Biçen, Ahmet Çağdaş
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Bicen, Ahmet Cagdas
Bicen, AC
Bicen, AC
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cagdasbicen@hotmail.com
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09.04. Surgical Sciences
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Article Citation - WoS: 2Comparison of Expandable and Locked Intramedullary Nailing for Humeral Shaft Fractures(Cureus Inc, 2021) Akdemir, Mehmet; Biçen, Ahmet Çağdaş; Ozkan, Mustafa; Ekin, AhmetIntroduction In this study, we clinically and radiologically investigated whether the application of expandable nails for surgical treatment of humeral shaft fractures has an advantage over locked intramedullary nails. Methods Patients treated with intramedullary fixation due to humeral shaft fractures in our clinic were investigated retrospectively. Patients with fractures of type 12A and 12B according to the AO classification in the middle 1/3 shaft region of the humerus were divided into two groups as those receiving fixation with expandable nails and with locked intramedullary nails. The union rate, union time, Q-DASH scores, duration of surgery, and complication rates were statistically compared between the two groups. Results The study included 38 patients with clinical follow-up from among 47 patients; 20 patients received fixation with locked intramedullary nails and 18 with expandable nails. The mean age of the patients was 56.92 (1991) years and 53% (n=20) were men while 47% (n=18) were women. During statistical evaluation, a statistically significant difference was found between the groups for union (100% and 72.2%) and complication rates (6% and 13%). More union and lower complication rates were found in patients treated with locked intramedullary nails. In comparing the mean of surgical times (71.1 and 30.2 min), expandable nails had a shorter surgical time. However, there was no statistically significant difference between the union time and Q-DASH scores between the two groups. Conclusion Locked intramedullary nails are a better fixation method than expandable nails due to the low complication rate and high rate of union. However, due to shorter surgery time, expandable nailing is an alternative method in limited cases.Article Long-Stem Prosthesis for Intertrochanteric and Femoral Neck Fractures in the Elderly: Retrospective Comparison of Short-Term Clinical Outcomes(Galenos Yayincilik, 2021) Biçen, Ahmet Çağdaş; Akdemir, Mehmet; Turken, Mehmet Aykut; Cekok, KubraObjective: Hip fracture treatment in elderly patients remains challenging. This study aimed to evaluate short-term clinical results of long-stem cementless arthroplasty in elderly patients with femoral neck and intertrochanteric fractures. Materials and Methods: We collected data of patients we treated with long-stem cementless arthroplasty between January 2011 and December 2019 due to hip fractures. This study included 48 patients (>= 65 years of age) with femoral neck and intertrochanteric fractures. The patients underwent either bipolar or total hip arthroplasty. A 2-year follow-up was conducted in all the patients. Outcomes were evaluated with the Harris hip score (HHS), Koval categories, complications and hip and mid-thigh pain. We compared clinical results of patients with femoral neck fractures and those with intertrochanteric fractures. Results: The mean follow-up period was 57 (34-92) months. Sixteen patients had femoral neck fractures and 32 had intertrochanteric fractures. No difference in demographic characteristics and comorbidities was noted between groups. The mean preoperative Barthel index of activities of daily living score was 79. At the last follow-up, the mean HHS of the control group was 77 and the mean Koval categories score was 3. Revision surgeries were conducted in two patients due to dislocation. Infection was observed in one patient and was treated by debridement and anti-biotherapy. Implant loosening and periprosthetic fractures were not noted. Conclusion: With fair outcomes, long-stem cementless arthroplasty is a potential treatment for hip fractures in elderly patients. A longer follow-up to evaluate the efficacy of these prostheses is warranted.Article Evaluation of the Elasticity and Thickness of the Heel Fat Pad With Ultrasound in Plantar Fasciitis(2022) Yıldırım, Mahir Utku; Biçen, Ahmet Çağdaş; Ünal, Abdullah MeriçObjective The aim of this study was to evaluate thickness and elasticity of heel fat pad in patients with unilateral plantar fasciitis and to investigate the effects of age, sex, body mass index (BMI), and functional scores on plantar fasciitis. Material and Method 70 patients who had been suffering from unilateral plantar fasciitis longer than 6 months were enrolled in the study. The thickness and elasticity of fat pad were compared between the painful and healthy feet of the patients with ultrasound. For measurement of elasticity, shear wave elastography (SWE) was used. Comparative analysis was performed for thickness and elasticity variables between the painful and healthy feet with Mann–Whitney U and independent samples t-test. Results Average of age of the patients was 44±11.66. The average thickness of the heel fat pad was 17.9±3.1 mm on the affected side and 18.3±3.3 mm on the healthy side. The mean SWE value of the painful side was 23.9 m/s (range 9.3-32) and was 24.7 m/s (range 10.8-34) on the healthy side. Heel fat pad thickness was greater in the healthy feet than in the painful feet, but there was no statistical significance (p=0.448). The painful feet were stiffer, but the difference was statistically similar (p=0.347). BMI had a statistically significant impact on thickness of heel fat pad. Conclusion The results showed that a decrease in the heel fat pad thickness was a supporting finding of plantar fasciitis in patients with normal BMI but not in patients with BMI>25.Article Efficacy of Preoperative Mri in Detecting Biceps Tendon Pathologies in Rotator Cuff Tears: Correlation of Mri and Intraoperative Findings(2022) Biçen, Ahmet Çağdaş; Ünal, Abdullah Meriç; Ekin, Ahmet; Özkan, MustafaObjective The aim of this study is to evaluate the accuracy of magnetic resonance imaging (MRI) in detecting biceps lesions in patients with rotator cuff tears. Material and Methods A total of 168 patients operated on between January 2012 and February 2020 were included in the study. All the patients underwent arthroscopic surgery with the diagnosis of rotator cuff tears. All patients were operated on under general anesthesia and in the beach chair position. Demographic data and preoperative MRI findings were recorded. Arthroscopic findings were accepted as the standard reference and correlated with preoperative MRI records. Results In preoperative images, full-thickness rotator cuff tears were identified in 118 (70.2%) cases and partialthickness tears in 50 (29.8%) cases. Labrum/SLAP lesions were detected in 18 (10.7%) cases. Biceps disorders were reported in 51 (30.4%) cases. During the surgeries, we observed additional pathologies in 41 (24.4%) cases besides the preoperatively detected lesions. Rotator cuff and labrum/SLAP repairs were performed in the same surgical sessions. The majority of newly detected lesions were biceps lesions, being identified in 26 (15.5%) cases. In 41 (24.2%) cases tenodesis, tenolysis, or tenotomy were performed for biceps lesions. LHBT surgery was performed in 26 cases with negative MRI. Biceps lesions were confirmed in 77 (45.8%) cases intraoperatively; therefore, the accuracy of MRI in detecting these lesions was 66.2%. Conclusion Biceps lesions are among the common pathologies of the shoulder. Preoperative MRI is important in evaluation of the shoulder, but the efficacy of MRI may be limited in detecting biceps disorders. Arthroscopic surgery is crucial in diagnosis and treatment of LHBT lesions.Article Citation - WoS: 14Citation - Scopus: 12Analysis of Risk Factors Affecting Mortality in Elderly Patients Operated on for Hip Fractures: a Retrospective Comparative Study(Turkish Assoc Orthopaedics Traumatology, 2021) Biçen, Ahmet Çağdaş; Akdemir, Mehmet; Turken, Mehmet Aykut; Cekok, Kubra; Ekin, Ahmet; Turan, Ahmet CemilObjective: The aims of this study were (1) to investigate the effects of different demographic and perioperative modalities on mortality rates and (2) to compare mortality rates between different implants in elderly patients operated on for hip fractures. Methods: In this retrospective study, a total of 314 patients who were operated on for hip fractures were included study. Patients were then divided into four groups based in their implant types: long-stem cementless bipolar hemiarthroplasty (n = 124; 102 female, 22 male; mean age = 84.2 +/- 6.4 years), standard-stem cementless bipolar hemiarthroplasty (n = 74; 48 female, 26 male; mean age = 83.5 +/- 6.9 years), antegrade intertrochanteric nail (n = 61; 35 female, 26 male; mean age = 78.5 +/- 6.8 years), and total hip arthroplasty (n = 55; 34 female, 21 male; mean age = 72.5 +/- 4.3 years). Data including gender, age, duration from injury to surgery, American Society of Anesthesiologists (ASA) score, comorbidities, use of antiplatelet agents, Barthel Index of Activities of Daily Living, type of anesthesia, operation time, preoperative hemoglobin values, blood transfusions given, duration of hospital stay, complications, and type of fracture were recorded. Results: Overall, the mean follow-up was 36.5 (range = 0 - 107) months. The overall mortality rate was 53.2%. The median survival duration was 44.2 +/- 5 months (range = 34.3 - 54). Survival rates were found significantly different among the groups (P = 0.001). In the first three years postoperatively, the mortality rate was higher in the standard-stem bipolar hemiarthroplasty group, but in the long-term follow-up, the long-stem bipolar hemiarthroplasty group exhibited the higher mortality rates. It was observed that some parameters had statistically significant effects on the mortality rates. Male gender, higher age, lower hemoglobin values, increased number of blood transfusions, ASA scores >= 3, the existence of >= 3 comorbidities were found as main predictors of increased mortality rates. Conclusion: The results of this study have shown that age, gender, preoperative hemoglobin levels, ASA scores, and comorbidities are significant factors affecting mortality in elderly patients operated on for hip fractures. Long-stem cementless bipolar hemiarthroplasty appears to show similar rates of mortality with standard-stem cementless bipolar hemiarthroplasty.Article Covıd-19 Pandemi Sürecinde Sağlık Çalışanlarında Maske Kullanımının Etkilerinindeğerlendirilmesi(2020) Ertürk, Emre; Biçen, Ahmet ÇağdaşBu çalışmanın amacı COVID-19 pandemisi sürecinde farklı maske tiplerinin ve bunların kullanım güçlüklerinin incelenmesidir. Çalışma etik kurul onayı sonrası düzenlendi. İzmir Ekonomi ÜniversitesiMedical Park Hastanesi’nde çalışan, sekreter, hemşire ve doktorlardan oluşan, yaş ortalaması 29,5 olan 78kadın, 34 erkek toplam 112 gönüllü çalışmaya dâhil edildi. Gönüllüler cerrahi tıbbi maske ve FFP2 maskekullananlar olarak iki gruba ayrıldı. 1. gruba cerrahi tıbbi maske kullanan 81 gönüllü, 2. gruba FFP2 maskekullanan 31 gönüllü dahil edildi. Gönüllülerin, maske kullanımı esnasında 60. dakika ve 180. dakikada nefesdarlığı, görme sıkıntısı, kulak ağrısı, baş ağrısı, yüzde rahatsızlık hissi, anksiyete şikâyetlerinin gelişipgelişmediği sorgulandı. Ayrıca 60. ve 180. dakikalarda pulse oksimetre cihazı ile gönüllülerin oksijensatürasyonları ve kalp atım sayılarındaki değişiklik ölçüldü ve başlangıç değerleriyle kıyaslandı. Şikâyetlerin;alerji, sigara kullanımı ve gözlük kullanımı ile değişkenlik gösterip göstermediği değerlendirildi. Verilerinanalizinde SPSS 17 paket program kullanıldı. Mevcut verilerin dağılımı Kruskal Wallis ve Shapiro Wilk testleriile incelendi. Verilerin normal dağılım paterninde olduğu saptandı ve ortalama±standart sapma olarak, gruplararasında başlangıç, 60 ve 180. dakika satürasyon ve nabız değerleri açısından fark olup olmadığı Student-t testiile karşılaştırıldı. p<0.05 istatistiksel olarak anlamlı kabul edildi. Nefes darlığı, anksiyete, yüzde rahatsızlıkhissi, baş ağrısı, kulakta ağrı ve görme sıkıntısı açısından grupların kendi içinde ve gruplar arasında fark olupolmadığı Ki-Kare testi ile değerlendirildi. Her iki grupta da başlangıç ile 60. Dakika(p<0.001) ve 180 dakika(p<0.001), oksijen satürasyonları açısından istatistiksel anlamlı fark bulunmuştur. Yine başlangıç nabızdeğerleri ile 60.dakika (p<0.001) ve 180. dakika nabız değerleri açısından (p<0.001) istatistiksel anlamlı farkbulunmuştur. 180. dakika satürasyon değeri arasındaki fark ile maske türü, alerji varlığı, gözlük kullanımı,sigara kullanımı, yaş ve cinsiyet arasında istatistiksel anlamlı ilişki saptanmamıştır. FFP2 tipi maskenin cerrahimaske kullanımıyla kıyaslandığında, daha fazla şikâyete yol açtığı saptanmıştır. Sonuç olarak FFP2 tipimaskenin kullanımda tolerasyonunun daha zor olduğu görülmüştür. Her iki maske tipinde de 180 dakikakullanım sonunda oksijen satürasyonu ve kalp atım hızında düşüş görülmesine rağmen, bu değerler fizyolojiksınırlarda kalmıştır. COVID-19 pandemisi sürecinde, sağlık çalışanları ve toplumdaki kişilerin kendilerininkorunması için önemli bir bariyer olan maske kullanımının sağlık üzerine olumsuz etkisi saptanmamıştır.Article Comparison of Conservative and Arthroplasty Treatment for 3 or 4 Part Proximal Humerus Fractures in the Elderly(2024) Akdemir, Mehmet; Biçen, Ahmet Çağdaş; Turan, Ahmet Cemil; Ekin, Ahmet; Kılıç, Ali İhsan; Ünal, MeriçAim: Proximal humerus fractures are common injuries in the elderly population. This study hypothesizes that arthroplasty is not superior to conservative treatment in the management of multi-part proximal humerus fractures in elderly patients. Material and Method: Patients aged 65 and above with 3–4-part proximal humerus fractures, treated either conservatively or with arthroplasty, were included in the study. The minimum follow-up period was set at 12 months. Functional evaluations of the patients were performed using the Quick Disabilities of Arm, Shoulder and Hand (Q-DASH) scoring system. Statistical analysis comparing the two groups was conducted using the SPSS software. The mean values of numerical data were analyzed using the Mann-Whitney U test, while categorical data were compared using the Chi-square test. A significant level of 0.05 was considered. Results: A total of 67 patients who received adequate clinical follow-up were included in the study (50 conservative 17 arthroplasty). The average age of the patients was 76.12 years, with 9 male and 58 female patients. The average follow-up period was 22.61 months (range: 12-82). There were no statistically significant differences in age, gender, side, follow-up period, and fracture type distribution between the two groups. However, a significant difference in Q-DASH scores was observed (p<0.05). Conclusion: In the treatment of proximal humerus fractures, even when they are multi-part fractures, conservative treatment should may be the first choice. We think that the early results of conservative treatment are better than arthroplasty.Article Citation - WoS: 5Depression, Anxiety, and Post-Traumatic Stress Disorder Following Orthopedic War Injuries(Cureus Inc, 2021) Biçen, Ahmet Çağdaş; Akdemir, Mehmet; Gulveren, Dilek; Dirin, Deniz; Ekin, AhmetIntroduction There are ongoing wars worldwide, during which significant numbers of people are injured. Several studies have indicated that high rates of depression and anxiety are seen in war-injured patients. Methods Eighty-one male patients treated between November 2019 and January 2021 far from home in a Turkish hospital due to war injuries that happened in the Libyan Civil War were investigated. Demographic characteristics and injury data of the patients were evaluated regarding age, Injury Severity Score (ISS), location of injuries, type and mechanism of injuries, operations, and accompanying traumas. The psychological statuses of the patients were evaluated with the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and post-traumatic stress disorder (PTSD) records filled out at the first admission to the hospital. Results The mean age of the patients was 29.8 +/- 7.7 (19-56) years. While 59 patients had fractures, 22 patients had only soft tissue injuries. Eighteen patients suffered from other accompanying injuries. While 85.2% of the patients showed symptoms of depression, 82.7% of the patients suffered from anxiety and PTSD symptoms were seen in 86.4% of the patients. Statistical analysis was performed to investigate the effects of injury severity, duration of hospitalization, number of operations, and age on depression, anxiety, and PTSD among these patients with war injuries. The results did not indicate any significant effect of injury severity, hospitalization duration, or operations. Conclusion Depression, anxiety, and PTSD are common in patients injured in wars. Injury severity does not seem to affect depression, anxiety, or PTSD in these patients.Article Citation - WoS: 3Citation - Scopus: 3Comparison of Single- and Double-Plate Fixation Techniques in the Treatment of Nonunions of the Humeral Shaft(Atha Comunicacao & Editora, 2022) Akdemir, Mehmet; Biçen, Ahmet Çağdaş; Ozkan, MustafaIntroduction: Humerus shaft fractures may be treated conservatively or surgically. In 2.5% to 13% of cases, nonunion is observed, and it leads to severe pain and morbidity. Plate osteosynthesis has become popular in the treatment of nonunion of the humeral shaft. In this study, we compared the clinical outcomes of patients with humerus shaft nonunion whom we treated with single- or double-plate fixation. Materials and Methods: Fifty-three patients diagnosed with aseptic humeral shaft nonunion and treated with plate fixation were included in the study. Patients were evaluated according to the number of plates (single vs. double plates). The two groups were subjected to statistical evaluation according to their clinical and radiographical results. Results: The average age of the patients was 53 years (range: 1-86); 28 (52.8%) were female and 25 (47.2%) were male. The union rate was 90.32% for single plate and 90.91% for double plate fixation. There was no statistically significant difference between single and double plates in the clinical and radiographical results (union time, union rate, Q-DASH score) (p > 0.05). There was a significant correlation between age and union times / Q-DASH scores according to the Spearman correlation test (p < 0.05). Transient radial nerve neuropraxia developed in 2 patients and 1 patient suffered from an infection that was treated with debridement and antibiotic therapy. Conclusion: In our study, similar good results were obtained with single and double plates. In treatment of humeral shaft nonunions, a second plate is not needed if enough stability is provided with single plate fixation.Article Two- Stage Treatment of Extremity Deformities Associated With Thrombocytopeniaabsent Radius Syndrome(Turkish Assoc Orthopaedics Traumatology, 2022) Akdemir, Mehmet; Bicen, Cagdas; Ozkan, MustafaObjective: The aim of this study was to evaluate the results of 2-stage treatment of upper and lower extremity deformities in patients with thrombocytopenia absent radius syndrome. Methods: Four patients (3 female, 1 male) with a mean age of 1.8 years (range 1-4) were included in the study. The patients were followed up for an average of 5.5 years. All 4 patients had bilateral radial longitudinal deficiency, whereas only 2 patients had bilateral fixed knee contractures. A 2- stage surgical procedure was implemented. The surgical procedure performed for radial longitudinal deficiency consisted of distraction with an Ilizarov frame in the first stage, followed by centralization performed in the second stage. Knee contractures were first treated using an Ilizarov frame, followed by a hamstring tendon transfer in the second procedure. Radiological evaluation of the radial longitudinal deficiency was done by measuring hand-forearm angle, hand-forearm position, and ulnar bowing preoperatively and at postoperative follow-ups. Knee contracture was evaluated by measuring the angle preoperatively and at postoperative follow-ups. Results: The mean hand-forearm angle values of patients at preoperative assessment, early postoperative period, and at the last follow-ups were 82.60, 5,80, and 11.10, respectively (P <.001). The hand-forearm position values were -14.25 mm, +11, and +7.1 mm, respectively (P <.001). The ulnar bowing values were 7.3 degrees, 4.5 degrees, and 2.9 degrees, respectively (P <.001). Recurrence of the radial longitudinal deficiency deformity requiring surgery occurred in 1 patient. In the other 3 patients, some deformity recurred but did not require surgical intervention. In addition, 1 patient with knee flexion contracture had a recurrence of the contracture that did not require surgical intervention. There was no circulatory disorder or skin necrosis in the lower or upper extremities of the patients. Conclusion: This study has shown us that two-stage treatment is a reliable method for lower and upper extremity deformities accompanying thrombocytopenia absent radius syndrome. However, recurrence is still a major problem. Level of Evidence: Level IV, Therapeutic Study
