Ten-Year Follow-Up of Lower Limb Replantation: Objective Evaluation With Gait Analysis.

ABSTRACT: The decision-making process for lower limb replantation involves several critical factors, such as age, comorbidities, ischemia time, type of injury, and psychosocial considerations. Advances in microsurgical techniques have led to a greater focus on enhancing functionality through limb salvage. To improve functional outcomes, it is essential to gain a better understanding of the current challenges in reconstruction and address them in future cases. Objective functional analysis of lower extremity replantation cases holds the potential to guide us in this endeavor. In this report, we present a lower limb replantation case with a 10-year follow-up, including objective functional evaluation with gait analysis.

The relation between ischemia modified albumin levels and carotid intima media thickness in patients with rheumatoid arthritis.

BACKGROUND: Cardiovascular diseases, among which atherosclerotic heart disease, are known to be one of the most important mortality and morbidity causes in patients with rheumatoid arthritis (RA). Ischemia modified albumin (IMA) is a potential marker that can be used to assess atherosclerosis-related myocardial ischemia. Another frequently used marker for the assessment of atherosclerotic lesions is the carotid intima media thickness (CIMT). AIM: To evaluate the role that IMA has on atherosclerosis development and its clinical usability in patients with RA, by assessing the values of IMA and CIMT. METHODS AND MATERIALS: Our prospective study was conducted between June 2012 and March 2013 at the Rheumatology Department of Necmettin Erbakan Meram Medical School, Turkey. Fifty-two RA patients, diagnosed according to the 1987 criteria of the American College of Rheumatology, and an age- and sex-matched control group of 46 healthy subjects were included in this study. RESULTS: No significant difference was detected between the groups with respect to age, sex and body mass index. In the patient group the IMA and CIMT values were found to be 0.37 ± 0.12 absorbance units (ABSU) and 0.80 ± 0.22 mm, respectively, while in the control group they were 0.31 ± 0.11 ABSU and 0.51 ± 0.18 mm, respectively. The IMA and CIMT values were significantly higher in the patient group (P = 0.022 and P < 0.0001, respectively). A positive correlation was found between IMA, CIMT and Disease Activity Score of 28 joints (P = 0.016 and P = 0.002, respectively). CONCLUSION: Since the values of IMA were higher in the patient group compared to controls and because of its correlation with CIMT, we suggest the use of IMA as an early marker of atherosclerosis in RA patients.

Evaluating neuropathic complaints by DN4 and LANSS scales after local corticosteroid therapy in carpal tunnel syndrome.

BACKGROUND/PURPOSE: The purpose of this study was to evaluate the neuropathic symptoms after local steroid injection in CTS. Since 2001, neuropathic pain scales have been used in the assessment and follow-up of neuropathic pain. DN4 and LANSS pain questionnaires have been applied to groups, mostly consisted of radiculopathy and polyneuropathy cases, before and after various treatments and the results have been compared with the electrophysiologic findings. However to our knowledge there is yet no such study focusing on neuropathic complaints and the relationship between neuropathic pain and electrophysiological findings before and after local corticosteroid injection. METHODS: Forty-one patients aged 22-65 years and diagnosed with carpal tunnel syndrome by nerve conduction studies who were also found to have neuropathic symptoms were included in the study. All patients received local steroid injection into the carpal tunnel while the questionnaires and nerve conduction studies were performed before and 2 months after the injection. RESULTS: Local steroid injection was found effective on clinical and electrophysiologic parameters as well as on DN4 and LANSS scores in CTS patients (p< 0.05). Electrophysiologic severity exhibited no statistically significant relationship with DN4 and LANSS scores, before and after treatment (p> 0.05). CONCLUSION: These findings suggests that the treatment of neuropathic complaints should be planned independently from the electrophysiologic findings and minimally invasive local steroid injection appears to be effective with regard to clinical and electrophysiologic aspects in CTS patients with neuropathic complaints.

Palmar contracture release with arterialized venous instep flap: An anatomical and clinical study.

BACKGROUND: Plantar skin has similar histologic features to the palmar area and appears to be the ideal tissue for reconstruction of the palmar region. In this study, an anatomic examination was performed to determine the superficial venous architecture of the instep area, and the use of arterialized venous instep flaps for palmar contracture release was assessed. METHODS: The anatomical study was performed on 12 fresh cadaver feet. The arterialized venous instep flap, including the skin, subcutaneous tissue and superficial venous plexus, was harvested. To determine the venous structure, dissection (n = 6) and injection-corrosion (n = 6) techniques were used. In the clinical study, nine arterialized venous instep flaps were used for palmar contracture release. All flaps were harvested above the deep fascia and included skin, subcutaneous fat, and the superficial venous plexus. At the plantar site of the flap, two or three veins, one of which was used, were dissected for a sufficient length for the arterial anastomosis. The saphenous vein was used for the venous anastomosis. RESULTS: Dissection and injection-corrosion techniques revealed that the flap had 7-12 and 4-6 veins at its plantar and superior edges, respectively, with numerous anastomoses and interconnections between the veins. The flap dimensions were between 3 × 5 cm and 4 × 6 cm. All flaps survived, with two partial flap necrosis that healed with spontaneous epithelization. No debulking procedures were undertaken and all flaps adapted well to the recipient site. CONCLUSIONS: The arterialized venous instep flap is a good alternative to reconstruct palmar contractures by adding similar tissue that is thin and pliable with minimal donor site morbidity.

An important cause of pes planus: the posterior tibial tendon dysfunction.

Posterior tibial tendon dysfunction (PTTD) is an important cause of acquired pes planus that frequently observed in adults. Factors that play a role in the development of PTTD such as age-related tendon degeneration, inflammatory arthritis, hypertension, diabetes mellitus, obesity, peritendinous injections and more rarely acute traumatic rupture of the tendon. PTT is the primary dynamic stabilizer of medial arch of the foot. Plantar flexion and inversion of the foot occurs with contraction of tibialis posterior tendon, and arch of the foot becomes elaveted while midtarsal joints are locked and midfoot-hindfoot sets as rigid. Thus, during the walk gastrocnemius muscle works more efficiently. If the PTT does not work in the order, other foot ligaments and joint capsule would be increasingly weak and than pes planus occurs. We present a 10-year-old female patient diagnosed as PTTD and conservative treatment with review of the current literature.

Nineteen reasons why physiatrists should do musculoskeletal ultrasound: EURO-MUSCULUS/USPRM recommendations.

This article is an eventual consensus of experts from the European Musculoskeletal Ultrasound Study Group (EURO-MUSCULUS) and the Ultrasound Study Group in Physical and Rehabilitation Medicine (USPRM) pertaining to the use of musculoskeletal ultrasound in physical and rehabilitation medicine. Nineteen important reasons (as regards general advantages, specific conditions in physical and rehabilitation medicine, as well as comparisons with other imaging tools) have been highlighted to consolidate the scenario of how/why the probe of ultrasound needs to become the stethoscope, the extended hand, and the pen of physiatrists.

Ultrasonographic evaluation of the flexor pollicis longus tendon in frequent mobile phone texters.

OBJECTIVE: The aim of this study was to assess flexor pollicis longus tendon by using ultrasound imaging in frequent mobile phone texters. SUBJECTS: In total, 149 subjects, aged 18-40 yrs, were recruited as frequent mobile phone texters (n = 71) and infrequent texters (n = 78). METHODS: Demographic data and estimate frequency of texting were noted. Thumb pain during activity, range of motion for thumb joints, grip and pinch strengths, and Quick Disabilities of arm, shoulder, and hand were evaluated. Standardized bilateral ultrasound evaluations were performed using a linear array probe, and tendon area measurements were done with axial imaging at midthenar region and midproximal phalangeal region with manual trace technique. RESULTS: The groups were similar except for the mean estimate number of messages/month (P = 0.001). Whereas grip and pinch strength values were significantly higher (frequent texter group, P = 0.001; infrequent texter group, grip strength P = 0.018; pinch strengths, P = 0.001) on the texting side in both groups, flexor pollicis longus tendons were larger (P = 0.001) and the activity pain was higher (P = 0.005) on the texting sides only in the frequent texter group. Flexor pollicis longus thickness significantly correlated with messages/month only in the frequent texter group (r = 0.592, P = 0.001). CONCLUSIONS: Flexor pollicis longus tendons seem to be thicker at the midthenar level in subjects who frequently use mobile phone texting. Because this increase in thickness parallels the number of messages per day, the authors believe that further studies are needed to elucidate whether such changes become problematic later on in life.

Nurse's Knowledge of Neuropathic Pain.

The aim of our study was to determine the levels of information and awareness of the nurses who work on neuropathic pain in the departments of physical medicine and rehabilitation, neurology and neurosurgery. A total of 60 nurses (20 per each department) who work in the physical medicine and rehabilitation, neurology and neurosurgery departments of Beyhekim State Hospital of Konya in Turkey took part in the study. The level of information and awareness of the nurses on neuropathic pain were assessed via a questionnaire prepared by specialists in the light of recent literature. The questionnaire was composed of 30 questions including the definition, symptoms, treatment and management of neuropathic pain. None of 60 nurses participating in the study were given any previous in-service training on neuropathic pain. According to the assessments, 80% of nurses (48) were found not to have sufficient knowledge about definition of neuropathic pain; 83.3% (50) about diseases causing neuropathic pain; 83.3% (50) about symptoms of neuropathic pain; and 90% (54) about management of neuropathic pain. The findings obtained from the nurses of these three departments showed no statistically significant relation. Our findings indicated that the knowledge of participants' about neuropathic pain who work in these three departments seriously lack of information. Informing nurses about neuropathic pain during in-service training will be an important step towards improving the quality of services provided.

Ultrasonographic assessment of the femoral cartilage in osteoarthritis patients with and without osteoporosis.

BACKGROUND: The relationship between osteoporosis (OP) and osteoarthritis (OA) is yet unclear. AIM: To evaluate the possible effect of OP on the femoral cartilage thickness in female patients with knee OA. MATERIALS AND METHODS: Eighty patients with a diagnosis of knee OA were enrolled. Forty subjects who also had OP comprised Group I and the remaining 40 OA subjects comprised Group II. Antero-posterior knee radiographs were obtained in standing position and they were evaluated according to Kelgren-Lawrence (K-L) grading scale. Femoral cartilage evaluations were performed using a linear array US probe (7-12 MHz). In addition, ultrasonographic femoral cartilage grading was also performed for each knee. RESULTS: Left knee scores pertaining to both gradings were found to be lower (p = 0.02, p = 0.04, respectively) in Group I when compared with those of Group II. The two grading scores were positively correlated for both knees-statistically significant only for the right side (r = 0.727, p = 0.01). No significant difference was found between the groups in terms of femoral cartilage thicknesses (all p > 0.05). DISCUSSION: Ultrasonographic and roentgenographic gradings were consistent and patients with OP had lower scores for both gradings. On the other hand, the presence of OP did not seem to have any effect on cartilage thickness measurements. CONCLUSIONS: To the best knowledge of the authors, this study is the first to have explored the impact of OP on OA using US in the literature.