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    An evaluation of the approach of orthopaedic surgeons to local anaesthetic toxicity
    (Alanya Alaaddin Keykubat Üniversitesi, 2019) Bilal, Bora; Topak, Duran; Vatansever, Fatih; Boran, Ömer Faruk
    Aim: To review the knowledge of orthopaedic surgeons related to the diagnosis, treatment and prevention of local anaesthetic systemic toxicity (LAST) and to raise awareness related to this subject. Material and Method: A 16-item questionnaire was applied to orthopaedic surgeons of different academic levels in different hospitals in Turkey. The items sought to questioned demographic information, general knowledge related to local anaesthetic drugs, general knowledge related to toxicity and current treatment options. Results: The study included a total of 172 orthopaedic surgeons in Turkey, of which 18.6% were orthopaedic residents, 51.7% orthopaedic and traumatology specialists, and 29.7% faculty members. Tenure in the orthopaedic area was determined to be >10 years in 45.3% of the participants. Local anaesthetic was seen to be used most in the operating theatre, followed by the Emergency Department, polyclinic intervention rooms, and on the wards. Of the total participants, 59.6% stated that they had never heard of the use of lipids in the treatment of LAST, 29.8% had heard of it but did not use it and 5.3% knew about the manner and area of use of lipid treatments. Conclusion: Awareness of physicians about LAST and preparedness for complications can ensure safer use of these local anaesthetics.
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    Are modified gartland type IV supracondylar humerus fractures different from Type III fractures? A retrospective clinical study
    (Alanya Alaaddin Keykubat Üniversitesi, 2020) Topak, Duran; Dere, İsmail; Doğar, Fatih; Kuşçu, Burak; Bilal, Ökkeş
    Aim: The present study investigates whether surgical treatment of modified Gartland Type IV supracondylar humerus fracture is radiologically and clinically different from the treatment of Type III fractures. Methods: The medical charts of 197 patients who underwent surgical treatment for pediatric supracondylar humerus fracture in our clinic between 2012 and 2015 were retrospectively reviewed, and 76 patients humerus Gartland Type III and unstable Type IV fractures regardless of neurovascular injury (49 males, 27 females) were included in the study as randomize. The patients were divided into two groups as patients with modified Gartland Type III (n=36) and patients with Type IV fractures (n=40). The mean age of the patients was 5.88±3.29 (1-15) years, and the mean duration of follow-up was 19.80±4.83 (12-29) months. All patients underwent surgery within the first 24 hours and closed reduction was first attempted. Posterior open reduction was performed in patients with failed attempts of closed reduction. The functional and cosmetic outcomes of the patients were evaluated according to the Flynn criteria. The Baumann’s angle was measured on the X-rays obtained in the last control visit.Results: The comparison of functional outcomes between the two groups revealed that satisfactory outcomes were obtained in 97.3% of patients in the Type III fracture group and 87.5% of patients in the Type IV fracture group; however, the difference was not statistically significant (p=0.509). The comparison of cosmetic outcomes showed that satisfactory outcomes have been obtained in 100% and 97.5% of the patients, and no significant difference was found between the two groups (p=0.495). There was no statistically significant difference between the two groups in terms of the need for open surgery, nerve injury, and Baumann’s angle (p=0.776, p=0.108, p=0.069, respectively).Conclusion: Modified Gartland Type IV pediatric supracondylar humerus fractures can be treated successfully just like Type III fractures with anatomical reduction, stable fixation and early initiation of joint movements. 
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    Coxa Magna following treatment of developmental dysplasia of the hip: investigation for associated potential factors
    (Lippincott Williams & Wilkins, 2024) Topak, Duran; Aslan, Ahmet; Yorgancigil, Hueseyin
    Coxa Magna (CM) is defined as a condition in which the horizontal (transverse) diameter of the femoral head is larger on the affected side than on the intact side. CM can occur as a manifestation of avascular necrosis (AVN) following treatment for the developmental dysplasia of the hip (DDH). Alternatively, it can also be secondary to other hip disorders, such as Perthes' disease. This study aimed to determine the prevalence and indicators of CM and AVN of the femoral head that can be detected during follow-up in patients with unilateral DDH treated with closed reduction (CR) or open reduction (OR) surgery. The files of 143 patients treated for unilateral DDH between January 1997 and December 2017 were reviewed retrospectively. A total of 104 patients, including Group 1 (n = 49) patients who underwent CR under general anesthesia and Group 2 (n = 55) patients who underwent OR were included in the study. CM; It was considered as the case where the femoral head was 15% or more larger than the intact side. A total of 104 patients were followed up for 77.27 +/- 13.96 months, with a mean age of 15.43 +/- 7.76 months. When Group 1 and Group 2 were compared, there was no statistical difference in terms of sex, side, adductor tenotomy, and AVN (P > 0.05). CM developed in 22.4% (n = 11) of the patients in Group 1 and in 49.1% (n = 27) in Group 2, and the difference was statistically significant (P = 0.008). When the effect of independent variables on the development of CM is evaluated with the multivariate logistic regression model, the risk of developing CM is 3474 times higher in those who underwent iliopsoas tenotomy compared with those who did not. The primary outcome of this study is that CM is more frequent in patients treated with OR for DDH. CM may be a nonpathological condition that occurs in connection with iliopsoas tenotomy or surgical treatment. Prospective studies with a larger number of cases, designed to minimize confounding factors, are required.