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Objectives: Replantation of a single finger amputated at the flexor zone 2 level keeps contradicting because the replanted finger may get in the way of other digits due to stiffness. On the other hand, some studies concluded that as the replantation results do not differ from stump closure, one should not immediately head towards stump closure. Therefore, we aimed to present our functional results of this level of replantation. Methods: Twenty-one patients with replantation for single finger flexor zone 2 total amputation were enrolled in the study. Kirschner wires were used to fix the bone. Only flexor digitorum profundus (FDP) tendon was repaired. Two veins per digital artery were anastomosed. Early motion was allowed from the third postoperative week. The functional results were assessed by Quick-DASH and modified Mayo scores, total active range of motion (TAM), and presence of cold intolerance. Results: The mean follow-up period was 33.9 (range 24-79) months. The mean Quick-DASH score was 18.1±8.6 (range 2.3-38.6). According to the modified Mayo score, three patients had excellent, nine had good, seven had fair, and two had poor results. TAM was found to be excellent in three, good in eleven, fair in five, and poor in two patients. Conclusion: We recommend bone fixation preserving the joints, only FDP tendon repair, vein anastomoses as many as possible, and early motion to achieve successful results in single finger amputations replanted at the flexor zone 2 level. [Hand Microsurg 2021; 10(3.000): 211-218]

Objectives In this study, we aimed to describe a new hook plate technique (HPT) and to compare our results with the conventional extension block technique (EBT) with a Kirschner wire (K-wire) for bony mallet finger treatment. Patients and methods Between April 2015 and January 2018, a total of 19 patients including 10 who were treated with EBT (7 males, 3 females; mean age: 30.1±7.3 years; range, 17 to 48 years) and nine who were treated with HPT (6 males, 3 females; mean age: 31.7±11.3 years; range, 19 to 42 years) for bony mallet finger with distal interphalangeal (DIP) joint subluxation and/or fracture fragment larger than one-third of distal phalanx (Wehbe-Schneider type 1/b, 2/a, 2/b, 3/a) joint were retrospectively analyzed. The DIP range of motion (ROM), Warren and Crawford scores, time to return to work/daily activity, operation time, the number of fluoroscopy shots, cost and complications were compared. Results No significant difference was found in the DIP ROM (p=0.708) and the Warren/Norris and Crawford scores (p=0.217 and p=0.175, respectively) between the two groups. Operation time and material cost were higher with HPT (p=0.006, p=0.001). There was no significant difference in the number of fluoroscopy shots (p=0.344). Although DIP joint motion was started at two weeks in the HPT group and at eight weeks in the EBT group, no significant difference was observed in the time of return to work and normal daily life in both groups (p=0.859). Complications were observed in two patients in the EBT group and in three patients in the HPT group. No significant difference in total complications was observed between the two groups (p=0.666). Conclusion Bony mallet finger treatment with a custom-made hook plate prepared from 1.3-mm AO plates appeared to be clinically and radiologically similar to EBT. Additionally, HPT had the advantages of allowing early ROM to DIP joint and eliminating the need for a secondary surgery such as K-wire removal. On the other hand, hardware cost with HPT was higher than EBT.

The aim of our study was to compare the clinical results and costs of wide-awake local anesthesia no tourniquet (WALANT), intravenous regional anesthesia (IVRA), and infraclavicular brachial plexus block (IC-BPB). The patients were divided into WALANT, IVRA, IC-BPB groups, each with 50 patients. Demographic information, induction time, use of sedation, number of patients who were converted to general anesthesia, time in postanesthesia care unit (PACU), amount of bleeding during surgery, presence of tourniquet pain, hand motor function during surgery, time to onset of postanesthesia pain, discharge time, complications, and anesthesia costs were compared. Sedation was given to 12 IC-BPB patients, 9 IVRA patients and 5 WALANT patients. Of these patients, 6 undergoing IC-BPB, 5 undergoing IVRA and 4 undergoing WALANT were converted to general anesthesia (p = 0.80). PACU time and anesthesia costs were the least in the WALANT group, followed by the IVRA group (p 0.001, p 0.001). Intraoperative active voluntary movements were best preserved in the WALANT group; however, bleeding was highest in the WALANT group (p 0.001, p 0.001). Tourniquet pain was the higher in the IVRA groups, while postoperative pain in the surgical area developed the fastest in this same group (p = 0.029, p 0.001). Time to discharge was similar in WALANT and IVRA groups, and the longest in the IC-BPB (p 0.001) group. There was no difference among the groups in terms of patient satisfaction (p = 0.085, p = 0.242 for the first and second survey question). In the current study, WALANT appears to be a suitable alternative to IVRA and IC-BPB methods, with better preservation of active intraoperative movement, lower cost, and shorter time spent in PACU at the expense of higher bleeding.

Objective The aim of this study was to compare clinical and radiological results of three different techniques (plate-screw, tension band, and intramedullary nail) in the fixation of olecranon osteotomy in patients with intercondylar fracture of the distal humerus surgically treated by the olecranon osteotomy approach. Methods Between January 2010 and December 2018, the study was initiated with 52 patients who underwent an olecranon osteotomy approach for an AO Type C distal humerus fracture. Thirty-seven patients (19 male, 18 female) who had regular control data and a final control examination were included in the study. In osteotomy fixation, we used tension band (K wire cerclage + Screw cerclage) in 20 patients, plate-screw in eight patients, and intramedullary nail fixation in nine patients. The functional evaluation included a measurement of the range of joint motion (flexion, extension, supination, pronation); MAYO elbow performance score; disabilities of the arm, shoulder, and hand (DASH) score; and comparative grip strength measurement, and a subjective pain assessment was performed using the visual analogue scale. Results The mean duration of follow-up was 44 (12-84) months. The mean time to union was 14 (7-32) weeks in patients that achieved union. The mean DASH score was 22 (0-72.7), the meanMAYOelbow performance score was 84 (35-100), and the mean VAS score was 3 (1-7). The mean grip strength was 32 (8-64) kgw in the treated extremity and 37 (17-70) kgw in the intact extremity. No statistically significant difference was detected between olecranon osteotomy fixation methods (tension band, plate-screw osteosynthesis, and intramedullary nailing) in terms of union time, DASH score, MAYO scale score, VAS score, extension, supination, and pronation (P > 0.05). The average grip strength (kgw) was lower than that in the uninvolved extremity, and this ratio was statistically significant (P = 0.04). Conclusion The results of this study have shown that successful and comparable radiological and functional outcomes can be obtained by all the three different olecranon osteotomy techniques in the surgical treatment of intercondylar fracture of the distal humerus. Level of evidence Level III, Therapeutic Study.

Aim: Lateral pain in the elbow is a widespread problem in orthopedics and physiotherapy. There are different conservative treatment options available, but there is no consensus on their superiority to each other. The aim of this study was to evaluate the efficacy of three different treatment methods applied to patients followed up with a diagnosis of lateral epicondylitis.Methods: The study included a total of 105 patients who were diagnosed with lateral epicondylitis between 2010 and 2016 and treated conservatively. The patients were separated into three groups according to the treatment administered. In Group 1 (n:28), 1 ml betamethasone dipropionate (Diprospan®, Schering-Plough Corp., Kenilworth, NJ, ABD) was applied with the peppering method. In Group 2 (n:28), the same peppering method was used to apply 1 ml local anesthetic (prilocaine hydrochloride, Citanest®, AstraZeneca plc., London, UK). In Group 3 (n:49), extracorporeal shockwave therapy (ESWT) treatment was performed. Data were evaluated before and at one, three, and six months after treatment. Clinical scores were evaluated according to the Quick Dash (Q-DASH, Quick disabilities of arm, shoulder, and hand) scoring system and VAS (visual analog scale) scores during the daily activities of the patients. Quality of life and patient satisfaction levels were evaluated based on Quick Dash scores.Results: A significant improvement was observed in all three methods in the VAS and quality of life of the patients at one, three, and six months after treatment compared to pre-treatment values (P, Amaç: Dirsek yan ağrısı, ortopedi ve fizik tedavi pratiğinde sık karşılaşılan bir problemdir. Farklı konservatif tedavi seçenekleri mevcut olup, birbirlerine üstünlükleri konusunda fikir birliği yoktur. Bu çalışmada lateral epikondilit tanısıyla takip edilen hastalarda üç farklı tedavi yönteminin etkinliğini değerlendirilmek amaçlanmıştır.Yöntemler: 2010-2016 yılları arasında lateral epikondilit tanısıyla takip edilen ve konservatif olarak tedavi edilen 105 hasta çalışmaya dahil edildi. Hastalar yapılan tedavi metoduna göre 3 gruba ayrıldı. Birinci gruptaki 28 hastaya 1 ml betametazon dipropiyonat (Diprospan®, Schering-Plough Corp., Kenilworth, NJ, ABD), ikinci gruptaki 28 hastaya sadece 1 ml lokal anestezik prilokain hidroklorür (Citanest®, AstraZeneca plc., Londra, Birleşik Krallık), aynı yöntemle 30-40 kez iğne ucu ciltten çıkarılmadan aynı bölgeye batırılıp çıkarılarak (peppering yöntemiyle) uygulandı. Üçüncü gruptaki 49 hastaya Ekstrakorporeal şok dalga terapisi (ESWT) tedavisi uygulandı. Tedavi öncesi ve 1. 3. ve 6. aydaki veriler değerlendirildi. Klinik skorlar Quick Dash (Q-DASH, Quick disabilities of arm, shoulder and hand) skorlama sistemine göre değerlendirilerek, hastaların günlük yaşam aktiviteleri sırasındaki VAS (Visual Analog Scale) skorlarına bakıldı. Yaşam kalitesi ve hasta memnuniyeti düzeyleri Quick Dash skorlarına göre değerlendirildi.Bulgular: Her üç yöntemde tedavi sonrası birinci ay, üçüncü ay ve altıncı aydaki VAS skorunda ve hastanın yaşam kalitesinde tedavi öncesine göre anlamlı olarak iyileşme gözlendi (P

Introduction We evaluated the clinical and radiological outcomes of capitellar fractures treated with modified screw insertion (inserting the first fixation screw anteroposteriorly and the second screw posteroanteriorly), a technique that can be applied with a minimally invasive lateral elbow approach. Materials and Methods Twenty-one isolated capitellum fractures that were surgically treated were included in the study. Fixation was achieved with two headless cannulated compression screws placed in anteroposterior and posteroanterior order using the modified lateral elbow approach. The Broberg-Morrey rating system was used to assess the post-operative functional status of the patients. Results According to the Broberg-Morrey criteria, the mean score was 92.7 (77-100) and 13 cases had excellent, 7 had good, and 1 had fair results. None of the patients developed avascular necrosis or heterotopic ossification. According to the Broberg-Morrey arthrosis score, two cases had Grade 1 and one had Grade 2 arthrosis. One patient had a superficial wound site infection that was treated with antibiotics, and in one case a 60° extension loss was observed in the elbow. Conclusion Treatment of isolated capitellar fractures with 2 headless screws placed anteroposteriorly and posteroanteriorly can provide stable fixation and is less traumatic for the elbow joint. Level of Evidence IV; Therapeutic Studies - Investigating the results of treatment. RESUMO Introdução Avaliamos os resultados clínicos e radiológicos das fraturas do capítulo do úmero tratadas com a técnica de inserção de parafuso modificada (inserção do primeiro parafuso de fixação anteroposterior e do segundo parafuso posteroanterior), que pode ser aplicada com acesso lateral minimamente invasivo do cotovelo. Material e Método Foram incluídas no estudo 21 fraturas isoladas do capítulo que foram tratadas cirurgicamente. A fixação foi obtida com dois parafusos de compressão canulados sem cabeça colocados em ordem anteroposterior e posteroanterior, usando acesso lateral modificado do cotovelo. O sistema de classificação Broberg-Morrey foi usado para avaliar o estado funcional pós-operatório dos pacientes. Resultados De acordo com os critérios de Broberg-Morrey, o escore médio foi de 92,7 (77-100) e 13 casos foram excelentes, 7 bons e 1 regular. Nenhum paciente desenvolveu necrose avascular ou ossificação heterotópica. De acordo com o escore de artrose de Broberg-Morrey, dois casos tinham Grau 1 e um tinha artrose de Grau 2. Um paciente tinha infecção superficial da ferida, que foi tratada com antibióticos, e em um caso observou-se perda de 60° da extensão do cotovelo. Conclusão O tratamento de fraturas isoladas do capítulo do úmero com 2 parafusos sem cabeça colocados anteroposterior e posteroanteriormente pode proporcionar fixação estável e é menos traumático para a articulação do cotovelo. Nível de evidência IV; Estudos terapêuticos - Investigação dos resultados do tratamento.

Purpose Opening-wedge osteotomy of the ulna restores normal ulnar length and corrects the angulation of the ulna in patients with chronic Monteggia fracture–dislocations. In addition, this eases the reduction of the radial head . Morbidity caused by annular ligament reconstruction surgery can be prevented by preserving the intact annular ligament. After dilatation and mobilization of the annular ligament, reduction of the radial head can be accomplished. This study evaluated the effectiveness of corrective opening-wedge ulnar osteotomy and radial head relocation into the intact annular ligament in the treatment of radiocapitellar instability secondary to pediatric chronic Monteggia fracture–dislocation. Methods Fourteen patients diagnosed with radial head dislocation associated with plastic deformation of the ulna or ulnar fracture were included in the study. Radiologic and clinical results of these patients who underwent corrective ulnar osteotomy and radial head relocation into an intact annular ligament were evaluated retrospectively. Results The mean age of the patients at the time of injury was 7.4 years (range, 3 years to 12 years). The average time between the injury and surgery was 19.1 months (median, 8 months; range, 3 months to 66 months); the average follow-up period was 28.7 months (range, 12 months to 60 months). The mean Kim score was 69.6 (range, 50 to 75) preoperatively and 92.9 (60 to 100) at last follow-up. According to Kim score, the results were considered excellent in 12 cases and poor in 2 cases. Radial head subluxation recurred in 2 separate cases. In addition, chondrolysis changes were seen in 1 case. Reduction loss and osteoarthritic changes in the radiocapitellar joint were considered poor results in follow-up radiographs. Conclusions Corrective ulnar osteotomy and relocating the radial head into the intact annular ligament can be safely used for treating chronic Monteggia fracture–dislocation cases without radial head and capitellum deformity. Type of study/level of evidence Therapeutic IV

The purpose of this study was to discuss the epiphysis salvage reconstruction procedure outcomes and complications in skeletally immature patients. The study included 12 patients with pediatric malignant tumors (osteosarcoma, Ewing’s sarcoma) located close to the epiphysis, who underwent epiphyseal-preservation surgery with vascularized fibula in the plastic surgery and orthopedics and traumatology clinic between January 2008 and November 2018. The study was designed retrospectively. Neoadjuvant and adjuvant chemotherapy was administered to all patients. None of the patients received radiotherapy. Functional evaluation was assessed using the Musculoskeletal Tumor Society (MSTS) scoring system. The patients were followed up for a mean period of 51 (21‑115) months. The mean age of patients was 10.4 (range, 5 to 15) years. Union times in the target region (epiphyseal region) and diaphyseal region were reported separately. Accordingly, the mean total union time in the target region of all patients was 7.9 months (5‑11), and the mean total union time in the diaphyseal region was 6.5 months (5‑9). According to the MSTS grading system, the mean score of the patients was 27.50 (range, 21‑30). The mean operative time was 480 (390‑540) min, the mean intraoperative blood loss was 790 (580‑1100) cc, and the mean length of hospital stay was 6 (4‑17) days. Six patients had shortness, 5 patients had delayed union, 3 patients had angular deformity, and 2 patients had infection. Epiphyseal-preservation surgery may be an alternative to other techniques used for malignant tumors located close to the growth line in skeletally immature patients. Despite the fact that this technique has plenty of complications, many of them can be successfully treated with secondary operations without leaving sequelae.

Aim: To examine whether the application of intra-articular lavage during arthroscopic joint fracture surgery can disturb fracture union and cartilage healing. Metods: Twenty New Zealand rabbits were then randomly divided into 3 groups; these groups consisted of 2 surgical groups including eight rabbits and a control group consisting of 4 rabbits. After both rear limbs exposed with a medial parapatellar incision, medial femoral condyle was fractured. Four groups were created by doing anatomic reduction or non-anatomic reduction and making irrigation or no irrigation. (Group 1: Fixed by creating a gap and no Irrigation; Group 2: Fixed by creating a gap and irrigation; Group 3: Fixed with complete reduction and no irrigation; Group 4: Fixed with complete reduction and irrigation) X-rays of both knees of all rabbits were taken at the end of the second week and at the end of the eighth week. The operated knees were collected for histopathological analysis. Results: Radiological data show a significant difference in the level of ossification between the groups in the 2nd week; however, this difference was lost in the 8th week. Histopathologically, at the end of week 8, it was observed that the subchondral bone tissue was incompletely renewed in all the groups. The cartilage tissue of the joint surface was not fully formed and renewed and that it did not completely coalesce with the old cartilage tissue in all of the groups. Compared with the other groups, the group that fracture was anatomically reducted with no irrigation (Group 1), the cartilaginous tissue layer formed was thicker while the surface of the tissue was flatter. Conclusion: There were no adverse effects of intra-articular lavage on fracture union and cartilage healing in an in vivo environment. Nonetheless, the findings of this study should be confirmed with a larger sample size.

Objective We aimed to analyze the resulting effects of COVID-19 pandemic on hand surgery outpatient clinic application trends, and to highlight the patients attitude towards surgical procedures. Methods Data of patients who applied to outpatient clinic between March 13,2020 and June 1,2020 were collected. The control group consisted of patients who applied during the same period in 2019. Information regarding the patient demographics, outpatient clinic attendances, main complaints, and diagnoses were obtained. Elective surgery recommended patients were called when elective operations resumed. Among these patients, those who refused to undergo surgery and their concerns for not agreeing were collected. Results Between 2019 and 2020 there is a %56 decrease in our hospital hand surgery outpatient clinics applications. It is observed that patients mean age decreased significantly during COVID-19 period (p [Hand Microsurg 2021; 10(3.000): 203-210]

Purpose: The treatment of Mason type II fractures is controversial, and the aim of our study is to define the outcome of surgical treatment with screw fixation in the Mason type II radial head fracture. Methods: The study was carried out between 2011 and 2015, and included 14 men and 9 women, with isolated Mason type II radial head fractures which were treated operatively with screw fixation. Cases involving the additional ligament injury or fractures in other areas, or having a follow-up period which is greater than 11 months were excluded. The clinical and radiological results of our patients were assessed, using the Mayo Elbow Performance Score (MEPS). Results: The average MEPS was 95.86 points. 100 degree arcs of motion were attained by a total of 21 patients (91 %) for both flexion–extension and pronation–supination. Nevertheless, 2 patients (9 %) did not recover the 100 degree arcs for the flexion–extension. Conclusion: Anatomical reduction of type II radial head fractures through open surgery and fixation with screws can have favorable results. Level of evidence: Level IV, Retrospective design

Avulsion of the flexor digitorum profundus (FDP) and superficialis (FDS) tendons in the same finger as a result of closed trauma is very rarely seen. Here in, the radiological and functional results of 59-year-old male patient treated for avulsion fracture of the FDS tendon combine with avulsion of the FDP tendon in the 4th finger as a result of closed trauma are presented. [Hand Microsurg 2017; 6(3.000): 150-153]