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This study aimed to investigate whether ultrasonographic inspection of the repair site of median nerve lacerations may provide useful evidence about the functional outcome in the affected hand. Forty-three patients with complete transection of the median nerve at the distal forearm were examined at a median of 40.9 months after operation by detailed ultrasonographic imaging and clinical assessment of the affected hand by the Michigan Hand Questionnaire and Rosén-Lundborg Protocol to investigate the quality of nerve healing. The continuity of individual nerve fascicles was assessed and the cross-sectional area of the enlarged nerve at the repair site was measured and compared with the contralateral median nerve at the same level. An enlargement ratio for the repair site of each nerve was calculated and compared with the numeric results obtained from the two clinical tests. A statistically significant reverse correlation was observed between nerve enlargement and the functional results of the repaired nerve. Level of evidence: IV

Objective: There has been no consensus in literature for the ideal flexor tendon repair technique. The results of zone 2 flexor tendon lacerations repaired primarily by 4 strand Modified Kessler core suture and epitendinous interlocking suture technique followed by Modified Kleinert protocol were investigated. Methods: 128 fingers of 89 patients who had flexor tendon laceration in zone 2 built the working group. Functional outcomes were evaluated using the Strickland formula. A statistical analysis was made between Strickland scores and some parameters such as age, gender, follow-up time, co-existing injury existence, repair time, single or multiple finger injury, tendon rupture and the effect of FDS injury and repair. Results: Excellent, good, fair, poor results were obtained from 71 (55.5%), 46 (35.9%), 8 (6.3%), 3 (2.3%) fingers, respectively. Time of the repair has a significant effect on the strickland scores. Surgery performed within the first 24 hours following the injury gave better results. 3 fingers (2.3%) had tendon ruptures. Existence of ruptures affected the results significantly. Co-existing injuries were found that they did not have any effect on the results. In the fingers in which both FDP and FDS tendons were lacerated, no significant relationship was found between only FDP repair, both FDP and FDS repair and single FDS slip repair. Additionally no significant relationships between follow-up time, gender, single or multiple finger injury and Strickland scores were observed. 13 fingers (10.1%) had PIP joint contracture above 20°. Conclusion: The low rupture rate (2.3%) and 91.4% ‘good’ and ‘excellent’ scoring rates in our series support the idea that modified Kessler 4-strand core suture and epitendinous interlocking suture repair combined with modified Kleinert protocol gives satisfactory results. Repair time is one of the most important factors affecting the functional results and surgery should not be delayed if there is an experienced surgeon available. Level of evidence: Level IV, therapeutic study. Keywords: Flexor tendon, Zone 2, Core suture, Strickland, Kleinert, Kessler

This article defines a sensate, pedicled heterodigital flap from the proximal radial side of the index finger for reconstructing large soft tissue defects of the thumb. The pedicle consists of the radial digital artery of the index finger. Dorsal sensory branch of proper digital nerve and one of the terminal sensory branches of radial nerve are included in the flap for sensation. The results of 17 consecutive patients at 24 months revealed mean static two-point discrimination of 7 mm at the reconstruction site and 10 patients were able to feel 4 mm at the reconstructed thumb. The mean range of motion of metacarpophalangeal and interphalangeal joints of operated thumbs reached 94% and 66%, the mean grip span reached 96% compared with the uninjured side. The presented flap provided a simple yet favourable alternative for reconstruction of the thumb tip, with thick and durable tissue requiring minimum dissection and donor side morbidity. Level of evidence: IV

Objectives: We evaluated late-term results of surgical repair and physical rehabilitation of isolated zone 3 extensor tendon injuries.Methods: Sixteen patients (13 males, 3 females; mean age 28 years; range 11 to 57 years) underwent surgical repair for isolated simple central slip injuries of zone 3 extensor tendon. Injuries involved the second, third, fourth, and fifth fingers in seven, three, two, and four patients, respectively. Primary tendon repair was performed in 14 patients. Two patients were treated after one week and two months following primary injury, respectively. Tendons were repaired by modified Kessler and epitendinous sutures in four patients, and by locking running suture in 12 patients. Following surgical repair, three patients underwent K-wire fixation in extension for two weeks, while 13 patients received the short arc motion protocol. The patients were assessed with respect to proximal interphalangeal (PIP) joint motion and extension loss. Functional results were assessed using the Strickland formula. The mean follow-up was 58 months (range 8 to 120 months).Results: Full range of motion of the PIP joint was achieved in 15 patients (93.8%). The mean PIP joint motion was 98 degrees. One patient (6.3%) had an extension loss of 10 degrees in the range of motion of the PIP joint. There were no losses in the range of motion in three patients treated with K-wire fixation. The mean of the Strickland formula was 94.8% (range 74% to 100%), showing an excellent result in 15 patients (98.3%) and a good result in one patient (6.3%). All the patients returned to their pre-injury work status. None had buttonhole deformity or soft tissue complication.Conclusion: A proper suture technique combined with the short arc motion protocol provides good results in the treatment of isolated zone 3 extensor tendon injuries., Amaç: Üçüncü bölgede izole ekstansör tendon kesisi olan hastalarda uygulanan cerrahi onarım ve fizik tedavinin geç dönem sonuçları geriye dönük olarak incelendi.Çalışma planı: Üçüncü bölgede izole basit santral slip ekstansör tendon yaralanması nedeniyle cerrahi onarım uygulanan 16 hasta (13 erkek, 3 kadın; ort. yaş 28; dağılım 11-57) çalışmaya alındı. Yaralanan parmaklar 2. parmak (n=7), 3. parmak (n=3), 4. parmak (n=2) ve 5. parmak (n=4) idi. On dört hastada tendon onarımı primer yapıldı. İki hastada girişim sırasıyla bir hafta ve iki aylık gecikmeyle yapıldı. Dört hastada modifiye Kessler ve epitendinöz dikiş, 12 hastada kilitli devamlı dikiş kullanıldı. Tendon onarımı sonrasında üç hastada iki hafta süreyle ekstansiyonda K-teli ile tespit uygulanırken, 13 hastaya kısa ark hareket programı uygulandı. Hastalar son kontrolde proksimal interfalengeal (PİF) eklem hareket açıklığı ve ekstansiyon kaybı açısından değerlendirildi. Sonuçlar, Strickland formülü kullanılarak değerlendirildi. Ortalama izlem süresi 58 ay (dağılım 8-120 ay) idi.Sonuçlar: Proksimal interfalengeal eklem hareket açıklığı 15 hastada (%93.8) tam bulundu. Ortalama PİF eklem hareket açıklığı 89 derece idi. Bir hastada (%6.3) PİF eklem hareket açıklığında 10º fleksiyon kaybı görüldü. K-teli ile tespit uygulanan üç hastada hareket açıklığında kayıp gözlenmedi. Strickland ortalaması %94.8 (dağılım %74-100) bulundu. On beş hastada (%93.8) çok iyi, bir hastada (%6.3) iyi sonuç elde edildi. Hastaların tamamı sorunsuz olarak işlerine döndü. Hiçbir olguda geç dönemde düğme iliği deformitesi, yumuşak doku komplikasyonu gözlenmedi.Çıkarımlar: İzole üçüncü bölge ekstansör tendon yaralanmalarında, uygun dikiş tekniği ve kısa ark hareket programı ile iyi sonuçlar elde edilebilir.