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    Axial external fixator in humerus shaft fractures
    (2023) Ulusoy, İbrahim; güzel, ismail
    The causes of humeral shaft fractures are mostly high-energy traumas such as falling, hitting, traffic accident, and gunshot wounds. It may also occur as a result of simple falls due to osteoporosis in elderly patients. In surgical treatment, there are options such as intramedullary nail, plate-screw fixation and external fixator treatment. External Fixator Treatment it is the primary treatment option for soft tissue damage, open fractures, gunshot wounds, segmental bone loss, pseudoarthrosis, nonunion, and major vascular injuries. The purpose of the present study was to present the functional results of Axial External Fixator Treatment, which we often apply in humerus shaft fractures in our clinic. A total of 30 patients, who had gunshot wounds, multisystem injuries, open fractures, and advanced age comorbid problems, and who underwent Axial External Fixator Treatment due to humerus shaft fracture between January 2016 and January 2019 were included in the study. Disabilities of the Arm, Shoulder, and Hand (DASH) scores were used in clinical evaluations. Visual Analogue Scale (VAS) was used to evaluate the pain intensity in patients subjectively. Also, the results of patients with advanced age comorbid problems were compared with other patients. After a 12-month follow-up, significant improvements were detected in DASH scores. Although fracture union was later in patients with advanced age comorbid problems than in other patients, no differences were detected between union rates, clinical outcomes, and the surgical processes.We think that it is a more appropriate surgical technique than other surgical methods, due to its shorter surgical time and less invasiveness in patients with advanced age, high comorbidity and multisystem damage.
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    Comparison of minimally invasive plate osteosynthesis and intramedullary nailing in the treatment of surgical neck fractures of the humerus in elderly patients
    (2025) Güzel, İsmail; Ulusoy, İbrahim; Kıvrak, Aybars; Yılmaz, Mehmet; Tantekin, Mehmet Fırat
    Proximal humerus fractures are common osteoporotic fractures in the elderly population, presenting challenges in treatment due to differences between surgical options. Minimally Invasive Plate Osteosynthesis (MIPO) and Intramedullary Nailing (IMN) are the primary techniques employed for managing these fractures, each offering distinct advantages and limitations. This retrospective study evaluated 56 patients aged 50 years or older who were treated for proximal humeral surgical neck fractures between 2018 and 2022. Locked plates were applied using the minimally invasive MIPO technique, while IMN was performed to enhance biomechanical stability. Patients were assessed for functional recovery (DASH scores), pain (VAS scores), and complication rates. The IMN group demonstrated superior functional outcomes with significantly lower DASH scores. Although pain scores were lower in the MIPO group, the difference was not statistically significant. Radiographic healing times were similar between the two groups, but the complication rate was higher in the MIPO group (12.% vs. 4.3%). While IMN appears to provide better functional outcomes, MIPO offers advantages in pain management and patient comfort due to its minimally invasive nature. However, the higher complication rates observed with MIPO warrant attention. Both IMN and MIPO are effective options for treating proximal humerus fractures in elderly patients. However, IMN is found to be more advantageous in terms of functional recovery and lower complication rates, making it a valuable alternative for specific patient populations.
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    Does timing matter? Impact of early versus delayed intramedullary nailing on healing and complications in isolated tibial shaft fractures
    (2025) Güzel, İsmail; Ulusoy, İbrahim; Tantekin, Mehmet Fırat
    This study aimed to compare the effects of early (<48 hours) and delayed (>48 hours) intramedullary nailing on fracture union time and complication rates in patients with isolated tibial shaft fractures. A total of 68 patients who underwent intramedullary nailing for isolated tibial shaft fractures were retrospectively included in the study. Patients were divided into two groups based on the timing of surgery: early surgery group (n=34) and delayed surgery group (n=34). Demographic data, AO classification, time to union, and complication rates were compared between the groups. The mean time to union was significantly shorter in the early surgery group (15.2 ± 3.4 weeks) compared to the delayed group (17.6 ± 4.1 weeks) (p=0.011). There was no statistically significant difference between the groups in terms of complication rates, including superficial/deep infections, nonunion, and implant failure (p>0.05). Fracture types according to the AO classification were evenly distributed between the groups. Early intramedullary nailing significantly shortens the union time in isolated tibial shaft fractures. However, surgical timing does not appear to have a significant effect on complication rates. Therefore, the decision on surgical timing should be individualized based on patient characteristics and soft tissue condition.
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    There Is No Role for Extracorporeal Shock Wave Therapy in Chronic Insertional Achilles Tendinopathy: A Comparative Study with Conservative Treatment
    (2026) Ulusoy, İbrahim; Yılmaz, Mehmet; Tantekin, Mehmet Fırat; Güzel, İsmail; Kıvrak, Aybars
    Background: Chronic insertional Achilles tendinopathy (CIAT) is a type of tendinopathy resistant to conventional conservative treatments. The efficacy of extracorporeal shock wave therapy (ESWT) remains controversial. This study aims to evaluate the effects of ESWT on pain management and functional improvement in CIAT patients and compare it with physical and medical treatments Methods: In this retrospective study, 372 patients diagnosed with CIAT between 2019 and 2023 were evaluated. The patients were divided into two groups: those who received only physical/medical therapy (Group 1) and those who underwent a combination of ESWT and physical/medical therapy (Group 2). Clinical outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) score and the Visual Analog Scale (VAS) scores. The severity of the disease was determined through magnetic resonance imaging (MRI). Group comparisons were conducted using the independent samples t-test and Fisher's exact test, while changes over time were assessed with repeated measures ANOVA. Correlation analyses were evaluated using Pearson and Spearman correlation coefficients. Results: Significant improvement in AOFAS and VAS scores was observed in both groups by the third month (p < 0.01). However, at 6 and 12 months, ESWT did not demonstrate superiority over physical/medical treatment. Correlation analysis showed a positive relationship between baseline AOFAS scores and functional improvement, while higher initial VAS scores correlated with greater post-treatment pain reduction. Cardiovascular risk factors negatively impacted both functional recovery and pain reduction (p < 0.05). Although patient satisfaction was higher in the ESWT group, the difference was not statistically significant. Conclusions: ESWT may provide short-term pain relief and functional improvement in CIAT but does not offer a long-term advantage over physical/medical treatment. The placebo effect may contribute to early positive outcomes. These findings do not support ESWT as a routine treatment for CIAT.
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    Treatments for Knee Cartilage Injuries in Athletes Using PRP and Hyaluronic Acid: A Retrospective Analysis
    (2025) güzel, ismail; YILMAZ, Mehmet; Altunkılıç, Tarık; Ulusoy, İbrahim
    Aim: This retrospective study seeks to evaluate the clinical outcomes and imaging findings in athletes with knee cartilage injuries treated using autologous platelet-rich plasma (PRP) and hyaluronic acid (HA) injections. Material and Method: Sixty athletes participated in this investigation, with 30 individuals in the PRP group and 30 in the HA group. PRP was administered via ultrasound-guided intra-articular injections over three sessions, spaced at three-week intervals. Similarly, HA was injected using high molecular weight hyaluronic acid following the same schedule. Clinical evaluation was performed using the Visual Analog Scale (VAS) for pain assessment and the Knee Injury and Osteoarthritis Outcome Score (KOOS) for functional evaluation. Radiological changes were assessed through magnetic resonance imaging (MRI). Results: Both VAS and KOOS scores demonstrated a greater improvement in the PRP group compared to the HA group (p<0.05). MRI findings revealed more pronounced cartilage regeneration in the PRP group (p<0.05). No statistically significant differences were found between the two groups regarding age, gender, or career duration (p>0.05). Conclusion: For sportsmen with knee cartilage problems, PRP therapy has been found to be a more successful treatment alternative than HA. PRP offers better outcomes for cartilage regeneration, pain management, and functional enhancement. The long-term effectiveness of these results may be further assessed in prospective randomized studies in the future.
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    Use of external fixator combined with titanium elastic nails in the treatment of tibia shaft fractures in children
    (2023) güzel, ismail; Ulusoy, İbrahim
    Tibia shaft fractures are common in all age groups. For these fractures; Conservative and surgical treatment methods are available. In surgical treatment, numerous surgical methods such as plate screw fixation, external fixator, and titanium elastic nail and K-wire fixation have been defined. The aim of the present study was to present the results of patients for whom external fixator combined with titanium elastic nails or titanium elastic nails alone were applied due to tibia shaft fractures. The study included 40 patients treated for tibia shaft fracture in our clinic between January 2016 and January 2019. Combined external fixator (EF) fixation was applied to patients who were found to be instable after Titanium elastic nail (TEN) application during the surgery. In clinical evaluation, Flynn classification, time to fracture union, fluoroscopy count, reoperation and time to full weight bearing were used. The results of patients for whom EF combined with TEN were applied were compared with the patients who had only TEN. Thirty patients were treated using TEN and 10 patients using EF combined with TEN. After 12 months of follow-ups, fracture union was achieved in all patients. There were 5% sagittal and 2.5% coronal plane angulation. Patients developed angular deformity of an average of 2.43 ± 1.9 degrees in the coronal plane and 2.65 ± 1.9 degrees in sagittal plane. Lower percentages of angular and rotational deformity were observed compared to the literature. Despite the disadvantages of using a greater number of fluoroscopy and longer operation periods in patients who underwent TEN+EF, these patients were mobilized earlier. It was concluded that combined EF application is a more feasible method in patients with pediatric tibia shaft fracture for whom stable fixation cannot be achieved with TEN.