Yazar: Sude Yılmaz

Abstract:

The treatment choice in scapholunate (SL) injury depends on the extent of the SL ligament tear, chronicity of injury, quality of the ligament remnants, reducibility of carpal malalignment, and cartilage status of the radiocarpal and midcarpal joints. In the absence of degenerative changes with chronic reducible dissociation, the optimal treatment would be the reconstruction of the SL interosseous ligament. Various SL reconstruction techniques via open or arthroscopic approaches have been described over the years; they include tendon reconstructions, volar/dorsal capsulodesis, SL allografts, bone-tissuebone composite grafts, reduction and association of the scaphoid and lunate procedure, SL axis method, and SL internal brace technique. However, all of these techniques have their own shortcomings and disadvantages. The present study demonstrates a new technique using a suture-button device for the reduction and fixation of SL diastasis. The suture-button system is positioned between the scaphoid and the triquetrum, the direction of the system prevents scaphoid flexion and maintains continuity of the reduction. Arthroscopic dorsal ligamentocapsulodesis technique can be added to achieve biological healing during the stabilization process. The major advantages of this technique over others are a straightforward application with shorter operative time and lack of a need for harvesting a tendon graft. The technique is performed through mini-incisions, which enable a shorter postoperative recovery time and rehabilitation period and a quicker restoration of function which decreases the risk of joint stiffness. Furthermore, large bone tunnels which increase the risk of fracture are avoided. 

Key Words: suture-button, scapholunate dissociation, carpal instability, arthroscopic dorsal capsulodesis.

Background: The literature is scarce regarding isolated tears of lunotriquetral interosseous ligament (LTIL). The purpose of this stuıdy was to present mid-term clinical and functional results of arthroscopic dorsal ligamentocapsulodesis in the treatment of isolated LTIL tears.

Methods: A total of 22 patients (8 female, 14 male; mean age = 31 years; age range = 18–42) with the diagnosis of isolated LTIL tears verified by wrist arthroscopy were retrospectively reviewed and included in the study. The mean follow-up was 55 (range = 24–84) months. The Modified Mayo Wrist Score, visual analog scale (VAS), flexion and extension deficits of passive wrist range of motion (ROM), pain-free ROM with forced wrist extension, and grip strength were measured in all patient both preoperatively and at the final follow-up appointment.

Results: The mean Modified Mayo Wrist Score significantly ameliorated from 50 ± 10.29 (range = 30–65) preoperatively to 86 ± 11.61 (range = 60–100) at the final follow-up (p < 0.001). The mean VAS score significantly improved from 7.1 ± 0.83 (range: 6–8) preoperatively to 2.2 ± 1.35 (range = 0–6; p < 0.001) at the final follow-up. At the final follow-up examination, the forced wrist extention was painless in all but three patients who developed pain at 70°, 75° and 80° of extension, respectively. The mean strength of hand grip significantly increased from 38.6 ± 9.68 (range = 24–54) kg to 49.5 ± 12.36 (range = 33–66) kg at the final assessment (p < 0.001). No major complications were observed during or after the procedure.
Conclusions: With the encouraging mid-term outcomes and a lower complication rate, arthroscopic LTIL dorsal ligamentocapsulodesis seems to be a safe and effective surgical technique in improving functional outcomes and reducing pain in the management of isolated LTIL tears.
Keywords: Unotriquetral interosseous ligament, Capsulodesis, Ligamentocapsulodesis, Arthroscopic capsulodesis, Isolated lunotriquetral tears.

ABSTRACT:

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.

ÖZET

Amaç: Çalışmadaki amacımız, perilunat çıkıklı olgularda dorsal yaklaşımla açık redüksiyon, K-teli uygulaması ve skafolunat ligaman tamiri sonrası orta-uzun dönem fonksiyonel ve radyolojik sonuçlarımızı sunmaktır.

Gereç ve Yöntem: 2014-2018 yılları arasında perilunat çıkık nedeniyle başvuran, en az 18 aylık takibi olan 11 hasta çalışmamıza dahil edildi. Bu olgularda, skafolunat açı, skafolunat gap, artroz ve avasküler nekroz varlığı değerlendirildi. Hastaların el bileği fleksiyon-ekstansiyon ve pronasyonsupinasyon hareket açıklığı gonyometre ile ölçüldü. Jamar dinamometresi ile el bileği kavrama gücü değerlendirildi. Olgular fonksiyonel olarak Kol, Omuz ve El Sorunları Anketi (DASH) skorlaması ve Herzberg klinik skorlama sistemine göre değerlendirildi.

Bulgular: Ortalama yaş 41,1 (28-64), ortalama takip süresi 3,8 (1,5-6) yıldı. Ortalama skafolunat açı 49,1±8,7 (37,3-70,4) derece, skafolunat interval 2,0±0,5 (1,2-2,8) mm, fleksiyon-ekstansiyon arkı 131±17,5 (90-155) derece, pronasyon-supinasyon arkı 155,4±6,1 (140-160) derece olarak ölçüldü.

DASH skoru ortalama 5,6±3,2 (0-10,9), Herzberg klinik skoru ortalama 89,1±9,4 (70-100) olarak bulundu.

ÖZET

El bilek artroskopisindeki gelişmeler ışığında; bileğin ulnar bölümünde yer alan TFCC yapısının anatomi ve işlevi daha anlaşılır hale gelmiştir. Bilek biyomekaniğinde stabililite ve yük aktarımı gibi önemli rolleri bulunan bu yapı; akut travma veya kronik dejeneratif süreç zemininde hasarlanmaktadır. Ulnar kaynaklı ağrı nedenlerinden biri olan TFCC lezyonları bilekte ağrı ve işlev kısıtlığı ile kendini gösterir. Dikkatli bir fizik muayene ve görüntüleme yöntemleri ile bu lezyonların çoğunda tanı koymak mümkün olsa da altın standart el bilek artroskopisidir. Günlük ortopedi ve el cerrahi polikliniklerinde karşılaşılabilecek bu hasta grubunda öncelikli tedavi konservatif yönde olmaktadır. Konservatif tedaviye beklenen yanıt alınamadığında açık veya artroskopik cerrahi yöntemler ile yüz güldürücü sonuçlar almak mümkündür.

Anahtar Kelimeler: El bileği yaralanmaları; üçgen fibrokartilaj; artroskopi

ÖZET

Birinci karpometakarpal (KMK) eklemin dejeneratif artriti hastaların günlük aktivitelerini etkiliyen ve sık görülen bir patalojidir. Konservatif tedavi yöntemleri ile şikayetleri gerilemeyen hastalar cerrahi olarak tedavi edilebilirler. Cerrahi tedavide trapeziektomi, ligaman rekonstrüksiyonu, interpozisyon artroplastisi, suspansiyonplasti, osteokondral allogreft uygulamaları, karpometakarpal protez, artrodez ve artroskopik tedavi yıllardır uygulanmaktadır. Yapılan çalışmalarda bu tekniklerin birinin diğerlerine olan üstünlüğü ile ilgili fikir birliği yoktur. Son yıllardaki teknolojik ve teknik gelişmeler sonucunda birinci KMK eklem artrit tanı ve tadavisinde artroskopi kullanımı artmaktadır.

Anahtar kelimeler: artroskopi; carpometacarpal; KMK; sütür button.

Abstract

Introduction: Soft-tissue mallet finger occurs due to loss of terminal extensor tendon secondary to rupture of distal phalanx. Although using noninvasive splints for 6–8 weeks is the gold standard for conservative treatment of closed soft-tissue mallet injuries, patient compliance is an important factor impacting on patient outcomes. In this study, we used a single Kirschner Wire (K-W) to fix the distal interphalangeal (DIP) joint in extension in those patients failed to comply with routine splinting.

Materials: and methods In this prospective study, 190 patients with Doyle type 1 closed soft-tissue mallet finger deformity were included in four groups between 2011 and 2015. These groups were determined according to treatment modalities. Patients in the first group were treated with a finger splint (n = 109). Patients in the second group first received a finger splint and then K-W was applied due to lack of adequate compliance (n = 23). Patients in the third group were treated with K-W only (n = 47), and the fourth group did not accept surgical treatment nor conservative treatment (n = 11). After 20 weeks of follow up, we evaluated the results with functional measurements according to Crawford criteria and patient satisfaction. Additionally, the mid-term outcome was assessed with a follow-up at 2 years.

Results: At 20th week postoperatively, average DIP extension lag was 6 degrees (0–30) for the first group, 6.1 degrees (0–30) for the second group, 3.8 degrees (0–25) for the third group, and 17.3 degrees (7–30) for the fourth group. Total patient satisfaction was 85%, which was considered excellent or good. Swan neck deformity was observed in 11% of patients. Osteomyelitis and KW related complications were not observed. There were no statistically significant differences between short-term and mid-term results.

Conclusion: Internal fixation via K-W may be a suitable treatment option compared to splint therapy for management of closed soft-tissue mallet finger in noncompliant patients. Using this treatment approach, the success rate for patients could satisfactorily be improved.

Keywords: Mallet finger, Compliance, Extensor tendon, Finger deformity

ABSTRACT

Objective: This study aimed to compare the perioperative clinical outcomes of trephine biopsy (TB) with the conventional open surgical method (COSM) in bone graft harvesting from the olecranon.

Methods: In this retrospective study, 130 patients who underwent bone graft harvesting from the olecranon using either TB or COSM were included. Patients were then divided into two groups: the COSM group (48 patients; 36 men and 12 women; mean age=32 years; age range=18-52) and the TB group (82 patients; 61 men and 21 women; mean age=34 years; age range=20-62). The mean follow-up was 30 months (range=17-57) in the COSM group and 26.8 months (range=6-48 months) in the TB groups. The two groups were compared in terms of pain intensity, operating time, complication rate, elbow range of motion, and the scar sensitivity of the graft donor site. Pain intensity was measured using the visual analogous scale (VAS) on postoperative days 1 and 15. Other outcome measures were evaluated at the final follow-up.

Results: In the TB group, the mean VAS score was 4±1.62 on postoperative day 1 and 1.6±0.76 on postoperative day 15. In the COSM group, the mean VAS score was 7.2±1.38 on postoperative day 1 and 3.1±1.34 on postoperative day 15. The early VAS scores were significantly higher in the COSM group than in the TB group (p<0.05). The mean operating time was 7±1.99 minutes in the TB group and 20±4.51 minutes in the COSM group. Hematoma occurred in one patient from each group, with an incidence of 2.1% in the COSM group and 1.2% in the TB group. There was no significant difference between the two groups regarding elbow range of motion at final follow-up p>0.05). No patient in the TB group showed sensitivity of the scar region, while scar sensitivity occurred in 3 of 48 patients (0.6%) in the COSM group.

Conclusion: Compared with COSM, TB seems to be a safe technique with similar complication rates. TB can provide shorter operating time, less postoperative pain, and smaller and less sensitive scar compared with COSM.

Level of Evidence: Level IV, Therapeutic study

ABSTRACT

Calcaneus is a unique-shaped hindbone, therefore the reconstruction of complex osteocutaneous defects of heel-calcaneal area remain challenging. Management of a complex defect in the complicated calcaneal area with allogenic tibia and free anterolateral thigh flap is presented. A 37-year-old male patient was presented with a heel defect after a mine injury. The pa­tient underwent serial debridement, thereafter allogeneic proximal tibia defect was properly shaped, hammered and forged into the tibia medullary defect without any fixation material. The graft was covered with free sensate anterolateral thigh flap. The most important disadvantage of allogeneic bone grafts is the lack of blood supply. In the presented case, the blood supply of the bone graft was provided thanks to the blood supply from the medulla of the tibia. Therefore, it was possible to pass the blood inside the allograft. It can be predicted that this intramedullary vascularization also carries stem cells into the medium, further triggering recovery and regeneration.

Key words: Anterolateral thigh flap, bone graft, calcaneus, defect, heel

Abstract

Background: Skin-only avulsion is a particular type of avulsion surgery. In this type of injury, tendons, bones, and joints maintain their integrity. In this report, we aimed to report the promising results of replantation in seven fingers with total skin-only avulsions.

Methods: From 2007 to 2015, 6 patients with a mean age of 34.6 (20–52) who underwent replantation surgery for total skin-only avulsion injuries distal to metacarpophalangeal (MP) joint were evaluated according to the injury type, etiology, level of repair, and the repaired structures.

Results: Seven fingers of 6 patients were evaluated. The mean repaired artery and vein number were 1.5 (1–2) and 3.8 (3–5), respectively. The mean percentage of partial necrosis in the three fingers and an amputated finger was 25.70%. Three fingers survived completely, whereas three developed partial necrosis which were managed by debridement and full thickness skin grafting. Mean static and dynamic two-point discriminations were 6 mm and 3.83 mm, respectively. The mean ROM degree of PIP/IP joints and DIP joints was 74.1 (60–85) and 56.6 (40–70) degrees, respectively. The mean follow-up was 28.3 months (24–36).

Conclusions Skin-only avulsions are a particular type of avulsion injury and very challenging to treat. In order to avoid from the partial necrosis due to the vascular deprivation of perforating branches of the proper digital artery, we recommend repairing both arteries in this type of avulsion. Skin-only replantation results can be successful when several technical details are observed. Level of evidence: Level V, therapeutic study.

Keywords: Amputation . Avulsion . Replantation . Skin-only