emoroasetabular impingement sendromu (FAÝS), kalça ekleminin iki komponenti olan asetabulum ve femur proksimali arasýndaki mekanik uyumsuzluk nedeniyle aðrýya ve fonksiyonel bozukluða yol açan, kalça osteoartriti öncülü bir patolojidir. Özellikle genç eriþkin sporcular, FAÝS açýsýndan önemli bir risk grubudur. Taný; semptomlar, klinik bulgular ve ilgili radyolojik incelemelerin her açýdan ve beraber deðerlendirilmesiyle konulmaktadýr. Pelvis ve kalça yan grafileri çoðu zaman taný için önemli yol göstericiler olsalar da, MRG ile labrum ve kýkýrdakla ilgili olasý lezyonlar da incelenmelidir. Temel tedavi protokollerini aktivitenin kýsýtlanmasý, aðrý kesici yöntemler, fizik tedavi ve rehabilitasyon uygulamalarý, manuel terapi, kýlavuz eþliðinde intraartiküler enjeksiyonlar ve cerrahi giriþimler oluþturmaktadýr. Cerrahi öncesinde önemli bir tedavi seçeneði olarak görülen rehabilitasyon programýný; yumuþak doku mobilizasyonu teknikleri, aðrý kesici tedavi amaçlý fizik tedavi modaliteleri ve eklem hareket açýklýðý, kalça çevresi kaslarý güçlendirme ve propriosepsiyon egzersizleri oluþturmaktadýr. Son yýllarda ultrason veya floroskopi eþliðindeki intraartiküler enjeksiyonlarýn tedavide fayda saðlayabileceðini destekleyen yöndeki çalýþmalar artmýþtýr. Konservatif tedavi yöntemlerinin yetersiz kaldýðý ve radyolojik görüntülemelerinde osseöz bulgular saptanan hastalara cerrahi yöntemler önerilmelidir. Sýkýþma tipine göre seçilen çeþitli cerrahi mekanizmalarýn uygulanmasýnda artroskopik yöntemler ön plana çýkmýþtýr. Cerrahi iliþkili rehabilitasyon protokolleri açýsýndan uluslararasý bir uzlaþý henüz saðlanamamýþ olsa da, preoperatif ve postoperatif rehabilitasyon yöntemlerinin cerrahi müdahalenin baþarýsýný artýrdýðý bildirilmektedir.

Femoroacetabular impingement syndrome (FAIS) is a precursor pathology of hip osteoarthritis that causes pain and functional impairment due to mechanical incompatibility between the two components of the hip joint, the acetabulum, and the proximal femur. Young adult athletes are especially an important risk group for FAIS. The diagnosis of FAIS is made by evaluating symptoms, signs, and related radiological evaluations. Although radiographs of the lateral hip and anteroposterior pelvis are often significant guides for the diagnosis, possible lesions related to the labrum and cartilage should be examined with MRI. The treatment protocols of the FAIS are activity restriction, pain relief therapies, physical therapy and rehabilitation, manual therapy, guided intra-articular injections, and surgical interventions. The rehabilitation program, which is seen as an important treatment option before surgery, consists of soft tissue mobilization techniques, physical therapy modalities for pain relief, joint range of motion, strengthening of the muscles around the hips, and proprioception exercises. In recent years, studies suggested that ultrasound or fluoroscopy-guided intra-articular injections may be beneficial. Surgical methods should be recommended to patients whose conservative treatment methods are inadequate and osseous findings are detected in their radiological imaging. Arthroscopic methods have become popular for treating these pathologies depending on type of impingement. Although an international consensus has not yet been achieved in terms of surgery-related rehabilitation protocols, it is reported that preoperative and postoperative rehabilitation methods increase the success of the surgery.

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Amaç: Çalýþmamýzda, geriatrik kalça kýrýðý tanýsý ile opere edilen Covid-19 pozitif hastalarý, mortalite ve komplikasyonlar yönünden Covid-19 negatif hastalar ile karþýlaþtýrmayý amaçladýk.
Yöntem: Nisan 2020 ve Temmuz 2021 tarihleri arasýnda kalça kýrýðý nedeniyle kliniðimizde bipolar endoprotez uygulanan 20 Covid-19 pozitif hasta ve kontrol grubu olarak yaþ, cinsiyet ve American Society of Anesthesiologists (ASA) skorlarý yönünden birebir eþlenmiþ 20 Covid-19 negatif hasta olmak üzere, 40 hasta (22 erkek 18 kadýn) çalýþmaya dahil edildi. Hastalarýn demografik verileri, ameliyata kadar geçen süre, ameliyat süresi, hastanede yatýþ süresi, mobilizasyon durumu, postoperatif yara yeri sorunlarý, 90 günlük mortalite, hemoglobin ve albümin parametreleri deðerlendirildi.
Sonuçlar: Yaþ, cinsiyet, komorbidite verileri açýsýndan birebir eþlenmiþ gruplar arasýnda doksan günlük mortalite, ameliyat süresi ve hastanede yatýþ süresi Covid-19 pozitif grupta anlamlý bir biçimde daha yüksekti (sýrasýyla p=0.025, p = 0,012, p<0.001).
Çýkarýmlar: Geriatrik kalça kýrýðý teþhisi konan ve Covid-19’un eþlik ettiði hastalar, hem kýrýk hem de sistemik Covid-19 enfeksiyonuna baðlý komorbiditelerle karþý karþýya kalmaktadýr. Olumlu sonuçlara ulaþmak için erken ortogeriatrik muayene, kapsamlý planlama ve hýzlý cerrahi müdahale zorunludur.

Aim: This study aims to evaluate the mortality and complication rates of patients surgically treated for geriatric hip fractures, and compare the results between groups with and without accompanying Covid-19 diagnosis.
Method: 40 patients (22 males and 18 females), including 20 Covid-19 positive patients who underwent bipolar endoprosthesis due to hip fracture in our clinic between April 2020 and July 2021, and 20 Covid-19 negative patients who were matched paired in terms of age, gender, and American Society of Anesthesiologists (ASA) scores as the control group were included in the study. Demographic data of the patients, time to surgery, operative time, length of hospital stay, mobilization status, postoperative wound problems, 90-day mortality, hemoglobin, and albumin parameters were evaluated.
Results: Ninety-day mortality, operative time, and hospital stay were significantly higher in the Covid-19 positive group compared to the matched Covid-19 negative control group in terms of age, gender, and comorbidity data (p=0.025, p=0.012, p<0.001, respectively).
Conclusion: Patients diagnosed with geriatric hip fractures and accompanying Covid-19, face comorbidities related to both fracture and systemic Covid-19 infection. An early orthogeriatric examination, thorough planning, and prompt surgical intervention are mandatory to achieve favorable outcomes.

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Gi̇ri̇þ ve Amaç: Bu çalýþmanýn amacý, yumuþak doku gevþetme ameliyatý uygulanan Legg-Calvé-Perthes (LCPD) hastalarýnda fonksiyonel ve radyolojik sonuçlarý araþtýrmaktýr.
Yöntem ve Gereçler: Hareket kýsýtlýlýðý nedeniyle konservatif olarak tedavi edilmiþ LCPD tanýsý almýþ 10 çocuk (11 kalça) çalýþmaya dahil edildi. Geç fragmantasyon dönemindeki hastalarýn kalçalarý artrografi ile kalça nötral, abduksiyon, abduksiyon/iç rotasyon ve adduksiyon pozisyonlarýnda deðerlendirildi. Herhangi bir kemik patolojisi (menteþe) olup olmadýðýný belirlemek için artrografi ile dinamik muayene yapýldý. Kemik patolojisi olmayan hastalara adduktor longus ve iliopsoas tenotomisiyle birlikte inferior kapsülotomi uygulandý. Ameliyattan hemen sonra oturmaya izin verildi ve yara iyileþtikten sonra destekli mobilizasyona izin verildi. Hastalar ameliyattan sonra ortalama 3 (1-5) yýl takip edildi. Hastalarýn fonksiyonel deðerlendirmeleri Harris kalça skorlama sistemi kullanýlarak yapýldý. Radyolojik deðerlendirilme Herring ve Stulberg sýnýflamasýna göre yapýldý.
Bulgular: Hastalarýn ortalama yaþý 10.9 (6-15) yýldý. Herring lateral pillar sýnýflamasýna göre bir hasta tip B, üç hasta tip B/C ve yedi hasta Tip C idi. 12 aylýk takipte aktif hareket açýklýðýnýn arttýðý ve kalça aðrýsýnýn azaldýðý görüldü. Son kontrolde çekilen röntgenlerde Stulberg sýnýflamasýna göre bir hasta tip II, yedi hasta tip IV ve üç hasta tip V olarak deðerlendirildi. Ortalama Harris kalça skoru 92.3 idi.
Tartýþma ve Sonuç: LCPD hastalarýnda yumuþak doku gevþetme ameliyatýnýn radyolojik olarak herhangi bir etkisi olmadýðý ancak olumlu fonksiyonel etkileri olduðu sonucuna varýldý.

Objectives: This study aimed to investigate the functional and radiological outcomes in Legg–Calvé–Perthes Disease (LCPD) patients undergoing soft tissue release surgery.
Materials and methods: Ten children (11 hips) diagnosed with LCPD who had previously been conservatively treated with movement limitation were included in the study. Patients in the late fragmentation period of the disease were evaluated with arthrography in hip-neutral, abduction, abduction/internal rotation, and adduction positions using radioscopy. Dynamic examination using arthrography was performed to determine whether the patient had any bone pathologies (hinging). For patients with no bone pathology, adductor longus and iliopsoas tenotomy and inferior capsulotomy were performed. Sitting was allowed immediately following surgery, and mobilization with support was allowed after the wound had healed. Patients were followed up at regular intervals. Functional assessments of patients were made using the Harris hip scoring system. Evaluation of radiological imaging was carried out according to the Stulberg classification.
Results: The mean age of patients was 10.9 (6–15) years. According to the Herring lateral pillar classification, one patient was type B, three were type B/C, and seven were Type C. At the 12-month follow-up, the active range of motion was increased, and hip pain decreased. At the final follow-up (patients followed for 1–5 years; mean: 3 years), one patient was evaluated as type II, seven as type IV, and three as type V according to the Stulberg classification. The mean Harris hip score was 92.3.
Conclusion: Soft tissue release surgery performed as tenotomy in LCPD patients had no effect in terms of radiological characterization, but had positive functional impacts.

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Amaç: Osteosarkom tedavisinde kullanýlan neo-adjuvan kemoterapilerin olumlu sonuçlarýna karþýn, post-operatif geliþen rekürrensler ortak bir sorun olarak varlýðýný korumaktadýr. Post-operatif hastalarda, rekürrensi önleyecek ve sistemik kemoterapi uygulamasýnýn dezavantajlarýný ortadan kaldýracak yeni yaklaþým arayýþlarý önem taþýmaktadýr. Çalýþmanýn amacý in vitro olarak sement içine emdirilmiþ kemoterapötik (ifosfamid) ve immunoterapötik (mifamurtid) ajanlarýn, osteosarkom hücre hattý olan K7M2 canlýlýðý üzerine etkilerini incelemektir.
Yöntem: K7M2 osteosarkom hücre hattý kültüre edilip, sonrasýnda hücreler tutunup %70 konfluent hale geldiðinde; hücrelerin kaybedilmemesine dikkat edilerek üst fazlar uzaklaþtýrýlmýþtýr. Ýfosfamidin (10 ug/ml, 20 ug/ml, 40 ug/ml) ve mifamurtidin (0,25 ug/ml, 0,5 ug/ml, 1 ug/ml) farklý dozlarý, tek baþýna ve sement ile birlikte mononükleer hücreler ile ko-kültür yapýlarak verilmiþtir. Kontrol grubu olarak sadece sement uygulamasý yapýlmýþtýr. Plate, %5 CO2 içeren 37°C inkübatörde, 24 saat ve 48 saatlik periyotlarla inkübasyona býrakýlmýþ ve sonrasýnda WST ile hücre canlýlýðý tayini yapýlmýþtýr.
Bulgular: 24. saatte, sement içerisinde lokal ifosfamid ve mifamurtidin uygulamasýnýn; osteosarkom hücrelerinde sementsiz olarak sadece ilaçlarýn kullanýmýna kýyasla daha fazla sitotoksik etkiye yol açtýðý saptanmýþtýr. 48. saatte mifamurtidinde artmýþ etki görülürken; ifosfamid artý, sement grubunda tek baþýna ifosfamid grubuna göre saptanamadý.
Sonuç: Bulgularýmýz, kemik çimentosu içinde lokal ifosfamid ve mifamurtid uygulamasýnýn; cerrahi uygulama sonrasý osteosarkomun lokal nüksünü önlemede eksizyon cerrahileri sonucu oluþan kemik defektlerini doldururken etkili olabileceðini desteklemektedir. Postoperatif biyomalzemeler içinde lokal tedavi, direkt ve mikro-çevre ile etkileþerek osteosarkomda rekürrensi önlemede tedavi seçeneði olabilir.

urpose: Despite the good results of neoadjuvant chemotherapy used in the treatment of osteosarcoma, post-operative recurrences continue to be a common problem. It is important to seek new approaches to prevent recurrence in post-operative patients and to eliminate the disadvantages of systemic chemotherapy. The study aims to examine the effects of chemotherapeutic (ifosfamide) and immunotherapeutic (mifamurtide) agents, which are adsorbed into cementum in vitro, on the viability of the osteosarcoma cell line K7M2.
Methods: After the K7M2 osteosarcoma cell line was cultured, the cells were adhered to and became 70% confluent, and the supernatants were removed, taking care not to lose the cells. Different doses of ifosfamide (10 ug/ml, 20 ug/ml, 40 ug/ml) alone and with cement; Different doses of mifamurtide (0.25 µg/ml, 0.5 µg/ml, 1 µg/ml) were given by co-culture with mononuclear cells alone and with cement. Cement was used as the control group. Cell viability was determined by WST after the plate was placed in a 37°C 5% CO2 incubator for 24 hours and 48 hours.
Results: It was determined that ifosfamide and mifamurtide in cementum were released into the environment compared to the agent alone, causing more cytotoxic effects in osteosarcoma cells at 24 hours. While an increased effect at 48 hours was observed in mifamurtide, it was not detected in the ifosfamide plus cement group compared to the ifosfamide group alone.
Conclusion: Our findings support that local application of ifosfamide and mifamurtide in bone cement may be effective in preventing local recurrence of osteosarcoma after surgery; while filling bone defects resulting from excision surgeries. Among post-operative biomaterials, local therapy may be an additive treatment option in preventing recurrence in osteosarcoma by interacting directly and with the microenvironment.

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Amaç: Bu çalýþmanýn amacý; BT kýlavuzluðunda mini açýk eksizyon, perkutan drilleme veya skopi kýlavuzluðunda eksizyon ile tedavi edilen proksimal femur osteoid osteomu olan 16 hastanýn sonuçlarýný bildirmektir.
Yöntem: Cerrahi tedavi uygulanan (7 BT kýlavuzluðunda mini açýk eksizyon, 6 BT kýlavuzluðunda perkütan drilleme, 3 skopi kýlavuzluðunda mini açýk eksizyon) ve ardýndan en az bir yýl takip edilen 16 hasta deðerlendirildi. Ameliyat öncesi ve son takipteki VAS aðrý skorlamasý ile hasta memnuniyetinin derecesi (0-10 puan) veya seviyesi (1 ‘yüksek’ - 4 ‘kötü’) analiz edildi.
Bulgular: Ameliyat sonrasý ortalama VAS aðrý skoru (0.7±1.1), ameliyat öncesi deðerlere (8±1) göre daha düþüktü (p: 0.0004). Ortalama seviye ve memnuniyet puaný 1,3±0,6 ve 8±2 puandý. Herhangi bir parametre için BT kýlavuzluðunda mini açýk eksizyon veya BT kýlavuzluðunda perkütan drilleme arasýnda fark bulunmadý. Ýzlemde herhangi bir nüks veya major komplikasyon görülmedi.
Sonuç: BT kýlavuzluðunda eksizyon grubunda lezyonun histolojik doðrulamasý daha belirgin olmasýna raðmen, her iki grupta semptom nüksü veya majör komplikasyon olmaksýzýn tüm hastalarda benzer aðrý rahatlamasý ve yüksek memnuniyet görüldü.

Objective: This study aims to report the results of 16 patients having proximal femur osteoid osteoma who were treated with CT guided mini-open excision, drilling, or x-ray guided excision
Method: 16 patients receiving surgical treatment (7 CT guided mini-open excision, 6 CT guided percutaneous drilling, 3 Scopy guided mini-open excision) who were followed for at least one year were evaluated. Preoperative and latest follow-up VAS pain scoring and degree (0-10 point) or level (1 ‘high to 4 ‘worse’) of patient satisfaction were analyzed.
Results: Mean postoperative VAS pain score (0.7±1.1) was lower compared to pre-operative values (8±1) (p: 0.0004). The mean level and point of satisfaction were 1.3±0.6 and 8±2 points. There was no difference between CT-guided mini-open excision or Ct-guided percutaneous drilling for any parameter. There was not any recurrence or major complication during follow-up.
Conclusion: Although histological verification of the lesion was more obvious in the CT-guided excision group, both groups resulted in similar relief of pain and high satisfaction at all patients with no recurrence of symptoms or major complications.

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