A new complication in volar locking plating of the distal radius: longitudinal fractures of the near cortex.

OBJECTIVE: The purpose of this study was to document a new complication in volar locking plating of the distal radius. METHODS: Between January 2007 and January 2014, 223 patients were identified from the department's surgical database with retrospective chart and radiographic review. Sixty-eight patients were over 60 years of age. All fractures were operated with Acu-Loc® (Acumed, Hillsboro, OR, USA) wrist volar locking plating systems. Longitudinal fracture lines (LFL) beneath volar plate-extending proximal shafts were documented. Correlations between age groups and LFLs were investigated. Radiographs with LFLs were assessed at final follow-up for the following parameters: volar tilt, radial inclination and radial length. RESULTS: Twenty-eight of 68 patients over age of 60 years had LFLs. Correlation was significant for age groups (p<0.05). The effect of these fracture lines on radiographic parameters was not significant (p>0.05). CONCLUSION: Surgeons should be aware of the complications that may occur with volar locking plates. Understanding of potential complications and their results are important. As a result of aging, thinning, and weakening, the near cortex may become more brittle. When the plate is reduced on the bone with a nonlocking screw, the conical head of diaphyseal locking screws can extend over plate thickness and penetrate the near cortex, acting as a screwing wedge. Additional divergent configuration may promote this effect and crack the cortex.

Limb salvage and amputation in Type 3C tibial fractures.

OBJECTIVE: The aim of this study was to evaluate the results of limb salvage and primary amputation treatments in patients with Type 3C tibia fractures and compare with normative population data. METHODS: Limb salvage was performed in 20 patients and primary amputation in 14 patients with Type 3C tibia fractures between 1993 and 2009. Mean follow-up period was 5.3 years. Treatment times, complications, number of operations and return-to-work status of groups were compared. The Short Form-36 (SF-36) was used to assess quality of life and domains were compared among the patient groups and normative data. RESULTS: Limb salvage patients had longer treatment periods with more operations and complications than the primary amputation group. Return-to-work percentage was 59% in the limb salvage group and 71% in the amputation group. There was no statistical difference in all SF-36 domains for limb salvage and primary amputation patients. Physical functioning, social functioning, limitation due to emotional problems and pain were statistically lower in all patients than in the general population. CONCLUSION: Type 3C tibia fractures treated with both limb salvage and primary amputation have negative effects on quality of life. Patients should be informed about limited functional capacity, pain complications and problems with return-to-work at the end of treatment. In addition, high rates of limb salvage can be achieved with proper conditions in suitable patients.

Comparison of dorsal and volar percutaneous screw fixation methods in acute Type B scaphoid fractures.

OBJECTIVE: In this study, we aimed to compare the clinical and functional results of patients treated with dorsal or volar percutaneous screw fixation for acute scaphoid fractures. METHODS: We retrospectively evaluated 27 wrists of 26 patients (24 males, 2 females; mean age: 33.1 years) who underwent dorsal or volar percutaneous screw fixation for acute scaphoid fractures between 2000 and 2009. The dorsal approach group contained 13 wrists and the volar approach group 14 wrists. Splint was removed and wrist exercises initiated on the 10th postoperative day. Pinch power, grip power and range of motion were evaluated using the contralateral wrist as controls. Functional evaluation was performed using the patient-rated wrist evaluation score (PRWE) and Mayo wrist scoring system. RESULTS: According to the Herbert and Fisher's classification system there were 9 B2, 3 B3 and 1 B1 fractures in the dorsal approach group, and 12 B2 and 2 B1 fractures in the volar approach group. Fracture union was achieved in all patients. There was no significant difference between the two groups according to functional and clinical results (p>0.05). All patients returned to their jobs in an average of 4.2 weeks and there was no significant difference between the groups (p=0.437). Wrist flexion was significantly better in the control wrists in both groups (p=0.009). In one patient, the screw was removed due to ongoing pain and asymptomatic screw head displacement in the scaphotrapezoid joint was detected in another. CONCLUSION: The surgical approach does not affect the clinical and functional outcomes in percutaneous screw fixation of Type B scaphoid fractures. Percutaneous fixation is a valuable treatment method for Type B scaphoid fractures as it enables early wrist motion and high patient satisfaction.

[Humeral shaft nonunions: plates and nails]. / Humerus cisim kaynamamalari: Plaklar ve çiviler.

OBJECTIVES: This study aims to compare the functional results of dynamic compression plates (DCP) and interlocked retrograde intramedullary nails (IRIN) used for the treatment of humeral shaft nonunions. PATIENTS AND METHODS: Twenty-six patients (12 males, 14 females; mean age, 42.8 years; range 21 to 61 years) who underwent surgical treatment of humeral shaft nonunion either with DCP (n=13) or IRIN (n=13) between October 1999 and January 2008, were retrospectively analyzed. Treatment consisted of removing previous implants and DCP or IRIN fixation with additional autogenous bone grafts for atrophic nonunions. Union time, range of motion, radiographic length difference, Constant-Murley Scale (CMS), Disabilities of the Arm, Shoulder and Hand (DASH-T) and Mayo Elbow Performance Score (MEPS) were evaluated at a mean follow-up time of 59.5 months (range; 17 to 125 months). RESULTS: There was a statistically significant correlation among the functional scores of DASH-T, MEPS and CMS. No statistically significant difference was observed in the functional outcome between the groups (DCP and IRIN). Range of motion of the elbow joint was significantly impaired in three patients who were plated for distal shaft nonunions. CONCLUSION: Both DCP and IRIN provide satisfactory functional outcomes in the treatment of humeral shaft nonunions. Distal shaft nonunions may demonstrate a decrement in elbow motion associated with distal placement of plates.

The effect of medial side repair in terrible triad injury of the elbow.

OBJECTIVE: The aim of this study was to evaluate the effect of surgical repair of the medial collateral ligament and ulnar nerve release in cases of terrible triad injuries of the elbow. METHODS: This study included 16 patients (average age: 34 years) who underwent surgery following a diagnosis of terrible triad injury of the elbow between 1996 and 2007. Average follow up was 34.5 months. In all cases, the radial head was first fixed or replaced and the anterior capsule/coronoid complex and lateral collateral ligament were repaired. The medial side of the elbow was addressed (medial collateral ligament repair and ulnar nerve release) in 8 cases and not addressed in the remaining 8 cases. Range of motion, pain, stability, ulnar nerve symptoms, functional Mayo Elbow Performance Index, and Disabilities of the Arm, Shoulder and Hand scores were documented. Serial X-rays were used to confirm ulnohumeral arthritis and development of ectopic calcification. Ultrasonography or MRI was used to detect ulnar nerve entrapment. RESULTS: Range of motion was slightly more limited in cases where the medial side was not addressed. Ulnohumeral range of motion and flexion degrees were higher in the cases where the medial side was addressed (p<0.05). Serial X-rays demonstrated impending ectopic calcification located at the proximal insertion of medial collateral ligament in patients who did not undergo medial side repair. MRI or ultrasonography confirmed these findings, revealing swollen displaced nerves resembling findings similar to cubital tunnel syndrome. CONCLUSION: Ulnar neuropathy is a common complication after medial collateral ligament injury and prophylactic release will facilitate overall results and postoperative patient satisfaction.

Results of volar locking plating for unstable distal radius fractures.

OBJECTIVE: The aim of this study was to analyze the complications and functional and radiographic results of volar locking plating in the treatment of unstable distal radius fractures. METHODS: Forty-six patients (mean age: 48.7 years) with Type C distal radius fractures were treated with volar locking plates and evaluated over a mean follow-up period of 19 months. Range of motion, strength, DASH questionnaire and MAYO wrist score were assessed. Shortening, inclination and palmar tilt were recorded on standard radiographs and tenosynovitis and tendon ruptures were assessed using ultrasound. The uninjured wrists were examined as controls. Statistical analysis was made using t-tests. RESULTS: All fractures achieved union. Postoperative MAYO scores revealed 14 excellent results, 11 good, 20 satisfactory and one poor result. The mean postoperative DASH score was 15.9 (range: 0 to 72). Active wrist motion averaged 52.3 degrees of flexion, 57.7 degrees of extension, 79.2 degrees of supination and 79.3 degrees of pronation. Mean grip strength was 82% of the uninjured side and mean loss of radial inclination was 0.6 degrees and palmar tilt was 6.6 degrees as compared to normal side. Carpal tunnel syndrome was observed in one patient, flexor tenosynovitis in one patient, extensor tendon rupture in one patient and extensor tenosynovitis in eleven patients. Functional and clinical limitations were most evident in the patients with tendon tear or tenosynovitis. CONCLUSION: Fixation of unstable distal radius fractures with volar locking plates provides sufficient stability, and satisfactory clinical outcomes. However, these systems have complication potential that may limit better outcomes.

Risk factors for occupational hand injuries: relationship between agency and finger.

BACKGROUND: The aim of this study was to define the risk factors for occupational hand injuries and explore the relationship between the machines and the fingers injured, based on the records of a hospital in Turkey specialized in hand and microsurgery. METHODS: Five thousand twenty seven occupational hand injuries treated at a hand and microsurgery hospital between 1992 and 2005 were included in the study. All the injuries were retrospectively recoded according to ICD-10, (ICECI) and ILO recommendations. Logistic regression and chi-square for trend analysis were used to evaluate the risk factors for occupational injuries. RESULTS: The most frequent injuries were traumatic amputation of wrist and hand (53.2%), open wound of wrist and hand (46.3%). Considering all injuries, 60.9% of agricultural machines, 52.7% of metal working machines, 54.7% of transmission machinery, and 42.8% of wood and assimilated machines affected the right hand. Powered wood cutters, presses, planning and milling machines, and machine belts were the most frequent five machines involved in injuries, each having a different finger pattern. The proportion of machinery among all hand injuries was significantly decreasing with time. CONCLUSION: A stricter and more frequent supervision of the use of protective equipment and prohibition of the purchase of machinery not complying with the regulations could contribute to the prevention of hand injuries.

The results of reverse-flow island flaps in pulp reconstruction.

OBJECTIVE: The aim of this study was to retrospectively review the results of homodigital reverseflow proximal or middle phalanx dorsal skin island flaps. METHODS: We reviewed the overall results of 67 dorsal skin flap reconstructions performed on 61 proximal phalanxes and 6 middle phalanxes at our hospital during an 11 year period. The results were evaluated with static two point discrimination, Semmes-Weinstein monofilament test, occurrence of nail deformities, loss of interphalangeal joint motion, scar appearance of flap donor area, the incidence of vascular insufficiency in postoperative period, and subjective evaluation of patient satisfaction. RESULTS: The highest incidence of defect types were palmar oblique pulp defects in 18 patients (26.8%), transverse pulp defects in 16 patients (23.8%), and hemipulp oblique amputations in 11 patients (16.4%). Crush injuries were the cause of injury in 66% of patients. The average followup time was 40 months and long-term results were available in 21 patients. Total necrosis of flap in one patient (1.4%), superficial epidermolysis in 4 patients (5.9%), and nail deformity in 4 patients (5.9%) were seen. According to Semmes-Weinstein monofilament test results, protective sensation was achieved in 76% of patients. Static two point discrimination data showed variable distribution between 2 mm and 11 mm. The subjective patient satisfaction level was 95%. CONCLUSION: Homodigital reverse-flow proximal or middle phalanx dorsal skin island flaps give satisfactory cosmetic and sensorial results outside the pinch area, even if the dorsal branch of the digital nerve is not included.

Results of partial matrixectomy for chronic ingrown toenail.

BACKGROUND: Several treatment modalities which targeted partial matrixectomies, including chemical, laser matrixectomy, and partial nail avulsion, have been used in the dermatology, podiatry, and orthopaedic literature. We report our experience with surgical matrixectomy. METHODS: We treated 224 patients with severe ingrowing toenails. Segmental wedge resection of involved margin was performed. Followup time was a minimum of 10 months. RESULTS: Statistical analysis of recurrence and disease parameters such as stage of disease, infection, involved margin, previous surgery, followup time, and age showed no significant correlation (p>0.05). Twenty-two patients (9.8%) had a recurrence. Revision surgery was performed in 16 patients (7.1%). CONCLUSION: We recommend the Winograd technique with a few modifications especially for severe Stage 2 and 3 cases. Both loupe magnification and observation of soft tissue in the postoperative period were important details.

The outcome of direct-flow neurovascular island flaps in pulp defects.

OBJECTIVE: In this study we aimed to evaluate the results of the direct-flow neurovascular island flap (NIF) transfers in pulp defects. METHODS: We reviewed the records of 96 patients with 115 NIF transfers performed for pulp defect reconstruction. The injury mechanism was crush type injury in 70 patients (72.9%). Ninety-three patients (97%) were emergency cases. Pulp reconstruction was performed by means of pedicled island flap transfer. The results were evaluated with proximal interphalangeal joint range of motion, the Semmes Weinstein monofilament test, static two-point discrimination and cold intolerance assessments. The relations between the injury mechanism, patient satisfaction, cold intolerance and scar problems were analyzed. Also, the association between skin grafting and hook nail deformity was investigated. The level of significance was set at p<0.05. RESULTS: All flaps survived. The mean follow-up time was 41±20.3 (range: 12-108) months. We observed proximal interphalangeal joint flexion contracture in 11 (9.5%) cases. In seven of these, the limitation was less than 10 degrees. Hook nail deformity was seen in 8 fingers (7%). Cold intolerance was found in 16 (17%) cases. Semmes Weinstein monofilament and static-two point discrimination tests of flaps revealed satisfactory results. There was no relation between the injury mechanism and cold intolerance, patient satisfaction and scar problems (p>0.05). Among patients, 91.7% were satisfied with their results. CONCLUSION: The transfer of direct-flow island flaps, from the same finger, causes minimal morbidity on the donor site and appears to be a safe method, providing satisfactory functional and aesthetic results in the reconstruction of pulp defects.

Long-term functional results after radial nerve repair.

OBJECTIVE: This study aimed to evaluate the functional results of end-to-end repairs in radial nerve injuries. METHODS: The study included 18 (15 males, 3 females) patients who underwent middle level end-to-end radial nerve repair and who responded to our final follow-up call. Patients' average age was 30 (range: 16 to 43) years. The average time lapse between injury and repair was 25.1 days (range: 1 day to 13 months). Pinch and grip strength measurements were graded according to the modified Verga classification. The Highet classification was used for the evaluation of sensorial recovery. Functional outcome were assessed with the DASH-T score. Average follow-up time was 62.5 (range: 24 to 156) months. RESULTS: Motor function according to the Verga classification was excellent in 16 patients and poor in two. Pinch and grip power measurement comparison of the two sides in the 16 patients with excellent results showed a respective 24.1% and 14.3% decrease on the affected side. According to Highet's classification, sensorial evaluation was S4 in seven patients, S3+ in four, S3 in three, S2+ in one, S2 in one, and S1 in two patients. The average DASH-T score of patients with excellent results was 7.3. CONCLUSION: Radial nerve repairs, if done end-to-end using an appropriate technique, may lead to nearly full recovery in younger patients.

Epidemiology of injuries treated at a hand and microsurgery hospital.

OBJECTIVES: The aim of this study was to evaluate the epidemiology of injuries treated at a hand and microsurgery hospital between 1992 and 2005. METHODS: This is a descriptive retrospective study based on medical records of a hand and microsurgery hospital in Izmir for the years 1992-2005. A total of 8,946 injuries involving 8,817 patients were included. Data on diagnosis were recorded according to ICD-10. Intent, activity when injured, mechanism of injury, object/substance producing injury, and place of injury were recoded according to International Classification of External Causes of Injury (ICECI). RESULTS: The most common types of injury were amputations (32.3%), fractures (23.7%), and open wounds (19.9%) of the wrist and hand. Most injuries were sustained by males; 28.4% of injuries occurred during summer. According to activity, 76.3% were injured during paid work, 10.4% during transportation, 9.1% during unpaid work, and 3.8% during leisure time sports and exercise. Injuries most commonly occurred while operating a machine. The risk of hand injury was elevated in those younger than 35 years of age, males, persons outside Izmir province, and in Social Security Instution (SSI) insured workers (p<0.001). The riskiest activity for hand injuries was paid work. Compared to baseline, the risk of hand injuries was 29 times [95% confidence interval (CI) 16.36-50.40] as high in industrial or construction areas, and 50 times (95% CI 17.29-143.96) as high in commercial places CONCLUSION: Hand injuries are important because of their consequences, such as permanent disability and their high treatment costs. This study points out many important risk factors, and has contributed the development of hypotheses about injury types, under-notification of occupational injuries, and child labour. The inclusion of medical records from such specialized hospitals into national databases will aid in the prevention of these injuries, and induce developments in diagnosis and treatment.

Validity of ultrasonography in surgically treated zone 2 flexor tendon injuries.

OBJECTIVES: The purpose of this study was to determine the validity of ultrasonography (USG) with surgical confirmation in surgically treated zone 2 flexor tendon injuries. METHODS: Between 2003 and 2008, zone 2 flexor tendon repairs of 30 patients were evaluated with real-time USG when there was a loss of motion and prediagnosis of rupture or adherence in follow-up. The mean duration between injury and USG evaluation was 81.5 days (range 10-240 days). USG demonstrated rupture in 15 patients, adherence in 14 patients, and tenosynovitis in one patient. After clinical examination, surgery was performed in 27 of the patients. RESULTS: Fifteen patients with diagnosis of rupture in USG were operated, and diagnosis was confirmed in 14 patients. Eleven patients in the adherence group were also surgically treated. Eight of them received only tenolysis, and three were repaired with tendon grafts-one for rerupture and two for insufficiency after tenolysis. One patient who was diagnosed with tenosynovitis also had a re-ruptured tendon. Therefore, USG resulted in one false finding out of the 15 patients in the rupture group, one false finding out of 11 patients in the adherence group, and one false finding in tenosynovitis group. In total, validity of USG was confirmed in 24 of 27 patients. CONCLUSION: USG is a dependable diagnostic aid in operated zone 2 flexor tendon injuries when there is uncertainty of rupture or adherence.

[The results of treatment for isolated zone 3 extensor tendon injuries]. / Uçüncü bölge ekstansör tendon izole yaralanmalarinda tedavi sonuçlari.

OBJECTIVES: We evaluated late-term results of surgical repair and physical rehabilitation of isolated zone 3 extensor tendon injuries. METHODS: Sixteen patients (13 males, 3 females; mean age 28 years; range 11 to 57 years) underwent surgical repair for isolated simple central slip injuries of zone 3 extensor tendon. Injuries involved the second, third, fourth, and fifth fingers in seven, three, two, and four patients, respectively. Primary tendon repair was performed in 14 patients. Two patients were treated after one week and two months following primary injury, respectively. Tendons were repaired by modified Kessler and epitendinous sutures in four patients, and by locking running suture in 12 patients. Following surgical repair, three patients underwent K-wire fixation in extension for two weeks, while 13 patients received the short arc motion protocol. The patients were assessed with respect to proximal interphalangeal (PIP) joint motion and extension loss. Functional results were assessed using the Strickland formula. The mean follow-up was 58 months (range 8 to 120 months). RESULTS: Full range of motion of the PIP joint was achieved in 15 patients (93.8%). The mean PIP joint motion was 98 degrees. One patient (6.3%) had an extension loss of 10 degrees in the range of motion of the PIP joint. There were no losses in the range of motion in three patients treated with K-wire fixation. The mean of the Strickland formula was 94.8% (range 74% to 100%), showing an excellent result in 15 patients (98.3%) and a good result in one patient (6.3%). All the patients returned to their pre-injury work status. None had buttonhole deformity or soft tissue complication. CONCLUSION: A proper suture technique combined with the short arc motion protocol provides good results in the treatment of isolated zone 3 extensor tendon injuries.

[Long-term results of major upper extremity replantations].

OBJECTIVES: The aim of this study was to evaluate long-term clinical and functional results of major upper extremity replantations. METHODS: We retrospectively evaluated 26 male patients (mean age 27 years; range 3 to 69 years) who underwent major upper extremity replantations and had a mean follow-up of 11.3 years (range 5 to 19 years). The levels of the replantations were transmetacarpal (n=6), wrist (n=4), forearm (n=5), elbow (n=4), and arm (n=7). Amputations were of clean-cut, crush, and avulsion types in seven, eight, and 11 patients, respectively. Secondary operations were performed in 19 patients. Functional results were assessed using the Chen's criteria and the Turkish version of the DASH questionnaire (Disabilities of the Arm, Shoulder and Hand) was administered. RESULTS: The mean surgical shortening was 37.2 mm, and the final mean radiographic shortening was 52.2 mm. The mean grip and pinch strengths on the affected side were 12.3 kg and 3.6 kg, compared to the strengths of 37.6 kg and 8.7 kg on the normal side, respectively. Monofilament testing showed sensory recovery in 20 patients. Two-point discrimination could be made by 18 patients for the median nerve, and by 17 patients for the ulnar nerve. According to the Chen's criteria, the results were very good or good in 17 patients (65.4%), moderate in three patients (11.5%), and poor in six patients (23.1%). Functional results were correlated with the level (r=0.71) and type (r=0.65) of injury, with injuries at the elbow level and avulsion injuries being associated with a worse outcome. The mean DASH score was 6.7 (range 0 to 32.5) and the mean scores of Chen's grade I-II and grade III-IV patients differed significantly (p<0.05). CONCLUSION: Lower DASH scores show increased satisfaction of the patients and improved use of their replanted extremities as the helper arm whereby functional deficiency is somewhat compensated.

[The importance of patient selection for the treatment of proximal humerus fractures with percutaneous technique]. / Proksimal humerus kiriklarinda perkütan tespit için hasta seçiminin önemi.

OBJECTIVES: We evaluated the indications and disadvantages of percutaneous technique for proximal humerus fractures in relation to complications encountered in osteoporotic elderly patients and the importance of patient selection. METHODS: The study included 18 patients (10 men, 8 women; mean age 48 years; range 14 to 89 years) who underwent percutaneous fixation (closed reduction and pin fixation with K-wires or Schanz screws) for proximal humerus fractures. Eight patients were beyond 60 years of age. According to the Neer classification, five patients had two-part, 13 patients had three-part neck fractures. The patients were evaluated with range of motion of the shoulder, radiographs, and the Disability of Arm Shoulder and Hand questionnaire (DASH). The mean follow-up was 23 months (range 8 to 60 months). RESULTS: The mean shoulder abduction was 134 degrees (range 30 degrees to 160 degrees) and the mean elevation was 118 degrees (range 30 degrees to 140 degrees). Full range of motion of the shoulder was achieved in 11 patients (61.1%), including all with two-part fractures. Abduction losses of 60 degrees to 130 degrees and less than 30 degrees were seen in four patients and three patients, respectively, all of whom were older than 60 years. The mean DASH score was 18 (range 0 to 77). Fourteen patients having a score of less than 10 had no pain or functional complaints. Four patients with a score of more than 10 were older than 70 years. Pin migration was observed in seven patients (38.9%), all of whom were over 60 years of age. One patient required revision with partial prosthesis. Nonunion was seen in one patient (5.6%) and malunion with a varus/valgus deformity occurred in four patients (22.2%). None of the patients developed avascular necrosis. CONCLUSION: Percutaneous fixation may be preferred in the treatment of two-part and carefully-selected three-part proximal humerus fractures. Due to high complication rate, patient selection is of primary importance among elderly patients.

[Long-term results of treatment including creation of a gutter and muscle transposition for chronic sclerosing osteomyelitis]. / Kronik sklerozan osteomiyelit tedavisinde oluklastirma ve kas tasima tekniginin uzun dönem sonuçlari.

OBJECTIVES: We evaluated long-term results of treatment including creation of a gutter and muscle transposition in patients with chronic sclerosing osteomyelitis (CSO). METHODS: Between 1980 and 1996, 11 patients (5 women, 6 men; mean age 36 years; range 17 to 69 years) with CSO were treated with creation of a gutter and muscle transposition. Seven patients had femoral, and four patients had tibial involvement. The main complaint was pain. The patients were evaluated with respect to complaints and radiologically (X-ray, computed tomography, and magnetic resonance imaging) after a mean follow-up of 12.4 years (range 6 to 24 years). RESULTS: During the follow up period, all the patients remained symptom-free without the need for antibiotic treatment except for one patient with tibial involvement, whose pain recurred after five years. The patient's complaint disappeared following reoperation with the same technique. Histologic examination of surgical biopsies showed nonspecific changes consistent with low-grade chronic osteomyelitis. Cultures were negative in all cases. Control radiographies showed no progression of sclerosis. Computed tomography showed cortical bone formation surrounding the transposed muscle, and magnetic resonance imaging showed fatty degeneration in the transposed muscle, without any signs of active osteomyelitis. CONCLUSION: The aim of gutter creation and muscle transposition is to increase blood supply to the diseased bone segment, without the need for microsurgical interventions and secondary reconstructive procedures. Our long-term results show that this technique is efficacious in patients with femoral and tibial involvement.

[Comparison between two mini incision techniques utilized in carpal tunnel release]. / Açik karpal tünel gevsetmesinde iki farkli mini kesi yönteminin karsilastirilmasi.

OBJECTIVES: We compared two mini skin incision techniques utilized in the treatment of carpal tunnel syndrome (CTS). METHODS: Twenty-seven patients who underwent surgery for CTS were evaluated in two groups according to the site of the mini incision performed for surgical release. A single mini skin incision was performed over the transverse carpal ligament in 12 patients (group 1; 17 hands; 1 man, 11 women; mean age 55 years; range 38 to 66 years), and on the distal side of the ligament in 15 patients (group 2; 17 hands; all women; mean age 54 years; range 34 to 71 years). The two groups were compared with regard to improvement in pain and numbness, rigidity and sensitivity of the scar tissue, time to use the hands, and palmar pinch and grip strengths. The mean follow-up was 26.6 months in group 1, and 23.7 months in group 2. RESULTS: Complete disappearance of symptoms was obtained in 14 wrists (82.4%) in group 1, and in 15 wrists (88.2%) in group 2, with no significant difference between the two groups (p>0.05). Rigidity and sensitivity of the scar tissue were seen in nine wrists (52.9%) in group 1, and in two wrists (11.8%) in group 2 (p<0.05), which lasted 3.5 months and 1.5 months, respectively. In group 2, time to use the affected hand for basic needs (9 days) and normal function (21 days) was significantly shorter, compared to 18 days and 35 days in group 1, respectively (p<0.05). The mean differences of grip and pinch strengths of the two hands were -2.78 kg and -0.60 kg in group 1, and -0.77 and -0.46 kg in group 2, respectively (p>0.05). CONCLUSION: Although both methods of release yield satisfactory results in the mid- and long-term, mini skin incision performed on the distal side of the transverse carpal ligament is associated with less incision-related morbidity.

Elbow arthrolysis in severely stiff elbows.

INTRODUCTION: This study involves the results of open elbow arthrolysis performed on a series of patients having fixed joint contracture. PATIENTS AND METHODS: Eighteen patients were treated with open arthrolysis. Eleven patients had very severely stiff elbows (flexion arc less than 30 degrees ), five patients had severely stiff elbows (31 degrees -60 degrees ) and two patients had moderately stiff elbows (60 degrees -90 degrees ). Fixed flexion deformity was observed in nine patients preoperatively.The mean interval between the trauma and arthrolysis was 14.8 months. The mean age was 27 years. After radiological examination, lateral kocher incision was used on 13 patients, medial and lateral incision on 3 patients, transolecranon approach on 1 patient and anterior and posterior approach on 1 patient. External fixator was applied on four patients. Fasia lata interposition was performed in three patients. Additional procedures were as follows, bone fixation in five patients, bone grafting in two patients, nerve grafting in one patient, subcutaneous ulnar nerve transposition in three patients. The average follow-up time was 47 months. RESULTS: At the final evaluation, the mean extension deficit had improved from 55 degrees to 32 degrees . The mean end flexion increased from 81 degrees to 124 degrees postoperatively. The flexion arc of three patients in whom heterotopic ossification was excised had increased to 65 degrees . Infection was diagnosed in two patients (11%). CONCLUSION: The importance of this study is that the patients have fixed deformities and a long follow-up time. Severely stiff elbow is one of the main indications of open arthrolysis in the patients without muscle atrophy. We suggest sequential arthrolysis as an effective way to obtain good range of motion especially in severe stiff elbows as well as to maintain the ligamantous stability of the elbow joint.