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

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

Reverse sural flep: Ayak anterolateralindeki araba lastiği yaralanmalarında klinik tecrübemiz]

BACKGROUND: Defects due to car wheel injury at the anterolateral aspect of the foot are challenging due to the characteristics of the region and the trauma. The aim of this study was to present the results of the patients whose skin defects on the dorsolateral aspect of the foot due to tire injuries were treated with reverse sural artery fasciocutaneous flaps. METHODS: Fourteen patients with a mean age of 26.9 years (range: 5-46 years) who experienced loss of tissue at the dorsolateral aspect of the foot due to tire injury between the years 2000 and 2014 were evaluated retrospectively. The mean defect size was 27.1 cm2. The patients were followed up for observing the tissue coverage and complications throughout a mean period of 32.4 months. RESULTS: Despite the development of marginal necrosis in two flaps in the early period, tissues in all cases were successfully covered without requiring additional reconstruction. Primary donor site coverage was achieved in all patients without any donor site problems. CONCLUSION: In case of tire injuries at the anterolateral aspect of the foot, low complication and high success rates can be achieved with a case-based approach with reverse sural artery fasciocutaneous flap coverage

Arthroscopic Hemitrapeziectomy and Suture Button Suspensionplasty in the Treatment of First Carpometacarpal Joint Eaton-Littler Stage 2-3 Arthrosis

Background Degenerative arthritis of the first carpometacarpal (CMC) joint is a common degenerative condition in the hand. Many different surgical procedures have been applied for years. However, in the studies there is no consensus about the superiority of one technique to another. Questions/Purposes In this study, we evaluated the results of the patients with first CMC Eaton-Littler stage 2-3 arthrosis who were operated to prevent first metacarpal joint lateral subluxation and migration with arthroscopic hemitrapeziectomy and suture button suspensionplasty. Patients and Methods Between 2011 and 2014, 21 patients (16 female, five male) were evaluated retrospectively. Mean age was 52.3 years. The preoperative and postoperative assessments were performed with visual analog scale (VAS) and disabilities of the arm, shoulder, and hand score (DASH) scores. The Kapandji's thumb opposition score was used to assess thumb range of movement. The patients were assessed after arthroscopy according to Badia classification. Results Mean follow-up period was 50.1 months. According to Badia classification, seven patients were found to be type 2 and 14 patients were type 3. The mean preoperative Kapandji's score was 7.6 and the mean postoperative Kapandji's score was 9.2. The mean VAS values were 8.2 preoperatively and 1.9 postoperatively. The mean preoperative DASH value was 23.4 and the mean postoperative DASH value was 5.5. The mean preoperative grip strength was 66.2 and the mean postoperative grip strength was 75.1. The mean preoperative pinch strength was 14.8 and the mean postoperative pinch strength was 20.2. Conclusion Arthroscopic hemitrapeziectomy and suture button suspensionplasty is a minimal invasive technique and can be performed with low morbidity in the treatment of first CMC joint Eaton-Littler stage 2-3 arthrosis. By this technique, the patients' existing instability and pain problems can be solved. Complications, such as loosening of the suture button at the first metacarpal at the postoperative period due to direct trauma to the first CMC joint, could be avoided using a new suture button

Treatment algorithm in synovial tuberculosis of the hand and wrist: a report of three cases

Bu yazıda biri el, ikisi el bileğinde sinovyal tüberküloz saptanan üç olgu sunuldu. Olguların hiçbirinde pulmoner tüberküloz ve ailede tüberküloz öyküsü yoktu. Hastalara tüberküloz tedavisine başlama kararı pozitif histolojik sonuçlar sonrası verildi. Alınan kültürlerde üreme olmadı. Uygulanan 12 aylık kombine antitüberküloz kemoterapiyle olguların tümünde semptomlar geriledi ve iyileşme sağlandı; 16-26 ay arası takiplerde hastalığın herhangi bir bulgusu tekrarlamadı. Klinik gözlemimiz tüberküloz tenosinovit olgularında antitüberküloz kemoterapi uygulanarak iyileşme sağlanabileceği yönündedir.Three patients with synovial tuberculosis are presented. Involvement was in the hand in one patient, and in the wrist in two patients. None of the patients had pulmonary tuberculosis or a family history of tuberculosis. Tuberculosis treatment was initiated only after histologic verification. The cultures remained negative. The patients received a 12-month course of multidrug chemotherapy for tuberculosis, resulting in symptomatic improvement and healing. There were no recurrences during a follow-up period of 16 to 26 months. Our clinical observations showed that tuberculosis tenosynovitis benefited well from antituberculosis chemotherapy

The results of digital replantations at the level of the distal interphalangeal joint and the distal phalanx

Amaç: Distal uç amputasyonlarında uygulanan replantasyonlar geriye dönük olarak değerlendirildi. Çalışma planı: Distal interfalangeal eklem distal seviyesinde total amputasyon gelişen 82 hastanın (75 erkek, 7 kadın; ort. yaş 29; dağılım 10-52) 98 parmağına uygulanan replantasyonlar incelendi. Tamai sınıflamasına göre amputasyonların 58’i zon 1, 40’ı zon 2’de idi. Yetmiş yedi (%93.9) hasta digital blok anestezisi altında ameliyat edildi. Kemik fiksasyonunu takiben arter anastomozu ve mümkün olan olgularda ven anastomozu ve nörorafi yapıldı. Ven anastomozu yapılamayan veya anastomoz yapılmasına karşın venöz yetmezlik oluşan olgularda tırnak yatağına iğneyle açılan delikler üzerine heparinize gaz konarak iki saatte bir heparin uygulandı. Hastaların fonksiyonel durumu ve kozmetik açıdan memnuniyeti değerlendirildi. Ortalama takip süresi 16 aydı (dağılım 3-46 ay). Sonuçlar: Altmış replantasyon (%61.2) başarılı, 38 replantasyon (%38.8) başarısız bulundu. Başarılı sonuç alınan olgularda, tırnağın ve parmak uzunluğunun korunması nedeniyle kozmetik olarak tatmin edici görünüm sağlandı; distal interfalangeal eklemi korunan olgularda fonksiyonel açıdan tatminkar sonuçlar alındı. Zon 1 amputasyonlardaki başarı oranının (%74.1) zon 2 amputasyonlara (%42.5) göre daha yüksek olduğu gözlendi. Çıkarımlar: Distal uç replantasyonları, teknik zorluklara karşın görünüm ve fonksiyonel açıdan tatmin edici sonuçlar verebilmektedir.Objectives: We retrospectively evaluated replantations performed for distal amputations. Methods: The study included 82 patients (75 males, 7 females; mean age 29 years; range 10 to 52 years) who underwent replantations distal to the distal interphalangeal joint for a total of 98 amputations. According to the Tamai classification, there were 58 zone 1 and 40 zone 2 amputations. Local digital anesthesia was used in 77 patients (93.9%). Arterial anastomosis was accomplished after bone fixation, and venous anastomosis and nerve repair were performed whenever possible. When venous anastomosis was not possible or in case of venous insufficiency, venous decompression was performed with heparinized gauze placed on the bleeding nail matrix. Functional results and the degree of patients’ satisfaction with the cosmetic outcome were evaluated. The mean follow-up was 16 months (range 3 to 46 months). Results: Replantation was successful in 60 amputations (61.2%) and unsuccessful in 38 cases (38.8%). In successful cases, cosmetic results were satisfactory due to the preservation of the nail and finger length. Functional results were satisfactory in cases in which the distal interphalangeal joint could be preserved. Replantations for zone 1 amputations (74.1%) yielded better results than those performed for zone 2 amputations (42.5%). Conclusion: Despite technical difficulties, replantations for distal finger amputations can provide satisfactory functional and cosmetic results

Mid-long Term Results of Dorsal Approach and Temporary Fixation Procedure in Overlooked Perilunate Carpal Dislocation

Aim:Our aim in this study is to present our mid-long term functional and radiological results after open reduction with dorsal approach, K-wire application and scapholunate ligament repair in cases with perilunate dislocation.Materials and Methods:Eleven patients who applied for perilunate dislocation between 2014 and 2018 and were followed up for at least 18 months were included in our study. The scapholunate angle, scapholunate gap, arthrosis, and avascular necrosis were evaluated in cases with isolated perilunate dislocations. The wrist flexion-extension and pronation-supination range of motion (ROM) of the patients were measured using a goniometer, and the wrist grip strength using a Jamar dynamometer. Functionally, the cases were evaluated according to the Disabilities of the Arm, Shoulder and Hand (DASH) scoring and the Herzberg clinical scoring system.Results:The mean age was 41.1 (28-64) years, the mean follow-up time was 3.8 (1.5-6) years. The mean scapholunate angle was 49.1±8.7 (37.3-70.4) degrees, the mean scapholunate gap was 2.0±0.5 (1.2-2.8) mm, the mean flexion-extension ROM was 131±17.5 (90-155) degrees, and the mean pronation-supination ROM was 155.4±6.1 (140-160) degrees. Patients had a mean DASH score of 5.6±3.2 (0-10.9) and a mean Herzberg clinical score of 89.1±9.4 (70-100).Conclusion:In perilunate dislocations, early and appropriate treatment is the main determinant of prognosis. Close follow-up of these injuries for at least 18 months is extremely important in terms of possible complications

Salvage of Devascularized and Amputated Upper Extremity Digits with Temporary Ectopic Replantation: Our Clinical Series

Background One of the reasons for unsuccessful replantation is recipient site problems. In cases where proximal stump status cannot be predicted exactly, reamputation may be required depending on the result of infection and tissue necrosis. The ectopic banking method has been defined for this type of injury. In this study, we presented the amputated or devascularized upper extremity digit ectopic banking application results in our clinical practice. Methods Nineteen digits (17 patients) banking ectopically were included in the study. All digits ectopically banked in the forearm volar of the non-injured upper limb. Transfers were made after waiting for the appropriate time. Ectopic banking periods, postoperative complications, and other descriptive data were recorded. In the postoperative 6th month, the range of motion (ROM) values of the digits were measured and compared with the ROM values of the same digit on the non-injured extremity.Also, in the postoperative 6th month, a questionnaire with a score of 1–5 was conducted for cosmetic results. Results The mean follow-up time was 13.6 months. The mean patient age was 39.5 years. The ectopic banking success rate is 94.1% (16/17). The orthotopic/heterotopic transfer success rate is 100% (17/17). Ectopic banking time is, on average, 19.2 days (min 5–max 55). Average cosmetic scale is 3.54. Conclusions We think that the results of our study will shed light on surgeons who make ectopic banking applications