Value of anatomic landmarks in carpal tunnel surgery.

This study investigated which anatomic landmarks were most useful for correct and safe incision placement in carpal tunnel surgery. Kirschner wires were attached to the hands to mark previously defined landmarks. The bony attachments of the transverse carpal ligament, which were identified previously, were drawn on an anteroposterior digital x-ray of the hand, with the thumb in full abduction. The relationship between anatomic landmarks and these bony attachments were examined. In all hands, either the line along the third web space or the crease between the thenar and the hypothenar regions, or both, were on the ulnar half of the transverse carpal ligament. During incision placement, we recommend selecting the most ulnar choice between the line drawn along the third web space and the crease between the thenar and hypothenar regions in order to be at safe distance from the recurrent motor branch of the median nerve.

Neglected patellar tendon rupture: a case of reconstruction without quadriceps lengthening.

Neglected rupture of the patellar tendon is a rare, can be easily missed in a group of patients. We present a 24 year old, male patient who sustained right femoral diaphyseal and tibial plateau fractures and a patellar tendon rupture following a motor vehicle accident. The fractures were treated by open reduction internal fixation but the patellar tendon rupture was missed and the diagnosis was delayed by 7 months. Patella was migrated proximally. It was moved distally to the original location and neglected patellar tendon rupture treated successfully with modified Ecker technique. Neither preoperative traction nor additional intraoperative procedures were performed to relocate the patella to its anatomic position in the extended knee and good functional result was achieved with intensive rehabilitation.

A new classification and guide for surgical treatment of spinal tuberculosis.

So far, there is no widely accepted classification system based on objective findings that can serve as a guide in selecting the treatment method for spinal tuberculosis. This retrospective study evaluates patients with spinal tuberculosis (Pott's disease) treated with different surgical procedures. Our aim was to outline a new classification of spinal tuberculosis. A retrospective review of 76 cases (55 male and 25 female patients) of spinal tuberculosis was conducted. Five of the patients were treated medically, and the others who were treated surgically were classified into three types (I, II and III) according to the new classification system for spinal tuberculosis. All 76 patients were classifiable by this new system. The most common complication observed was local kyphosis (maximum 8 degrees) in type-II patients, but none of the patients needed correction. No neurological deterioration was observed in any of the cases. This new classification system helps in differentiating the various manifestations of spinal tuberculosis and appears to correlate with the surgical treatment of spinal tuberculosis. We believe that this new classification system can be used as a practical guide in the treatment of Pott's disease.

Outcomes of acute arthroscopic repair and conservative treatment following first traumatic dislocation of the shoulder joint in young patients.

INTRODUCTION: The aim of this study was to compare patients who had arthroscopic repair done following the first traumatic dislocation with patients who were treated conservatively, in terms of stability and function. MATERIALS AND METHODS: Acute arthroscopic Bankart repair with absorbable tack was used in 30 shoulders after the first dislocation, while 32 patients who sustained traumatic anterior dislocation were treated conservatively at Gülhane Military Medical Academy, Department of Orthopaedics and Traumatology between March 1997 and April 2001. Preoperative and postoperative range of motion of the shoulder and Constant score of all patients were recorded. RESULTS: In the conservative group, the average pretreatment Constant score was 46.8 (range, 30 to 70) and the average post-treatment Constant score was 71.4 (range, 30 to 95). In the surgical group, the average preoperative Constant score in cases with Bankart lesion was 44.7 (range, 30 to 60) and the average postoperative Constant score was 92.3 (range, 65 to 100), (P = 0.0001). CONCLUSION: Our results support the use of acute arthroscopic repair of traumatic anterior shoulder dislocations with absorbable tacks. Arthroscopic repair is the treatment of choice in young and active patients who are having their first traumatic dislocation.

Surgical treatment results in scaphoid nonunion.

Fracture of the scaphoid is the most common fracture in the wrist. We retrospectively reviewed 42 cases of established nonunion of the scaphoid that had been treated by four methods: with two Kirschner wires (K wires) and pronator quadratus pedicled bone graft in 5 patients; AO cannulated screw and graft in 8 patients; Herbert screw and graft in 19 patients; and two K wires and graft in 10 patients. Follow-up ranged from 1 to 5 years (between January 1995 and January 2000). Radiographs and computed tomography (CT) scans were analyzed for confirmation of osseous union. The average period of clinical and radiologic union was 13.2 weeks (range, 10 to 33 weeks). There was a significant improvement in the grasping power, radiologic healing, clinical satisfaction, and pain relief in the patients who had operation.

Reduction of restrictive adhesions by local aprotinin application and primary sheath repair in surgically traumatized flexor tendons of the rabbit.

The effects of microsurgical and medical treatments on reduction of adhesions in surgically traumatized flexor tendons of rabbits are quantified in this study. The effects of the mentioned techniques were investigated for the following 4 groups: (1) neither primary sheath repair nor aprotinin application was done, (2) primary sheath repair was done but no aprotinin was used, (3) primary sheath repair was not done but local aprotinin (15,000 IU/kg) was applied, and (4) primary sheath repair was done and local aprotinin was applied. At the sixth and twelfth postoperative weeks, the flexor digitorum profundus tendons of the second and the third digits were subjected to biomechanical tests. Only the third digit was used in macroscopic and histopathologic evaluations. There were 6 digits included in each subgroup of biomechanical tests and 4 digits per subgroups in macroscopic and histopathologic evaluations. Work of flexion (WOF) values were obtained by calculating the area under the load-displacement curve. Percent resistive work of flexion (PRWOF) was obtained by calculating the difference between the WOF value for the repaired right digit and the WOF value for the contralateral corresponding nonrepaired digit. Combined primary sheath repair and medical treatment yielded the best results in reducing the restrictive adhesions in injured tendons. The differences between the PRWOF values of group 4 were 33.7% +/- 8.2% and 15.8% +/- 7.7% for the sixth and twelfth postoperative weeks, respectively. The corresponding values for group 1 were 95.7% +/- 13.8% and 51.75% +/- 10.25%.