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Background: Successful web space reconstruction is the most challenging in the treatment of syndactyly, and the choice of the ideal reconstructive technique is still controversial. The aim of the present study was to evaluate the use of the dorsal metacarpal artery perforator (DMAP) propeller flap for simple syndactyly reconstruction. Methods: From May 2016 to May 2018, 14 consecutive children (8 male, 6 female) at a mean age of 5.3 years (2–7 years) with 16 syndactylous webs were included in this prospective study. They underwent web reconstruction using DMAP propeller flap. All patients had primary simple syndactyly. Simple syndactylies were incomplete in 8, complete in 6, unilateral in 12, and bilateral in 2 cases. Operative time and early post-operative complications were recorded. Objective assessment by 2 senior hand surgeons regarding web creep, the quality of scar, scar contracture, and the passive range of motion of the MCP was done. Parents' satisfaction on esthetic outcome was assessed. Results: Sixteen flaps (mean size, 1.8 × 4.9 cm) were used in 14 patients. Surgery time per web space ranged from 50 to 75 min (mean, 54.9 min). All flaps survived completely except for one developed distal tip partial necrosis and treated conservatively. All donor sites healed uneventfully. One patient had a hypertrophic scar which was treated by silicone gel. Full range of motion, no web creep, no scar contracture, and 78.6% subjective cosmetic satisfaction were noted, at a mean follow-up of 25.1 months (range, 12–42 months). Conclusions: DMAP propeller flap is proved to be a reliable option for simple syndactyly reconstruction. It is easily performed and versatile without the need for skin grafts. Moreover, the final results are functionally and cosmetically good. Level of evidence: Level IV, therapeutic study. [ABSTRACT FROM AUTHOR]

Background and aim Tennis elbow is an abuse condition that out comes in pain over lateral side of elbow, provoked by activities involving gripping and manipulating objects by hand. It is frequently a consequence of participation in activities requiring repetitive manual tasks with awkward wrist positions. Tennis elbow has a variety of treatment options, starting from nonoperative treatment, including conservative treatment, bracing, and physiotherapy, to the last line of treatment being surgical intervention. Materials and methods A systemic review was performed using Google, PubMed, and Medline for a period from 2015 to 2019 comparing three methods of tennis elbow treatment: steroid injection, open surgery, and arthroscopic surgery. Results A total of 21 studies included 2055 patients treated by arthroscopic surgery. Overall, 3638 patients were treated by open surgery and 633 patients were treated by steroid injection. Conclusion This systematic review looked at high-level evidence to compare arthroscopic technique, open surgical technique, and steroid injection. There were no clinically significant differences among the three techniques (open, arthroscopic, and steroid injection) according to postoperative pain intensity (visual analog scale). Steroid injection had the least complication rate, with early return to work, but had higher recurrence rate. [ABSTRACT FROM AUTHOR]

Background: Fracture acetabulum is a challenging, difficult to treat orthopedic injury due to its location and associated concomitant injuries. The modified Stoppa approach for reduction of fracture acetabulum improves access to quadrilateral surface and posterior column and is considered to be advantageous in many facets of the surgery. Methods: A randomized controlled clinical study was conducted to provide an update on our experience with modified Stoppa as a favorable surgical approach in acetabular fractures. In the period between 2015 and 2017; 18 patients with acetabular fractures operated by the classical ilioinguinal approach were retrospectively reviewed through their medical records as a controlled group and selected 20 patients with acetabular fractures were operated in the period between 2017 and 2019 using the modified Stoppa approach, as a clinical case group. The two groups were compared regarding operative data and postoperative clinical data, complications, and follow up. Cases were operated in Al Zahraa University Hospital and Nasr City Insurance Hospital by the same surgeon and one of the co-authors. Results: (Group A) those operated by ilioinguinal approach and (Group B) those operated using Stoppa approach. The whole study included 25 males (66%); mean age was 41.8 ± 8.42 (range 18-65) years. The mean follow-up period was 18.5 months with 5 patients lost to follow-up. Both column fractures were observed in most of the patients (45%). We observed anatomical reduction, excellent clinical outcome scores in 75% of patients of group B (p = 0.030), and less complications. Conclusion: Our findings indicated that the modified Stoppa approach is the most convenient approach when surgery is required and achieved favorable results in the treatment of anterior acetabular fractures because it improves visualization in lateral compression injuries and allows treatment of both column fractures with single incision. Hence, it is recommended as an alternative to ilioinguinal approach in developing countries. Further, larger-scale comparative studies of the two surgical modalities for different acetabular fracture types and long-term complications are recommended. Trial registration: A retrospective registration is proceeding through Clinicaltrials.gov. Level of evidence: Level III, therapeutic clinical study [ABSTRACT FROM AUTHOR]