Patient education articles

Our wrist is a joint formed by the forearm bones (radius and ulna) and the 8 small carpal bones in front of them. The most common wrist fractures are those seen at the lower end of the radius bone (distal radius fractures).

Our forearm bones are called the "radius" and "ulna." The radius is on the thumb side, and the ulna is on the little finger side. The most common fractures here are those of the distal radius.

Whether the fracture is comminuted, open or closed, the patient's age, expectations, and occupation are very important in treatment selection. In elderly patients, usually female, bones have softened due to osteoporosis and can break from a simple fall. Falls typically occur with an outstretched hand landing on the palm. The wrist swells and becomes very painful. It should immediately be splinted with cardboard or a piece of wood, and ice should be applied over a towel. The nearest healthcare facility should be visited promptly.

About 80% of these fractures are treated with a cast by attempting to realign the fracture ends using closed reduction techniques.

Surgical treatment is required for wrist fractures with more than 1mm of intra-articular step-off, particularly in young or active patients. Current treatment involves open reduction — directly visualizing and precisely realigning the fracture ends, then securing them with plate-screw systems. Because this system provides very rigid fixation, wrist movements can begin as early as one day after surgery.

In my own practice, I frequently prefer plate-screw systems for wrist fracture surgeries. The results are very gratifying.

One of the most exciting developments in modern medicine. Stem cells are being applied in the treatment of many diseases under the name of regenerative medicine.

The most common application in orthopedics is knee osteoarthritis. Stem cells can be obtained from blood, bone marrow, and adipose (fat) tissue. I prefer adipose tissue in my clinical practice because harvesting from fat tissue is easier, less invasive, and more efficient.

It is appropriate to apply this treatment in early stages (grade 1 and 2) of knee osteoarthritis. The main goal is to stimulate the worn cartilage tissue to form new cartilage and prevent the need for future surgical treatments such as joint replacement.

Patients are discharged on the same evening or the next day after the procedure. Full recovery with return to active sports and pain-free living is expected around the 4th month.

A condition characterized by sudden locking, stiffness and pain in the fingers, especially when waking up in the morning. It is more common between ages 40-60 and in women.

Examining the anatomy of the disease, there are pulley systems at the finger joints that function like tunnels, allowing the tendons that move our fingers to travel in a specific plane. In this condition, the A1 pulley at the base of the finger thickens excessively due to overuse, essentially strangling and locking the tendon passing through it.

Initial treatment should include resting from repetitive finger activities. It should be noted that injection treatment has a healing probability of around 70% even in early stages.

Surgical treatment is a fairly simple, safe, and quick procedure. It is performed under local anesthesia, takes approximately 10 minutes, and finger movement begins immediately after surgery.

Menisci are two rubber-like crescent-shaped (C-shaped) tissues located between two bones on the inner and outer sides of the knee joint. Their primary function is to protect the knee joint cartilage, nourish the cartilage tissue, and contribute to knee stability.

Meniscus tears frequently occur from sudden twisting movements of the knee under heavy load. As we age, degeneration begins as water content in the tissues decreases, and tears can easily develop even with minimal strain.

Diagnosis is straightforward and is made with MRI. However, the orthopedic surgeon should not only evaluate the MRI but also confirm the diagnosis by performing detailed meniscus tests on the patient.

Meniscus tears are now successfully treated arthroscopically (minimally invasive surgery). In young active patients, if the meniscus tear is fresh, it should be repaired by arthroscopic suturing.

The hip joint is composed of the femoral head (ball) and acetabulum (socket). Fractures of the upper end of the femur (thigh bone) and the surrounding area are generally called hip fractures.

As we age, the spongy bone around the femoral head becomes hollow and fragile due to osteoporosis. This is why hip fractures are common in elderly and female patients.

Surgery should be performed as soon as possible. Every moment a hip fracture patient remains immobile increases the risk of embolism, pressure sores, and lung and urinary tract infections.

The patient begins in-bed movements and mobilization on the first day after surgery. It is vitally important for the patient to begin walking within the first month.

Hallux valgus is the deviation and rotation of the big toe toward the other toes. This results in a painful bone protrusion (bunion) on the inner side of the big toe. It is frequently bilateral.

The most common known cause is wearing improper footwear — pointed-toe, narrow-fit, and high-heeled shoes. It is commonly seen in women in their 40s who have worn such shoes for many years.

For patients with painful and significant hallux valgus that does not improve with shoe modifications, the permanent, definitive, and only solution is surgery. Toe spacers, night splints, and insoles can never correct the deformity.

After surgery, the hospital stay is only 1 day. The full recovery period ranges from 2 to 4 months.

Today, arthroscopic methods are the most commonly performed surgical procedure for the diagnosis and treatment of intra-articular problems in orthopedics. With this method, surgery is completed in a minimally invasive manner, providing faster recovery compared to open surgery.

The most commonly performed arthroscopic shoulder surgeries include: rotator cuff tears, bone spur removal, labrum tear repair, ligament repair, and recurrent shoulder dislocation repair.

Usually one overnight hospital stay is required. A successful surgery depends on successful rehabilitation.

Hip osteoarthritis (coxarthrosis) is the most common cause of hip pain. It usually occurs in middle and advanced ages. When it progresses, the patient cannot walk 300 meters, and the pain does not subside even with rest.

For a hip prosthesis to be recommended, at least 2 of the following criteria should be met: inability to walk 300 meters without pain, pain at rest, daily need for painkillers, and limitation in daily activities.

For total hip replacements, ceramic-ceramic bearing surfaces with the lowest wear rates should be preferred. Prostheses implanted after age 55 can last a lifetime with proper technique.

The patient walks with a walker 24 hours after surgery. Discharge is typically on the 2nd day after surgery.

PRP (Platelet Rich Plasma) is one of the natural treatment methods. It is a natural and biological method used for non-surgical treatment of joint, muscle, and tendon problems.

Blood drawn from the patient is centrifuged to obtain platelet-rich plasma, which is then injected into the damaged area. PRP is not just a pain-relieving treatment but a healing method. Its benefits become apparent within 4-6 weeks.

Areas where PRP therapy is applied: sports injuries, joint osteoarthritis, tendon injuries (tennis elbow, golfer's elbow, shoulder impingement syndrome), and heel spurs.

Frozen shoulder, as the name suggests, is the stiffness and loss of motion of the shoulder joint. The main source of the condition is pain, and it develops as the patient guards the shoulder joint, leading to stiffness.

It is more common in women. Risk factors include: prolonged immobility after surgery or fracture, diabetes, thyroid diseases, cardiovascular diseases, and Parkinson's disease.

If left untreated, it can resolve over a long period of about 2 years, but range of motion limitations may not completely disappear. Closed manipulation is a method that yields very good results in many resistant cases.

As the median nerve travels from the wrist to the hand, it passes through a space called the "carpal tunnel," and compression occurs within this tunnel. It is common in people who perform repetitive hand tasks.

If your hands hurt and tingle especially at night, you may have carpal tunnel syndrome. It is most common in women between ages 40-70 and is usually bilateral.

Treatment involves surgical release of the median nerve. The surgery is performed through an approximately 1.5-2 cm incision and does not require general anesthesia. Immediately after surgery, all or most symptoms resolve in all patients.

In recent years robotic surgery has become a frequently heard but sometimes confusing topic, and I want to explain it to you simply.

First, know this: I am still the one performing the surgery. The robot does not make decisions — it only increases precision. Just as you are the driver of the car while the GPS shows you the best route, the robot is a high-tech navigation device for me.

So how does robotic surgery make a difference?

Before the operation, a three-dimensional CT scan of your knee or hip is taken. From these images we prepare a plan tailored exactly to you. Everyone's bone, curvature, and wear pattern is different, and the robotic system takes this into account. It keeps me from deviating from the planned angle and depth. In particular, the risk of leg-length inequality in hip replacement, and the risk of an incorrect cut or imbalance in knee replacement, is significantly reduced.

Thanks to the robotic system, we avoid unnecessary bone cutting and preserve healthy tissue. Less pain, less bleeding, faster recovery. Most of my patients can stand up the same day; many are discharged within a day or two and return to daily life in a short time.

Is robotic surgery necessary for every patient? No. In mild cases, and in patients without significant deformity, conventional replacement also gives very successful results. The robotic system stands out especially in these situations: patients who have previously had a bone fracture or surgery, congenital or acquired severe bone deformities, advanced wear and bone loss, and patients with a marked leg-length difference.

Regarding risk — as with any operation, the basic risks such as infection and blood clots apply. However, the robotic system does not increase these risks; on the contrary, its precision reduces some complications. The cost of the technology is somewhat higher, so I recommend you investigate your insurance coverage carefully.

Finally, I want to remind you: robotic surgery is a wonderful assistant, but the longevity of the implant also depends on your contribution — following the rehabilitation program, watching your weight, and attending your regular check-ups is very important.

Robotic knee and hip replacement is a safe option that offers more predictable results and a more comfortable recovery. But every patient is unique. To determine the most appropriate method for you, we decide together after your examination and imaging.

The pelvis is a ring-shaped structure formed where the sacrum, at the base of the spine, meets the two hip bones (the ilium, ischium, and pubis). Major blood vessels, nerves, and vital organs such as the bladder and bowel pass through this ring. That is why a pelvic fracture is often more than a bone problem alone.

I look at pelvic fractures in two groups. The first is high-energy injuries such as traffic accidents and falls from height. These occur in younger patients and can break the ring in several places, causing serious bleeding and organ injury; they need emergency care. The second is low-energy fractures in older patients with osteoporosis (bone loss), which can happen with a simple fall or even while getting out of the bathtub. These are usually simpler and stable.

The most important distinction guiding treatment is whether the fracture is stable or unstable. In a stable fracture, the ring breaks in a single place and the bone ends stay in position. In an unstable fracture, the ring breaks in two or more places and the bones shift. The second situation is far more serious.

A pelvic fracture is almost always painful; moving the hip or trying to stand makes the pain worse. We begin the diagnosis with an X-ray, then turn to computed tomography (CT) to see the exact fracture pattern and plan surgery if needed.

Most stable fractures heal without surgery; we limit weight on the leg with crutches or a walker, control the pain, and use blood thinners to prevent clots. Unstable fractures call for surgery. Any bleeding is controlled first, then the ring is stabilized either from the outside with bars (an external fixator) or from the inside with plates and screws.

Recovery depends on how severe the fracture is. The crutch or walker period usually lasts six to eight weeks, full weight-bearing is generally possible by the third month, and the surrounding muscles may take up to a year to regain their former strength. In high-energy pelvic fractures especially, I place real value on timely, correct surgery, because early and proper treatment directly shapes a patient's long-term comfort in walking and sitting.

Kienböck's disease is the loss of blood flow to the lunate bone in the wrist, so that over time it can no longer nourish itself and collapses; the medical name is avascular necrosis. It is seen most often in men aged 20 to 40 who use their hands heavily, and usually on the dominant side. We encounter it more often in people whose ulna is shorter than the radius in the forearm (negative ulnar variance), because more load passes onto the lunate.

The symptoms are insidious: pain over the upper-middle part of the wrist that grows over time, restricted movement, and reduced grip strength. Many patients mistake it for a sprain and arrive months late.

Early on, the X-ray often looks normal, so when I suspect it, I ask for an MRI. An MRI shows the blood-supply problem in the bone even when the X-ray shows nothing. Seeing which stage the disease has reached directly guides treatment.

Treatment depends on the stage of the disease; there is no single method that fits everyone. In the early stage, resting the wrist in a splint may be enough for a while. In later stages, to shift load away from the lunate, we use procedures such as shortening the radius bone, vascularized grafts that bring fresh blood to the bone, or fusing certain small joints. The goal is to reduce pain and stop the wrist from collapsing.

The scaphoid (navicular) is the most commonly broken of the small wrist bones. It can be felt at the base of the thumb, in the slight hollow we call the "anatomic snuffbox." The fracture usually happens when the hand lands open on the ground and the wrist is forced backward, especially in young, active people.

The most treacherous part of this fracture is that the pain is mild and it is often taken for a sprain. Yet the scaphoid's blood supply runs backward; blood enters the bone from its far end, so if the fracture is in the upper (proximal) part, the bone may not get enough blood and may fail to unite.

For that reason, when there is tenderness in the snuffbox even though the X-ray looks normal, I splint the wrist and repeat the X-ray after 10 to 14 days, or confirm the diagnosis with an MRI or CT. A missed scaphoid fracture can come back months later as a bone that never united.

Fractures that have not shifted are treated with a cast, but this bone heals slowly; the cast can stay on for months, and longer for upper-end fractures. For displaced fractures or those at the upper end, I prefer fixation with a screw; in old fractures that have not united, a bone graft has to be added. Because smoking clearly slows healing, I particularly ask patients to quit during this period.