case report
    (Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2023) Karatag, Gulden; Nusran, Gurdal; Zateri, Coskun; Karatag, Ozan
    Acute longus colli calcific tendinitis (ALCT) is a non-infectious inflammatory process. The typical clinical triad is acute neck pain, neck stiffness, and odynophagia. These findings can be confused with many common pathologies. As ALCT treatment is conservative and relatively easy, making the correct diagnosis is important. Radiology is of critical importance in the diagnosis of ACLT. The detection of prevertebral calcification by computed tomography is pathognomonic. Herein, we present a case with a sudden onset of neck and occipital pain accompanied by odynophagia following acute trauma and diagnosed with ALCT by radiological examination.
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    The effects of carbogen and hyperbaric oxygen treatment on fracture healing in rats
    (Turkish Assoc Trauma Emergency Surgery, 2022) Menendi, Umman; Nusran, Gurdal; Kaymaz, Burak; Tiskaoglu, Ramazan; Yilmaz, Onur; Goret, Ceren Canbey
    BACKGROUND: Bone fractures and fracture healing are one of the most common problems among orthopedic surgeons. In this study, we investigated the effects of hyperbaric oxygen (HBO) and carbogen (C) treatment on fracture healing in the experimental animal model. METHODS: Twenty-four male Wistar-Albino rats were randomly divided into three groups as Group 1 (C inhalation therapy), Group 2 (HBO inhalation therapy), and Group 3 (control group), with eight rats in each group. HBO and C treatment were given to the rats in Group 1 and Group 2 1 week before the surgical procedure and 3 weeks after the surgical procedure. Following the surgical procedure, all rats were killed at the end of the 3rd week and the healing tissue in the fracture line was evaluated clinically, radiologically, and histopathologically. RESULTS: Although there were higher histopathological, radiological, and clinical scores in the HBO and C groups in terms of fracture healing compared to the control group, there was no statistically significant difference between the groups. CONCLUSION: There are many studies in the literature that examine the systemic and local effects of HBO and C treatments and show that they increase tissue oxygenation. Our study showed that HBO and C groups had no beneficial or harmful effects on fracture healing compared to the control group.
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    The relation between chondromalacia patella and meniscal tear and the sulcus angle/trochlear depth ratio as a powerful predictor
    (Ios Press, 2017) Resorlu, Hatice; Zateri, Coskun; Nusran, Gurdal; Goksel, Ferdi; Aylanc, Nilufer
    PURPOSE: To investigate the relation between chondromalacia patella and the sulcus angle/trochlear depth ratio as a marker of trochlear morphology. In addition, we also planned to show the relationship between meniscus damage, subcutaneous adipose tissue thickness as a marker of obesity, patellar tilt angle and chondromalacia patella. METHODS: Patients with trauma, rheumatologic disease, a history of knee surgery and patellar variations such as patella alba and patella baja were excluded. Magnetic resonance images of the knees of 200 patients were evaluated. Trochlear morphology from standardized levels, patellar tilt angle, lateral/medial facet ratio, subcutaneous adipose tissue thickness from 3 locations and meniscus injury were assessed by two specialist radiologists. RESULTS: Retropatellar cartilage was normal in 108 patients (54%) at radiological evaluation, while chondromalacia patella was determined in 92 (46%) cases. Trochlear sulcus angle and prepatellar subcutaneous adipose tissue thickness were significantly high in patients with chondromalacia patella, while trochlear depth and lateral patellar tilt angle were low. The trochlear sulcus angle/trochlear depth ratio was also high in chondromalacia patella and was identified as an independent risk factor at regression analysis. Additionally, medial meniscal tear was observed in 35 patients (38%) in the chondromalacia patella group and in 27 patients (25%) in the normal group, the difference being statistically significant (P - 0.033). CONCLUSIONS: An increased trochlear sulcus angle/trochlear depth ratio is a significant predictor of chondromalacia patella. Medial meniscus injury is more prevalent in patients with chondromalacia patella in association with impairment in knee biomechanics and the degenerative process.
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    The treatment of intertrochanteric fractures comparison of PFN and hemiar-throplasty 3-year mortality study
    (Acta Medica Belgica, 2016) Golge, Umut Hatay; Pazarci, Ozhan; Kilinc, Seyran; Nusran, Gurdal; Kaymaz, Burak; Goksel, Ferdi; Komurcu, Erkam
    Intertrochanteric fractures in elderly patients can increase mortality due to complications and negative functional results. The aim of this study is to retrospectively compare the follow-up and mortality rates among patients given a proximal femoral nail (PFN), the current routine treatment for these types of fractures, with those given hemiarthroplasty. The study retrospectively investigated 202 patients over the age of 60 who completed at least 3 years of follow-up after hemiarthroplasty or PFN for intertrochanteric fractures between 2007 and 2012. While 132 patients underwent cemented hemiarthroplasty, 70 had PFN. The monitoring duration for those with PFN surgery was 31.25 +/- 1.3 months while the duration of follow-up for those with hemiarthroplasty surgery was 20.0 +/- 1.2 months. At the end of 3 years of monitoring of the 202 patients, 99 were deceased. There was a statistically significant difference found in terms of patient life expectancy between those with PFN and those with hemiarthroplasty; Cox regression analysis identified that the mortality rate of those with hemiarthroplasty was 5.1 times greater. As a result, patients undergoing hemiarthroplasty should be carefully chosen and if possible, PFN should be preferred.
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    The treatment of intertrochanteric fractures comparison of PFN and hemiarthroplasty 3-year mortality study
    (ARSMB-KVBMG, 2016) Gölge, Umut Hatay; Pazarci, Özhan; Kilinç, Seyran; Nusran, Gurdal; Kaymaz, Burak; Göksel, Ferdi; Kömürcü, Erkam
    Intertrochanteric fractures in elderly patients can increase mortality due to complications and negative functional results. The aim of this study is to retrospectively compare the follow-up and mortality rates among patients given a proximal femoral nail (PFN), the current routine treatment for these types of fractures, with those given hemiarthroplasty.The study retrospectively investigated 202 patients over the age of 60 who completed at least 3 years of follow-up after hemiarthroplasty or PFN for intertrochanteric fractures between 2007 and 2012. While 132 patients underwent cemented hemiarthroplasty, 70 had PFN. The monitoring duration for those with PFN surgery was 31.25±1.3 months while the duration of follow-up for those with hemiarthroplasty surgery was 20.0±1.2 months. At the end of 3 years of monitoring of the 202 patients, 99 were deceased. There was a statistically significant difference found in terms of patient life expectancy between those with PFN and those with hemiarthroplasty; Cox regression analysis identified that the mortality rate of those with hemiarthroplasty was 5.1 times greater.As a result, patients undergoing hemiarthroplasty should be carefully chosen and if possible, PFN should be preferred. © 2016, Acta Orthopædica Belgica.