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    Can radiation exposure be reduced in thetreatment of femur fractures with the Intrameduller nail?
    (Alanya Alaaddin Keykubat Üniversitesi, 2017) Konya, Mehmet Nuri; Kaya, Ömer Ali
    Aim: In this study, ouraim is to compare surgery time and radiation exposure for  patients of treated with two differentintramedullar nail distal locking systems; free-hand technique andelectromagnetic navigation system.Method:We evaluated 40 patients' femur fractures.  we treated with Intramedullar Nail due tofemur fractures between the dates of February 2012 and February 2013 wereoperated on by two different distal locking techniques; Distal Electromagneticguided technique(DML+) and Free-hand Technique(DML-). Radiation exposure was measuredby radiationmeter (NAB223) obtained from Civil Defense Directorate. Results:In groupDML(-) 20 femur fractures were evaluated. Mean flouroscopy time was 33,7± 12,6,operation time 68.5±7.1 minutes and whole radiation exposure was 461,7±172,7.In group DML(-) 20 femur fractures were evaluated. Mean flouroscopy time was29±17,6,operation time 66.25±10.1 minutes and whole radiation exposure was397,3±241,1.Concllusion:Inthis study we compared distal locking time, radiation exposure and fluoroscopyshoot by using two different distal locking techniques in long bone fracturesand found no significant  differences inboth of techniques (p>0.05).
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    Clinical and Radiographic Outcomes of Pediatric Femoral Neck Fractures
    (Alanya Alaaddin Keykubat Üniversitesi, 2017) Issın, Ahmet; Çamurcu, İsmet Yalkın; Konya, Mehmet Nuri; Şahin, Vedat
    Aim: The aim of thisstudy was to evaluate the clinical and radiological results of pediatricfemoral neck fractures and compare the results with the literature.Methods: We retrospectivelyreviewed patients with the diagnosis of femoral neck fracture who were treatedbetween 2005 and 2012. 14 patients (6 girls, 8 boys) were found in compliancewith the follow-up and with a minimum follow-up of 1 year. Causes of thefracture and types of the treatment were investigated from our medical records.Delbet-Colonna classification was used to determine the type of the fractures.At the last follow-up, femoral neck shaft angle (FNSA) and range of motion(ROM) of the affected hip were measured. Outcome was scored according toRatliff’s assessment criteria. Avascular necrosis (AVN) was classifiedaccording to Ratliff’s AVN classification system. Results: The mean age ofpatients was 9.9 years and the mean follow-up was 35 months. According toDelbet-Colonna classification; 1 patient was type I (7.1%), 4 were type II(28.6%), 8 were type III (57.2%) and 1 was type IV (7.1%). Eight of 14fractures were displaced (57.2%) and six were non-displaced (42.8%). Eleven of14 patients had good (78.6 %), 1 had fair (7.1%) and 2 had poor (14.3%) resultsaccording to Ratliff’s assessment criteria. According to Ratliff’s AVNclassification, 2 patients had Type-III (14.2 %) and 1 had Type-I AVN (7.1 %). Conclusion: According to ourresults, we recommend anatomical reduction (close or open) and stable internalfixation for the treatment of pediatric femoral neck fractures.
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    Clinical, radiological and patient-reported outcomes in intra-articular calcaneal fractures: Comparison of conservative and surgical treatment
    (2019) Aslan, Ahmet; Sargın, Serdar; Gülcü, Anıl; Konya, Mehmet Nuri
    Objectives: This study aims to compare the radiological, clinical and patient-reported outcomes of patients with intra-articular calcaneus fractures treated conservatively or surgically. Patients and methods: Fifty-four patients (30 males, 24 females; mean age 41.0 years; range, 18 to 73 years) treated due to calcaneus fracture were included in the study. Twenty-nine patients underwent conservative treatment (group 1) and 25 patients underwent surgical treatment (group 2). The fractures were classified according to Sanders. At the final follow-up, patients’ Bohler’s angle, The American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score and Foot Function Index (FFI) were used to evaluate their radiological, clinical and patient-reported outcomes. Postoperative complications were also noted. Results: The fracture was at the right foot in 28 patients and the left foot in 26 patients. The mean follow-up duration was 41.1±23.2 months (range, 24 to 126 months). No statistically significant differences were found between the groups in terms of gender, fracture side, mean age, or follow-up duration (p=0.951, p=0.571, p=0.326, and p=0.620, respectively). According to Sanders classification, 18 patients were type 2 and 11 patients were type 3 in group 1, while 11 patients were type 2 and 14 patients were type 3 in group 2. However, there was no statistically significant difference between the groups in terms of the type of the fracture (p=0.184). On the other hand, the outcomes were significantly better for group 2 compared to group 1 in terms of the Bohler’s angle, AOFAS and FFI scores (p=0.004, p=0.003 and p=0.006, respectively). In group 1, subtalar arthritis developed in three patients. In group 2, wound healing problems and superficial infection developed in three patients, while subtalar arthritis developed in two patients. Conclusion: Surgical treatment is more effective in intra-articular calcaneus fractures compared to conservative treatment according to clinical, radiological and patient-reported outcomes. In addition, wound problems should be considered in surgical management.
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    Does treatment modality affect clinical results of calcaneal fractures: A retrospective comparative study
    (Alanya Alaaddin Keykubat Üniversitesi, 2017) Konya, Mehmet Nuri; Sargın, Serdar
    Aim: To determine if there is anydifference in functional results between surgical and conservative treatmentsin displaced intra-articular fractures of the calcaneum. Methods: 27 patients (22 males, 5females, who were treated with surgical or conservative modalities (13conservative and 14 surgical) due to displaced calcaneal fractures in differenthospitals, were evaluated in this study between the years of 2012 and 2014. Allpatients were followed up at least for 2 years. All patients were comparedusing the AOFAS questionnaire.Results: There was no significantdifference in terms of ages and sexes of the patients. (p>0, 05) The meanAOFAS score was 69, 15 (56-82) in conservative group, and 84, 3 (56-96) insurgical group. When these AOFAS scores were compared (Mann Whitney-U Test),the functional scores were significantly higher in surgical group (p<0, 05).Conclusion: Our study showed – as theexisting literature also supports– that surgical treatment of intraarticularcalcaneal fractures is functionally and clinically more effective thanconservative treatment.
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    How is hip prosthesis and proximal femoral nail stability affected by lesser trochanter fractures: A comparative finite element analysis
    (2018) Konya, Mehmet Nuri; Aslan, Ahmet; Bakbak, Sibel
    Objectives: This study aims to evaluate the effects of lesser trochanter (LT) and iliopsoas tendon on implant stability by using finite element analysis (FEA). Materials and methods: Effects of iliacus and psoas major muscles on hip joint was evaluated with inverse dynamics methods to calculate joint reaction and muscle forces. Intertrochanteric femur fracture was simulated according to AO (Arbeitsgemeinschaft für Osteosynthesefragen) 31A1 and 31A2 classifications in threedimensional modelling software. Uncemented three-dimensional model of modular nail prosthesis combination was used in FEA. All analyses were performed with Ti6Al4V’s 114 GPa elastic modulus value. Effects of LT on implant stability were evaluated with two different implant designs using the same femoral stems and four different femoral models, two of which with intact LT and two of which with fractured LT. Results: Reaction forces of the hip joint decreased by 10% in the 0-40° hip flexion range. Maximum stress distribution for proximal femoral nail (PFN) model with fractured LT was 204.68 MPa at the distal locking screw on the interconnection point of PFN, while it was 335.35 MPa for the hip prosthesis with fractured LT. The direction of stress distribution for PFN model with fractured LT varied from medial to lateral and anterior to posterior. Maximum stress distribution for the hip prosthesis model with intact LT was 357.42 MPa, with direction of stress distribution from lateral to medial and posterior to anterior. Conclusion: Hip prosthesis models with intact or fractured LT were similar in terms of stress distribution and deformation values, while there were differences between PFN models with intact or fractured LT. Thus, intact LT was significant in PFN implant stability. Further clinical and experimental analyses are necessary on this topic.
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    İs combined acellular collagen matrix and high tibial osteotomy treatment effective in osteochondral defects? Preliminary study
    (Alanya Alaaddin Keykubat Üniversitesi, 2017) Konya, Mehmet Nuri; Horata, Erdal; Maralcan, Gökhan; Erten, Abdullah Recep; Turamanlar, Ozan
    Aim:  In this study, we want to compare clinical andradiological results of 12 patient treated with acellular collagen matrix (ACM)and High Tibial osteotomy-cellular collagen matrix(ACM-HTO) combination.Method: In this study, weevaluated 12 patients with chondral lesion prospectively the years of between2014- 2016 after ethical approval. Cartilage damage was diagnosed with MRI andcartilage degeneration volume was calculated with Mimics medical imageprocessing software and axis deviation was diagnosed with ortho X-ray. Patientswere divided into two groups. ACM only (Group 1) and ACM- HTO (Group 2). Results: ACM only group consists of 5 patients.Preoperative mean of chondral lesion volume was 77.11±137.5 (0.27-321.61).Post-operative mean Knee  score was175.20±24.4(150-203) and chondral lesion volume was 0.3±0.03(0-0.8). ACM-HTOgroup consists of 7 patients. Preoperative mean of chondral lesion volume was112.72±239(0.27- 653). Post-operative mean of HSS score was 155±20.4(135-183)and chondral lesion volume was 0.26±0.09(0-0.69).Conclusion: According to theseresults, all patients’ HSS scores and Cartilage volume are increased, but therewere no significant differences were found between two groups.
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    Is electromagnetic guidance system superior to a free-hand technique for distal locking in intramedullary nailing of tibial fractures? A prospective comparative study
    (2020) Aslan, Ahmet; Konya, Mehmet Nuri; Gülcü, Anıl; Sargın, Serdar
    ABSTRACT BACKGROUND: Intramedullary nailing (IMN) technique is the gold standard for the treatment of closed fractures of the lower extremity long bones. For orthopedic surgeons, one of the most important problems in IMN procedures is the fixation of distal locking screws (DLS). Accurate and rapid placement of DLSs with minimal radiation exposure is crucial. In this study, we aimed to compare the results of two different distal locking methods concerning surgery duration and radiation exposure in patients who underwent osteosynthesis of tibia fractures with IMN. METHODS: In this prospective study, the results of 56 patients who met the inclusion and exclusion criteria from 72 patients were evaluated. Patients were divided into two groups according to the distal screwing method. Group 1 (n=29) comprised patients who used free-hand technique (FHT) for distal locking, while Group 2 (n=27) consisted of patients who used electromagnetic guidance system (EMGS) for distal locking. Demographic and medical data of the patients, duration of surgery time, amount of bleeding, total fluoroscopy counts, the time elapsed for distal locking, the measure of radiation exposure, number of attempts for distal screw locking, incorrect screw placements, complications and follow-up time were recorded. The groups were compared concerning demographic data and clinical results. RESULTS: There was no statistically significant difference between the groups about gender and side (p=0.928 and p=0.432, respectively). The mean age in Group-1 was higher than that of Group-2, and the difference was statistically significant (p=0.012). However, there was no statistically significant difference in length of hospital stay in Group-1 (p=0.140). On the other hand, in Group-2, the number of distal shots, fluoroscopy duration, effective radiation dose and operation duration were lower compared to Group-1, although this difference was not statistically significant (p=0.057, 0.073, 0.058 and 0.056, respectively). Failure was encountered in distal locking during the first attempt in three cases in Group-1 and in two cases in Group-2. Aseptic nonunion was observed in one patient in both groups. CONCLUSION: Both the FHT distal screwing technique and the EMGS distal screwing technique are highly effective methods for distal locking. The duration of operation, the duration of the fluoroscopy and radiation exposure were similar. FHT can be preferred for distal locking in conventional intramedullary nail applications, as it is effective, easy and inexpensive.
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    The effects of zoledronic acid treatment on fracture healing, morbidity and mortality in elderly patients with osteoporotic hip fractures
    (Jaypee Brothers Medical Publishers (P) Ltd, 2019) Sargın, Serdar; Konya, Mehmet Nuri; Gülcü, Anıl; Aslan, Ahmet
    Background: In this study, the effects of zoledronic acid (ZolA) administered at different times to patients undergoing surgical treatment for hip fracture were investigated. Materials and methods: Ninety patients who underwent surgical treatment for osteoporotic (OP) hip fractures between February 2013 and September 2016 in our hospital were included in the study. After surgical treatment, patients were allocated into three groups: group I—patients who had osteosynthesis using proximal femoral nail (PFN) for an intertrochanteric fracture of the femur were given ZolA within 1 week after fracture and before discharge; group II—patients who had osteosynthesis using the PFN for an intertrochanteric fracture of the femur were given ZolA within 1 month after fracture post discharge; group III—patients in the same age group who had a hemiarthroplasty (HA) for an intertrochanteric fracture of the femur were administered ZolA before discharge. In addition, all patients were given daily oral calcium and vitamin D3. The Radiographic Union Score for Hip (RUSH), Harris Hip Score (HHS), and bone mineral density (BMD) were used at the follow-up as evaluation criteria, and complications were noted. Results: There were no significant differences between groups in terms of demographic data and laboratory outcomes (p > 0.05). Radiographic Union Score for Hip scores were similar between groups I and II (p > 0.05). Fracture union occurred by the sixth month in all patients whose results were evaluated. No statistically significant difference was found between three groups (p > 0.05). There was no difference between the three groups in the hip and vertebrae BMD and t scores (p > 0.05). When t and BMD scores before treatment were compared with those at 1 year after treatment, a benefit from ZolA treatment was observed in all three groups (p < 0.05). Conclusion: This study shows that the timing of ZolA administration has no effect on fracture healing and complication incidence in elderly patients with hip fractures. In addition, ZolA was found to be beneficial in increasing BMD of both femur and vertebra in all groups, but there was no significant difference between the groups. Clinical significance: The study demonstrated that ZolA may be used early in the treatment of osteoporotic hip fractures with PFN. © The Author(s). 2019.
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    The use of a proximal femoral nail as a hip prosthesis: A biomechanical analysis of a newly designed implant
    (Sage Publications Ltd, 2018) Konya, Mehmet Nuri; Korkusuz, Feza; Maralcan, Gökhan; Demir, Teyfik; Aslan, Ahmet
    Complication rates of hip fractures after proximal femoral nail are not rare. In such fractures, treatment invariably comprises the extraction of proximal femoral nail and the introduction of a different hip prosthesis. To solve this problem, we aimed to develop a new implant, the modular nail prosthesis, which combines an intramedullary nail with a hip prosthesis. The aim of this study was to determine the effect of stress load distribution on the stem using finite element analysis under laboratory conditions. For this, the shortest stem of 175mm was chosen. In addition, six proximal femoral nail-hip prosthesis combinations were produced and tested with a biomechanical test device and passed 2300-N load bearing. According to the test results, our newly developed modular nail prosthesis can be converted to hip prosthesis securely.