Multidisciplinary treatment and functional outcome evaluation of combined injuries of nerves, vessels, and flexor tendons: spaghetti wrist.

OBJECTIVE: In this study, we aimed to evaluate the effectiveness of the modified Kessler technique in managing spaghetti wrist lacerations by multidisciplinary treatment. PATIENTS AND METHODS: Patients who were operated and followed up with the diagnosis of spaghetti wrist tears in our clinic between January 2012 and December 2020 were included in the study. In the postoperative follow-ups, the parameters evaluating the functionality of the patients were examined. RESULTS: Patients were 105 male (86.7%) and 16 women (13.2%), with a mean age of 36.83 ± 16.38 years. At the final follow-up, functional outcomes were assessed. The most common injury mechanism was glass-related injuries (35.5%). The mean starting surgery time of the patients was 4.64±2.98 hours. The most frequently involved structures were the palmaris longus with a rate of 51% and the flexor digitorum superficialis with a rate of 45%. There were significant differences regarding intrinsic function and grip strength between male and female patients (p = 0.04, p = 0.21, respectively). There were significant differences regarding sensation and grip strength between smoker and nonsmoker patients (p = 0.03, p = 0.01, respectively). The number of the damaged structures was negatively correlated with postsurgical functional outcomes of four tests, including tendon function, opposition, intrinsic function, and grip strength. The physical therapy period was correlated to hand function tests (r = 0.756, p < 0.05). Nerve damage was negatively correlated with sensation (p = 0.011, r = -0.932). CONCLUSIONS: The modified Kessler technique is reliable with functional outcomes for spaghetti wrist injuries involving tendons, nerves, and arteries. Meticulous and early surgical treatment within the first 8 hours of spaghetti wrist injury and early initiation and long-term physical therapy are vital in patients' functional outcomes.

Comparison of the results of percutaneous and open screw fixation in the treatment of scaphoid nonunion fractures.

OBJECTIVE: Our study aims to compare the clinical results of percutaneous screw fixation and non-vascularized bone grafting with open screw fixation in patients who did not achieve union due to failure in diagnosis and treatment after a scaphoid fracture. PATIENTS AND METHODS: Forty-three patients with scaphoid nonunion fractures corresponding to the first three Slade and Dodds classification were divided into two groups. Non-vascularized bone grafting with open reduction and internal fixation (ORIF) was applied to 24 patients in the first group, and 19 patients in the second group were treated with a closed reduction and internal fixation (CRIF) (percutaneous screw fixation). The patients were followed up for preoperative and postoperative functional scores and time to union. RESULTS: Our study found that the scaphoid was most commonly fractured in the waist of the scaphoid. In our study, we found that distal scaphoid fractures had the highest union rate (100%), followed by the waist fractures (93.2%) and the weakest union (50%) in the proximal pole fractures. We observed that the fastest union had occurred in the fractures of the waist. We also observed that the union was completed earlier in patients who operated with ORIF than those with CRIF. We found union in 87.5% of patients who underwent ORIF, in 84.2% of patients who underwent CRIF. CRIF operation duration was shorter than expected from ORIF operation duration. CONCLUSIONS: We found that similar union rates could be achieved in the patient groups who underwent percutaneous and open screw fixation by selecting the appropriate patient in scaphoid nonunion fractures. Union was faster and functional results were more satisfactory in the ORIF group. The operation time was shorter in the CRIF group.

Soft spot: the important zone at the standard posterior portal of shoulder arthroscopy

Background/aim: The localization of the standard posterior portal of shoulder arthroscopy and landmarks mentioned in the literature are unclear. The purpose of this prospective cadaveric study was to determine the localization of the standard posterior portal and its distance to the neural structures. Materials and methods: One fresh frozen and 10 formalin-fixed adult cadaveric shoulders were dissected. In the beach chair position, a 5-mm trocar was placed anteroposteriorly from the superior edge of the subscapularis muscle, superior to the tip of the coracoid process and tangent to the glenoid. The relevant distances of the posterior exit point were measured. Results: In all specimens, the exit point was a triangular fibrous area, between the posterior and lateral parts of the deltoid. Medial and inferior distances of the trocar to the posterolateral tip of the acromion were 1.88 ± 0.53 cm and 1.35 ± 0.34 cm and distances to the axillary and suprascapular nerves were 4.54 ± 1.08 cm and 2.54 ± 0.85 cm, respectively. Conclusion: The most important finding of this study was the superficial localization of the soft spot between the posterior and lateral parts of deltoid.

Evaluation of corpus callosum morphometry in patients with mesial temporal lobe epilepsy with hippocampal sclerosis.

PURPOSE: The purpose of the study was to evaluate the effects of mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) on corpus callosum (CC) morphometry in large and pathologically proven MTLE-HS patients. METHODS: We measured certain CC dimensions in 103 patients and 33 healthy controls using in vivo magnetic resonance imaging. In particular, we compared the two groups in relation to the clinical (localization of the HS, duration of epilepsy, frequency of seizures and length of seizures) and demographical (age, gender, handedness) features. Students' t test, two-way ANOVA and Spearman test were used for statistical analysis. RESULTS: There was no significant difference between CC morphometry with respect to age and handedness among patients. The differences between the genders, however, were significant favouring longer diameters in males. We found significant decrease in the dimensions of the genu, body, isthmus and splenium of the CC in the MTLE-HS group, but there was no reduction in the size of the rostrum. CONCLUSIONS: This general reduction in the size of the CC except for the rostrum was thought to be the result of cortical atrophy secondary to the disease. Concerning the preserved rostral part of the CC, it was thought that the fibers of the frontal lobe pass through different pathways than the tracts in the rostrum.