Transverse Carpal Ligament and Forearm Fascia Release for the Treatment of Carpal Tunnel Syndrome Change the Entrance Angle of Flexor Tendons to the A1 Pulley: The Relationship between Carpal Tunnel Surgery and Trigger Finger Occurence

Purpose. The appearance of trigger finger after decompression of the carpal tunnel without a preexisting symptom has been reported in a few articles. Although, the cause is not clear yet, the loss of pulley action of the transverse carpal ligament has been accused mostly. In this study, we planned a biomechanical approach to fresh cadavers. Methods. The study was performed on 10 fresh amputees of the arm. The angles were measured with (1) the transverse carpal ligament and the distal forearm fascia intact, (2) only the transverse carpal ligament incised, (3) the distal forearm fascia incised to the point 3 cm proximal from the most proximal part of the transverse carpal ligament in addition to the transverse carpal ligament. The changes between the angles produced at all three conditions were compared to each other. Results. We saw that the entrance angle increased in all of five fingers in an increasing manner from procedure 1 to 3, and it was seen that the maximal increase is detected in the middle finger from procedure 1 to procedure 2 and the minimal increase is detected in little finger. Discussion. Our results support that transverse carpal ligament and forearm fascia release may be a predisposing factor for the development of trigger finger by the effect of changing the enterance angle to the A1 pulley and consequently increase the friction in this anatomic area. Clinical Relevance. This study is a cadaveric study which is directly investigating the effect of a transverse carpal ligament release on the enterance angle of flexor tendons to A1 pulleys in the hand

Tendon Interposition and Ligament Reconstruction with ECRL Tendon in the Late Stages of Kienböck’s Disease: A Cadaver Study

Background. The optimal surgical treatment for Kienböck’s disease with stages IIIB and IV remains controversial. A cadaver study was carried out to evaluate the use of coiled extensor carpi radialis longus tendon for tendon interposition and a strip obtained from the same tendon for ligament reconstruction in the late stages of Kienböck’s disease. Methods. Coiled extensor carpi radialis longus tendon was used to fill the cavity of the excised lunate, and a strip obtained from this tendon was sutured onto itself after passing through the scaphoid and the triquetrum acting as a ligament to preserve proximal row integrity. Biomechanical tests were carried out in order to evaluate this new ligamentous reconstruction. Results. It was biomechanically confirmed that the procedure was effective against axial compression and distributed the upcoming mechanical stress to the distal row. Conclusion. Extensor carpi radialis longus tendon has not been used for tendon interposition and ligament reconstruction in the treatment of this disease before. In view of the biomechanical data, the procedure seems to be effective for the stabilization of scaphoid and carpal bones

A comparison of the InterTan Nail and Proximal Femoral Nail Antirotation in the Treatment of Reverse Intertrochanteric Femoral Fractures

The aim of this study was to compare the clinical and radiological results of InterTan nail and proximal femoral nail antirotation (PFNA) in the treatment of reverse intertrochanteric fractures (AO/OTA 31-A3). The study included a total of  consecutive patients who presented at trauma centre with a reverse intertrochanteric fracture between in the last 7 years. Treatment was applied with PFNA in 33 patients and with InterTan nail in 36. Evaluation was made from the radiographs taken on postoperative day 1 and at the final follow-up examination of changes in the femoral neck and shaft angulation, measurement of telescoping of blade and lag screws and reduction quality. The mean telescoping was measured as 7.21±7.13mm in the PFNA group and 4.18±4.32 mm in the InterTan group (p=0.039). Mechanical failure was seen in 8 (24.2%) cases in the PFNA group and in one case of the InterTan group. Cut-out was observed in 4 cases of the PFNA group and in none of the InterTan group.The use of InterTan nailing in the fixation of reverse intertrochanteric fractures provided better clinical and radiological results compared to PFNA in terms of less telescoping, less change in the neck shaft angle and lower complication rates