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  • Küçük Resim
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    The effect of gluteus maximus tenotomy in primary total hip arthroplasty with posterior approach: kinematic analysis of hip extensor strength
    (SAGE Publications Ltd, 2021) Ímren, Yunus; Karslıoğlu, Bülent; Dedeo?lu, Süleyman Semih; Çabuk, Haluk; Atar, Sevgi; Gürbüz, Serhat; Gürbüz, Hakan
    Background: The posterior approach (PA) is the most commonly used surgical approach for total hip arthroplasty (THA), but the proximity of the sciatic nerve may increase the likelihood of sciatic nerve injury (SNI). Gluteus maximus tenotomy can be performed to prevent SNI because tenotomy increases the distance between the femoral neck and sciatic nerve and prevents compression of the sciatic nerve by the gluteus maximus tendon (GMT) during hip movements. We aimed to kinematically compare the postoperative hip extensor forces of patients who have and have not undergone gluteus maximus tenotomy to determine whether there is a difference in hip extensor strength. Methods: Seventy-two patients who underwent gluteus maximus tenotomy during THA were included in the group 1, and 86 patients who did not undergo tenotomy were included in group 2. The Harris hip score, body mass index and hip extensor forces were measured both preoperatively, and 6 months after surgery with an isokinetic dynamometer and compared. Results: The mean age was 64.6 ± 2.3 years in group 1 and 63.8 ± 2.1 in group 2. Mean body mass index was 25.7 ± 1.1 in group 1, and 25.5 ± 1.3 in group 2. Baseline Harris hip score (HHS) was 42.36 ± 12 in group 1 and 44.07 ± 9.4 in group 2 (p = 0.31), whereas it was 89.1 ± 7.8 and 88.4 ± 8.1 at 6 months after surgery, respectively. Baseline hip extensor force (HEF) was 2 ± 0.4 Nm/kg in group 1, and 2.1 ± 0.7 Nm/kg in group 2 (p = 0.28), while it was 2.4 ± 0.6 Nm/kg, and 2.5 ± 0.5 Nm/kg, respectively at 6 month follow-up (p = 0.87). Both groups had significantly improved HHS and HEF when comparing baseline and postoperative measurements (p < 0.0001). No cases of sciatic nerve palsy were noted in group 1, whereas there were two (2.32%) cases in group 2, postoperatively. Conclusion: The release of the GMT during primary hip arthroplasty performed with the PA did not lead to significant decrease in hip extension forces. Hip extensor strength improves after THA regardless of tenotomy. Gluteus maximus tenotomy with repair does not reduce muscle strength and may offer better visualization.
  • Küçük Resim
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    Evaluating the results of retrograde intramedullary nailing for distal femur fractures: A level 3 trauma center retrospective study
    (DergiPark, 2022) Ergün, Tuğrul; Bayraktar, Mehmet Kürşad; Taşatan, Ersin; Tekin, Ali Çağrı; Akdaş Tekin, Esra; Gürbüz, Hakan; Karslıoğlu, Bülent
    Aim: Distal femur fractures can be treated with modern anatomic plates and nails. This study aimed to examine the clinical and radiological results of displaced distal femur fractures in adult people who had been treated with a retrograde intramedullary nail (RIN). Material and Methods: The study included all patients who underwent RIN surgery for distal femur fracture between January 2013 and April 2018 in a level 3 trauma center. Patients were divided into two groups based on fracture pattern: open fracture and closed fracture. The preoperative and postoperative clinical, radiological and functional characteristics of patients who had RIN for a distal femur fracture were analyzed. Results: Thirty patients were included in the study. 21 (70%) patients were male. The median age of the patients was 39 (range, 18-58) years. 17 (56.7%) of the affected femur were left-sided. The etiology of the fractures was traffic accident and fall in 19 (63.3%) patients and gunshot injury in 11 (36.7%) patients. Of the patients, 17 (56.7%) were closed fractures and 13 (43.3%) were open fractures. There were no significant differences between two groups related to the surgery time (p=0.086), fluoroscopy time (p=0.805), blood loss (p=0.967), and hospitalization time (p=0.967), clinical pain and function scores (p=0.341, p=0.902), and union time (p=0.385) at the postoperative period. Conclusion: RIN is a minimally invasive method that may prevent excessive blood loss and decrease the duration of surgery time. It is an effective and reliable surgical intervention that should be considered for the treatment of distal femur fractures.