Treatment of persistent large cystic lesions of the humerus with vascularized fibular grafts

Objectives: In this study, we aimed to evaluate the short-to -mid-term results of the resection and reconstruction of large cystic lesions of the humerus. Patients and methods: Eight male patients (median age: 22.9 +/- 10.4 years; range, 12 to 42 years) with large cystic lesions of the humerus operated between January 2017 and December 2019 were retrospectively analyzed. The age of the patients, their previous treatments and follow-up periods, the size and location of the cysts, postoperative functional scores, presence of a union, recurrence of the cyst, and graft resorption were examined. Results: The mean follow-up was 42.8 +/- 7.5 (range, 34 to 54) months. Preoperatively, the mean length of the cystic lesions was 15.1 +/- 2.6 (range, 10 to 18) cm. At the final follow-up, the patients had a normal range of shoulder flexion-extension, internal rotation-external, abduction-adduction, and elbow flexion-extension, pronation-supination. The patients had a mean DASH score of 1.13 +/- 1.1 (range, 0 to 3.3) and MSTS score of 28.75 +/- 1.8 (range, 26 to 30) postoperatively. Complications such as pseudoarthrosis, graft resorption, or cyst recurrence were not observed in any of the patients. Conclusion: Although the risk of recurrence is low in small cystic lesions of the humerus, it increases as the size of the lesion increases. This reconstruction technique using vascularized fibular grafts, which we applied, seems to be extremely successful in ensuring biological healing and preventing recurrence and complications in patients with large cystic lesions of the humerus

Determination and ecological evaluation of Meydanköy Boxwood Forest land characteristics in Firtina Watershed using of GIS

Hızlı sanayileşme, değişim ve aşırı tüketim çok ciddi çevresel sorunları da beraberinde getirmektedir. Artan çevre sorunları ormanlık alanlar ve hassas ekosistemler üzerinde yerel veya küresel ölçekte ciddi riskler ve sorunların oluşmasına neden olmaktadır. Bu çalışmanın amacı, dünya genelinde 200 önemli ekolojik bölgeden biri olarak tanımlanan Kuzeydoğu Anadolu coğrafyası içerisinde yer alan Fırtına vadisi Meydanköy şimşir ormanlarının arazi ve çevre karakteristiklerinin tespit edilmesi ve şimşir orman ekosistemi ile arasındaki etkileşimin ortaya konulmasıdır. Bu amaçla araştırma alanı arazi karakteristiklerine (eğim, yükselti, anakaya, meşcere karakteristikleri, drenaj ağı, vb) ait verilerin analizleri Google Earth Pro ve ArcGIS 10.5 yazılımı kullanılarak gerçekleştirilmiştir. Araştırma alanı Fırtına havzası içerisinde ve Çamlıhemşin ilçe merkezine 20 km uzaklıktadır. Araştırma alanı 3,70 ha olup Şimşir ekosisteminin tamamı 1. derece sit alanı içinde ve mevcut alanın yaklaşık %75-80 arasındaki bölümünün ise Kaçkar Dağları Milli Parkı içerisinde olduğu tespit edilmiştir. Araştırma alanı arazisinin vadi tabanında ve yaklaşık %75’inin gölgeli bakılar üzerinde olduğu ve şimşir ekosisteminin tam ortasına trafik yoğunluğu oldukça fazla olan bir yolun geçtiği tespit edilmiştir. Koruma kullanma prensibine uygun ve bazı kısıtlarını içere alan kullanım ve yönetim modelinin oluşturulması, ekosistem içindeki bazı kızılağaçların alandan çıkarılması, alan içinden geçen yol güzergahının değiştirilerek alan dışına çıkarılması Şimşir ekosisteminin sağlığının artırılması ve sürdürülebilir yönetimi için yararlı olabilir: Rapid industrialization and excessive consumption bring about very serious environmental problems. Increasing environmental problems cause serious risks and problems on forest areas and sensitive ecosystems on a local or global scale. The aim of this study is to determine the land and environmental characteristics of the Meydanköy boxwood forests in Fırtına creek located in the Northeast Anatolian geography, which is defined as one of the 200 important ecological regions around the world, and to reveal the interaction between the boxwood forest ecosystem. The analysis of the data belonging to the land characteristics of the research area (slope, elevation, bedrock, stand characteristics, drainage network, etc.) was carried out using Google Earth Pro and ArcGIS 10.5 software. It has been determined that the research area is 20 km away from the Çamlıhemşin district center in the Fırtına valley, its approximate area is 3,70 ha and the entire boxwood ecosystem is within the 1st degree protected area, and approximately 75-80 % of this area is within the Kaçkar Mountains National Park. It has been determined that the research area is on the valley floor and approximately 75% of it is on shady views, and a road with a high traffic density passes right in the middle of the boxwood ecosystem. Establishing a use and management model that complies with the conservationuse principle and includes some of its limitations, removing some alder trees within the ecosystem from the area, changing the road route through the area and taking them out of the area may be beneficial for increasing the health of the boxwood ecosystem and its sustainable management

Evaluation of basin and land characteristics using geographic ınformation systems (GIS): The case of Pazar Hemşin Creek

Doğal kaynaklar sürekli etkileşim halinde olan ekosistemlerdir. Bu ekosistemlerin planlanması bütünleşik havza planlanma ilkelerine göre yapılmalıdır. Ancak Rize il ölçeğindeki doğal kaynak planlama ve altyapı çalışmalarında bu hususun layıkıyla dikkate alındığı pek söylenemez. Bu çalışmanın amacı Pazar Hemşin havzası bazı havza karakteristikleri ile arazilerin yükselti kademeleri, eğim, bakı ve jeolojik yapıya göre dağılımlarının Coğrafi Bilgi Sistemi yardımıyla ortaya konulmasıdır. Araştırma sonucuna göre araştırma alanı 21216 hektar ve ortalama eğimi % 30,97’dir. Yükselti kademelerine göre en geniş arazi varlığı 4153,35 hektar (%19,58) ile 901-1200 m yükseltiler arasında ve en az arazi varlığı 633,26 hektar (% 2,98) ile 2100- 2400 m yükseltileri arasında olduğu belirlenmiştir. Eğim ve bakı faktörlerine göre arazilerin % 63,14’ü gölgeli bakılar üzerinde ve % 36,86’sı güneşli bakılar üzerindedir. Eğime göre en geniş ziraat alanı % 38,35 ile % 11-20 eğim gurubunda yer almaktadır. Orman arazilerinin % 30,44’ü asidik kayaçlar, % 69,43’ü nötr kayaçlar ve % 0,13 ile alüvyon alanlar üzerindedir. Kayaç türlerine göre en geniş orman varlığı % 30,33 ile granit kayaçlar üzerindedir. Yerleşim yerlerinin % 44,55’i asidik kayaçlar, % 54,37’si nötr kayaçlar ve % 1,08’i ile alüviyon alanlar üzerindedir. Mevcut yerleşim yerlerinin % 63,99’u gölgeli bakılar üzerinde, % 36,01’i güneşli bakılar üzerindedir. Havza genelinde yerleşim yeri kullanımlarında gölgeli bakılar baskın durumdadır. Yerleşim yerlerinin seçimi, yol ve alt yapı çalışmaları ile tarım arazilerinin kullanılmasında yukarıda ortaya konulan havza özelliklerinin dikkate alınması hem sorunların çözümlenmesi hem de sürdürülebilir havza yönetimi için faydalı olabilirNatural resources are ecosystems in constant interaction. Planning of these ecosystems should be done according to integrated watershed management principles. However, it cannot be said that this issue is taken into account in natural resource planning and infrastructure works in Rize. The aim of this study is to determine some basin characteristics of Pazar Hemsin basin and the distribution of lands according to elevation, slope, aspect and geological structure using of Geographical Information System. As a result of the study, the drainage area of the study area is 21216 hectares and its average slope is 30.97%. According to the elevation steps, it was determined that the largest land was 4153.35 hectares (19.58%) in 901-1200 m elevation steps, while the least amount of land was 633.26 hectares (2.98%) in 2100-2400 m elevation steps. According to the slope and aspect factors, 63.14% of the lands are on shady views and 36.86% are on sunny views. According to the slope, the largest agricultural area (38.35%) is in the slope group of 11-20 %. 30.44% of forest lands are on acidic rocks, while 69.43% on neutral rocks and 0.13% on alluvium areas. According to the rock types, the largest forest area is on granite rocks with 30.33%. 44.55% of the settlements are on acidic rocks, while 54.37% on neutral rocks and 1.08 % on alluvium areas. 63.99% of the settlements are on shady views, while 36.01% are on sunny views. Shaded views are dominant in the choice of settlement. Take into basin characteristics in the selection of settlements, road and infrastructure works and the use of agricultural lands may be beneficial for both solving problems and sustainable basin management in Pazar Hemşin River Basi

Results of the 4-5 ECA vascularized pedicle bone grafting in avascular pseudoarthroses of the scaphoid proximal pole

Objective: The scaphoid bone is the most injured carpal bone and is the cause of severe wrist dysfunction seen in nonunioncases. The probability of avascular necrosis is very high especially in fractures of the proximal pole, due to the retrogradeblood flow in the region. In these cases, vascularized pedicle bone grafts, with high rates of union, is a good alternative tothe conventional techniques. In this study, we present the results of vascularized bone grafting with grafts harvested fromthe 4-5 extensor compartment artery (ECA) and fixation with the Herbert screw in patients with avascular pseudoarthrosesof the scaphoid proximal pole.Methods: Fifteen patients who presented to our clinic due to nonunion of the scaphoid and who were applied vascularizedpedicle bone grafts harvested from the ECA between 2006 and 2015 were included in the study. The mean age of the patients was 30.1 (19-42) and all patients were male. Patients were followed up for an average period of 22.7 (18-56) months.Union in the patients were evaluated with the preoperative and postoperative wrist ranges of motion. VAS (visual analogscale) and, for functional evaluation, the Turkish version of the Quick-DASH scale were used.Results: Union was achieved in all patients after a mean period of 8.2 (6-10) weeks. The most significant improvementsafter surgery were detected in the VAS and functional Quick-DASH scores. No significant improvement was observed inwrist contractures. Other than the hematoma in one patient, no complication was observed.Conclusion: In cases of nonunion of the scaphoid proximal pole fractures accompanied by avascular necrosis, pediclegrafts from the 4-5 ECA offer high rates of union and improvement in the pain and functional scores of the patients. Level ofevidence Level IV, therapeutic study

Une nouvelle technique dans le traitement chirurgical du ressaut congénital et spontané des tendons extenseurs: Dorsalisation-ulnarisation de la tête métacarpienne]

The present study reports results of a metacarpal transposition technique we have developed for congenital and spontaneous extensor tendon snapping. Six patients with a mean age of 14 years (range: 12-19 years) were included and evaluated retrospectively. They had Rayan-Murray type-3 atraumatic chronic extensor tendon instability: 2 on the middle finger, 3 on the ring finger, and 1 on the index and middle fingers. In selecting the cases, preoperative examination included elevation of the metacarpals to check whether this decreased the tendon snapping, and patients in whom no snapping persisted were scheduled for surgery. Pre- and post-operative pain at rest and in activity was assessed on visual analog scale (VAS), and the QuickDASH test was administered. Pre- and post-operative active and passive ranges of metacarpophalangeal motion were measured, as was grip strength on a Jamar dynamometer. Mean follow-up was 38 months (range: 26-42 months). Postoperatively, pain during activity and QuickDASH score showed significant improvement. No wound problems or recurrence were encountered. There were no significant postoperative changes in active and passive joint range of motion. At follow-up examination, no physical therapy needed to be prescribed and no limitation of motion was observed. For tendon snapping, in which treatment is technically difficult and may lead to problems, we believe that our easily applicable minimally traumatizing technique does not restrict joint motion and is an appropriate solution for patients with positive elevation test. (C) 2021 SFCM. Published by Elsevier Masson SAS. All rights reserved