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Elastic intramedullary nailing is the main treatment method in the surgical treatment of pediatric forearm fractures. In this study, we compared the clinical outcomes of intramedullary nailing of forearm fractures with leaving the tips exposed and with placing the tip of the nails under the skin. We aimed to present the clinical outcomes of intramedullary nailing and determine the advantages and disadvantages of leaving the tips of the nails exposed. One hundred and ninety-two children with both-bone forearm fracture who were treated with titanium elastic nailing (TEN) in the Department of Orthopedics at Erzurum Regional Training and Research Hospital between January 2009 and December 2016 were included in the study. All cases had been followed up for at least 1 year. The tips of the TENs were left exposed in 74 and buried subcutaneously in 118 children. Union was achieved in all cases. Delayed union was observed in just one case. Skin irritation was observed in 11 (5.7%) of the exposed TEN cases. Superficial infection developed in two (1%) cases with exposed TEN tips. Migration developed during the follow-up of 11 (5.7%) cases with buried tips. The mean time to removal of TEN was 7.9 weeks in cases with exposed and 26.2 weeks in cases with buried cases. Refracture was observed in six buried (3.1%) cases and four exposed TEN (2.1%) cases in the first year after the removal of the nails. Perfect outcomes were achieved in 146 (76%) cases and good outcomes in 36 (19%) cases in our study. On comparing the rate of complications and clinicaloutcomes, leaving the TEN exposed seems to be safe.

Nörofibrolipom nadir görülen bir ortopedik patolojidir ve pekçok terim bu kitleyi tanımlamak için tarih boyunca kullanılmıştır. Nörofibrolipom sıklıkla el ve ayak parmaklarını tutar. Muayene esnasında saptanan bir kitleye bu tanıyı koyabilmek için biopsi sonrası patolojik inceleme şarttır. Nörofibrolipomlar sadece semptomatik olduklarında çıkarılmaları önerilmektedir. Asemptomatik vakalar güvenle takip edilebilir. Sunmuş olduğumuz vakamızda biopsi sonrası hastanın tüm şikayetleri gerilemesi üzerine kitle çıkarımı için ikincil operasyon yapılmadı. Biopsi sonrası nörofibrolipom tanısı doğrulanan hastalarda kitle çıkarılması için çok acele edilmemesinin gereksiz ikincil operasyonların önüne geçeceğine inanmaktayız.

Karpal tünel sendromunun tedavisi konservatif ve cerrahi metodlar olmak üzere iki büyük gruba ayrılır. Steroid enjeksiyonu bu hastalarda ağrıyı azaltmak amacıyla kullanılabilmektedir. Bu enjeksiyon literatürde iğne ucu sinire temas etmediği takdirde oldukça güvenli bir metod olarak görülmektedir. Bu çalışmada karpal tünele steroid enjeksiyonu yapılmış bir hastanın tedavi sonuçlarını sunmaktayız. Dış merkezde karpal tünele steroid enjeksiyonu yapılan hastanın el bileği harektleri kısıtlanmış, ağrısı ise giderek artmış. Bu şikayetler ile tarafımıza başvuran hastada enjeksiyon nedeni ile oluşan fibröz dokular cerrahi olarak temizlendi. Debritman sonrası el ve el bileği eklem hareket açıklıkları normale dönen hastanın şikayetleri geriledi. Biz bu çalışmamızda karpal tünel enjeksiyonunun tamamen güvenli bir metod olmadığını, sendromun tedavisinde etkisinin kısıtlı ve geçici olduğunu vurgulamayı amaçlıyoruz.

Parmak ucu elde en sık yaralanan bölgedir. Bu bölge ampütasyonlarında sekonder yara iyileşmesi ile tedavi planlandığında enfeksiyon ciddi bir problemdir. Ayrıca sekonder iyileşmede oluşan skar dokusu hissiz ve fonksiyonsuz parmak ucuna neden olmaktadır. Replantasyon ise bu bölgede zor bir cerrahi seçenek olmasına rağmen uygun teknik ile yapıldığında daha başarılı sonuçlar sunmaktadır. Pulpa replantasyonları teknik olarak zor olmasına rağmen kozmetik ve fonksiyonel açıdan çok iyi sonuçlar vermektedir. Özellikle başparmak pulpa ampütasyonlarında başparmaktaki uzunluk kaybı el fonksiyonlarını olumsuz etkilediği için diğer parmaklara nazaran replantasyonu ön planda düşünmek gerekmektedir. Bu çalışmamızda başparmak total pulpa ampütasyonu olan olgumuzun replantasyon tedavisinin aşamalarını ve sonuçlarını sunmayı amaçlıyoruz., The fingertip is the most frequently injured area on the hand. Infection is a serious problem when treatment with secondary wound healing is planned in these region amputations. In addition, the scar tissue that develops in secondary healing causes a senseless and nonfunctional fingertip. Replantation is a difficult surgical option in this region, but it offers more successful results when applied with appropriate technique. Although pulp replantations are technically difficult, they give very good cosmetic and functional results. Especially in the thumb pulp amputations, loss of the length of the thumb affects the hand functions negatively, so it is necessary to think about replantation in comparison with other fingers. In this study, we aim to present the stages and outcome of replantation for our patient with total thumb pulp amputation.

In emergency services, Intravenous catheters are most useful instruments to hidrate patients, administrate drugs fast and get serial blood sample with a single invasive procedure emergency departments. Accidentally, the venous catheters may be introduced into arteries ending up with pulseless hands. Following up pink pulseness hands is an important concept to rescue the extremity. The presented case is a 3-days old infant with no trauma history to the upper extremities but showing up with bilateral, pink, pulseless hand secondary to accidental arterial vascular injury during venous catheterization. Pink pulseness hand treatment is still controversial in the literature. In pink pulseness hand cases where close monitoring can be applied, good results are obtained without surgical exploration. İntravenöz kateterler acil servislerde hastaları hidrate etmek, hızlı ilaç uygulamak ve tek bir invaziv işlem ile seri kan örneği almak için en kullanışlı araçlardır. Venöz kateterler kazara artere uygulanabilmektedir ve bu durum klinikte nabızsız el tablosuna neden olabilmektedir. Pembe nabızsız elin takibi ekstremiteyi kurtarmak için çok önemli bir prosedürdür. Sunmuş olduğumuz vaka üst ekstremitede herhangi bir travma öyküsü olmayan, ancak venöz kateterizasyon sırasında kaza ile arteryel vasküler yaralanmaya sekonder gelişen bilateral pembe nabızsız el ile başvuran 3 günlük infanttır. Pembe nabızsız el tedavisi hala literatürde tartışmalıdır. Yakın izlem uygulanabilen pembe nabızsız el olgularında yakın takip uygulanabilir ve cerrahi eksplorasyon olmadan iyi sonuçlar elde edilebilmektedir.

Intracompartmental pressure (ICP) monitoring is a widely used modality, particularly after intramedullary nailing of tibial shaft fractures. It was hypothesized that ICP value in fracture fixed with Ilizarov circular fixator (ICF) might be lower than in fracture fixed with intramedullary pin (IMP). The present study is a comparison of ICP value in tibial fractures in a rabbit model fixed with ICF and IMP.Twenty male New Zealand White rabbits were randomly divided into 2 groups of equal size: ICF group (Group 1) and IMP group (Group 2). Under anesthesia, half of proximal part of the right tibia of all rabbits was fractured. Tibial fractures were fixed with ICF in Group 1 and IMP in Group 2. ICP values were monitored at 6-hour intervals for 48 hours.There was statistically significant difference in ICP value between groups (p0.001). While there was statistically significant increase in ICP values 24 hours post surgery, there was statistically significant decrease during second 24 hours following surgery. Most importantly, ICP values of ICF group were significantly lower than those of IMP group at 30, 36, and 42 hours post surgery (p0.05).At 24th hour after fixation, ICP values measured in ICF group were lower compared with those of IMP group. These results indicate that use of ICF in tibial fractures provides additional decompression in the anterior compartment. In light of these findings, ICF may be preferable for treatment of tibial fractures with high risk for compartment syndrome.

A local injection of corticosteroid–lidocaine into the periarticular soft tissue structures is used commonly for rapid pain relief. It is hypothesized that knee pain associated with knee osteoarthritis would be relieved quickly and effectively in patients receiving intraarticular hyaluronic acid combined with a periarticular lidocaine–corticosteroid injection. To test this hypothesis, the clinical effect of the combined treatment with hyaluronic acid injection alone in patients with symptomatic knee osteoarthritis as compared in this prospective single-blinded randomized trial. This study included 70 patients. Group 1 (n = 35) received intraarticular hyaluronic acid injections only, whereas group 2 (n = 35) received intraarticular hyaluronic acid injections combined with a single local injection of corticosteroid–lidocaine. Injections were administered to the most painful areas of the anterior or posterior medial condyle of the femur or tibia. The outcome was measured by independent assessors (blinded to treatment) using a linear VAS pain scale and WOMAC and HSS knee scores. Assessments were performed at baseline and at 1, 3, 6, 12, 26, and 52 weeks. During the first 3 weeks, group 2 patients showed significantly better all scores than did group 1 patients (p

We compared the intracompartmental pressures (ICPs) of open and closed tibial fractures with the same injury pattern in a rabbit model. In all, 20 six-month-old New Zealand White male rabbits were used. They were randomised into two equal groups of ten rabbits; an open fracture group (group 1) and a closed fracture group (group 2). Each anaesthetised rabbit was subjected to a standardised fracture of the proximal half of the right tibia using a custom-made device. In order to create a grade II open fracture in group 1, a 10 mm segment of fascia and periosteum was excised. The ICP in the anterior compartment was monitored at six-hourly intervals for 48 hours. Although there was a statistically significant difference in ICP values within each group (both p < 0.001), there was no significant difference between the groups for all measurements (all p ≥ 0.089). In addition, in both groups there was a statistically significant increase in ICP within the first 24 hours, whereas there was a statistically significant decrease within the second 24 hours (p < 0.001 for both groups). We conclude that open tibial fractures should be monitored for the development of acute compartment syndrome to the same extent as closed fractures. Cite this paper: Bone Joint J 2013;95-B:111–14.

BACKGROUND Intracompartmental pressure (ICP) monitoring is a widely used modality, particularly after intramedullary nailing of tibial shaft fractures. It was hypothesized that ICP value in fracture fixed with Ilizarov circular fixator (ICF) might be lower than in fracture fixed with intramedullary pin (IMP). The present study is a comparison of ICP value in tibial fractures in a rabbit model fixed with ICF and IMP. METHODS Twenty male New Zealand White rabbits were randomly divided into 2 groups of equal size: ICF group (Group 1) and IMP group (Group 2). Under anesthesia, half of proximal part of the right tibia of all rabbits was fractured. Tibial fractures were fixed with ICF in Group 1 and IMP in Group 2. ICP values were monitored at 6-hour intervals for 48 hours. RESULTS There was statistically significant difference in ICP value between groups (p

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]