Person: UZER, GÖKÇER
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Publication Open Access Comparison of Small-diameter-hole and Traditional Microfracture in Cartilage Repair and the Effect of Adding a Hyaluronic Acid-based Acellular Matrix Scaffold: An Animal Study(2021-03-01T00:00:00Z) UÇAN, VAHDET; YILDIZ, FATİH; ELMADAĞ, Nuh Mehmet; UZER, GÖKÇER; GÜZEL, YUNUS; TOK, OLGU ENİS; Mukaddes, E.; UÇAN, VAHDET; YILDIZ, FATİH; ELMADAĞ, NUH MEHMET; UZER, GÖKÇER; TOK, OLGU ENİS; EŞREFOĞLU, MUKADDESObjective: Since, there is no standardized technique for the treatment of focal cartilage defects that can recreate original cartilage tissue; researchers continue to explore and evaluate various treatment modalities. This study compared post-operatke healing of cartilage defects after treatment with small-diameter-hole microfracture (SDHM) technique with that of traditional microfracture technique. The effects of the hole density and augmentation with hyaluronic acid-based acellular matrix (HA-based AM) on cartilage healing were also investigated. Methods: Articular cartilage defects measuring 5 mm in diameter and 3 mm in depth were created in each femoral trochlear groove of 21 New Zealand rabbits. Rabbits were assigned to seven groups comprising six knees each. The rabbits were sacrificed 12 weeks later, and the regenerated cartilage was harvested for histological evaluation using the Wakitani scoring system. Results: All defects were filled with regenerated tissue macroscopically. Group I (14; range 10-14 points) had significantly higher Wakitani score than in groups VI (6; range 1-11 points) and VII (5; range 3-10 points) (p=0.043 and p=0.016, respectively). No significant differences were observed among the other groups. Augmentation with HA-based AM did not contribute to cartilage healing. Conclusion: Improved cartilage healing was observed with increasing SDHM density than with traditional microfracture technique. SDHM combined with HA-based AM implantation did not improve the quality of the regenerated cartilage.Publication Open Access Treatment of unusual proximal humeral fractures using unilateral external fixator: a case series(2015-05-01) UZER, GÖKÇER; YILDIZ, FATİH; Elmadağ, Mehmet; Bilsel, Kerem; PULATKAN, Anil; UZER, GÖKÇER; YILDIZ, FATİH; BİLSEL, İSMAIL KEREMObjective To report the functional and radiological results of unusual comminuted fractures of the proximal humerus, treated with ‘closed reduction and external fixation’ (CREF) using hybrid-type unilateral external fixators (EFs). Patients and methods Between January 2012 and June 2013, eight patients (mean age 62.6; range 48–84 years) with comminuted proximal humeral fractures extending to the humeral head and one-third proximal diaphysis were treated with CREF using hybrid-type EFs. Functional results were evaluated in terms of shoulder ranges of movement, Constant, DASH, and VAS scores, and radiological results were evaluated using antero-posterior and lateral radiograms of the treated humerus. Results The mean follow-up was 16.6 (range 12–28) months. The mean fixator time was 84 (range 63–118) days. The mean range of forward flexion, internal rotation, external rotation, and abduction were 145°, 61.2°, 65°, and 115°, respectively. The mean Constant, DASH, and VAS scores were 79.8, 10, and 1.75, respectively. Seven of the eight patients (87.5 %) healed radiologically. Two complications were observed in two patients: non-union and superficial pin site infection. Conclusions In the treatment of unusual, comminuted proximal diaphyseal humeral fractures, CREF using a hybrid-type EF is a minimally invasive, advantageous procedure with acceptable rates of healing, low risk of surgical site infection, and early range of motion. Level of evidence Level IV, case series.Publication Open Access The Stoppa approach versus the ilioinguinal approach for anterior acetabular fractures: A case control study assessing blood loss complications and function outcomes(2014-10-01T00:00:00Z) Elmadag, M.; Guzel, Y.; Acar, M. A.; UZER, GÖKÇER; ARAZI, M.; ELMADAĞ, NUH MEHMET; UZER, GÖKÇERBackground: The modified Stoppa approach was introduced to manage fracture of the anterior column instead of the ilioinguinal approach to reduce morbidity. However there is no clinical evidence to confirm its efficiency. Therefore this study was designed to ascertain: (1) if the Stoppa approach versus ilioinguinal allows less blood loss, (2) if functional and radiological results are superior to that of the ilioinguinal approach, (3) if the rate of complication was different.Publication Open Access Is Hyperflexion Possible with the Solitary Use of High-Flexion Insert in Knee Replacement Preserving the Posterior Cruciate Ligament? (Mid-term Results)(2018-10-01T00:00:00Z) ÖZDEN, Vahit Emre; DİKMEN, Göksel; UZER, GÖKÇER; Tozun, Ismail Remzi; UZER, GÖKÇERObjective: For evaluating the early midterm results of our patients who underwent total knee replacement allowing for hyperflexion and for identifying the factors affecting the range of flexion in particular.Publication Open Access Superior Mesenteric Artery Syndrome due to a Vertebral Hemangioma and Postpartum Osteoporosis following Treatment.(2015-01-01) Elmadag, M; GÜZEL, Y; UZER, GÖKÇER; TUNCAY, İBRAHİM; ELMADAĞ, NUH MEHMET; UZER, GÖKÇER; TUNCAY, İBRAHİMIn pregnancy, advanced vertebral hemangiomas may be seen, and these require treatment. The case reported here is of a 35-yearold female in the 32nd week of pregnancy who was admitted to the orthopaedics clinic with a history of backache and difficulty walking. A burst fracture of L1 associated with a vertebral hemangioma was identified with an L3 compression fracture secondary to osteoporosis. The local kyphosis angle between T12 and L2 was 27∘ . Kyphotic deformity was corrected and postoperatively, the measured T12–L2 local kyphotic angle was 9∘ . Twelve hours postoperatively, oral nutrition was allowed, but she developed nausea and vomiting and twenty-four hours postoperatively, an electrolyte imbalance developed. Postoperatively, the patient was diagnosed with superior mesenteric artery syndrome. To the best of our knowledge, this is the first reported case of superior mesenteric artery syndrome, which occurred following the correction of a kyphotic deformity that had developed secondary to an advanced hemangioma in pregnancyPublication Open Access Reply to Letter to Editor: Safety of one-stage bilateral total knee arthroplasty-one-surgeon sequential vs. two surgeons simultaneous: a randomized controlled study(2020-08-01T00:00:00Z) Gungoren, Nurdan; UZER, GÖKÇER; ALIYEV, ORKHAN; YILDIZ, FATİH; ELMALI, NURZAT; TUNCAY, İBRAHİM; UZER, GÖKÇER; ALIYEV, ORKHAN; YILDIZ, FATİH; GÜNGÖREN, NURDAN; ELMALI, NURZAT; TUNCAY, İBRAHİMPublication Open Access Comparison of two types of proximal femoral hails in the treatment of intertrochanteric femur fractures(2015-09-01) Uzer, GÖKÇER; Elmadag, NUH MEHMET; Yildiz, FATİH; Bilsel, Kerem; Erden, TUNAY; Toprak, HÜSEYİN; UZER, GÖKÇER; ELMADAĞ, NUH MEHMET; YILDIZ, FATİH; BİLSEL, İSMAIL KEREM; ERDEN, TUNAY; TOPRAK, HÜSEYİNBackground: Hip nailing is frequently used to treat unstable intertrochanteric femoral fractures (ITF) in elderly patients. In this retrospective study, we compared the functional and radiological results, and the complications, of patients treated using proximal femoral nails (PFN) with an integrated, interlocking, compression lag screw, or two separate lag screws, which allow linear compression at the fracture site. Methods: A total of one hundred and eighteen patients were operated on for AO/OTA 31-A2 ITF between May 2010 and April 2012, and eighty-two of these patients, for whom sufficient follow-up data and documentation were available, were included into the study. PFNs with interlocking, integrated lag screws (Group I) were used in forty-four patients, and PFNs with two separate lag screws (Group II) in thirty-eight. Outcome parameters were the extent of varus collapse and leg length discrepancy on radiographs, and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Harris hip scores (HHS) as functional results. Results: Mean follow-up duration was 20 months (range, 12-36 months); fractures healed in all patients. Mean varus collapse values were 2.03±5.68° and 5.21±5.27° (p=0.01), Harris hip scores 73.2±11.65 and 74.72±11.15 (p=0.54), and WOMAC scores 70.78±11.41 and 71.78±11.19 (p=0.69) in Groups I and II, respectively. No difference was detected between the groups in terms of outcome parameters or complication rate. Conclusion: In the treatment of ITF, PFNs with an integrated, interlocking, compression lag screw, or two separate lag screws did not differ in terms of functional and radiological results or complication rate.Publication Open Access Onlay fibula autografting technique and its comparison with cortical allograft for the reconstruction of periprosthetic bone defects around the femur(2020-11-01T00:00:00Z) TUNCAY, İBRAHİM; Tozun, Remzi; ALIYEV, ORKHAN; Dikmen, Goksel; UZER, GÖKÇER; ÖZDEN, Vahit Emre; YILDIZ, FATİH; TUNCAY, İBRAHİM; ALIYEV, ORKHAN; UZER, GÖKÇER; YILDIZ, FATİHBackground Bone defect around the femur related to revisions or periprosthetic fractures (PFF) is an issue. We present a bone defect reconstruction technique in femoral revisions and/or PFF using fibula autograft and compared our radiological and clinical results to that of allograft. Methods A total of 53 patients who underwent revision hip arthroplasty and/or PFF fixation with the use of cortical fibula autograft (FG group) or cortical allograft (CG group) were evaluated. After exclusions, 20 patients who had minimum two years of follow-up were investigated for each group, for their radiological and clinical outcomes. Results In FG and CG groups, the median ages were 69.5(44-90) and 62(38-88) years, follow-ups were 59(28-72) and 120(48-216) months, defect lengths were seven (1-10) and ten (1-17) cm, and grafts lengths were 16.5(10-30) and 20(12-37) cm, respectively. The rate of graft incorporation was 90% in each group and median time to incorporations were seven (4-12) and 12(6-24) months (p < 0.001), and graft resorption (moderate and severe) rates were 10% and 25% (p = 0.41), respectively. Median Harris Hip (77.6 vs 78.0), WOMAC (23.2 vs 22), SF-12 physical (50.0 vs 46.1), and SF-12 mental (53.8 vs 52.5) scores were similar between the groups, respectively. Kaplan-Meier survivorship analyses revealed an estimated mean survival of 100% at six years in FG group and 90% at 14 years in CG group. Conclusion In the reconstruction of periprosthetic bone defects after femoral revision or PPF, onlay cortical fibula autografts provide comparable clinical and radiological outcomes to allografts. Its incorporation is faster, it is cost-effective and easy to obtain without apparent morbidity.Publication Open Access Safety of modified Stoppa approach for Ganz periacetabular osteotomy: A preliminary cadaveric study(2016-08-01T00:00:00Z) Elmadag, Mehmet; Uzer, GÖKÇER; Yildiz, FATİH; CEYLAN, Hasan H.; Acar, Mehmet A.; ELMADAĞ, NUH MEHMET; UZER, GÖKÇER; YILDIZ, FATİHObjective: The aim of this cadaveric study was to investigate the efficacy of the modified Stoppa approach in Ganz periacetabular osteotomy (PAO). Methods: The Ganz PAO was performed on 10 hemipelvises with normal hips, from 5 cadavers using the modified Stoppa approach through the Pfannenstiel incision. All of the osteotomies were performed under fluoroscopic control and direct visualizing the osteotomy site from the same incision. After the osteotomy, the acetabulum was medialized and redirected anterolaterally, and fixed with 2 screws. The neurovascular structures and the joints were examined by dissecting the soft tissues after fixation of the osteotomies. Outcome parameters were center-edge (CE) angle, the distances between the osteotomy and anterior superior iliac spine (ASIS), and between the osteotomy and the sciatic notch, neurovascular and joint penetrations. Results: After the osteotomy, the mean CE angle was improved from 19.8 degrees to 25.2 degrees, mean distance between the osteotomy and ASIS was 3.1 cm, and the mean distance between the osteotomy and the sciatic notch was 10.2 mm. The neurovascular structures and the joints were examined by dissecting the soft tissues after fixation of the osteotomies. No damage to the joint, surrounding arteries, veins or nerves was detected in any of the cadavers. Conclusions: Bilateral dysplastic hips can be treated with a 10 cm, cosmetically more acceptable incision in the same session using this approach. Quadrilateral surface of the acetabulum can be directly seen using this approach and the osteotomy can be safely performed. (C) 2016 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V.Publication Open Access Cytotoxicity of a new antimicrobial coating for surgical screws: an in vivo study(2017-01-01) Guzel, Yunus; Elmadag, Mehmet; Uzer, GÖKÇER; Yildiz, FATİH; Bilsel, Kerem; Tuncay, Ibrahim; ELMADAĞ, NUH MEHMET; UZER, GÖKÇER; YILDIZ, FATİH; BİLSEL, İSMAIL KEREM; TUNCAY, İBRAHİMhe risk of surgery-related infection is a persistent problem in orthopaedics and infections involving implants are particularly difficult to treat. This study explored the responses of bone and soft tissue to antimicrobialcoated screws. We investigated whether such screws, which have never been used to fix bony tissues, would result in a cytotoxic effect. We hypothesised that the coated screws would not be toxic to the bone and that the likelihood of infection would be reduced since bacteria are not able to grow on these screws. METHODS Titanium screws were inserted into the left supracondylar femoral regions of 16 rabbits. The screws were either uncoated (control group, n = 8) or coated with a polyvinylpyrrolidone-polyurethane interpolymer with tertiary amine functional groups (experimental group, n = 8). At Week 6, histological samples were obtained and examined. The presence of necrosis, fibrosis and inflammation in the bony tissue and the tissue surrounding the screws was recorded. RESULTS Live, cellular bone marrow was present in all the rabbits from the experimental group, but was replaced with connective tissue in four rabbits from the control group. Eight rabbits from the control group and two rabbits from the experimental group had necrosis in fatty bone marrow. Inflammation was observed in one rabbit from the experimental group and five rabbits from the control group. CONCLUSION Titanium surgical screws coated with polyvinylpyrrolidone-polyurethane interpolymer were associated with less necrosis than standard uncoated screws. The coated screws were also not associated with any cytotoxic side effect.