Outcome of free gracilis muscle transfer for the restoration of elbow flexion in traumatic brachial plexus palsy.

OBJECTIVES: The aim of this study was to evaluate the functional outcomes of patients with free gracilis muscle transfer (FGMT) for the restoration of elbow flexion. PATIENTS AND METHODS: Between January 2012 and January 2019, a total of 16 patients (13 males, 3 females; mean age: 27.3±11.7 years; range: 18 to 53 years) who underwent FGMF to achieve elbow flexion after traumatic brachial plexus palsy (TBPP) were retrospectively analyzed. Data including demographic and clinical characteristics of the patients, etiology, affected side, injury level, accompanying injuries, time between injury and surgery, follow-up time, complications, whether nerve reconstruction and artery repair were performed previously, and details of the procedure were recorded. The outcome measures were elbow range of motion in degrees, muscle strength, and Disabilities of the Arm, Shoulder and Hand (DASH) and Short Form-36 (SF-36) scores. RESULTS: The mean follow-up was 30±11.5 (range, 24 to 42) months. Two patients had C5-C8 injuries, two patients had C6-T1 injuries, and all other patients had injuries to the C5-T1 roots. Muscle strength was M3/M4 in 11 (68.8%) patients, M2 in two (12.5%) patients, and M0 in one (6.2%) patient. The median active range of motion of the elbow joint in patients with successful results (M3 and above) was measured as 75 (range, 30 to 100) degrees. A statistically significant improvement was observed in the pre- and postoperative DASH scores and in some SF-36 subscale scores of patients with successful results. CONCLUSION: Free gracilis muscle flap is a reliable option in the restoration of elbow flexion in patients with TBPP. Although there is an improvement in functional results, disability, and quality of life, there may be no change in patients' mental status and pain.

[Comparison of phenol applications of different durations for the cauterization of the germinal matrix: an efficacy and safety study]. / Germinal matriks koterizasyonunda farkli fenol uygulama sürelerinin etkinlik ve güvenlik açisindan karsilastirilmasi.

OBJECTIVES: Partial nail avulsion with phenol matricectomy is one of the most widely performed procedures for the treatment of ingrowing nails. We compared phenol applications of different durations with respect to efficacy and safety. METHODS: The study included 148 ingrowing nails (grade 2-3) of 110 patients (54 males, 56 females). The patients were randomized to three groups for 1-, 2-, and 3-minute applications of phenol cauterization of the germinal matrix following surgical removal of ingrowing nails. Postoperative evaluations were made on days 2, 10, 16, 24, and 30 for pain, drainage, and tissue damage. Recurrences were recorded during a follow-up of 24 months. RESULTS: Improvements in pain, drainage, and tissue damage in each group were significant (p<0.001). Time to complete healing and durations of drainage and tissue damage were significantly shorter in patients receiving 1-minute phenol application (p<0.001), and the remaining groups did not differ in this respect. The mean duration of pain was similar in three groups. While the frequencies of pain and tissue damage were similar in three phenol groups, the number of patients having drainage on day 16 was significantly lower with 1-minute phenol application (p<0.001). All recurrences appeared in the sixth month and there was no significant difference between the three groups with respect to the recurrence rate. CONCLUSION: Our findings suggest that 1-minute phenol cauterization of the germinal matrix has a better safety profile than prolonged applications in the treatment of ingrown nails.

Mini-open versus all-arthroscopic rotator cuff repair: comparison of the operative costs and the clinical outcomes.

INTRODUCTION: Rotator cuff injury is one of the most frequently encountered problems of the shoulder in the daily practice of orthopaedic surgeons. This study compared all-arthroscopic cuff repair (ARCR) and mini-open rotator cuff repair (MORCR) methods in regard to clinical outcomes and costs. METHODS: Fifty patient charts and operative repairs were analysed (25 ARCR and 25 MORCR). Pre-and postoperative Constant-Murley and UCLA scores along with factors such as tear size, tear type, pre-operative physical therapy, motion and satisfaction levels were compared for the two procedures. Cost-benefit analysis was also performed for comparison between procedures. The duration of follow-up was 31.20 and 21.56 months for MORCR and ARCR groups, respectively. RESULTS: Tear sizes (P=0.68), pre-and postoperative Constant-Murley and UCLA scores (P=0.254) and satisfaction levels were not significantly different between groups. However, the differences between pre-and postoperative Constant-Murley and UCLA scores were statistically significant within both groups (P<0.01). The MORCR group stayed 1 day longer in hospital than the ARCR group, which was statistically significant (P=0.036). The differences regarding mean pain scores, abductions, internal and external rotations in Constant-Murley scores and forward flexion scores in UCLA scores were not significant. The ARCR group cost more, leaving less profit. CONCLUSION: Results suggest that ARCR yields similar clinical results but at a higher cost compared with MORCR.

Clinical results versus subjective improvement with anterior transposition in cubital tunnel syndrome.

This study was conducted to compare the results of anterior transposition methods and to determine the time needed to attain subjective well-being in patients with cubital tunnel syndrome. A total of 49 cases were retrospectively evaluated. Patients were called for follow-up, completed a questionnaire, and were reexamined. They were assigned to one of 3 groups: subcutaneous transposition (SCT), submuscular transposition (SMT), or intramuscular transposition (IMT). The McGowan classification and Wilson-Krout criteria were used for classification and outcomes assessments. Categorical variables were analyzed with the chi2 test, and metric variables by analysis of variance or through Kruskal-Wallis variance analysis. Improvement of at least 1 McGowan grade was observed in 87.63% of patients. The least responsive group was assigned a McGowan grade of III. The most effective procedure for resolving clawing was SMT. Clinical results were excellent in 26 patients (53.06%), good in 12 (24.48%), fair in 4 (8.16%), and poor in 7 (14.28%). At the latest follow-up, overall grip and pinch strength had improved by 23% and 34%, respectively, compared with the contralateral side. Thirty-six patients exhibited an improvement in grip power and 38 in fine dexterity. Complete resolution of numbness was observed in 32 patients, and complete resolution of pain was noted in 30 patients. The preoperative mean visual analog scale score of 6.82 improved to 3.36 postoperatively. Clawing improved in 4 patients and atrophy in 7. The mean time to subjective improvement was shortest in the SMT group and longest in the IMT group. The greatest pain relief was reported in the IMT group and the least in the SMT group. One case with IMT required reoperation because of recompression of the nerve. The most frequent complication in the SMT and IMT groups was muscular tenderness. In conclusion, SCT offers an alternative to other anterior transposition methods because of its simplicity and quicker recovery time, especially in mild to moderate cases.

[Early functional results of arthroscopic surgery for ankle lesions]. / Ayak bilegi lezyonlarinda artroskopik cerrahinin erken dönem fonksiyonel sonuçlari.

OBJECTIVES: We evaluated early functional results of arthroscopic surgery in the treatment of ankle pathologies. METHODS: A total of 32 patients (17 males, 15 females; mean age 35 years; range 17 to 54 years) underwent arthroscopic surgery for ankle lesions, which included osteochondritis dissecans (n=21), synovitis (n=6), impingement syndrome (n=4), and synovial chondromatosis. Arthroscopic surgery was performed in the left ankle in 15 patients, and in the right ankle in 17 patients. Osteochondral lesions were assessed by the Berndt-Harty, arthroscopic views by the Ferkel-Cheng classification systems. Preoperative and postoperative functional evaluations were made using the Freiburg ankle scoring system. The mean follow-up was 42 months (range 11 to 84 months). RESULTS: There was no improvement in Freiburg scores within nine weeks in patients with osteochondritis dissecans, whose preoperative mean score was 66. However, at the end of 3.5 months, the Freiburg scores manifested a marked increase to a mean of 88. Functional scores increased from 72 to 90, and from 80 to 95 in patients with synovitis and impingement syndrome, respectively, at the end of nine weeks. The patient with synovial chondromatosis became symptom-free after two months. Complications included breakage of a drill in one patient and development of reflex sympathetic dystrophy in another. CONCLUSION: Arthroscopic surgery for ankle lesions decreases surgical morbidity and promotes functional improvement, especially in patients with osteochondritis dissecans, synovitis, and impingement syndrome.

Can simple release relieve symptoms of carpal tunnel syndrome caused by a persistent median artery? Clinical experience.

INTRODUCTION: Compression of the median nerve at the wrist by a persistent median artery is one of the uncommon reasons for carpal tunnel syndrome. Most of the studies in the literature deal with thrombosed persistent median artery. MATERIALS AND METHOD: In this study, we present surgical treatment of four carpal tunnel syndromes, which had persistent median arteries. The mean age of the patients was 51 years. All four median arteries were patent and only transverse carpal ligament releases were performed using a standard anterior open approach for decompression of the carpal tunnel. Neither ligation nor transposition of the arteries was done. RESULTS: All patients became symptom free after a few weeks. Only one patient had a slight recurrence 13 months postoperatively. Splint use and modification of her activities reduced her disturbance, and no further treatment was applied. CONCLUSION: If the patient has no additional anomaly, our clinical experiences lead us not to advise resection or transposition because simple release of the transverse carpal ligament can relieve symptoms.