Relative Motion Extension Splint after Extensor Tendon Reconstruction.

Recently, the wide-awake local anesthesia no tourniquet (WALANT) technique and relative motion extension (RME) splint changed practice in extensor tendon reconstruction and therapy. We wanted to share our approach for zones 5 to 8 extensor tendon management following the up-to-date developments. The impacts of surgery under WALANT and early active motion therapy with RME splinting were explained frankly and shown in several videos throughout the article.

Comparison of single and double incision leg fasciotomy in disaster settings-Experience from 2023 Türkiye earthquakes.

INTRODUCTION: Although there are studies comparing methods for leg fasciotomy in compartment syndrome after fractures, choice of single or double fasciotomies in disasters was not investigated. The aim of this study was to compare the efficacy of single and double incision leg fasciotomy in the setting of disaster. METHODS: Patients that have undergone fasciotomy after 2023 Kahramanmaras earthquakes were retrospectively analyzed. The cases were separated into two groups as single incision and double incision according to the method of the first fasciotomy. The number of debridements after each fasciotomy, muscle group excisions, completion time of treatment, presence of amputation, the method of closure (primary closure or graft/flap) and positive results of wound cultures were analyzed and compared between two groups. RESULTS: 62 legs of 52 patients (22 females, 30 males, age 36.9 ± 11.2 years) with compartment syndrome that have undergone fasciotomy after 2023 Kahramanmaras earthquakes were included in the study. Single-incision group included 27 legs and double incision group included 35 legs. Amputation was needed in 15 patients (%24.2), six in single incision group and nine in double incision group. (p = 0.75). Compartment excision (eight patients in single incision, nine patients in double incision groups, p = 0.81), number of debridements (median 4 in both groups, p = 0.55), wound closure time (median 17 days in single incision, 22 days in double incision groups, p = 0.52), graft or flap requirement (11 patients in single incision, 16 patients in double incision groups, p = 0.53), positive culture results (15 patients in single incision, 16 patients in double incision groups, p = 0.44) were not different statistically between two groups. CONCLUSION: Single and double incision fasciotomy methods are equally effective and safe in treatment of compartment syndrome of the leg in disaster situations. To our knowledge, this is the first study comparing outcomes of single and double incision fasciotomy in disaster settings.

Pinch strength analyses in lacertus syndrome.

PURPOSE: Lacertus syndrome is defined as proximal median nerve entrapment at the lacertus fibrosus. We aimed to analyze change in pinch strengths in patients who underwent median nerve release at the lacertus fibrosus under WALANT (wide-awake local anesthesia, no tourniquet). METHODS: Pinch strength was measured with a pinch gauge. Subjective DASH score and pain, numbness in the operated extremity and satisfaction on visual analog scales were analyzed before and 6 weeks after surgery. RESULTS: There were 32 patients. Median nerve release under the lacertus fibrosus elicited statistically significant increases in tip-to-tip, lateral and tripod pinch strength at postoperative week 6. Improvements in DASH score, pain and paresthesia were also statistically significant. CONCLUSIONS: For lacertus syndrome treatment, mini-incision release of the lacertus fibrosus under WALANT was satisfactory and increased pinch strength significatively. LEVEL OF EVIDENCE: Therapeutic, Level IV - Case series.

Outcomes of bipedicle V-Y 'cup' flap for repair of volar oblique fingertip amputations.

We used bipedicle V-Y 'cup' flaps to reconstruct 13 consecutive volar oblique fingertip amputations encountered in a nearly 2-year period. All flaps survived completely with no bone protuberance, scarring or neuroma evident at the end of follow-up (mean, 7 months; range 4-13 months). Two of the 13 patients had moderate or severe tenderness, three had moderate or severe cold intolerance and two had noticeable hook nails. There were no significant (≥10°) flexion contracture in the interphalangeal joints. The mean static two-point discrimination score was 4 mm (range 3-6) and the modal Semmes-Weinstein monofilament test score was 3.6 g (range 3.2-4.2). All patients were satisfied with their surgical outcomes. The bipedicle V-Y 'cup' flap provides good results in terms of fingertip contour, padding and sensation, and has a low complication rate when used to treat volar oblique fingertip amputations.Level of evidence: IV.

Triggering Thumb Is Not Always a Trigger Thumb.

Although rare, the thumb can trigger because of de Quervain disease. An 18-year-old woman presented with painful triggering during thumb movements. Physical examination revealed locking upon thumb extension and painful snapping upon thumb flexion, with tenderness over the first extensor compartment. During the ultrasonography examination, the extensor pollicis brevis tendon snapped with a jerky movement. According to intraoperative active movement under wide-awake local anesthesia no tourniquet, only the extensor pollicis brevis tendon subcompartment was released, and the snapping was resolved. The patient was symptom-free at the second postoperative week control. Triggering because of de Quervain tenosynovitis is a rare condition, and surgical release is required in most cases. Dynamic ultrasonography is an effective tool for precise preoperative assessment of pathology and assists surgical planning. Surgery under wide-awake local anesthesia no tourniquet is advised, which helps intraoperative assessment of pathology and ensures accurate treatment.

Clinical outcomes of the oblique V-Y advancement pulp flap for repair of lateral fingertip injuries.

We report the use of obliquely oriented V-Y advancement pulp flaps to reconstruct 17 consecutive, lateral oblique fingertip traumatic defects over a 2-year period. All flaps survived completely with no bone protuberance, prominent scar or neuroma evident at an average follow-up of 11 months (range 7 to 19). Although there was no incidence of severe hook nail deformities, there were two patients who had residual mild hook nails, two with pulp/nail asymmetries and one with an ingrown nail. The mean static two-point discrimination was 3.9 mm (range 2 to 8) and the mean Semmes-Weinstein monofilament test score 3.6 g (range 2.44 to 4.56). No correlation was found between the flap obliquity angle and sensory test results. We recommend the obliquely oriented V-Y pulp flap as a reliable reconstructive option for the cover of lateral oblique fingertip defects.Level of evidence: IV.

Patient satisfaction after innervated digital artery perforator flap for fingertip injuries.

OBJECTIVE: The aim of this study was to evaluate the results of the innervated digital artery perforator (IDAP) flap and to analyze the relationship between patient satisfaction and outcome measures. METHODS: A total of 17 fingertips of 15 patients (14 men and one woman; mean age: 47.2 (26-62) years) were included in this retrospective study. Patients' injured finger and defect type were recorded. At the last follow-up, the static two-point discrimination (s2PD) test, Semmes Weinstein monofilament (SWM) test, and range of motion of the affected finger were analyzed. We interviewed patients to determine hand dominance, cold intolerance, and their satisfaction with the result. We performed correlation and logistic regression analyses between patient satisfaction and outcome measures. RESULTS: The mean follow-up period was 13.8 (7-18) months. The mean range of motion was 77.3±3.5 (70-80) degrees for the distal interphalangeal joints of affected fingers. The mean s2PD was 6.4 (3-10) mm, and the SWM records ranged from 2.83 to 4.93 monofilament markings. Cold intolerance was noted in seven fingers (41%). Patient satisfaction was negatively correlated with cold intolerance, and cold intolerance decreased as the follow-up period extended. CONCLUSION: IDAP flap satisfies both patient and surgeon, with the only significant problem being cold intolerance, regarding which patients must be informed. Although cold intolerance is hard to treat, fortunately, it generally improves with time. LEVEL OF EVIDENCE: Level IV, Therapeutic study.

Spiked railing penetration that causes injuries in the upper extremities of children.

BACKGROUND: Children have a curiosity for climbing walls, stairs, and railings and have an increased risk of falling. Here, we report our experience with railings causing injuries by penetrating the upper extremities, and aim to call attention to spiked railing injuries in children. METHODS: We report on five children with a mean age of 8.8. All of the children were male. The penetrating railing parts were removed in a surgical room. RESULTS: The injured structures repaired immediately were as follows: flexor digitorum profundus tendon, A4 pulley, volar plate of the distal interphalangeal joint, radial digital nerve, ulnar digital artery, and radial digital artery. CONCLUSION: Spiked railings can lead to significant injury that requires further exploration. Boys particularly are at risk, and parents should be alert regarding these type of injuries. We recommend a standard regulation for fence erection, and we wish to warn owners of this type of fence regarding probable legal sanctions.