Publications by authors named "Saygin Kamaci"

10 Publications

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Plate osteosynthesis of midshaft clavicle fractures in adolescent contact sports athletes 'adolescent clavicle fracture'.

J Pediatr Orthop B 2020 Sep 24. Epub 2020 Sep 24.

Division of Sports Medicine, Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.

Surgical treatment of mid-shaft clavicle fractures via anatomical plates in adult athletes is documented to be safe and effective. Functional and cosmetic outcomes in adolescent contact sports athletes have not been well documented. Adolescent athletes (age 11-19) surgically treated for mid-shaft clavicle fractures between 1 May 2011 and 30 October 2017 were included in this study. Twenty-one adolescent athletes with a mean follow-up of 44 months were reviewed. Retrospective chart reviews were performed. Functional and cosmetic outcomes, return to sports time/rate were analyzed using Nottingham Clavicle Scores and a 'Custom Questionnaire'. Return of function and healing, evidenced on radiographs, was achieved in all 21 patients. All patients returned back to competitive sports. The mean time to return back to training was 45.9 ± 16 (24-76) days. Sixteen (76.1%) of the patients reported Nottingham Clavicle Scores with a mean score of 91.7 (85-98). In the Custom Questionnaire, 16 patients who participated in the phone interview were satisfied with the cosmetic outcomes. The most common complaint was implant prominence and irritation in 6 (40%) patients, subsequently requiring implant removal in 3 (18.8%). Surgical fixation of mid-shaft clavicle fractures can lead to excellent union and cosmetic outcomes and a rapid return to sports in adolescent contact sport athletes. However, one should consider the outcomes of implant-related complaints and the possibility of implant removal surgery in the future.
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http://dx.doi.org/10.1097/BPB.0000000000000810DOI Listing
September 2020

Septic Arthritis following Arthroscopic Anterior Cruciate Ligament Reconstruction.

Case Rep Orthop 2020 20;2020:2813134. Epub 2020 Jan 20.

University of Cincinnati Medical Center, Cincinnati, OH, USA.

. We report two cases of () septic arthritis following arthroscopic anterior cruciate ligament (ACL) reconstruction. Both initial surgical procedures were ACL reconstruction along with simultaneous collateral ligament and meniscus procedures. Patients presented with septic arthritis three and ten weeks following the index procedure. Both patients successfully recovered with early arthroscopic irrigation, debridement, and synovial culture, in addition to long-term parenteral and oral antibiotics. () septic arthritis following arthroscopic anterior cruciate ligament (ACL) reconstruction. Both initial surgical procedures were ACL reconstruction along with simultaneous collateral ligament and meniscus procedures. Patients presented with septic arthritis three and ten weeks following the index procedure. Both patients successfully recovered with early arthroscopic irrigation, debridement, and synovial culture, in addition to long-term parenteral and oral antibiotics.) septic arthritis following arthroscopic anterior cruciate ligament (ACL) reconstruction. Both initial surgical procedures were ACL reconstruction along with simultaneous collateral ligament and meniscus procedures. Patients presented with septic arthritis three and ten weeks following the index procedure. Both patients successfully recovered with early arthroscopic irrigation, debridement, and synovial culture, in addition to long-term parenteral and oral antibiotics.
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http://dx.doi.org/10.1155/2020/2813134DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6995318PMC
January 2020

Mid-term results of displaced acetabulum fractures surgically treated using anterior intra-pelvic approach (modified Stoppa).

Ulus Travma Acil Cerrahi Derg 2020 Jan;26(1):130-136

Department of Orthopaedic Surgery, Memorial Hospital, Ankara-Turkey.

Background: This study aims to evaluate the radiological and clinical mid-term results of the patients with displaced acetabular fractures surgically treated with open reduction and internal fixation using an anterior intra-pelvic approach (AIP).

Methods: In this study, we retrospectively reviewed 12 patients with displaced acetabular fractures treated surgically via the AIP approach. Patients were analyzed for Letournel's acetabular fracture classification, associated injuries, time to surgery, additional surgical procedures needed, perioperative and postoperative complications, radiologic and functional results.

Results: Of the 12 patients, the male/female ratio was 1/2; the mean age was 40.5±16.2 (16-64) years. The mean follow-up time was 59.8±32.2 (12-124) months. Seven patients had both column fractures, three patients had anterior column + posterior hemitransverse fractures, one patient had transverse + posterior wall and one patient had anterior column fracture. The mean time to surgery was 6.6±4.4 (2-16) days. The mean intraoperative blood transfusion was 830 (300-2000) ml. Intra-operative and post-operative complications were noted in eight patients. The mean Merle d'Aubigné and Postel score was 14.5±2.7 (10-18). Six patients with an anatomical reduction of the fracture showed excellent/good functional and radiologic outcomes. Three patients with a non-anatomic reduction developed post-traumatic arthrosis that was treated with total hip arthroplasty.

Conclusion: AIP approach provides a satisfactory exposure for the surgical treatment of displaced anterior wall/column and both column acetabular fractures. Clinical outcome is directly related to the reduction quality. Patients with poor reduction are most likely to develop mid-term complications, such as hip joint arthrosis.
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http://dx.doi.org/10.14744/tjtes.2019.03835DOI Listing
January 2020

Loss of pronation-supination in patients with heterotopic ossification around the elbow.

J Shoulder Elbow Surg 2019 Jul 23;28(7):1406-1410. Epub 2019 Jan 23.

Department of Orthopedics, Biomechanics Laboratory, Mayo Clinic, Rochester, MN, USA. Electronic address:

Background: Heterotopic ossification (HO) is a well-recognized cause of limited flexion-extension, but it can also limit pronation-supination. There is a paucity of literature concerning restriction of pronation-supination due to HO.

Methods: We conducted a retrospective review of patients who had undergone elbow surgery for HO removal between January 1, 2003, and September 27, 2013. Computed tomography scans were reviewed to determine the presence of HO restricting forearm rotation and were rated independently by 4 observers. Each elbow was given 1 of 4 scores according to the likelihood that HO was restricting forearm rotation. Agreement was achieved when 3 or 4 observers thought that HO definitely or probably caused a loss of pronation-supination.

Results: Of 132 post-traumatic patients undergoing HO excision for restricted elbow motion, 61 (46%) also lacked a functional arc of pronation and supination (50° and 50°, respectively). Of these 61 patients, 32 (53%) were considered to have lost forearm rotation because of HO. The remaining 29 patients (47%) were thought to have restricted forearm rotation for reasons unrelated to HO.

Discussion: In this study, loss of pronation-supination affected almost half of the patients (61 of 132 [46%]) undergoing HO excision around the elbow. Of these 61 patients, 32 (52%) had HO extending into the proximal forearm and affecting rotation. From our data, one can expect that about one-quarter (24% of patients in this study, or 32 of 132) with post-traumatic HO of the elbow will have a significant functional loss of pronation-supination due to HO extending into the forearm.
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http://dx.doi.org/10.1016/j.jse.2018.10.029DOI Listing
July 2019

The Evolution of Sagittal Spinal Alignment in Sitting Position During Childhood.

Spine (Phila Pa 1976) 2015 Jul;40(13):E787-93

*Department of Orthopaedics and Traumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey; and †Yeditepe University Pharmacoepidemiology and Pharmacoeconomics Research Center, Istanbul, Turkey.

Study Design: This is a cross-sectional descriptive study.

Objective: The purposes of this study are to describe normative data of the sagittal plane in the sitting position within the pediatric population and document the evolution of sagittal alignment during the growth.

Summary Of Background Data: Surgical procedures addressing the deformity aim to make the maximal correction on the coronal and transverse planes and to restore the physiological curves on the sagittal plane. Prerequisite for sagittal plane reconstruction is to know the physiological values.

Methods: Children between 3 and 17 years of age, followed by pediatrics unit for nonskeleton disease with lateral radiographs of the entire spine and pelvis on sitting positions, were included to the study. Children with history of surgery or disease that may affect spine development were excluded. Children were evaluated in 4 age groups (3-6, 7-9, 10-12, and 13-17 yr) in terms of spinal sagittal alignment on sitting position.

Results: Of the screened, 124 children (49 girls, 75 boys) were included. Descriptive statistics of all possible segmental angles were summarized. Thoracic kyphosis and lumbar lordosis values were lower on sitting position than on standing position. Thoracic segmental angulations steadily increased from T1-T2 to midthoracic segments and then decreased in caudal direction. Moreover, lumbar segmental angulations steadily increased in cephalocaudal direction. Sacral slope, L4-S1 angulation, and T1-T12 and T1-S1 distance tend to increase as the age increases.

Conclusion: Sagittal spinal alignment in the sitting position is different than that in the standing position and it changes as the child grows. There is a statistically significant difference between different age groups, especially at the cervicothoracic, thoracolumbar, and lumbosacral junctions. These findings should be taken into consideration for young nonambulatory patients who require spinal instrumentation and/or fusion.

Level Of Evidence: 2.
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http://dx.doi.org/10.1097/BRS.0000000000000884DOI Listing
July 2015

Reliability and Validity of the Adapted Turkish Version of the Early-onset Scoliosis-24-Item Questionnaire (EOSQ-24).

J Pediatr Orthop 2015 Dec;35(8):804-9

*Department of Orthopaedics and Traumatology, Faculty of Medicine †Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University ‡Department of Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey §Department of Orthopaedic Surgery, Columbia University, New York, NY.

Introduction: Early-onset scoliosis (EOS) can have negative effects on the developing thorax, lungs, and quality of life in general. Children with EOS can face various health problems and require recurring hospitalization and surgeries. Radiographic parameters are insufficient to evaluate the severity and efficacy of treatment in EOS. Early-onset Scoliosis Questionnaire (EOSQ)-24 questionnaire is a new instrument developed for this specific age group. To date, reliability of this questionnaire has not yet been interrogated in wide patient groups from different cultures. The aim of this study was to evaluate the validity and reliability of culturally adapted Turkish version of the EOSQ-24.

Methods: Forward translation and back translation of the English version of the EOSQ-24 was done, and all steps for cross-cultural adaptation process were performed properly by an expert committee. Turkish version of the EOSQ-24 and Child Health Questionnaire-Parent Form-50 (CHQ-PF-50) were applied to 61 (24 male, 37 female) EOS patients. The average age of these patients was 9.1 ± 3.1 years (0.4 to 14.3 y), and 50 of them had undergone surgical treatment. Data quality was assessed by mean, median, percentage of missing data, and extent of ceiling and floor effects. Reliability was assessed by internal consistency using Cronbach's α and item-total correlations. The construct validity was evaluated by comparing the results of the EOSQ-24 with the Turkish version of the CHQ-PF-50. Subgroup analyses were applied for sex, diagnosis, treated/untreated, mobilization ability, and complications.

Results: The item response to the EOSQ-24 was high with a small number of missing answers (1.6% to 3.3%). Of the 24 items, 22 were evenly distributed. This resulted in a floor effect in 0% to 21.7% of patients, and a ceiling effect in 1.6% to 68.3%. The calculated Cronbach's α for the 24-item scale was 0.909, indicating excellent reliability. Construct validity showed that high correlations between the EOSQ and the CHQ by means of similar domains. Correlation coefficient was between 0.348 and 0.688 (P=0.0001). Subgroup analyses also showed significant difference in treated/untreated patients (P=0.032) and mobilization ability (P=0.001).

Discussion: The Turkish adaptation of the EOSQ-24 exhibits favorable psychometric properties and excellent reliability, validating its use in this population.
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http://dx.doi.org/10.1097/BPO.0000000000000378DOI Listing
December 2015

Preoperative nerve imaging using computed tomography in patients with heterotopic ossification of the elbow.

J Shoulder Elbow Surg 2015 Jul 12;24(7):1149-55. Epub 2015 Mar 12.

Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address:

Hypothesis: This study evaluated the usefulness of computed tomography (CT) imaging for preoperative planning of heterotopic ossification (HO) excision, specifically the spatial relationship between HO and radial and median nerves. Our hypotheses were that CT imaging of the elbow can be used (1) to trace the paths of the radial and median nerves, (2) to distinguish the nerves from the heterotopic bone, and (3) to precisely measure distances from the respective nerve to the most clinically relevant HO.

Materials And Methods: Patients who had HO removed from the elbow were reviewed retrospectively. On the basis of preoperative CT scans, 22 were identified as likely having HO along the pathway of the radial or median nerve. These cases were independently evaluated by 4 observers, who answered these questions: (1) Can the location of the nerve be adequately seen on sequential images to permit tracing of its path for surgical planning? (2) Can the nerve be distinguished from the HO accurately enough to permit measurement of its distance from the bone? Each observer also measured the shortest distance between nerves and the HO.

Results: Overall utility of the CT images for visualizing the nerves was high. The radial nerve was more readily distinguished from the HO (21 of 22 cases) than the median nerve (17 of 22 cases). The distance measured from HO was less for the radial nerve (3 mm) than for the median nerve (9 mm).

Conclusion: This study demonstrates the usefulness of CT imaging to determine the paths of the radial and median nerves and their spatial relationship to HO at the elbow.
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http://dx.doi.org/10.1016/j.jse.2014.12.030DOI Listing
July 2015

Neonatal physeal separation of distal humerus during cesarean section.

Am J Orthop (Belle Mead NJ) 2014 Nov;43(11):E279-81

Koç University, School of Medicine, Orthopaedics and Traumatology, Istanbul, Turkey.

Diagnosing physeal separation of the distal humerus in a newborn can be challenging. Skeletal immaturity and absence of secondary ossification centers make radiographic diagnosis difficult for inexperienced providers. This fracture is seen in the setting of complicated deliveries with excessive traction and rotation applied to the forearm. We report a case of physeal separation of the distal humerus in a newborn as a complication of cesarean section and describe the intervention used and the short-term results.
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November 2014

Lipoma arborescens of the knee.

Knee Surg Sports Traumatol Arthrosc 2015 Aug 22;23(8):2196-2201. Epub 2014 Apr 22.

Department of Orthopaedics, University of Missouri-Kansas City, 2301 Holmes Street, Kansas City, MO, USA.

Purpose: Lipoma arborescens (LA) is a benign lesion described as replacement of mature fat cells with sub-synovial tissue, which causes the formation of villous projections. Underlying inflammatory conditions might predispose LA. This study demonstrates the treatment, post-operative survey and MRI demonstrations of this rare entity.

Methods: Five patients (6 knees) diagnosed and treated with arthroscopic (5/6) and open (1/6) synovectomy were reviewed retrospectively. An additional mini-transquadricipital incision is used for excision of the extensive suprapatellar lesions. The patients had post-operative follow-ups at first and sixth months and then yearly. Radiographs and MRI of the affected knees were taken at the final follow-up.

Results: The median follow-up was 59 (4-105) months. Major symptom was painless swelling of the joint. The presenting age was under 18 years in four patients. Recurrent lesions were detected in MRI scan of three patients with JRA, ARF and Tbc. Two out of three were located adjacent to the posterior capsule. The median of the Kujala questionnaire scores was 88 (74-95), and the median of the Knee Society Clinical Rating System scores was 95 (80-100) at the final follow-up.

Conclusions: Lipoma arborescens should be considered in the differential diagnosis of paediatric patients who have painless swelling of the knee joint. The lesion is totally curable. However, underlying persistent disease might aggravate the inflammatory process and might cause recurrent lesions. Although resecting the lesion adjacent to the posterior capsule of the knee joint is technically demanding, arthroscopic treatment is an effective procedure and transquadricipital approach may help resection of the extensive lesions in suprapatellar pouch.

Level Of Evidence: Case series, Level IV.
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http://dx.doi.org/10.1007/s00167-014-2996-3DOI Listing
August 2015

The effect of dual growing rod instrumentation on the apical vertebral rotation in early-onset idiopathic scoliosis.

J Pediatr Orthop 2014 Sep;34(6):607-12

Department of Orthopedics and Traumatology, Hacettepe University, Ankara, Turkey.

Background And Aim: Treating progressive early-onset idiopathic scoliosis is challenging. Surgical treatment is indicated in patients whose curves progress despite nonsurgical treatment. Dual growing rod (DGR) technique allows control of the curve while permitting continued spine growth and pulmonary development. Correction in coronal and sagittal planes with this technique has demonstrated both clinically and radiologically in previous studies. It is shown that apical vertebra rotation (AVR) increases with single-rod instrumentation technique. The effect of DGR technique on AVR has not been investigated, yet. The aim of our study was to assess the impact of DGR instrumentation technique on the apical AVR.

Methods: The study included 12 patients with early-onset idiopathic scoliosis treated with DGR technique. Mean follow-up was 74 months. Vertebral rotation angle in the apex of the curve in preindex surgery was measured with Perdriolle and Stokes' method. As pedicle shadows were masked by rods postoperatively, vertebral rotation angle of same levels in final computed tomography scans was measured using Aaro and Dahlborn's method. Standing anterior-posterior and lateral x-rays were measured for assessing Cobb angle, thoracic kyphosis, lumbar lordosis in coronal and sagittal planes preoperatively, postoperatively, and at the time of final follow-up.

Results: Mean age at the time of growing rod instrumentation was 69 (36 to 108) months. Mean follow-up was 77 (57 to 91) months. The mean preoperative AVR angle was 27 (18 to 38) degrees and decreased to 18 (4 to 35) degrees at the time of final follow-up. The difference between preoperative and final follow-up AVR was found to be significant (P=0.003). Preoperative mean Cobb angles were found to be 63.8 (40 to 98) degrees, 25 (10 to 46) degrees (60%) (P<0.001) after index surgery and at the time of final follow-up 20 (7 to 42) degrees (66%) (P<0.001). The mean thoracic kyphosis and lumbar lordosis angles were found to be 46 (20 to 90) and 34 (16 to 80) degrees at preoperative stage; 25 (12 to 50) and 22 (8 to 35) degrees at immediate postoperative stage; and 38 (16 to 83) and 37 (16 to 60) degrees at the time of final follow-up.

Conclusions: This study proves that the DGR technique has no negative effect on transverse plane deformities. When compared with preoperative values, correction of the AVR during the treatment period suggests that DGR is effective in controlling the coronal and sagittal planes along with transverse plane deformities. Further studies are needed to prove that DGR treatment definitely prevents progression of AVR.
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http://dx.doi.org/10.1097/BPO.0000000000000169DOI Listing
September 2014