Person: ELMADAĞ, NUH MEHMET
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Publication Metadata only Apophyseal avulsion fracture of the anterior inferior iliac spine due to a simple bone cyst(2015-03-01T00:00:00Z) Elmadag, Mehmet; CEYLAN, Hasan H.; ERDIL, Mehmet; Bilsel, Kerem; ELMADAĞ, NUH MEHMET; BİLSEL, İSMAIL KEREMApophyseal avulsion fractures of the anterior inferior iliac spine are rare; they are usually seen in adolescents as a result of sudden contraction of the rectus femoris muscle. Treatment is usually conservative, but surgical management may be necessary in certain circumstances. We present an unusual case of a 14-year-old male who was referred to our department for a suspicious pathological fracture of his right anterior inferior iliac spine; he was found to have an avulsion fracture of the anterior inferior iliac spine due to simple bone cyst. We discuss the treatment of this rare injury caused by a benign osseous tumour.Publication Open Access Excess retained cement in the posteromedial compartment after unicondylar knee arthroplasty(2013-07-01) Elmadag, Mehmet; IMREN, Yunus; ERDIL, Mehmet; Bilsel, Kerem; Tuncay, Ibrahim; ELMADAĞ, NUH MEHMET; BİLSEL, İSMAIL KEREM; TUNCAY, İBRAHİMAcute mechanical symptoms due to excess retained cement in the posterior compartment of the knee joint following unicondylar knee arthroplasty (UKA) are uncommon. Infection, aseptic loosening, polyethylene wear and progressive arthritis are well-documented complications of UKA procedure. We present a patient with acute pain and 'clicking' sensation in the knee joint due to cement extrusion in the posteromedial compartment after UKA. Full functional recovery was achieved after arthroscopic removal of the cement debris. Of retrospectively screened 43 UKA cases, asymptomatic cement extrusion was detected in 8 patients in the posteromedial compartment on direct X-rays. Careful inspection of components is essential to minimize the risk of cement extrusion into the posterior compartment and perioperative fluoroscopy may be helpful during UKA procedure.Publication 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 Metatarsal head resurfacing hemiarthroplasty in the treatment of advanced stage hallux rigidus: outcomes in the short-term(2012-07-01) ERDIL, Mehmet; Bilsel, Kerem; IMREN, Yunus; MUTLU, Serhat; GULER, Olcay; Gurkan, VOLKAN; Elmadag, NUH MEHMET; Tuncay, Ibrahim; BİLSEL, İSMAIL KEREM; GÜRKAN, VOLKAN; ELMADAĞ, NUH MEHMET; TUNCAY, İBRAHİMObjective: The aim of this study was to evaluate the short-term outcomes of metatarsal head metal resurfacing hemiarthroplasty in patients with advanced stage hallux rigidus. Methods: The study included 14 feet (4 left, 10 right) of 12 patients (10 female, 2 male; mean age: 63 ± 5; range: 55 to 71 years) who underwent metatarsal head metal resurfacing hemiarthroplasty (HemiCAP(®)) between 2007 and 2010. Additionally, capsular release and periarticular osteophyte debridement were performed. Staging was made according to Coughlin and Shurnas' clinical and radiological grading system. Hallux valgus and intermetatarsal angles were measured using pre and postoperative standing AP and lateral foot views. Clinical assessment was made with first metatarsophalangeal joint range of motion, the AOFAS (American Orthopaedic Foot and Ankle Society) hallux metatarsophalangeal-interphalangeal scale and satisfaction level. Results: Mean follow up was 19.5 (range: 14 to 26) months. Two patients had bilateral involvement. According to Coughlin and Shurnas' clinical and radiological grading system, nine feet were Stage 3 and five feet were Stage 4. According to the AOFAS scale, results of eight feet (57.1%) were excellent, four feet (28.6%) were good and two feet (14.3%) were moderate. Mean total AOFAS score increased by 26.2 points postoperatively (p<0.05). Mean range of motion of the first metatarsophalangeal joint improved significantly from a preoperative 22.2 ± 5.6 (range: 10 to 28) degrees to a postoperative 56.3 ± 9.6 degrees (p<0.05). Mean hallux valgus angle decreased from a preoperative 14.3 (range: 9 to 17) degrees to a postoperative 11.1 (range: 4 to 13) degrees and the mean intermetatarsal angle increased from a preoperative 10.5 (range: 8 to 14) degrees to a postoperative 10.8 (range: 8 to 15) degrees. Patient satisfaction levels were very good in 10 feet (71.4%), good in 3 (21.4%), and moderate in one (7.2%). Complications included metatarsalgia aggravated by long walks in one patient and hypoesthesia of the great toe in three patients. Push-off power of the great toes was measured as 4/5 in three cases, and 5/5 in others. Conclusion: Metatarsal head metal resurfacing hemiarthroplasty provides high patient satisfaction level and good functional outcome in the short-term, in the surgical treatment of advanced stage hallux rigidus refractory to conservative treatment options.Publication Open Access Evaluation of mobile bearing unicompartmental knee arthroplasty, opening wedge, and dome-type high tibial osteotomies for knee arthritis(2015-01-01) Tuncay, Ibrahim; Bilsel, Kerem; Elmadag, Mehmet; Erkocak, Omer Faruk; ASCI, Murat; Sen, Cengiz; TUNCAY, İBRAHİM; BİLSEL, İSMAIL KEREM; ELMADAĞ, NUH MEHMETObjective: Three methods of surgery used in the treatment of knee osteoarthritis (OA) are mobile bearing unicompartmental knee arthroplasty (Oxford UKA), opening wedge high tibial osteotomy (HTO), and dome-type HTO. This article aimed to retrospectively compare these three methods in terms of outcomes for health status, patient satisfaction, and function. Methods: Between 2003 and 2010, 255 knees of 235 patients underwent operations for medial knee OA. Three types of surgery were performed. Group 1 consisted of 109 knees of 94 patients who underwent Oxford UKA. Group 2 was made up of 36 knees of 36 patients who underwent HTO using circular external fixation, and Group 3 comprised 57 knees of 52 patients on whom opening wedge type HTO using locking plate fixation was performed. SF-36 and HSS knee scores were used to compare the functional outcomes among groups. Results: Statistically significant differences were found between the preoperative and postoperative measures in all 3 of the treatment groups for physical function, physical role, pain, general health, vitality, social function, emotional role, and mental health according to SF-36 and HSS scores. In the 2nd group, the average correction of the mechanical axis deviation (MAD) was 38 mm with 11.7º along the femorotibial axis and 6.2º along the medial proximal tibial angle (MPTA). In the 3rd group, the average correction in the MAD was 28 mm with 9.7º along the femorotibial axis and 5.6º along the MPTA. All 3 of the treatment alternatives were observed to be sufficient. Satisfactory postoperative results were achieved in the UKA group in terms of social function and mental health, and the patients were able to achieve early rehabilitation and return to their previous life activities. Conclusion: UKA is the ideal option for patients who wish for the earliest possible return to social and recreational activities.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.