Person: ATICI, TEOMAN
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ATICI
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TEOMAN
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Publication Primary treatment of complex proximal humerus fractures using humelock cementless reversible shoulder arthroplasty in the elderly(Turkish Assoc Trauma Emergency Surgery, 2021-07-01) ; Atici, Teoman; ATICI, TEOMAN; Ermutlu, Cenk; ERMUTLU, CENK; Yerebakan, Selcan; Özyalcin, Ali; ÖZYALÇIN, ALİ; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anestezi ve Reanimasyon Anabilim Dalı.; 0000-0002-3396-3407; AEQ-5464-2022BACKGROUND: Proximal humerus fractures are quite common, constituting 5% of all fractures. Plate osteosynthesis of comminuted fractures in the elderly with osteoporotic bones is prone to complications, including loss of reduction, intraarticular protrusion of screws, avascular necrosis and non-union. Hemiarthroplasty may be preferred to achieve a stable fixation, which permits early shoulder motion. Prerequisites for the successful functional outcome of this surgical technique are to have an intact rotator cuff, which is often torn, and achieve proper soft tissue balance, which is technically demanding. In RSA design, deltoid muscle replaces the function of the supraspinatus, compensating for a dysfunctional rotator cuff or a displaced tuberculum. We designed a retrospective study to evaluate the results of proximal humerus fractures treated with reverse shoulder arthroplasty using Humelock II reversible prosthesis in elderly patients.METHODS: Thirty-one patients (25 females, six males) above 65 years old who underwent reverse shoulder arthroplasty between 2014 and 2019 for Neer 3-4 part fractures or head split injuries were included in this study. Patients with a previous internal fixation attempt, cases with neurological deficit or previous upper extremity fractures, patients who presented later than three weeks after the trauma, cases with less than six months follow-up and patients with additional fractures were excluded. Twenty-eight patients were available for final analysis. Fracture mechanism, time from trauma till surgery, hospital stay and preoperative ASA scores were noted. Humelock II Reversible (FX Solutions) implants were used in all cases. Patients' shoulder range of motion and functional outcome using UCLA, DASH and Constant scores at minimum six months follow-up were evaluated.RESULTS: The mean age was 72.2 (65-95) years, and mean follow-up time was 15.5 (6-48) months. The mean UCLA, Constant and Dash scores at the last follow-up were 27.6 (14-35), 67.9 (38-80) and 30.8 (9.9-79.2), respectively. Mean shoulder flexion, abduction, internal and external rotation were 130 (110-160), 100 (70-140), 40 (15-60) and 39 (15-75) degrees, respectively.CONCLUSION: RSA is a very reliable treatment for proximal humerus fractures in patients over 65 years old. Early active and passive shoulder exercises can be started postoperatively, and good functional outcome and wide ROM can be achieved with this age group. Although stable fixation of the tuberculum is not required for shoulder abduction, it facilitates external rotation and should be attempted in all cases. Clinical outcomes of patients who underwent RSA due to proximal humerus fracture are as good as the outcomes of patients with different etiologies.Publication High-dose short-course oral corticosteroid protocol for treatment of primary frozen shoulder: A retrospective cohort study(Sage Publications Ltd, 2021-07-01) Atıcı, Teoman; Ermutlu, Cenk; Akesen, Selcan; Özyalçın, Ali; ATICI, TEOMAN; ERMUTLU, CENK; AKESEN, SELCAN; ÖZYALÇIN, ALİ; Uludağ Üniversitesi/Tıp Fakültesi/Travmatoloji Anabilim Dalı; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Yoğun Bakım Bölümü; 0000-0002-3396-3407; AEQ-5464-2022; A-5095-2018; ELR-9087-2022; FPA-5997-2022Objective To evaluate the effect of high-dose prednisolone on the functional outcome of patients with early-stage primary frozen shoulder. Methods Eighteen patients treated with oral prednisolone at an initial dose of 1 mg/kg/day for primary frozen shoulder were retrospectively evaluated. The patients' range of motion, Disabilities of the Arm, Shoulder, and Hand (DASH) score, Constant-Murley score, American Shoulder and Elbow Surgeons (ASES) score, and visual analog scale score were recorded at baseline and at 4 weeks and 6 months after treatment. Results Rapid recovery of shoulder motion was noted at 4 weeks with the exception of abduction, which was maintained at 6 months. Significant improvement in pain perception and the Constant-Murley score was evident at 4 weeks and extended to 6 months. The DASH and ASES scores did not show significant improvement in the first 4 weeks but were significantly improved at 6 months. Conclusion High-dose oral prednisolone treatment provides rapid symptom resolution that persists long after drug discontinuation. The early treatment period is characterized by marked reduction in pain and rapid recovery of shoulder motion. Improvements in functional outcomes and disability indices tend to be more subtle in the early period but significantly improve during late treatment.Publication Efficacy of single-dose radiotherapy in preventing posttraumatic tendon adhesion(Springernature, 2020-06-02) Ermutlu, Cenk; ERMUTLU, CENK; Kaleli, Tufan; KALELİ, HÜSEYİN TUFAN; Yalçınkaya, Ulviye; YALÇINKAYA, ÜLVİYE; Çetintaş, Sibel; ÇETİNTAŞ, SİBEL; Atıcı, Teoman; ATICI, TEOMAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Patoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyasyon Onkolijisi Anabilim Dalı.; 0000-0001-8259-3695; 0000-0003-1109-8958; 0000-0002-3396-3407; AAH-8924-2021; AAB-6136-2022; A-5095-2018; AAB-2795-2021Background and AimPosttraumatic peritendinous adhesion is the greatest obstacle to achieve normal tendon function following lacerations of extrinsic flexor tendons of the hand. In this study, we aimed to evaluate whether single-dose radiotherapy (RT) has the potential to modulate intrasynovial tendon adhesions.Materials and MethodsA total of 80 tendons from the third to fourth flexor profundus of both hind paws of 20 adult New Zealand rabbits were used in this study. Rabbits in the RT group received 3 Gy of X-irradiation in a single fraction. Histopathological evaluation of longitudinal sections of tendons was made using the Tang grading system for peritendinous adhesions. Intratendinous quality of the healing tissue in the laceration zone was assessed using a modified Movin scale.ResultsAdhesion and inflammatory response were greater in the RT group (p(<)0.001). Tendon healing in the radiation group was found to he more uniform and organized compared with the control group. However, this difference was not statistically significant. The nuclei of the tenocytes in the radiation group showed a closer resemblance to normal tendon tissue when compared with the control group (p=0.007).ConclusionsDespite RT's certain advantages such as extracorporeal use, anti-inflammatory effect, and homogenous tissue penetration, 3-Gy X-irradiation resulted in increased peritendinous posttraumatic adhesion, possibly due to dose imbalance. Increased roundness in the tenocyte nuclei was present in the RT group. Studies with different dosing regimens and a higher number of subjects are necessary to establish an ideal dose suppressing the synovial response without compromising tendon healing.Publication Effect of muscle atrophy and fatty infiltration on mid-term clinical, and functional outcomes after achilles tendon repair(Elsevier, 2021-09-24) Eken, Gökay; Mısır, Abdulhamit; Tangay, Cem; Atıcı, Teoman; Demirhan, Nevzat; Şener, Nadir; ATICI, TEOMAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı; A-5095-2018Objectives: Muscle atrophy is one of the most common problems after Achilles tendon repair. The aim of this study was to evaluate the effect of gastrosoleus muscle atrophy and fatty infiltration on clinical, and functional outcomes after Achilles tendon repair.Material and methods: A total of 46 patients (mean age = 39.3 +/- 7.4 years) who underwent open Achilles tendon repair were included in the study. During the clinical evaluation of muscle atrophy, ipsilateral and contralateral calf circumference (CC), maximum heel rise (HR), and ankle range of motion measurements were recorded. Functional outcomes were assessed via The Achilles tendon Total Rupture Score (ATRS), the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and the Leppilahti score. Muscle volume (MV), cross-sectional area (CSA), and percent of fatty infiltration (FI) were measured via magnetic image resonance.Results: The functional outcome scores were excellent: ATRS = 98.1 +/- 2.2; AOFAS = 97.3 +/- 4.1; Leppilahti score = 95.8 +/- 5.1. There were significant differences detected between injured and non-injured legs regarding CC, HR, MV, CSA, and FL Additionally, there were significant negative correlations between CSA and MV loss with all functional outcome scores. Fl was correlated with only the AOFAS ankle-hindfoot score.Conclusions: Significant muscle atrophy was measured after a mean follow-up period of 7.4 (range 2.0-12.6) years post-surgery and negatively correlated with clinical outcomes. CC is an easy and cost-effective measurement method to predict MV during the follow-up of Achilles tendon repairs. (C) 2020 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.Publication Comparison of efficacy between the genicular nerve block and the popliteal artery and the capsule of the posterior knee (IPACK) block for total knee replacement surgery: A prospective randomized controlled study(Türkiye Ortopedi Travmatoloji, 2021-03-01) Akesen, Selcan; Akesen, Burak; Atıcı, Teoman; Gurbet, Alp; Ermutlu, Cenk; Özyalçın, Ali; AKESEN, SELCAN; AKESEN, BURAK; ATICI, TEOMAN; GURBET, ALP; ERMUTLU, CENK; ÖZYALÇIN, ALİ; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı; 0000-0002-3396-3407; 0000-0002-6503-8232; JHR-5447-2023; AEQ-5464-2022; ELR-9087-2022; AAH-9833-2021; A-5095-2018; A-7994-2018Objective: The aim of this study was to compare the efficacy of popliteal artery and the capsule of the posterior knee (IPACK) block and genicular nerve block on postoperative pain scores, the need for rescue analgesics, range of motion (ROM), walking distance, and perioperative monitorization variables in patients undergoing total knee replacement (TKR) surgery.Methods: Sixty American Society of Anesthesiologists (ASA) physical status I-III patients were enrolled in this study and then were randomly assigned into three groups: the IPACK block group (17 female, 3 male; mean age=67.5 +/- 1.4 years), genicular nerve block (16 female, 4 male; mean age=68 +/- 1.76 years), and the control group (13 female, 7 male; mean age=63 +/- 1.67years). All the patients underwent TKR under spinal anesthesia. The visual analog scale (VAS) score, mobility, pre- and intra-operative monitorization of systolic and diastolic holding area, non-invasive blood pressure, heart rate, and SPO 2 were compared between the groups.Results: Patients in the IPACK and genicular block groups had a significantly lower visual analogous scale (VAS) at postoperative 4 hours (p<0.01), 8h (p<0.01), 12h (p<0.01), and 24h (p<0.05). VAS score was significantly lower in the genicular block group at the postoperative 4h (5.5 +/- 0.55) and 8h (5.0 +/- 0.53) in the mobile state compared to the IPACK (8.0 +/- 0.47 and 8.0 +/- 0.43, respectively) and the control group (9.5 +/- 0.20; 10 +/- 0.28, respectively) (p<0.01). The use of patient-controlled-analgesia (PCA) devices and button push count for analgesics demand were significantly lower in the genicular block group on the immediate postoperative period (p<0.01 at the postoperative 0 to 4 h). The total consumption of morphine equivalents on the postoperative day 0 was significantly lower in the genicular block group (p<0.01, and p<0.001 for IPACK and control groups, respectively). The degree of flexion was significantly higher in the genicular block group at the postoperative 12h compared to the IPACK and the control group (p<0.001). The length of hospital stay was significantly lower in the genicular block group compared to the IPACK and the control group (p<0.05 for both variables).Conclusion: IPACK and genicular blocks both are effective in improving patient comfort during and after TKR surgery and reducing the potential need for systemic analgesic and opioids. The genicular block seems to be a promising technique that can offer improved pain management in the immediate and early postoperative period without adverse effects on systemic and motor variables.Publication Evaluation of titanium release from titanium alloy implants in patients with spinal instrumentation(Sage Publications Ltd, 2021-01-01) Ulusaloğlu, Armağan Can; Atıcı, Teoman; Ermutlu, Cenk; Akesen, Selcan; ATICI, TEOMAN; ERMUTLU, CENK; AKESEN, SELCAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Yoğun Bakım Anabilim Dalı; 0000-0002-3396-3407; AEQ-5464-2022; A-5095-2018; ELR-9087-2022ObjectiveThis study was performed to investigate the baseline serum titanium levels in patients with short-segment titanium alloy posterior instrumentation and to assess patient-, implant-, and surgery-related factors that might affect the serum titanium level.MethodTwo groups of patients were included in the study. The study group comprised 39 patients who had undergone short-segment posterior instrumentation from January 2013 to June 2016. The control group comprised 11 randomly selected patients who presented to the outpatient clinic with no history of orthopedic surgery. The serum titanium levels and inter-group differences were analyzed.ResultsThe mean serum titanium level was significantly higher in the study group than in the control group. No significant difference was observed between patients with different etiologies, implants used for fusion, numbers of instrumented segments, or postoperative durations.ConclusionThe serum titanium levels of patients with posterior lumbar spinal instrumentation are significantly higher than those of the normal population even after achievement of solid fusion. These levels are not affected by the use of transverse connectors, the use of cages, the operated segments, or the duration of implants.Publication Diagnostic accuracy of fresno-quebec rules and risk factors for an associated fracture in patients presenting to the emergency department with anterior shoulder dislocation: A retrospective study(Turkish Assoc Trauma Emergency Surgery, 2021-01-01) Durak, Vahide Aslihan; DURAK, VAHİDE ASLIHAN; Atici, Teoman; ATICI, TEOMAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı.; 0000-0003-0836-7862; 0000-0002-3396-3407; AAE-9483-2021BACKGROUND: Anterior shoulder dislocation is the most common shoulder injury in patients presenting to the emergency department (ED). Up to 25% of these injuries are fracture-dislocations. In general, the standard approach is to obtain plain radiographs before and after reduction. Fresno-Quebec Rules (FQR) are described to identify the patients who require an x-ray before reduction to reduce radiation exposure and delays in treatment. We aimed to evaluate the efficacy of clinical predictors used in the Fresno-Quebec algorithm for detecting a shoulder fracture-dislocation.METHODS: Records of patients who presented to the Emergency Department with presumed shoulder dislocation were retrieved and retrospectively analyzed according to 'Fresno-Quebec Rule (FQR)'. Sensitivity, specificity, and predictive values of FQR for detecting associated injuries were calculated.RESULTS: Eighty-nine (65.9%) men and 46 (34.1%) women were included. The mean age of patients was 46 years (16-89). Ninety-nine (73.3%) of the cases had their shoulder dislocated for the first time, whereas 36 (26.7%) patients had a recurrent dislocation. Fifty percent of the patients (18 cases) with recurrent dislocation presented with an atraumatic episode. The remaining 18 patients with a history of recurrent dislocations had their shoulder dislocated as a result of trauma, and four (22%) of them had fracture-dislocation. Using the Fresno-Quebec rules yielded 100% specificity for the diagnosis of fracture-dislocation. The severity of the injury mechanism was not predictive in traumatic but recurrent dislocations. Only one of four patients with a fracture-dislocation in the traumatic recurrent dislocation group had high energy trauma.CONCLUSION: FQR has 100% sensitivity in detecting fracture-dislocations in patients admitted to ED with anterior shoulder dislocation. It utilizes simple parameters that are easy to use and recall. Using these rules, 30% of unnecessary radiographs can be avoided, saving time and money and reducing radiation exposure in anterior dislocations.Publication Augmenting posterolateral fusion with transforaminal lumbar interbody fusion cage improves clinical outcome, but not fusion rate, of posterior decompression(Sage Publications, 2020-04-01) Atıcı, Teoman; Yerebakan, Selcan; Ermutlu, Cenk; Özyalçın, Ali; ATICI, TEOMAN; Yerebakan, Selcan; ERMUTLU, CENK; ÖZYALÇIN, ALİ; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Yoğun Bakım Anabilim Dalı.; 0000-0002-9518-541X; 0000-0001-8259-3695; 0000-0003-3772-1699; AAB-2795-2021; EGQ-9946-2022 ; A-5095-2018; JHR-5447-2023ObjectiveThis study was performed to compare fusion rates and clinical outcomes of posterior decompression by posterolateral fusion (PLF) versus transforaminal lumbar interbody fusion (TLIF) for treatment of lumbar spinal stenosis.MethodsThis retrospective cohort study involved 157 patients with lumbar spinal stenosis treated with instrumented PLF alone or instrumented PLF combined with TLIF from 2010 to 2018. The patients were divided into two groups: the PLF group (Group A), in which posterior decompression with instrumented PLF was performed, and the cage-augmented group (Group B), in which TLIF was added to the procedures described for the PLF group. Patient outcomes (Oswestry Disability Index, visual analog scale score, and 36-Item Short-Form Health Survey scores) and fusion rates were compared.ResultsThe fusion rate was similar between the two groups. Among patients with two- and three-level fusion, improvements in the clinical outcome scores were significantly greater in Group B than Group A.ConclusionCombining TLIF with PLF provides better clinical outcomes than PLF alone when multilevel fusion is indicated. TLIF augmentation does not improve the fusion rates in either single- or multi-level surgery.Publication Association of clinical characteristics with decision making in patients with severe lower extremity trauma(Mre Press, 2021-01-01) Durak, Vahide Aslıhan; Ermutlu, Cenk; Atıcı, Teoman; DURAK, VAHİDE ASLIHAN; ERMUTLU, CENK; ATICI, TEOMAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Bölümü; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi Bölümü ve Travmatoloji; 0000-0003-0836-7862; 0000-0002-3396-3407; AAE-9483-2021; AEQ-5464-2022; A-5095-2018Severe lower limb trauma represents a challenge for both the emergency department physicians and the surgeons. These injuries are associated with significant incidence of limb loss and it is not uncommon for the treating physician to make the hard decision between limb salvage, amputation or stump closure for a patient in critical condition. Our aim was to evaluate the epidemiology of traumatic lower extremity amputations and to analyze the factors which may have effect on patient resuscitation, limb salvage and efficient patient management. Patients who were admitted to our institution's emergency department for traumatic lower extremity amputation over an 8 years' period (2012 to 2020) were retrospectively analyzed. Patient files with the possibility of severe lower limb trauma and mangled extremity were retrieved and analyzed using ICD codes recorded/registered during the emergency department admission. Mean time from emergency admission to transfer to operating theater was 184,5 minutes. Replantation of the amputate was performed in 4 patients (19%). 25% of the amputations at the ankle level (1 out of 4) and 37.5% of the transtibial amputates (3 out of 8) were replanted. A multidisciplinary approach is necessary in every aspect of patient management; however, this does not justify a delay in treatment. Time spent during conclusion of necessary consultations does not have negative effects on patient outcome as long as patient is closely monitored and resuscitated in the emergency department.Publication Is Coonrad-Morrey total elbow arthroplasty a viable option for treatment of distal humeral nonunions in the elderly?(Ortopedi Travmatoloji, 2015-01-01) Ersen, Ali; Demirhan, Mehmet; Atalar, Ata Can; Atıcı, Teoman; Kapıcıoğlu, Mehmet; ATICI, TEOMAN; Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı; A-5095-2018Objective: The purpose of this study was to evaluate the functional and radiological results of semiconstrained Coonrad-Morrey total elbow arthroplasty for distal humeral nonunions in the mid-term period.Methods: Seven patients were treated with Coonrad-Morrey total elbow arthroplasty for distal humeral nonunion. All patients were female, and the mean age was 65.6 years (range: 64-68 years). Patients were followed for at least 5 years, and the mean follow-up time was 73 months (range: 63-84 months). Anteroposterior and lateral radiographs at preoperative and early postoperative period of the joint replacement and latest follow-up were used to detect postoperative radiological changes in terms of loosening. The Mayo Elbow Performance Index (MEPI) and Q-DASH Score were used for functional evaluation.Results: At the latest follow-up, joint stability had been achieved in all 7 patients. Six patients (85.7%) were pain free. The mean range of motion was 30 degrees (range: 0-60 degrees) preoperatively, and this improved to 90.7 degrees (range: 60-110 degrees) at the latest follow-up (p<0.05). Five patients (71.4%) had excellent or good outcomes on the MEPI. The mean Q-DASH Score was improved from 93.2 to 34.5 (p<0.01). Two humeral components had aseptic loosening, and 1 of them was revised.Conclusion: Semiconstrained total elbow arthroplasty can be a reliable choice of treatment if other internal fixation methods fail. Significant pain relief and improvements in elbow function and stability can be achieved with semiconstrained elbow arthroplasty in patients with distal humeral nonunion.