Yazar: Sude Yılmaz

Amaç: Başparmak Tamai tip 1 amputasyonlarda uygulanan replantasyonlar geriye dönük olarak değerlendirildi.

Çalışma planı: Çalışmaya, başparmak tırnak yatağı distalinde meydana gelen Tamai tip 1 amputasyonlar nedeniyle replantasyon uygulanan ve tedavi sonrasında dolaşım devamı sağlanan 14 hasta (12 erkek, 2 kadın; ort. yaş 28; dağılım 14-40) alındı. Tüm hastalarda santral digital arter anastomozu yapıldı. Anastomoza uygun ven bulunabilen dört hastada birer adet volar ven anastomozu yapıldı. Sinir tamiri sadece üç hastada yapılabildi. Duyu değerlendirmesi Semmes-Weinstein testi, iki nokta ayrım testi, hareketli iki nokta ayrım testi ve vibrasyon testi ile yapıldı; ayrıca, hastalar parmak atrofisi, soğuk intoleransı ve tırnak yatağı deformiteleri açısından incelendi. Ortalama takip süresi 11 ay (dağılım 6-48) idi.

Çıkarımlar: Başparmak distal uç replantasyonları, teknik zorluklara rağmen, görünüm açısından ve fonksiyonel açıdan iyi sonuçlar vermektedir. Sinir tamiri yapılamayan olgularda da yeterli duysal iyileşme sağlanmaktadır.

The sensory recovery outcomes of fingertip replantations without nerve repair were retrospectively studied. Between 2000 and 2006, 112 fingertip replantations with only arterial repair were carried out in 98 patients. About 76 of the replants survived totally, with a success rate of 67.8%. Evaluation of sensory recovery was possible in 31 patients (38 replantations). Sensory evaluation was made with Semmes–Weinstein, static and dynamic two-point discrimination, and vibration sense tests. Fingertip atrophy, nail deformities, and return to work were also evaluated. According to the Semmes–Weinstein test, 29.0% (11/38) of the fingers had normal sense, 60.5% (23/38) had diminished light touch, 7.9% (3/38) had diminished protective sensation, and 2.6% (1/38) had loss of protective sensation. Mean static and dynamic two-point discriminations were 7.2 mm (3–11 mm), and 4.60 mm (3–6 mm), respectively. Vibratory testing revealed increased vibration in 42.1% of the fingers, decreased vibration in 36.8%, and equal vibration when compared with the non-injured fingers in 21.1%. Atrophy was present in 14 (36.8%) fingers and negatively affected the results. Nail deformities, cold intolerance, return to work, and the effect of sensory education were investigated. Comparison of crush and clean cut injuries did not yield any significant difference in any of the parameters. Patients who received sensory education had significantly better results in sensory testing. The results were classified as excellent, good, and poor based on results of two-point discrimination tests. The outcome was excellent in 18 fingers and good in 20 fingers. Overall, satisfactory sensory recovery was achieved in fingertip replantations without nerve repair.

Distal phalangeal fractures are the most common fractures of the hand but nonunions are unusual in the distal phalanx. Eleven patients were operated on for nonunions of the distal phalanx.

The diagnosis of nonunion was made by the presence of the clinical (pain, deformity, instability)and radiological signs of nonunion more than 4 months after the initial injury. Three patientshad developed infection and four of them had bone resorption after their initial treatments, whichprobably caused nonunion. Olecranon bone grafting combined with Kirschner wire fixation wasdone in all patients. The mean follow up was 7 months (range 5–18 months). There were no major complications at the donor or recipient sites. One patient had a haematoma formation at the donor site. There was complete radiological union of bone-grafted sites in all patients except one.
There were no cases of pain, deformity, or instability after the treatment. The olecranon bone graft was found to be safe and easy to harvest. Its strong tubular structure replaced the distal phalanx successfully.

AMAÇ: Bu çalışmada, ağır hasarlı el yaralanmalı hastalarda yapılan işlemler ve bu işlemlerin tedavi sonuçlarının değerlendirilmesi amaçlandı.

GEREÇ VE YÖNTEM: 2000-2005 yılları arasında başvuran, 130 ağır hasarlı el yaralanması olan hasta geriye dönük olarak değerlendirildi. Bu hastalardan 25’inin geç dönem takibi ve analizi yapılabildi. Hastaların kavrama gücü, eklem hareket açıklıkları ölçüldü. Fonksiyonel değerlendirme için Minnesota manipülasyon hızı testi ve Purdue Pegboard testi kullanıldı.

BULGULAR: Eklem hareket açıklığı değerlendirmesinde en düşük hareket yüzdesi %17,5, en iyi hareket yüzdesi %96 idi. Ortalama hareket sağlam elin %64,7’si olarak hesaplandı. Kavrama gücü değerleri en zayıf %15, en kuvvetli %80 ortalamayla kaydedildi ; ortalama kaba kavrama gücü sağlam elin %52’si olarak hesaplandı. Yan tutma gücünde ölçümler karşı tarafın %66’sı (%25-% 81), uç tutmada %53’ü (%12-%68), üçlü tutmada %52’si olarak kaydedildi. Minnesota manipülasyon hızı testinde; hastaların %92’sinde el becerisi, kuvvet ve koordinasyon açısından tatminkâr sonuçlara ulaşıldı. Purdue Pegboard testinde ameliyatlı elin ince parmak becerilerinde azalma olduğu görüldü.

SONUÇ: Ağır hasarlı el yaralanmalarında tedavi stratejisi, hastanın temel günlük ihtiyaçlarını sağlayacak bir ekstremite kazanmak için planlanmalı, hastanın işine geri dönmesi amaçlanmalıdır.

Autogenous bone grafts are frequently in use in the field of reconstructive upper extremity surgery. Cancellous bone grafts are applied to traumatic osseous defects, nonunions, defects after the resection of benign bone tumors, arthrodesis, and osteotomy procedures. Cancellous bone grafts do not only have benefits such as rapid revascularization, but they also have mechanical advantages. Despite the proximity to the primary surgical field, cancellous olecranon grafts have not gained the popularity they deserve in the field of reconstructive hand surgery. In this study, the properties, advantages, and technical details of harvesting cancellous olecranon grafts are discussed.

Dear Sir,
Tuberculosis (TB) may affect almost any body tissue. Musculoskeletal TB, which may affect bones, tendons and bursa, is a rare form of extrapulmonary disease and occurs in about 1.3% of cases (Lakhanpal et al., 1987). The diagnosis of TB tenosynovitis is often delayed. Typically, patients with TB synovitis describe local pain and have a swelling on the hand with limitation in the range of motion of the fingers (Lakhanpal et al., 1987; Sueyoshi et al., 1996).

Primary synovial chondromatosis is a benign metaplasia in which synovial tissue transforms into cartilagenous tissue. Primary synovial chondromatosis develops from joint or tendon synovium. Secondary synovial chondromatosis occurs with the implantation of cartilage fragments into the tissue as a result of degenerative disease (osteoarthritis), neuropathic arthropathy, or trauma.[1,2] Synovial chondromatosis is twice as common in males, and the most frequent complaints are pain, swelling, and restricted range of motion in the affected joint.[1] This condition may present with findings of trigger finger or carpal tunnel syndrome, depending on the location.[2] Synovial chondromatosis originating from the joints most commonly affects the knee, hip, and wrist joints, whereas the disease originating from the tendon sheath most frequently involves the feet and the fingers

Carpal tunnel syndrome is the most common entrapment neuropathy. Rare aberrant-bifid tendon, muscle, nerve or arterial anomalies may be the cause of this syndrome. Experienced surgeons do not fail to examine the tunnel for anomalies during the operation. We however came across an extra-tunnel arterial anomaly during one such carpal tunnel decompression

We read this paper with interest and thank the authors for reporting their experience in the surgical treatment of nonunion of fractures of the distal phalanx. O¨zc¸elik et al. recommend surgical treatment with bone graft harvested from the olecranon and stabilization of the nonunion with a Kirschner wire. We too, found that nonunion of these fractures are mostly atrophic and agree that surgery is needed, but only for symptomatic nonunion and possibly within the first three months after trauma.

The hand is the body part most frequently injured by broken glass. Glass fragments lodged in soft tissues may result in numerous complications,such as infection, delayed healing, persistent pain, and late injury as a result of migration. Between 2005 and 2010, we removed 46 glass particles from the hands of 26 patients. The injuries were caused for the following reasons:by car windows broken during motor vehicle accidents in 11 patients (42%); by fragments from broken glasses, dishes, or bottles in 9 (35%); by the hand passing through glass in 5 (19%); and by a fragment from a broken fluorescent lamp in 1 (4%) patient. Despite the efficacy of plain radiographs in detecting glass fragments, they are sometimes not obtained. Given the relatively low cost, accessibility, and efficacy of radiographs, and the adverseconsequences of retained foreign bodies, the threshold for obtaining radiographs should be low in diagnosing glass-related injuries of the hand.