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Unal M, Kati YA, Ergun M, Aktan C, Celik OF, Guler F. Comparison of patient positions without traction table for proximal femoral nailing: Supine, semilithotomy and lateral decubitus positions. Injury 2024; 55:111416. [PMID: 38364683 DOI: 10.1016/j.injury.2024.111416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/22/2024] [Accepted: 01/31/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Femur intertrochanteric fractures are performed commonly in a supine position with a traction table. There is a challenge in obtaining traction tables, especially in low- and middle-income countries. However, there is still a debate on which position should be preferred if the traction table cannot be obtained. METHODS A total of 123 patients who were treated for femur intertrochanteric fracture (AO/OTA A1 or A2) using cephalomedullary nail (CN) were retrospectively analyzed. All three positions without traction table (supine:25 patients, semilithotomy:36 patients and lateral decubitus:62 patients) were compared according to preparation time, surgical time, Tip-Apex distance (TAD), zones of lag screw placement, collodiaphyseal angle (CDA), CDA difference (∆ CDA), postoperative posterior sag, medial cortical support and Baumgardner reduction quality criteria. RESULTS The preparation time was longer in the semilithotomy group, and surgery time was longer in the supine position group. There was no difference according to total time, surgical time, TAD, CDA difference (∆ CDA), postoperative posterior sag, medial cortical support and Baumgardner reduction quality criteria. Target lag screw placement is superior in supine and semilithotomy group than lateral decubitus. CONCLUSION This study concluded that there was a difference in preparation time, surgery time and optimal lag screw placement in the lateral plane between groups. The surgeon may prefer all three methods according to patient benefit and surgeon familiarity.
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Affiliation(s)
- Melih Unal
- Department of Orthopedics and Traumatology, University of Health Sciences, Medical Faculty, Antalya Training and Research Hospital, Antalya, Turkey.
| | - Yusuf Alper Kati
- Department of Orthopedics and Traumatology, University of Health Sciences, Medical Faculty, Antalya Training and Research Hospital, Antalya, Turkey
| | - Muhammed Ergun
- Department of Orthopedics and Traumatology, University of Health Sciences, Medical Faculty, Antalya Training and Research Hospital, Antalya, Turkey
| | - Cemil Aktan
- Department of Orthopedics and Traumatology, University of Health Sciences, Medical Faculty, Antalya Training and Research Hospital, Antalya, Turkey
| | - Omer Faruk Celik
- Department of Orthopedics and Traumatology, University of Health Sciences, Medical Faculty, Antalya Training and Research Hospital, Antalya, Turkey
| | - Ferhat Guler
- Department of Orthopedics and Traumatology, University of Health Sciences, Medical Faculty, Antalya Training and Research Hospital, Antalya, Turkey
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Soydan Z, Saglam Y, Key S, Kati YA, Taskiran M, Kiymet S, Salturk T, Aydin AS, Bilgili F, Sen C. An AI based classifier model for lateral pillar classification of Legg-Calve-Perthes. Sci Rep 2023; 13:6870. [PMID: 37106026 PMCID: PMC10140055 DOI: 10.1038/s41598-023-34176-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/25/2023] [Indexed: 04/29/2023] Open
Abstract
We intended to compare the doctors with a convolutional neural network (CNN) that we had trained using our own unique method for the Lateral Pillar Classification (LPC) of Legg-Calve-Perthes Disease (LCPD). Thousands of training data sets are frequently required for artificial intelligence (AI) applications in medicine. Since we did not have enough real patient radiographs to train a CNN, we devised a novel method to obtain them. We trained the CNN model with the data we created by modifying the normal hip radiographs. No real patient radiographs were ever used during the training phase. We tested the CNN model on 81 hips with LCPD. Firstly, we detected the interobserver reliability of the whole system and then the reliability of CNN alone. Second, the consensus list was used to compare the results of 11 doctors and the CNN model. Percentage agreement and interobserver analysis revealed that CNN had good reliability (ICC = 0.868). CNN has achieved a 76.54% classification performance and outperformed 9 out of 11 doctors. The CNN, which we trained with the aforementioned method, can now provide better results than doctors. In the future, as training data evolves and improves, we anticipate that AI will perform significantly better than physicians.
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Affiliation(s)
- Zafer Soydan
- Orthopedics and Traumatology, Bhtclinic İstanbul Tema Hastanesi, Nisantası University, Atakent Mh 4. Cadde No 36 PC, 34307, Kucukcekmece, Istanbul, Turkey.
| | - Yavuz Saglam
- Orthopedics and Traumatology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Sefa Key
- Orthopedics and Traumatology, Bingol State Hospital, Bingol Merkez, Turkey
| | - Yusuf Alper Kati
- Orthopedics and Traumatology, Antalya Egitim ve Arastirma Hastanesi, Antalya, Turkey
| | - Murat Taskiran
- Department of Electronics and Communication Engineering, Yildiz Technical University, Istanbul, Turkey
| | - Seyfullah Kiymet
- Department of Electronics and Communication Engineering, Yildiz Technical University, Istanbul, Turkey
| | - Tuba Salturk
- Department of Informatics, Yildiz Technical University, Istanbul, Turkey
| | - Ahmet Serhat Aydin
- Orthopedics and Traumatology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Fuat Bilgili
- Orthopedics and Traumatology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Cengiz Sen
- Orthopedics and Traumatology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
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Kati YA, Kose O, Turan A, Guler F, Sarikcioglu L. A rare cause of foot pain in an adolescent due to os paracuneiforme: a case report and review of the literature. Skeletal Radiol 2021; 50:1023-1028. [PMID: 33236234 DOI: 10.1007/s00256-020-03677-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/07/2020] [Accepted: 11/15/2020] [Indexed: 02/02/2023]
Abstract
Os paracuneiforme is an extremely rare accessory ossicle located at the medial aspect of the medial cuneiform bone. Although foot pain secondary to accessory ossicles is well known, symptomatic os paracuneiforme that requires surgical excision is rarely reported in the current literature. Herein, a 12-year-old boy with symptomatic os paracuneiforme is presented, and its clinical and imaging findings as well as the treatment are discussed.
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Affiliation(s)
- Yusuf Alper Kati
- Orthopedics and Traumatology Department, Antalya Training and Research Hospital, Kazım Karabekir cd, 07100 Soguksu Muratpasa, Antalya, Turkey
| | - Ozkan Kose
- Orthopedics and Traumatology Department, Antalya Training and Research Hospital, Kazım Karabekir cd, 07100 Soguksu Muratpasa, Antalya, Turkey.
| | - Adil Turan
- Orthopedics and Traumatology Department, Antalya Training and Research Hospital, Kazım Karabekir cd, 07100 Soguksu Muratpasa, Antalya, Turkey
| | - Ferhat Guler
- Orthopedics and Traumatology Department, Antalya Training and Research Hospital, Kazım Karabekir cd, 07100 Soguksu Muratpasa, Antalya, Turkey
| | - Levent Sarikcioglu
- Anatomy Department, Medical Faculty, Akdeniz University, Pinarbasi 07070 Konyaalti, Antalya, Turkey
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Unal M, Kose O, Aktan C, Gumussuyu G, May H, Kati YA. Is There a Role of Meniscal Morphology in the Risk of Noncontact Anterior Cruciate Ligament Rupture? A Case-Control Study. J Knee Surg 2021; 34:570-580. [PMID: 32659821 DOI: 10.1055/s-0040-1713814] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to identify the anatomical risk factors and determine the role of meniscal morphology in noncontact anterior cruciate ligament (ACL) rupture. A total of 126 patients (63 with noncontact ACL rupture and 63 age- and sex-matched controls) with intact menisci were included in this retrospective case-control study. On knee magnetic resonance imaging (MRI), meniscal morphometry (anterior, corpus, and posterior heights and widths of each meniscus), tibial slope (medial and lateral separately), notch width index, roof inclination angle, anteromedial bony ridge, tibial eminence area, and Q-angle measurements were assessed. The data were analyzed using multiple regression analyses to identify independent risk factors associated with ACL rupture. Using a univariate analysis, medial and lateral menisci anterior horn heights (p < 0.001; p < 0.003), medial and lateral menisci posterior horn heights (p < 0.001; p < 0.001), lateral meniscus corpus width (p < 0.004), and notch width index (p < 0.001) were significantly higher in the control group. Lateral tibial slope (p < 0.001) and anteromedial bony ridge thickness (p < 0.001) were significantly higher in the ACL rupture group. Multivariate analysis revealed that decreased medial meniscus posterior horn height (odds ratio [OR]: 0.242; p < 0.001), increased lateral meniscus corpus width (OR: 2.118; p < 0.002), increased lateral tibial slope (OR: 1.95; p < 0.001), and decreased notch width index (OR: 0.071; p = 0.046) were independent risk factors for ACL rupture. Notch stenosis, increased lateral tibial slope, decreased medial meniscus posterior horn height, and increased lateral meniscus corpus width are independent anatomical risk factors for ACL rupture. Meniscal morphological variations also play a role in ACL injury. This is a Level III, retrospective case-control study.
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Affiliation(s)
- Melih Unal
- Department of Orthopedics and Traumatology, Antalya Education and Research Hospital, Antalya, Turkey
| | - Ozkan Kose
- Department of Orthopedics and Traumatology, Antalya Education and Research Hospital, Antalya, Turkey
| | - Cemil Aktan
- Orthopedics and Traumatology Clinic, Kahramankazan State Hospital, Ankara, Turkey
| | - Gurkan Gumussuyu
- Department of Orthopedics and Traumatology, Medical Park Bahcelievler Hospital, Istanbul, Turkey
| | - Hasan May
- Department of Orthopedics and Traumatology, Antalya Education and Research Hospital, Antalya, Turkey
| | - Yusuf Alper Kati
- Department of Orthopedics and Traumatology, Antalya Education and Research Hospital, Antalya, Turkey
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Turan A, Kati YA, Acar B, Kose O. Magnesium Bioabsorbable Screw Fixation of Radial Styloid Fractures: Case Report. J Wrist Surg 2020; 9:150-155. [PMID: 32257617 PMCID: PMC7113003 DOI: 10.1055/s-0039-1685489] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/03/2019] [Indexed: 10/27/2022]
Abstract
Background Several types of fixation materials may be used for the radial styloid fractures such as Kirschner wire fixation, screw fixation, volar plate fixation, and fragment-specific radial buttress plate fixation. However, each of these fixation techniques has certain complications usually related to either the surgical dissection or the application of fixation and symptomatic permanent hardware. Implant removal secondary to irritation of prominent screw heads or bulky plates is not uncommon after radial styloid fracture fixation. Case Description Herein, two patients with an isolated radial styloid fracture who were treated with bioabsorbable magnesium (alloy: MgYREZr) screws are presented. In both patients, the fracture union was achieved without any complication and need for implant removal. Literature Review This is the first report on the use of magnesium screws for this indication. Clinical Relevance Magnesium bioabsorbable compression screw fixation may be an alternative solution that eliminates removal operations due to symptomatic hardware in radial styloid fractures.
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Affiliation(s)
- Adil Turan
- Department of Orthopedics and Traumatology, Antalya Education and Research Hospital, Antalya, Turkey
| | - Yusuf Alper Kati
- Department of Orthopedics and Traumatology, Antalya Education and Research Hospital, Antalya, Turkey
| | - Baver Acar
- Department of Orthopedics and Traumatology, Antalya Education and Research Hospital, Antalya, Turkey
| | - Ozkan Kose
- Department of Orthopedics and Traumatology, Antalya Education and Research Hospital, Antalya, Turkey
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Acar B, Kose O, Unal M, Turan A, Kati YA, Guler F. Comparison of magnesium versus titanium screw fixation for biplane chevron medial malleolar osteotomy in the treatment of osteochondral lesions of the talus. Eur J Orthop Surg Traumatol 2019; 30:163-173. [PMID: 31375999 DOI: 10.1007/s00590-019-02524-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 07/30/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE This retrospective study aimed to compare the clinical and radiological outcomes of patients who underwent biplane chevron medial malleolar osteotomy (MMO) for osteochondral lesions of the talus (OLT), fixed with either magnesium (Mg) or titanium (Ti) screws. METHODS A total of 22 patients (12 male and 10 female) with a mean age of 40.6 ± 12.5 years (range 18-56 years) who underwent MMO for OLT treatment were included in this retrospective study. Of the 22 patients, MMO was fixed with bioabsorbable Mg screws (Alloy: MgYREZr) in 11 patients, and in the remaining 11 patients (one bilateral) MMO was fixed with Ti screws. All patients were followed up for at least 1 year with a mean of 20.7 ± 8.9 months (range 12-49 months). The American Orthopedic Foot and Ankle Society (AOFAS) scale and the visual analog scale (VAS) were used to evaluate the clinical results. Union of the osteotomy, postoperative displacement and all other complications were followed and analyzed. RESULTS An improvement in the AOFAS scale and VAS points were recorded in both groups with no statistically significant difference between the groups (p 0.079 and 0.107, respectively). Complete union of the osteotomy was obtained in all patients. One patient in the Ti group required implant removal due to pain and irritation. There were no other significant complications in either group. CONCLUSIONS The results of this study showed that bioabsorbable Mg compression screws have similar therapeutic efficacy to Ti screws in respect of functional and radiological outcomes in MMO fixation. Bioabsorbable Mg screw is an alternative fixation material which can be safely used for MMO in ankle surgery. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Baver Acar
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, University of Health Sciences, Soğuksu mah. Kazım Karabekir cd., Muratpaşa, 07100, Antalya, Turkey
| | - Ozkan Kose
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, University of Health Sciences, Soğuksu mah. Kazım Karabekir cd., Muratpaşa, 07100, Antalya, Turkey.
| | - Melih Unal
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, University of Health Sciences, Soğuksu mah. Kazım Karabekir cd., Muratpaşa, 07100, Antalya, Turkey
| | - Adil Turan
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, University of Health Sciences, Soğuksu mah. Kazım Karabekir cd., Muratpaşa, 07100, Antalya, Turkey
| | - Yusuf Alper Kati
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, University of Health Sciences, Soğuksu mah. Kazım Karabekir cd., Muratpaşa, 07100, Antalya, Turkey
| | - Ferhat Guler
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, University of Health Sciences, Soğuksu mah. Kazım Karabekir cd., Muratpaşa, 07100, Antalya, Turkey
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Polat O, Tuncer C, Kati YA, Uckun OM, Er U. Investigation of Lateral Epicondylitis in Neurosurgeons. Turk Neurosurg 2019; 29:414-419. [PMID: 30649825 DOI: 10.5137/1019-5149.jtn.24499-18.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AIM To investigate the frequency of lateral epicondylitis (LE), depending on the tasks performed by neurosurgeons, and to determine whether it can be accepted as an occupational disease depending on its frequency. MATERIAL AND METHODS All neurosurgery specialists enrolled in the Turkish Neurosurgical Society website were prospectively included. A questionnaire form was shared, and the subsequent responses were recorded. Those who provided incomplete responses were excluded from the study. The respondents diagnosed with LE were recorded. Exclusion criteria were investigated on complaints of pain. They were examined by an orthopedics and traumatology specialist with application of Thomsen test and necessary maneuvers. RESULTS The study was conducted with 216 neurosurgeons. Those with more than 30 operations per month (p=0.002), those with a specialization duration of 10-20 years and > 20 years (p=0.001), and those who specialized in spinal surgery (p=0.014) had a significantly higher prevalence of epicondylitis. Considering the relationship between lumbar/thoracic pedicle screw insertion and epicondylitis, the epicondylitis diagnosis rate was significantly higher in physicians inserting 20â€"60 screws per month than those inserting < 20 screws (p=0.009). CONCLUSION LE frequently occurs in neurosurgeons who regularly perform spinal instrumentation and appears to be an occupational disease. However, data obtained during the current study should be combined with findings from case-control studies of neurosurgeons.
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Affiliation(s)
- Omer Polat
- Duzce University, School of Medicine, Department of Neurosurgery, Duzce, Turkey
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Yildirim AO, Aksahin E, Sakman B, Kati YA, Akti S, Dogan O, Ucaner A, Bicimoglu A. The effect of rotational deformity on patellofemoral parameters following the treatment of femoral shaft fracture. Arch Orthop Trauma Surg 2013; 133:641-8. [PMID: 23443529 DOI: 10.1007/s00402-013-1705-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Indexed: 02/09/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the effect of rotational deformities on patellofemoral alignment using the dynamic magnetic resonance imaging method on patients whose femur fractures were treated with intramedullary locking nails. METHODS The dynamic patellofemoral magnetic resonance imaging results of 33 patients (5 females and 28 males) were reviewed. The mean age of the patients was 36.3 (range 19-61) years. The mean follow-up was 30.2 months (range 24-38). All the patients were given Kujala patellofemoral clinical evaluation scores at the latest follow-up. Those with less than 10° of rotational deformity in either direction were classified as Group A, those with more than a 10° of internal rotation deformity as Group B and more than a 10° of external rotation deformity as Group C. The three groups were then compared regarding to clinical scores. Patellofemoral parameters of operated and contralateral side were also compared in each group. RESULTS There were 14 (42.4 %) patients in Group A, 12 (36.4 %) patients in Group B and 7 (21.2 %) patients in Group C. The mean patella score in Group C (74 ± 7.02) was significantly lower when compared with Group B (87.6 ± 9.9) and group A (90.6 ± 6.1) (p < 0.05). In Group C patients, medial patellar tilt was detected when compared with the intact side. There were no significant changes in patellofemoral position in either Group A or Group B. CONCLUSION The results of this study revealed that more than 10° of external rotation deformity could cause a detoriation in the patellofemoral scores. Anatomic reduction of the fracture site should be performed as soon as possible and external rotational deformities should especially be avoided in order to prevent patellofemoral malalignment.
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Affiliation(s)
- Ahmet Ozgur Yildirim
- Ankara Numune Education and Research Hospital, Orthopaedics and Traumatology Clinics, Konutkent 2 Sitesi B5/C no: 16, Çayyolu/Ankara, Turkey.
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Affiliation(s)
- Metin Akinci
- Ankara Numune Education and Research Hospital, Clinics of Orthopedics and Traumatology, Ankara, Turkey.
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