Biomechanical assessment of brachioradialis pronatorplasty

Objective: Transfer of the brachioradialis muscle, proposed by Ozkan et al. can be applied to cases, in which, the biceps rerouting technique is not appropriate for the correction of forearm supination contracture and restoration of active pronation. We have aimed to assess the biomechanical effects of the brachioradialis transfer

Does bone impaction technique reduce tunnel enlargement in ACL reconstruction?

The aim of this study was to investigate effects of bone impaction technique on tunnel enlargement after ACL reconstruction at a minimum 2 years follow-up. Two groups of patients who had been operated upon with the same arthroscopic technique with the exception of tibial tunnel constitution were compared. Twenty-one patients of group A (drilling to 6 mm followed enlargement to 8-9 mm by using dilators) and 23 patients of group B (directly drilling to the size of the graft) were evaluated clinically and radiographically based on multislice computerised tomography (MSCT) retrospectively. At follow-up, there was no statistical difference between tunnel diameters between two groups at the femoral site, but significant difference at the tibial site (p = 0.00192 for coronal; p = 0.0171 for sagittal diameter). Both groups were comparable according pre- and postoperative Lysholm and IKDC scores (p < 0.5 Mann-Whitney U test). Compacted tunnel walls may resist enlargement, suggesting this technique resulted in better tunnel diameter values especially with intratunnel fixation

Anxiety and Trauma Perception and Quality of Life in Patients Who Have Undergone Replantation

The difficulty in keeping an amputated limb biologically alive is overcome day by day thanks to the successful replantation procedures applied in the early period. However, the reflections of this biological success on patients in functional and psychological terms may not be pleasing all the time. In our study, we aimed to evaluate the perceptual responses of patients to trauma after replantation and their possible effects on clinical results. We conducted a retrospective study of 43 patients who underwent replantation. The average age was 32.4 years and the average follow-up period was 38.6 months. When the results of the Short Form-36 (SF-36), Beck's Depression Inventory, and the assessment scores of the disabilities of the arm, shoulder, and hand survey were evaluated, there was a negative correlation between the patients diagnosed with depression and all SF-36 subunits. A negative correlation between the severity of trauma and the average physical and mental values included in the SF-36 evaluations was observed (r = 0.48, r = 0.51, respectively),. These results revealed that the psychology of the patient was one of the important factors that could not be ignored in the success of replantation

Surgical treatment of type III acromioclavicular dislocation: Bosworth technique versus hook plating

WOS: 000453318400010PubMed ID: 30859165OBJECTIVE: In this study, it was compared the clinical results of the Bosworth technique and hook plating in acromioclavicular (AC) dislocations. METHODS: 44 patients are retrospectively evaluated in this study whom diagnosed as type III AC dislocations and treated by two different surgical methods in two different clinics. The patients were 30 males and 14 females with a mean age of 44 years (range, 18-80 years). The patients were divided into 2 groups according to the applied surgical technique. Group I comprised 25 patients to whom coracoclavicular fixation was applied by using the Bosworth technique. Group II comprised 19 patients to whom acromioclavicular fixation was applied by using hook plate. All patients are evaulated by The University of California at Los Angeles Shoulder Score (UCLA) and The disabilities of the arm, shoulder and hand (DASH) scoring system. RESULTS: The mean follow-up period was 23 months (range, 12-42 months). A statistically significant diffference was determined between the surgical groups in respect of the modified UCLA scale (p=0.012) and Quick DASH score (p=0.008). Hook plating group had better clinical results according to Bosworth group in terms of both UCLA and DASH score. A statistically highly significant negative correlation was determined between the UCLA and DASH scores (r=0.677, p=0.000). CONCLUSION: Although hook plating had better clinic outcomes compared to Bosworth technique, there is not seen difference between two groups in terms of the time of return to work. Treatment of the AC dislocation should perform early reconstruction for better reduction, fewer complications and higher levels of patient satisfaction

Chronic wrist pain in a goalkeeper; bilateral scaphoid stress fracture: A case report

Introduction: Bilateral scaphoid stress fractures are uncommon, and rarely presented with chronic wrist pain. Most fractures of the scaphoid heal with immobilization. Presentation of case The case presented here is of a bilateral stress fractures of the carpal scaphoid in a 19-year-old male.The patient had been playing as a goalkeeper and presented with a 4-year history of chronic pain in both wrists. We had a successful result in the treatment of these stress fractures with long- arm thumb plaster cast.Discussion Most fractures of the scaphoid in the immature skeleton heal with immobilization. Approximately 88–95% of acute scaphoid fractures are said to heal with conservative treatment using cast immobilisation. Non-surgical treatment is successful for scaphoid fractures in children and for those fractures which are non-displaced, stable, and where there is no damage to other bones or ligaments. In stable fractures, union is achieved within 8–12 weeks.Conclusion Bilateral stress fractures of the scaphoid can be considered for the wrist pain, especially for the patients that had repetitive minor wrist trauma, and in spite of developments in surgical techniques and materials used, treatment by plaster casting should still be considered initially for non-displaced, stable scaphoid stress fractures

Radiation in the orthopedic operating theatre

Objective: The aim of the study was to determine the amount of radiation exposure in the orthopedic operating theater, to show that the radiation dose was decreased with distance from the tube, and to inform personnel about protective measures. Methods: Ionised radiation was measured in the orthopedic operating theater where fluoroscopy was used between 18 February 2014 and 02 June 2014. Four dosimeters were placed at the head and foot of the operating table and at 200 cm from those areas at a height of 60 cm vertical to the floor. Results: At the end of 104 days, the total values were determined as 90.5 mrem at the foot of the table, 68.17 mrem at the head of the table, 7.5 mrem at 200 cm from the foot of the table, and 5.17 mrem at 200 cm from the head of the table. A significant decrease was observed in the values determined at a distance from the radiation source. Conclusion: The rate of radiation determined in the dosimeters decreased when distance from the radiation source increased. During the use of fluoroscopy in orthopedic surgery, the wearing of lead aprons, neck protectors, and glasses, in addition to maintaining a distance from the tube, will reduce the radiation exposure of individuals

Lack of experience is a significant factor in the missed diagnosis of perilunate fracture dislocation or isolated dislocation

Objective: The aim of this study was to analyze the risk factors contributing to the misdiagnosis of perilunate injuries. Methods: The study included patients who had perilunate dislocation or fracture dislocation correctly or incorrectly diagnosed on initial examination between 2008 and 2014. Data related to the length of time until correct diagnosis of the perilunate injury; cause of injury; presence of associated fractures, polytrauma or concomitant trauma in the ipsilateral upper extremity; time between injury and first presentation; first treatment applied; presence of ligamentous perilunar injuries only or fracture and dislocation; inadequate radiographic assessment; and experience of the physicians were recorded and analyzed. Results: A total of 44 wrists were included in the study. Of those, 10 (22.7%) wrists (mean patient age: 44.4 years [28 ± 58 years]) with perilunate injuries were misdiagnosed in the initial evaluation. All of the risk factors were found to be similar between the group of patients with correct initial diagnosis and missed diagnosis group, except for the experience of the orthopedic surgeon assessing the injury (p = 0.0001). Of the surgeons who missed the diagnosis, 70% reported that it was their first encounter with a perilunate injury. Conclusion: The results of this study indicated that lack of experience was the most important factor in the misdiagnosis of perilunate fracture dislocation or isolated dislocation. Level of Evidence: Level IV, diagnostic study. Keywords: Dislocation, Lunate, Perilunate, Wrist injury, Scaphoid fracture, Trans-scaphoi