Plate Positioning Affects the Pressure on the Axillary Nerve Following a Deltopectoral Approach.

PURPOSE OF THE STUDY To investigate the pressure levels on the axillary nerve at different plate positions after plate fixation of a proximal humerus fracture. MATERIAL AND METHODS Eight fresh-frozen cadaveric specimens were used. The plates were applied on the lateral side of the humerus. A FlexiForce pressure sensor was placed between the nerve and the plate, and the pressure on the nerve was measured (Group 1). The plates were then placed in two different positions such that distal portion of the plates would have 30° anterior and 30° posterior angles to the anatomical axis of the humerus (Group 2 and 3). The anterior of the distal attachment of the deltoid muscle was then elevated and the plates were placed in the middle of the anatomical axis of the humerus (Group 4). The position of the plates were controlled by fluoroscopy and the pressure was measured for each configuration sequentially. RESULTS The mean age of the cadavers was 70.5 ± 6.8 years (range: 61-80 years). Mean pressure values of the groups were 2.65 ± 0.8, 2.52 ± 0.8, 5.65 ± 1.4, and 2.56 ± 0.9 N, respectively. Group 3 had statistically highest-pressure values than the other groups, while no difference was found among groups 1, 2, and 4. DISCUSSION Numbness and weakness of the shoulder muscles are other clinical findings. If numbness on the deltoid muscle is reported, then atrophy is noted in the deltoid muscle in later stages. Persistent pain may be seen even if fracture union occurs after PHF surgery. Axillary nerve entrapment may be considered after the removal of common complications such as avascular necrosis due to fracture, screw migration, infection, and biceps tendon and rotator cuff problems. The sensory branch of the axillary nerve provides the sensation of the anterior joint capsule and lateral part of the deltoid muscle. CONCLUSIONS Proximal humerus plates, which are angled posteriorly along, lead to an increased pressure on the axillary nerve. Anterior orientation of the plate or elevation of deltoid insertion may be used to prevent the possible complications related to axillary nerve. Level of evidence Level II. Key words: proximal humerus fracture, Philos, axillary nerve, nerve injury.

Is Peroneus Longus Allograft Good Alternative for Anterior Cruciate Ligament Reconstruction: a Comparison Study.

PURPOSE OF THE STUDY To compare the early clinical results of patients who had anterior cruciate ligament (ACL) reconstruction with peroneus longus allograft versus hamstring tendon autograft. MATERIAL AND METHODS Forty patients who underwent ACL reconstruction were included in the study. Patients were grouped by their graft preference. Lachman and Pivot-shift tests were performed to the patients. Laxity was measured by KT-1000 arthrometer test with 15, 20 and 30 pound power. The maximum force values of nonoperated knee and the operated knee were recorded with Cybex II isokinetic dynamometer (HUMAC) and compared to each other. International Knee Documentation Committee (IKDC) form, modified Lysholm and Cincinnati evaluation forms were compared between two groups. RESULTS Twenty patients included into peroneus longus allograft (Group 1) and 20 patients were included into hamstring autograft group (Group 2). The mean age of patients Group 1 and 2 were 34.25 ± 6.73, and 29.6 ± 4.55, respectively. No significant difference was noted between two groups at modified Lysholm, Cincinati and IKDC scores (p > 0.01). There was no statistically significant difference between the Lachman and Pivot hift levels (p > 0.01). No significant difference was found in KT-1000 device measurements between groups according to the performed techniques (p > 0.01). There was no statistically significant difference between Cybex extension-flexion 60 /sec measurement and extension 240 /sec measurement of the patients (p > 0.01). DISCUSSION Allografts can be preferred because of the advantages, such as lack of donor site morbidity, short operative time, large graft, small incision, minimal scar, good cosmetic appearance, less postoperative pain, less movement restriction, and less arthrofibrosis. However, there are disadvantages, such as disease transmission, low biocompatibility, immune response, long recovery time, and high cost. Although it is difficult to compare the stability and functionality of allografts and autografts because of the differences in graft processing, fixation methods, and surgical techniques in studies, similar clinical results are reported in long-term follow-ups CONCLUSIONS Graft preference is dependent on surgical experience, patient age, activity status, comorbidities, presurgical status, and patient decision. Allograft ACL reconstruction is a good alternative to arthroscopic ACL reconstruction performed with hamstring tendon graft. Key words: anterior cruciate ligament, peroneus longus allograft, hamstring autograft, ACL reconstruction.

The Evaluation of Results of Repair using All-Soft Suture Anchor in the Treatment of Chronic Tendinous Mallet Finger Surgery.

PURPOSE OF THE STUDY The purpose of this study is to evaluate the results of chronic tendinous mallet finger repair with all soft suture anchors. MATERIAL AND METHODS In this retrospective study we evaluated 14 patients. Data included age, side of surgery, the degree of extensor lag, the ratio of the damaged articular surface, postoperative recovery period and time to return to work. We recorded extensor lag and Crawford scores of all patients at the last follow-up. RESULTS Mean follow-up period was 22.07 months. The preoperative and postoperative extensor lags were 27.2 (15-35) and 3 (0-19), respectively. Crawford scores of patients were moderate in 1 patient, fair in 2 patients and excellent in 10 patients. We observed only one skin complication in the postoperative period. CONCLUSIONS All-soft suture anchors have high patient satisfaction rates and functional results. Thus, they could be used in the treatment of patients with chronic tendinous mallet finger. The low complication rate is a major advantage. Key words: tendinous mallet finger, hand surgery, all-soft anchor. Level of evidence: Level-4, Retrospective case-control study.

Modified Lindgren-Turan Osteotomy for Hallux Valgus Deformity - a Review of 60 Cases.

PURPOSE OF THE STUDY To evaluate the clinical and radiological results of a new modification of relatively less-known Lindgren-Turan osteotomy technique in HV deformity that is performed by combining bunionectomy and capsuloplasty. MATERIAL AND METHODS 60 feet of 52 patients with moderate and heavy deformity who were operated between 2009 and 2014 were included in the study. The patients had clinically severe pain, did not respond to at least 6-month conservative treatment and had moderate and severe deformity before Hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal joint angle (DMAA), proximal phalangeal joint angles (PPAA) and shortening amount in the first metatarsus were measured through preoperative and follow-up radiography. Clinical evaluations were conducted on all patients using American Orthopedic Foot and Ankle Society's (AOFAS) and visual analog scale (VAS). Data of the radiological and clinical evaluations in preoperative and follow-up periods were compared statistically. Statistical significance was accepted at p < 0.05. RESULTS 42 (76.1%) and 10 (23.9%) of 52 patients were female and male, respectively. Mean age of the patients was 50.9±15.52 years. Mean follow-up period of the patients was 43.3±2.1. Preoperative and last measurements: HVA: 36.34°±6.36° - 15.6°±2.83°, IMA: 12.62°±2.24° - 5.83°±1.32°, DMAA: 16.3°±3.45° - 10.3°±2.24°, PFAA: 7.24°±1.32° - 6.12°±0.84° (p < 0.001). Shortness of first metatarsus was measured to be 5.94±1.84 mm. Mean VAS values of the patients which was 8.6±0.4 before the operation was detected as 0.8±0.04 after follow-up (p < 0.001). AOFAS score of the patients which was 42.4±5.3 before the operation was found to be 88.9±7.6 (p < 0.001). All patients started to work again within 5.22±1.7 weeks. Union was completely seen along osteotomy line in all cases. Three patients had screw extraction. Two patients had superficial wound infection. DISCUSSION Capsule plication which we apply with osteotomy as part of our surgical procedure is a significant point in correcting deformity and raising stability. First metatarsophalangeal rigidity risk can be avoided with a controlled plication in operation and by giving the final decision after testing. Such flexibility shows that soft tissue contracture is not the main factor of deformity, so lateral release is not indicated. Thus, our opinion is that digital nerve damage and extra scar are avoided during lateral release. The osteotomy we applied which is extraarticular and subcapital, and protection of racket-shaped capsule cannot be attributed to finding no AVN case. CONCLUSIONS Modified Lindgren-Turan surgical procedure which is applied with capsuloplasty and bunionectomy is an effective and reliable method in treatment of moderate and severe HV deformities. It is recommended as a satisfactory option in HV treatment due to its ease in surgery, use of single incision and perfect clinical and radiological long-term results. Key words:hallux valgus, osteotomy, Lindgren-Turan, capsuloplasty, capsulorrhaphy, bunionectomy, plication.