Yazar: Sude Yılmaz

Hypothesis: Using radiologic and clinical results, we studied the outcome of patients who underwent open reduction and plate osteosynthesis for comminuted olecranon fractures.

Materials and methods: We retrospectively studied 18 patients (5 women [27.8%] and 13 men [72.2%]; mean age, 41 years [range, 19-67 years]) with comminuted fractures of the olecranon who underwent locking-plate osteosynthesis after open reduction between March 2005 and August 2009. According to the Mayo classification, 11 cases were classified as type IIB (61.11%) and 7 cases were classified as type IIIB (38.88%). In 7 cases, additional injuries were present in the olecranon area.We evaluated results with respect to clinical and radiologic findings. The mean follow-up duration was 22.6 months (range, 7-42 months).

Results: Complete union was achieved in all cases. Mean union time was 4.4 months (range, 4-6 months). According to the Morrey scale, 4 cases were considered very good; 8, good; 5, fair; and 1, poor. The mean QuickDASH (Disabilities of the Arm, Shoulder, and Hand) score was 17 (range, 0-75). There were no statistically significant differences between the Mayo type IIB and type IIIB cases in terms of elbow range of motion, QuickDASH score, and Morrey score. On long-term follow-up, elbow stiffness developed in 1 patient, who underwent surgical release with simultaneous removal of the hardware. The cases with fair and poor scores were cases with open fractures and additional elbow injuries.

Conclusions: Locking-plate osteosynthesis is an effective and safe treatment option for comminuted olecranon fractures, allowing early joint motion and yielding satisfactory radiologic and clinical results. In cases with concomitant injuries, the risk of limited elbow motion is high.

Level of evidence: Level IV, Case Series, Treatment Study. 
2011 Journal of Shoulder and Elbow Surgery Board of Trustees.

Bony fixation methods for amputated digits must be simple, easy to use, create minimal additional bone and soft tissue damage and must be applicable with speed and consistency (Gordon and Monsanto, 1987; Whitney et al., 1990). Various methods such as fixation with single or multiple K-wires, intraosseous wires, plates and screws and external fixation have been reported for this purpose (Yamano et al., 1982). All these methods provide adequate fixation when used properly

We read with interest this short report letter about the use of a plastic aspiration tube to prevent soft tissue entrapment during K-wire fixation. We have been using a similar technique in our practice for some time (Sabapathy et al., 2003). Instead of a plastic aspiration tube, we use the plastic protective sleeve of a hypodermic needle (after cutting one end off). This is easily available and is more rigid. We find this technique especially valuable in replantation of ring avulsion amputations. In fixation of these amputations, the sleeve must be maintained till the K-wire is withdrawn from outside the finger and clears the proximal end of the bone being fixed.

Cross-over replantation is a salvage option for cases with bilateral extremity amputations where the wound conditions do not enable an orthotopic replantation. Here, we present a 24-year-old patient who applied to our
center with bilateral transhumeral amputations. Due to the wound conditions, a cross-over replantation was performed. 24 months after the initial operation, the patient exhibits good protective sensation at the distal levels and
function to some degree, whereas the active range of motion is not as promising as previously expected. In this article, we present this case together with its immediate and long-term outcomes and the consequences of the cross-over replantation.

Abstract
Objective: This study aims to report the results of locking compression plate along with intramedullary fibular graft that was implemented in patients with the diagnosis of nonunion of humerus diaphysis.

Materials and methods: Five patients, operated between 2000 and 2009 for atrophic type nonunion of humeral diaphysis, were included in this study. Two patients were women (40%) and three were men (60%). The mean age was 49.2 years. Nonunion was found to be on the right humerus of 3 patients and on the left side of 2 patients. Causes of fractures were traffic accident in 2 cases, simple fall in 2 cases, and fall from height in 1 case. Mean duration after the elementary fracture was 70 months. Nonunion was diagnosed at 1/3 proximal humeral diaphysis in 2 patients, 1/3 distal humeral diaphysis in 2 patients, and 1/3 middle humeral diaphysis in one patient. Initially, conservative treatment was chosen for 3 cases and plate-screw osteosynthesis for 2 cases.

Results: Complete union was obtained in all cases radiologically. Mean union time was 20.1 weeks. With a mean of 1.78 cm, shortening was detected in comparative radiographies of both humeri. Mean range of motion at the elbow was 118° in flexion–extension arch of patients. The mean Constant-Murley score was 88 points. There was no complication regarding the operation and graft donor sites.

Conclusion: The management of atrophic type humeral nonunions is difficult. The method that we practice in such patients is a reliable treatment option with its stabile fixation and high union rates.

AMAÇ: Bu çalışmanın amacı, etyolojik mekanizmalarına bağlı olarak iş kazalarına bağlı el yaralanmaları için alternatif bir sınıflama sistemi ortaya koymaktır.

GEREÇ VE YÖNTEM: İki el cerrahisi ünitesi cerrahlarınca, Ocak 2005 ile Aralık 2007 yılları arasında ameliyat edilen hastaların geriye dönük olarak analizleri yapıldı. Hasta dosyaları retrospektif incelendi ve yaralanmaya neden olan mekanizmalar incelendi. Benzer yaralanma mekanizmaları aynı gruplarda sınıflandırıldı ve görülme sıklıkları araştırıldı. Yaralanmaların sınıflandırılmasında hasarlanan dokular temel alındı. Hastaneye yatırılan 4120 el cerrahisi hastasından 2188’i (%53,1) iş kazası sonucu yaralanan olgular idi. Bunların 2063’ü erkek (%94,3), 125’i kadındı (%6,7). Ortalama yaş 28,2 (dağılım 15-71 yaş) idi.

BULGULAR: Yaralanmaya neden olan ajanların incelenmesinde 62 ajan belirlendi. Bu ajanların ileri incelemesi ile benzer yaralanmaya neden olan ajanlar “iş kazalarına bağlı el yaralanmalarının etyolojik sınıflandırması”na (İKEYES) göre gruplandırıldı. Bu grupları kesici-delici, kesici-ezici, ezici-delici, ezici-sıkıştırıcı, ezici-yakıcı, batıcı, avulziyon, elektrik çarpması ve kimyasal yaralanmalar ve diğer yanıklar oluşturdu. Etyolojideki en sık iki mekanizmayı 744 (%34,0) olgu sayısı ile ezici-sıkıştırıcı yaralanmalar ile 514 (%23,5) olgu sayısı ile kesici-ezici yaralanmalar oluşturmaktaydı.

SONUÇ: İKEYES sınıflamasının literatürde etyolojik faktörlerin sınıflaması için ortak bir dil oluşturulabilmekte önemli olduğuna inanmaktayız.

We protect soft tissues from Kirschner (K) wires by passing the wire through a drill guide, which can also help steer the K-wire. Other methods of isolating the K-wire from the soft tissues may decrease control of the thin, flexible wire. The guide is not transparent, but this is not a problem. Drill guides down to 1.0 mm are available, although any guide with an internal diameter greater than that of the wire can be used.

The most decisive step during free tissue transfers and replantation surgery may be respected as microvascular anastomosis. The conventional end-to-side anastomosis technique with simple interrupted sutures is well established and proven to be successful. On the other hand, conventional technique can be time consuming and can cause vascular thrombosis, vessel narrowing, and foreignbody reactions. Search for a more rapid and secure alternative to conventional technique is carried on. In this study, we defined a new technique for end-to-side anastomosis with fish-mouth incisions and application of fibrin glue and compared our results with those we obtained with conventional end-to-side anastomosis. We evaluated end-to-side anastomosis of carotid arteries of a total number of 64 Wistar-Albino rats. In control group (n = 32), conventiona anastomoses with 8 to 10 sutures were performed. In experimental group (n = 32), fish-mouth incisions were applied first on the recipient artery, followed by performing anastomosis with only 2 corner sutures and applying commercially available fibrin glue. Time taken to perform the anastomosis was significantly shorter with the experimental group (P = 0.001), whereas early and late patency and aneurysm rates were comparable to those achieved with control group. Histological evaluation did not point out any significant differences between the groups. We have defined a rapid and safe alternative technique of end-to-side anastomosis with the use of fibrin glue. This method may be an alternative especially where multiple anastomoses are required or where it is difficult to approach anastomotic line, as it is easily performed, rapid, safe, and not involving any complex equipments.

In cases where a mutilated hand with multiple digital amputations is concerned, an ideal replantation may not be possible depending on the type and severity of the trauma. In these cases, heterotopic digital replantations (HDR) may be considered in order to achieve the maximum functional outcome.

It is an easy and fast technique. Moreover, suturerelated bulging at the tendon ends is avoided, thus enabling the tendon to glide more easily within the
tendon sheath.