Reverse Wafer Procedure for Ulnar Impaction Syndrome.

Ulnar impaction syndrome occurs when excessive load across the ulnocarpal joints results in pathologic changes, especially over the articular surface of the ulnar head and proximal ulnar corner of the lunate. The 2 main surgical options in ulnar impaction syndrome are ulnar shortening osteotomy and wafer procedure, whether open or arthroscopically, to decompress the ulnocarpal joint load. However, all of these techniques have their shortcomings and drawbacks. The current study demonstrates a novel technique to decompress the ulnocarpal joint load: the "reverse wafer procedure" for ulnar impaction syndrome. In this surgical technique, we resected the proximal ulnar side of the lunate instead of partial resection of the thin wafer of the distal ulnar head dome in the standard wafer procedure. This technique avoids iatrogenic central tear of triangular fibrocartilage and distal radioulnar joint portal arthroscopy, which is technically demanding while preserving the distal radioulnar joint.

New interlocking intramedullary nail for treating acute midshaft clavicular fractures in adults: A retrospective study.

BACKGROUND: The aim of this study was to retrospectively examine the radiological and functional results of midshaft clavicle fractures that were treated with a new, interlocking intramedullary nail, and employing a different locking option. METHODS: Between January 2018 and January 2020, 24 displaced midshaft clavicle fractures were operated with new, interlocking intramedullary nail. Fractures were classified according to the AO/orthopedic trauma association classification, according to which there were 22 15.2.B (wedge) and 2 15.2.C (comminuted) fractures. The mean patient age was 35.5±14.2 (range: 18-63) years. Eighteen (75%) of the patients were male and six (25%) were female. RESULTS: Follow-up data were recorded at a minimum of 1 year (range 12-36 months), with an average of 21.5 months (SD±8). The mean interval between the injury and surgery was 4.1 (SD±2.3; range: 1-9) days. Full shoulder movements had been achieved by all patients, relative to the contralateral side. The mean constant score was 95.6 (SD±4.2; range 90-100), and the mean visual analog scale score was 0.8 (SD±0.8; range: 0-3). Union was achieved in all patients. The mean union time was 9.5 (SD±1.8; range 6-12) weeks as assessed by radiograph. Average shortening of the clavicle relative to the contralateral side was 3.4% (SD±1.1; range 1.1-6.3). One patient experienced implant irritation, implant removal was performed after 14 months. No implant migration, hardware loosening, implant breakage, or neurovascular damage occurred. One hypertrophic scarring developed. One wound detachment developed at the 3rd post-operative week. CONCLUSION: We think that this new intramedullary nail is a good alternative for wedge type fractures in adult, acute, displaced, and midshaft clavicle fractures.

Technical trick in suture-button suspensionplasty for the treatment of thumb carpometacarpal arthritis.

Suture-button suspensionplasty has been popularized in the treatment of thumb carpometacarpal (CMC) arthritis in recent years. The surgical technique of this method was well defined previously. The most challenging and important part of this technique is the tensioning of the suture-button system to preserve first metacarpal height after trapeziectomy. In present study, we would like to present a technical trick about adjusting the tension while performing suspensionplasty using suture-button device in thumb CMC joint osteoarthritis. In the original technique, trapeziectomy is performed prior to fixation and tensioning of suture-button system. However, it is quite difficult to recreate the original trapezial space, since first metacarpal subsides after trapeziectomy. The trick in our technique is that trapezium remains in its anatomic position up to the end of the operation. Thus, we do not need to make effort to adjust the thumb ray height and use fluoroscopic imaging to ensure its position. In conclusion, we believe that our technique simplifies the most challenging part of the operation, shortens the operation time, preserves the original first ray height and diminishes the exposure of ionizing radiation as it reduces the need for fluoroscopy.

A comparison of intramedullary cannulated screws versus miniplates for fixation of unstable metacarpal diaphyseal fractures.

We carried out a prospective randomized study to compare the clinical and radiological results of metacarpal diaphyseal fractures treated with retrograde intramedullary headless cannulated screws (IHCS) and plates. Fractures were fixed with IHCS in 34 patients (37 metacarpals) and locked miniplates in 35 patients (40 metacarpals). The mean age was 33 years (range 18-61) in the IHCS group and 32 years (range 17-68) in plate group. All patients were followed up for 1 year. All fractures in the IHCS group united but there was one nonunion in the plate group. At final follow-up, there was no significant difference between the groups in total active movement, visual analogue pain score, Disabilities of the Arm, Shoulder, and Hand score and grip strength, although the study was not sufficiently powered to exclude differences with certainty. IHCS is a safe and fast technique that is a good alternative to plate fixation in metacarpal diaphyseal fractures.Level of evidence: I.

Comparison of the functional and radiological outcomes of vascularized and non-vascularized bone graft options in the treatment of scaphoid nonunion.

OBJECTIVES: This study aims to compare the functional and radiological outcomes of the patients with scaphoid waist nonunion treated with non-vascularized bone graft and vascularized bone graft options. PATIENTS AND METHODS: Between January 2016 and February 2020, a total of 24 patients (22 males, 2 females; mean age: 30.6±9.4 years; range, 18 to 66 years) with scaphoid waist nonunion who were treated with vascularized or non-vascularized bone graft were retrospectively analyzed. Of these patients, eight were treated with iliac crest non-vascularized bone graft (IC-NBG), seven with vascularized free medial femoral condyle (MFC) graft, and nine with 1,2-intercompartmental supraretinacular artery pedicled vascularized bone graft (1,2-ICSRA-VBG). The grip strength, flexion, extension, radial deviation, ulnar deviation angles were measured and compared to the contralateral hand for functional outcomes. Union rates, the scaphoid height-to-length ratio, the lateral intrascaphoid angle (LISA) were evaluated for radiological outcomes. The Mayo Wrist Score, Visual Analog Scale (VAS) score, and Quick Disability of the Arm, Shoulder and Hand (Q-DASH) Questionnaire score were calculated. RESULTS: Union was observed in seven (87.5%) patients after IC-NBG, in six (85.7%) patients after MFC bone graft and nine (100%) patients in the treatment group with 1,2-ICSRA-VBG. There were no statistically significant differences among the IC-NBG, MFC and 1,2-ICSRA-VBG groups in terms of the union rates, the scaphoid height-to-length ratio, VAS score, Q-DASH score, grip strength and flexion, ulnar deviation, radial deviation angles after surgery (p>0.05). However, extension was statistically lower in the MFC group than IC-NBG and 1,2-ICSRA-VBG groups after surgery. The Mayo score was better in the IC-NBG group than MFC and 1,2-ICSRA-VBG, indicating a statistically significant difference (p<0.05). CONCLUSION: Based on our study results, we suggest to use IC-NBG for scaphoid waist nonunion as the primary procedure, as the union rates are comparable with the MFC and 1,2-ICSRA-VBG techniques and it has advantages such as shorter operation time, easier technique, no special experience requirement, and better functional outcomes.

Long-term clinical outcomes of innervated digital artery perforator flap in the treatment of fingertip injuries.

OBJECTIVE: The aim of this study was to evaluate the long-term clinical outcomes of innervated digital artery perforator (IDAP) flap in the treatment of patients with fingertip injuries. METHODS: Eighty-three patients (93 fingers; 70 male, 13 female; mean age = 35.2 years, age range = 5-65) with fingertip injuries who underwent acute or late reconstruction with IDAP flap between 2011 and 2016 were retrospectively reviewed. The mean age was 35.2 (range = 5-65) years. Reconstructions performed in 85 fingers (91.4%) were acute, and 8 fingers (8.6%) were late. Hypersensitivity, cold intolerance, and patient satisfaction were questioned as subjective evaluation parameters. The objective patient outcome evaluations consisted of static two-point discrimination (s2PD) test, the Semmes-Weinstein monofilament (SWM) test, and range of motion of the reconstructed fingers. RESULTS: The mean follow-up period was 33.1 (range = 12-62) months. The smallest flap size was 1.6 x 0.7 cm; the largest flap size was 4 x 2 cm. All flaps survived completely. There was no postoperative infection or donor site morbidity. Hyperesthesia was observed in 4 fingers (4.3%), of which 3 were mild and 1 was moderate. Eighteen patients (18 fingers, 19.3%) experienced mild cold intolerance on reconstructed fingertips. 75 patients (90.3%) were highly satisfied, and 8 patients (9.7%) were satisfied with functional and aesthetic results of their fingertip reconstructions. No range of motion limitation was observed in any joints of 90 fingers (96.8%). The s2PD in the flaps ranged from 2mmto 6mm(mean = 3.71 ± 0.97 mm), compared with 2mmto 5mm(mean = 2.73 ± 0.66 mm) on the contralateral hand. TheSWMtest results of the flaps ranged from 2.44 to 4.56, compared with 2.44 to 4.31 on the contralateral hand. The difference regarding s2PD and SWM test was statistically significant (P < 0.001). CONCLUSION: IDAP flap seems to be a sensate, reliable, and versatile flap that can be used in acute and late reconstructions of any type of fingertip defects. Satisfactory functional and aesthetic results can be achieved with better sensorial results and lower complication rates compared to other conventional reconstruction techniques. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

Suture-button Fixation and Arthroscopic Dorsal Ligamento-capsulodesis in Chronic Scapholunate Dissociation.

The treatment choice in scapholunate (SL) injury depends on the extent of the SL ligament tear, chronicity of injury, quality of the ligament remnants, reducibility of carpal malalignment, and cartilage status of the radiocarpal and midcarpal joints. In the absence of degenerative changes with chronic reducible dissociation, the optimal treatment would be the reconstruction of the SL interosseous ligament. Various SL reconstruction techniques via open or arthroscopic approaches have been described over the years; they include tendon reconstructions, volar/dorsal capsulodesis, SL allografts, bone-tissue-bone composite grafts, reduction and association of the scaphoid and lunate procedure, SL axis method, and SL internal brace technique. However, all of these techniques have their own shortcomings and disadvantages. The present study demonstrates a new technique using a suture-button device for the reduction and fixation of SL diastasis. The suture-button system is positioned between the scaphoid and the triquetrum, the direction of the system prevents scaphoid flexion and maintains continuity of the reduction. Arthroscopic dorsal ligamento-capsulodesis technique can be added to achieve biological healing during the stabilization process. The major advantages of this technique over others are a straightforward application with shorter operative time and lack of a need for harvesting a tendon graft. The technique is performed through mini-incisions, which enable a shorter postoperative recovery time and rehabilitation period and a quicker restoration of function which decreases the risk of joint stiffness. Furthermore, large bone tunnels which increase the risk of fracture are avoided.

Bilateral brachial artery infiltration by tumoral calcinosis: A case report.

We, herein, presented a rare case of bilateral brachial artery infiltration by tumoral calcinosis located on both elbows. A 58-yearold man presented with a history of painless, palpable solid mass restricting the range of motion of both elbows. These masses were located on the anterior aspect of the elbows and gradually enlarged. After clinical, laboratory and radiological examinations, tumoral calcinosis was suspected, and excisional biopsy was planned for a definite diagnosis. Surgery was first performed on the left elbow. The median nerve was found to be compressed but not infiltrated by the mass. Interestingly, the brachial artery was totally infiltrated throughout the entire mass. Occlusion was observed in the brachial artery located within the mass. The tumor on the left elbow, 8.5 × 5.5 × 2.5 cm in size, was totally excised with approximately 12-cm brachial artery segment. The artery was resected until the healthy tissue was reached. The defect was reconstructed with saphenous vein graft obtained from the ipsilateral lower extremity. The same surgical procedure was performed on the right elbow after 3 months. The tumor size on the right elbow was 7 × 3.5 × 1.7 cm. Approximately 15-cm brachial artery segment was excised, and the defect was reconstructed with saphenous vein graft. Tumoral calcinosis is a rare benign condition that can be located in close relationship with neurovascular structures. In such cases, detailed neurologic and vascular examination, including imaging modalities, for arterial flow is essential to establish a more accurate surgical plan and avoid any unexpected situation during surgery.

Treatment of scaphoid nonunion with 1,2 intercompartmental supraretinacular artery vascularized graft and compression screw fixation.

PURPOSE: Aim of the present study was to evaluate the clinical, functional, and radiological outcomes of 1,2-intercompartmental supraretinacular artery (1.2-ICSRA) vascularized graft technique together with compression screw fixation for the management of scaphoid nonunions. METHODS: A retrospective study was designed to evaluate the medical records of the 21 patients treated with 1,2-ICSRA vascularized graft for established scaphoid nonunion of the waist or proximal pole between 2015 and 2018. Seventeen patients who met the criteria were included in the study. The retrospectively analysed demographic parameters included age, gender, injured hand (dominant/non-dominant), aetiology of the injury, delay between injury and operation, initial treatments following the fracture, tobacco use, and background diseases that may affect healing (diabetes, vasculopathy etc.). Radiological and clinical examinations were routinely performed 2 weeks, 6 weeks, 3 months and 6 months after surgery and during the final follow-up. Postoperative clinical and functional outcomes at the latest follow-up were evaluated by measuring active wrist range of motion, grip strength, Turkish version of Quick Disabilities of the Arm, Shoulder and Hand Questionnare (Quick DASH) and Mayo Wrist scores and comparing them with preoperative values. RESULTS: All 17 patients were male with an average age of 26.82 ± 4.08 years (range 20-35 years). The fracture site was located in the scaphoid waist and proximal pole in 5 (29.4%) and 12 (70.6%) patients, respectively. Avascular necrosis was observed in 13 patients (2 at the waist, 11 at the proximal pole). The mean follow-up duration was 18.88 ± 11.98 months (range 6-44 months). No graft extrusion occurred, and no other complication was observed in any of the patients. Amongst the 17 patients, 15 (88.2%) achieved union. The total wrist motions of patients were better postoperatively than preoperatively. However, only improvement in wrist extension was found to be statistically significant. Quick DASH and Mayo Wrist scores of the patients and grip strength were significantly improved postoperatively. CONCLUSION: The 1,2-ICSRA vascularized graft technique together with compression screw fixation offers an easy and reliable option for the treatment of scaphoid nonunions with a high union rate and good functional and clinical outcomes. LEVEL OF EVIDENCE: IV Therapautic.

Is Boston questionnaire an alternative to electromyography for evaluation of the surgical outcome for carpal tunnel syndrome?

OBJECTIVES: This study aims to identify the optimal follow-up method for evaluation of the surgical outcome for carpal tunnel syndrome (CTS). PATIENTS AND METHODS: Between January 2006 and December 2010, 61 hands of a total of 46 patients (7 males, 39 females; mean age 56.0±10.4 years; range, 20 to 71 years) with a diagnosis of CTS were retrospectively analyzed. All operations were performed by a single surgeon with a mini-incision distal to the transverse carpal ligament. At a mean follow-up of seven years after surgery, electromyography (EMG) was repeated for all patients. The Boston Carpal Tunnel Questionnaire (BCTQ), Boston Symptom Severity Scale, Boston Functional Status Scale, palmar pinch strength, grip strength, and EMG of the patients were compared before and after surgery. RESULTS: The mean follow-up was 84±10 (range, 72 to 104) months. There were significant improvements in the Boston Symptom and Functional Scale scores postoperatively, as well as in the grip and pinch strength. After surgery, EMG findings improved in 83.6% of the patients. However, there was no significant correlation between pre- and postoperative Boston Symptom Severity Scale scores, functional status, pinch and grip strengths, and pre- and postoperative EMG results. CONCLUSION: Our study results demonstrate that the symptom severity and functional status scores of the BCTQ are favorable, and this tool is reliable and easy-to-apply for the diagnosis and follow-up of CTS surgeries.

Pediatric tibial shaft and distal metaphyseal fractures.

OBJECTIVES: This study aims to investigate the effects of associated factors like age, fracture level, accompanying fibular fractures and wound condition on healing by determining and comparing union scores of pediatric tibial fractures (PTFs). PATIENTS AND METHODS: Forty-five patients with 46 PTFs (32 males, 13 females; mean age 9.5 years; range 2 to 16 years) who were treated by closed reduction and casting or operated between January 2016 and January 2019 were retrospectively evaluated. The union scores were evaluated at the end of fourth, sixth and eighth weeks and compared to each other. Effects of the age, associated fibular fractures, wound condition, fracture level and treatment type to union score were analyzed. RESULTS: Twenty-eight (60.9%) out of 46 PTFs had associated fibular fractures and 18 (39.1%) did not. Motor vehicle accident was the most frequent etiologic factor (47.8%). Thirty-four out of 46 fractures were closed tibial fractures (73.9%) and 12 had open wound (26.1%). There was a negative correlation between age and the union scores (p<0.001 for each week). No significant difference was observed between the union score of diaphyseal and metaphyseal fractures at the fourth, sixth, and eighth weeks. The union scores of each week were higher in the conservative group compared to operative group (p<0.001 for each week). Associated fibular fracture group had lower union scores compared to isolated tibial fracture group at fourth, sixth and eighth weeks. Likewise, the union scores of the open fracture group were lower than the closed fracture group (p<0.05 for each week). CONCLUSION: Associated fibular fractures, open fractures and aging negatively affect union scores of PTFs. Attention should be paid, particularly in these conditions, during the selection of the operation type and the follow-up period of PTFs.

Tenolysis rate after zone 2 flexor tendon repairs.

OBJECTIVES: This study aims to evaluate the tenolysis rates of zone 2 flexor digitorum profundus (FDP) with flexor digitorum superficialis (FDS) tendon repairs using four-strand technique and early passive motion exercises. PATIENTS AND METHODS: In this retrospective study, we performed zone 2 flexor tendon repairs in 149 patients (117 males, 32 females, mean age 33.3±12.9 years; range, 13 to 72 years) (82 right and 67 left hands) between November 2014 and January 2019. A total of 194 FDP and FDS tendons were repaired primarily by using modified Kessler and Bunnell methods. Patients underwent pure passive motion protocols after surgery according to modified Duran's protocol. No active flexion components were added until postoperative fourth week. RESULTS: Twenty-three out of 149 patients and 28 out of 194 fingers (14.43%) had tenolysis. There was no significant relationship between the number of operated fingers, gender, and tenolysis rate (p=0.836, p=0.584, respectively). CONCLUSION: The repair of the FDP with FDS tendon increases the tenolysis rate in zone 2. The tenolysis rate does not change according to the number or distribution of injured fingers and gender of the patient.

Tumorous conditions of the pediatric hand and wrist: Ten-year experience of a single center.

OBJECTIVES: This study aims to evaluate the distribution and prevalence of pediatric hand tumors and tumor-like lesions according to age and gender. PATIENTS AND METHODS: We retrospectively examined the details of hospital records of 646 patients who were operated for hand mass between January 2009 and January 2019 and whose pathological diagnosis was established in the same hospital. A total of 54 patients (18 males, 36 females; mean age 12.07 years; range, 3 month to 17 years) under 18 years of age who had been operated for the wrist or hand mass were included in the study. RESULTS: Out of 54 tumors, 53 were benign (98%) and one was malignant (2%). There were 42 soft tissue tumors (78%) and 12 bone tumors (22%). The most common soft tissue mass was ganglion cyst (n=12). Six out of 12 ganglion cysts were on the dorsal side of hand or wrist and six were on the volar side. The distribution of the tumors according to gender was not statistically significant (p=0.73). We had two recurrences: one patient with giant cell tumor of the tendon sheath and one with palmar fibromatosis. CONCLUSION: Pediatric hand/wrist masses are mostly benign tumorous conditions. The location of the pathologies may be different from the adults. Diagnosis of the tumor should be established carefully clinically and radiologically while malignant tumors should be kept in mind by both pediatricians and orthopedic surgeons.

Stepped osteotomy of femoral head autograft for acetabular reconstruction in total hip arthroplasty for dysplasia of the hip: 3 to 12 years' results.

OBJECTIVES: This study aims to describe a stepped osteotomy technique applied to the femoral head autograft to keep the graft volume at a sufficient level, provide primary stability, and direct cancellous-cancellous bone contact. PATIENTS AND METHODS: In this retrospective study, 24 hips of 20 patients (5 males, 15 females; mean age 53 years; range, 43 to 68 years) with dysplasia of the hip (DDH) who underwent total hip arthroplasty with femoral head stepped osteotomy technique were evaluated between April 2003 and June 2010. Patients' age, gender, operation side, and postoperative complications were recorded. Aseptic loosening of the acetabular cup and graft integration/resorption were evaluated radiographically. Radiological evaluations were performed according to the methods of DeLee and Charnley, and Mulroy and Harris. Functional status of the patients was determined according to the criteria of Merle d'Aubigné and Postel, and Harris hip score (HHS). RESULTS: The mean follow-up period was 5.5 years (range, 3 to 12 years). None of the patients had any complications in the early postoperative period. In all patients, the percentage of acetabular component coverage by the graft was measured as 27% (range, 19 to 38%) on average. At the last follow-up, all patients were satisfied with the result and there was no sign of clinically loosening, osteointegration was complete, and there was no radiographic evidence of graft resorption or collapse of any hip. The overall Merle d'Aubigné scores and HHSs of the patients significantly improved at the final follow-up. CONCLUSION: This stepped osteotomy technique increases the probability of osteointegration, reduces the need for early revision, and provides reliable stability with satisfactory clinical and radiological midterm results.

Glomus tumors of the nail bed: topographic anatomy and an algorithmic approach based on the topography.

PURPOSE: Glomus tumors are rare vascular pathologies characterized by a triad of symptoms: tenderness, pain and cold intolerance. In the hand they are highly concentrated under the nail bed. In this retrospective study, we aimed to present a topographic map of the location of glomus tumors in the nail bed and a map-based surgical approach algorithm to the subungual glomus tumors. METHODS: We prepared a nail bed map with 6 zones and named these zones as ulnar distal, ulnar proximal, central distal, central proximal, radial distal and radial proximal. With respect to the tumor location and the used surgical approach we retrospectively evaluated the intraoperative photos and the hospital records of patients who were operated between 2008-2019 and had the pathological diagnosis of glomus tumor. The examination records of the postoperative first year were evaluated for each patient retrospectively. A descriptive statistical analysis was performed. In addition we analyzed the described surgical approaches to excise a glomus tumor in the nail bed. The described approaches and the approaches used by us were matched with the localisation of the tumors in this study developing an algorithm for the surgical approach depending on the localisation of the nail bed glomus tumor. RESULTS: Finally 44 patients had inclusion criteria. The distribution of the glomus tumor was as follows: 2 were on ulnar distal (4.5 %), 9 on ulnar proximal (20.5 %), 1 on central distal (2.3 %), 18 on central proximal (40.9 %), 4 on radial distal (9.1 %) and 10 were on the radial proximal zones (22.7 %). 4 lateral approaches, 1 nail sparing and 39 transungual approaches were performed. We had one recurrence in a male patient operated by transungual approach. CONCLUSION: Glomus tumors are mostly located on the central proximal part of the nail bed. Our glomus map and the algorithm we described might be helpful for the selection of the surgical approach for the glomus tumor.

Associations between initial injury severity in acute hand, wrist or forearm injuries and disability ratings and time to return to work.

BACKGROUND: This study aimed to examine the relationships between the initial anatomic severity of hand, wrist and forearm injuries, as evaluated by the Modified Hand Injury Severity Score (MHISS), and each of the following parameters: disability rating and time to return to work. METHODS: In this study, 94 patients who underwent operations due to acute hand, wrist and forearm injuries were included. MHISS was used to assess the severity of the injury. Disability rates of the patients were calculated six months after injury in accordance with the 'Regulation on Disability Criteria, Classification and Health Board Reports to be Given to Disabled People'. The time to return to work was defined as the length of time (in days) between the injury and the patient's return to work. Spearman rank correlation analysis was performed to analyse correlations between the MHISS and each of the following: disability rates and time to return to work. RESULTS: The mean overall MHISS was 125.23 (5-880). The mean overall upper extremity disability ratio (UEDR) was 17.64±22.6 (range: 0-94), and the mean overall total body disability ratio (TBDR) was 10.57±13.45 (range: 0-56). Among the study population, 87 (92.6%) patients were able to return to their jobs. The mean overall time to return to work was 138.69 (range: 35-365 days). A statistically significant correlation was found between MHISS and UEDR, TBDR and time to return to work and UEDR, TBDR (p<0.001). CONCLUSION: As a result, as the initial injury severity increased, greater disability remained and the time to return to work increased. Predicting prognosis by determining the injury severity in the initial evaluation of patients may be important in predicting a patient's future permanent disability level, which can contribute to maintaining patient expectations at a reasonable level, thereby aiding in psychosocial support.

Surgical Treatment of Solitary Enchondromas of the Hand.

OBJECTIVE: The present retrospective study evaluated the clinical and radiologic results of patients who underwent complete curettage and autologous bone grafting for hand-located isolated enchondromas with a minimum follow-up period of one year. PATIENTS AND METHODS:  Thirty-two patients with a follow-up period of at least 12 months who underwent operation between August 2010 and October 2018 due to the presence of solitary enchondroma of the hand were included in the study. All patients underwent complete curettage and filling of the defect via autologous bone grafting. Autologous bone graft was harvested from the iliac crest and distal radius in 24 and eight patients, respectively. The patients underwent radiography on the first postoperative visit and at six weeks, 12 weeks, and annually. The range of movement of the finger joint was evaluated by comparing it with the healthy contralateral side. Functional outcomes and radiologic outcomes were evaluated. The frequency of complications and recurrences were established. RESULTS: Twelve patients were male and 20 were female. The average age was 34 (range: 16-56) years. The most common digit involved was the little finger (nine cases, 28.125%); the proximal phalanx was the most common location (17 cases, 53.125%). Control radiography in the sixth week revealed graft consolidation in all patients. No case of nonunion or recurrence was detected clinically or radiologically, with a mean follow-up period of 54 (range: 12-96) months. Functional outcomes were classified as excellent in 28 patients and as good in four patients. The final radiographic appearances included Tordai's group 1 in 28 bones and group 2 in four bones.  Conclusion: Curettage and autologous bone grafting are safe, costless, and effective treatment options for hand enchondroma, with satisfactory functional and radiographic outcomes. Harvesting bone graft from the distal radius provides a shorter length of hospital stay and lower complication rates compared to obtaining the graft from the iliac crest.

Acetabular fractures treated surgically: Which of the parameters affect prognosis.

BACKGROUND: This study aims to evaluate the surgical approaches, complications, clinical and radiological findings in acetabular fractures treated with surgical methods and to determine the parameters affecting prognosis. METHODS: Out of 144 patients undergone surgical treatment with the diagnosis of displaced acetabular fractures between 1994 and 2014, a total of 103 patients with 75 male and 28 female with a mean age of 36.3 years (range 19-67 years) whom clinical and radiologic follow-ups (mean: 34 months, range 2-8 years) were performed at least for two years were included in this study. RESULTS: Clinically excellent to good outcomes were obtained in 64% of the patients and moderate to poor outcomes were recorded in 36% of the patients, while radiologically excellent to good outcomes were achieved in 57.3%of the patients and moderate to poor outcomes were recorded in 42.7% of the patients. Presence of one of the complications, creating mechanical block (chi-square p<0.001), complex fractures (chi-square p=0.023), increased duration between trauma and operation (p=0.039), operational time taking longer than six hours (chi-square p<0.001), more than 3 mm intra-articular step (Fisher's p=0.033), avascular necrosis (p<0.001), arthritis (p=0.006) and heterotopic ossification (p=0.007) worsened the clinical outcomes (chi-square p<0.001). The age of the patient was not effective on the clinical outcome (p=0.461). CONCLUSION: It was found that three major parameters affecting the prognosis of acetabular fractures are as follows: type of fracture, operational time and reduction quality. The duration between trauma and operation indirectly affects the outcomes. Avascular necrosis, heterotopic ossification and arthritis may cause negative effects only on long term outcomes.

Distribution of intramuscular giant lipomas in the functional compartments of the forearm: a report of 12 cases.

PURPOSE: The aim of this study was to investigate the distribution of intramuscular giant lipomas in the functional compartments of the forearm and to compare their clinical, radiological and histopathological features with those reported in the current literature. METHODS: The study included 12 patients who were surgically treated for intramuscular lipomas > 5 cm in size located in the forearm that had been confirmed histopathologically between April 2006 and March 2017. Data about the patients with respect to age, sex, affected side, localisation of the lipomas in the forearm functional compartments, size, histopathological features and recurrence were collected. According to the clinical complaints, direct radiography and magnetic resonance imaging were applied. RESULTS: The average diameter was 6.5 cm (range: 5.5-9 cm). All lipomas had a well-defined border. All the patients presented with soft-tissue masses that were painless in seven patients. Five patients had nerve compression symptoms. When the lipomas were classified according to the functional compartments of the forearm, six of them were located in the superficial volar compartment, two in the deep volar compartment, two in the deep dorsal compartment and two in the lateral compartment. All lipomas were surgically removed by marginal excision. None had complications or recurrence at a mean of 6.5 years follow-up (range: 1-12 years) after surgery. CONCLUSIONS: Intramuscular lipoma is a relatively uncommon tumour, especially in the forearm. Because of the proximity to the neurovascular structures in the forearm, excision of lipomas should be performed with care and include wide incisions. Additionally, knowing the anatomical features of the compartment where the lipoma is localised in the forearm is important in planning surgery to enable easier dissection of the lipoma and lessen the risk of damage to adjacent neurovascular structures. LEVEL OF EVIDENCE: Level 4.

Deep palmar tumorous conditions of the hand.

PURPOSE: Deep palmar tumors of the hand are very rare, and reported cases are usually benign. The most important issue is frequent anatomical variations with challenging surgical exposure and excision of these lesions. Some case reports or a small series of patients have been reported in the literature. The aim of this study was to present our experience with the deep palmar tumors of the hand. PATIENTS AND METHODS: In the study, retrospective analyses of 43 patients treated with deep palmar tumors of the hand between January 1998 and June 2015 were evaluated. Tumors and tumor-like pathologies of the deep palmar space of the hand were retrospectively evaluated according to age, gender, localization, preoperative symptoms, size, site, treatment methods, histopathology, and early and late complications. Statistics and data analyses were also performed. RESULTS: All 43 pathologies were benign, and histopathologic diagnoses were 10 lipomas, 8 ganglions, 5 giant cell tumor of the tendon sheath, 4 schwannomas, 3 hemangiomas, 3 palmar fibromatosis, 2 epidermal cysts, 2 neurofibroma, 1 angiolymphoid hyperplasia with eosinophilia, 1 granuloma, 1 calcifying aponeurotic fibroma, 1 digital fibroma, 1 foreign body granuloma, and 1 lipofibromatous hamartoma. The most common complication was temporary numbness and paresthesias of the digits. Marginal excision was performed in 40 patients, excision with nerve grafting in 2 patients (with neurofibroma) and carpal tunnel release in one patient with lipofibromatous hamartoma. CONCLUSION: In the deep palmar space of the hand, pathologies are closely associated with tendons, muscles, and neurovascular structures. Preoperative magnetic resonance imaging is helpful for the preoperative diagnosis, evaluating tumor extension, and successful surgical planning. Level of Evidence: IV Therapautic.