[Assessment of the effects of surgical treatment options for cubital tunnel syndrome on the ulnar nerve by USG and EMG]. / Kübital tünel sendromunda cerrahi tedavi seçeneklerinin ulnar sinir üzerine etkilerinin USG ve EMG ile degerlendirilmesi.

OBJECTIVES: The morphology and functional results of the ulnar nerve were evaluated in patients treated with simple decompression and anterior subcutaneous transposition due to the diagnosis of cubital tunnel syndrome. PATIENTS AND METHODS: Thirteen elbows of 13 patients (8 males, 5 females; mean age 41 years; range 25 to 56 years) treated with simple decompression and anterior subcutaneous transposition due to the diagnosis of cubital tunnel syndrome were investigated. The involvement was on the dominant side in six patients. There was a 25° cubitus valgus deformity in one patient. No significant etiologic cause was found in the other patients. Seven patients were treated with anterior subcutaneous transposition and six with simple decompression. During the follow-ups, the atrophy magnitude, the new pressure areas and the intrinsic structure of the nerve tissue along the ulnar nerve path were evaluated by using soft tissue ultrasonography (USG). The flow rate of the artery supplying the ulnar nerve by Doppler mode USG and ulnar nerve conduction rate by electromyography (EMG) were assessed. Functional results were evaluated according to the Akahori's criteria and the modified Bishop scoring system. The average follow-up time was two years (range 12-44 months). RESULTS: In the Doppler USG examination, no arterial blood flow supplying the ulnar nerve was found in five of seven patients who underwent anterior transposition. A blood flow decrease of approximately 20 cm/s was found in two patients. A blood flow decrease of 10 cm/s on average was found in six patients who underwent simple decompression. There was a significant difference between the two groups (p<0.05). The control EMG revealed an increase of 9 m/s in the ulnar nerve conduction rate in the transposition group (p>0.05) and an increase of 17 m/s in the simple decompression group compared to the preoperative values (p<0.05). In seven patients who underwent anterior subcutaneous transposition, five excellent and two good results and an average of 8.2 points were achieved according to the Akahori's criteria and the modified Bishop scoring system, respectively. In six patients who underwent simple decompression, five excellent results, and one good result and an average of 8.1 points were achieved according to the Akahori's criteria and the modified Bishop scoring system, respectively. There was no statistically significant difference between functional results of both surgical techniques (p>0.05). CONCLUSION: Although the functional results of the cubital tunnel syndrome surgery are good, it must be noted that the blood supply to the nerve may be distorted, especially during anterior transposition. If there is no additional requirement, simple decompression may be considered as the first option.

[Approaches to distal humeral fractures in adults and comparison of treatment results]. / Eriskinlerde humerus alt uç kiriklarinda tedavi yaklasimlari ve sonuçlarin karsilastirilmasi.

OBJECTIVES: We compared the results of surgical techniques used in the treatment of distal humeral fractures. METHODS: The study included 22 patients (15 men, 7 women; mean age 52 years; range 21 to 80 years) who were treated for closed distal humeral fractures. The fractures were classified according to the Müller's classification (18 type 3, 4 type 4) and Mehne-Matta's classification of intraarticular fractures. Following open reduction, internal fixation was performed with the use of double reconstructive plates in seven patients (32%), multiple K-wires in eight patients (36%), and multiple screws in seven patients (32%). The mean follow-up period was 42 months (range 24 to 72 months). The results were assessed using the Mayo Elbow Performance Scoring system. RESULTS: The results were very good in five patients (22.7%), good in eight patients (36.4%), fair in five patients, and poor in four patients (18.2%). Valgus and varus deformities were found in six (27.3%) and three (13.6%) patients, respectively, and 12 patients (54.6%) had decreased muscle strength. Two patients (9.1%) in the K-wire group developed instability due to insufficient union. Heterotopic ossification was detected in five patients (22.7%). None of the patients had persistent or severe pain. Two patients (9.1%) were free of pain, while 11 patients (50%) had occasional and mild pain, and nine patients (40.9%) had moderate pain on activity. The mean Mayo Elbow Performance scores were 88, 72, and 55 with plate, screw, and K-wire applications, respectively. CONCLUSION: It was concluded that open reduction followed by internal fixation with double reconstructive plates was superior to K-wire and screw fixations in the treatment of distal humeral fractures.