[The effect of dorsal cortical comminution on radiographic results of unstable distal radius fractures treated with closed reduction and K-wire fixation]. / Kapali redüksiyon ve K-teli ile tedavi edilen radius alt uç kiriklarinda dorsal korteks parçalanmasinin radyografik sonuçlara etkisi.

OBJECTIVES: The purpose of this study was to evaluate the effect of dorsal cortical comminution on radiographic outcome of unstable distal radius fractures after treatment with closed reduction and K-wire fixation. METHODS: Forty-two patients were treated with closed reduction and K-wire fixation for unstable, extra-articular distal radius fractures with dorsal angulation. The patients were evaluated in two groups depending on the presence or absence of dorsal metaphyseal cortical comminution observed as a radiopacity on lateral radiographs. Thus, 30 patients (13 males, 17 females; mean age 56 years; range 22 to 77 years) did not have dorsal cortical comminution, whereas 12 patients (8 males, 4 females; mean age 48 years; range 18 to 76 years) did. The mean follow-up period was 8.8 months (range 3 to 106 months) in the former, and 5.5 months (range 3 to 131 months) in the latter groups. Radiographic parameters were compared including palmar tilt measured on lateral, radial inclination and radial length on posteroanterior radiographs obtained before treatment and after union. RESULTS: Radial inclination, palmar tilt, and radial length showed significant improvements in both groups (p<0.05). The results were acceptable in all the patients with achievement of standard reference values. The presence of dorsal cortical comminution did not have any significant effect on radiographic parameters (p>0.05). No significant complications were encountered during the follow-up period. CONCLUSION: Dorsal cortical metaphyseal comminution does not have an adverse effect on radiographic results. Treatment with closed reduction and K-wire fixation is safe and effective even in the presence of dorsal cortical comminution.

[The importance of finger extension test in the diagnosis of occult wrist ganglion]. / Okült gangliyon tanisinda parmak ekstansiyon testinin önemi.

OBJECTIVES: The aim of this study was to evaluate the accuracy of diagnostic tools in comparison with surgical results of occult ganglion cyst of the wrist, which is one of the causes of chronic wrist pain. METHODS: Twenty-five patients (4 males, 21 females; mean age 29 years; range 16 to 46 years) underwent surgery with an initial diagnosis of occult ganglion following unsuccessful conservative treatment. The mean symptom duration was 29 months (range 3 months to 10 years). Diagnosis was based on finger extension test performed in 24 patients. Six patients and 13 patients were assessed by ultrasonography and magnetic resonance imaging (MRI), respectively. Interosseous neurectomy was performed in three patients. The mean follow-up was 31 months (range 6 to 72 months). RESULTS: Occult dorsal ganglion was resected from the scapholunate interval in 22 patients (88%). No ganglion was found in three patients, who had only degeneration of the scapholunate ligament. Finger extension test was positive in 23 patients. One patient with a negative test result was found to have degeneration of the scapholunate ligament. The test yielded two false positive results, one of which was negative by MRI. Surgical confirmation was achieved in 11 patients evaluated by MRI and in four patients evaluated by ultrasonography. Diagnostic accuracy rates for MRI, ultrasonography, and finger extension test were 92%, 66%, and 92%, respectively. Two patients (8%) underwent reoperation for recurrence. None of the patients complained of instability in the late period. Except for one patient, all patients (96%) were asymptomatic at final evaluations. CONCLUSION: Finger extension test is an important diagnostic tool for occult ganglion with 92% accuracy. Both diagnosis and treatment of occult ganglion cysts have become easier by evolving diagnostic tools.

[Assessment of quality of life of patients after hemiarthroplasty for proximal femoral fractures]. / Femur üst uç kiriklari nedeniyle hemiartroplasti ile tedavi edilen hastalarda yasam kalitesinin degerlendirilmesi.

OBJECTIVES: The quality of life of patients was assessed with the SF-36 Health Survey following hemiarthroplasty for hip fractures. METHODS: Forty patients were divided into two groups according to the type of hip fracture. Group 1 included femoral neck fractures (24 patients; 21 women, 3 men; mean age 76 years; range 64 to 94 years) treated with straight stem prostheses. Group 2 included intertrochanteric femoral fractures (16 patients; 13 women, 3 men; mean age 81 years; range 62 to 102 years) treated with calcar replacement prostheses (Leinbach). The SF-36 questionnaire was administered before and at least six months after surgery to assess changes in the quality of life. The effect of gender, fracture type, and the type of prosthesis on the SF-36 scores were examined. RESULTS: In group 1, the mean preoperative and postoperative physical health scores were 53.4 and 41.7, the mean mental health scores were 55.2 and 48.5, respectively. The mean corresponding scores were 52.8 and 35.1 for physical health, and 55.2 and 48.9 for mental health in group 2, respectively. Significant decreases were found in physical health and mental health scores postoperatively (p<0.05), with all the patients having decreased quality of life compared to the preoperative levels. The highest decrease was observed in physical role (56.8%), followed by physical function (42.8%) and mental role (42.9%) scores. The least affected were mental health (10.3%) scores. Gender, fracture type, and the type of prosthesis were not found to have a significant effect on the summary scores (p>0.05). CONCLUSION: Health related quality of life significantly decreases following hemiarthroplasty in elderly patients with hip fractures. Nonetheless, arthroplasty procedures enable these patients to maintain basic activities of daily living.