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We aimed to investigate the effects of erythropoietin, acetyl-l-carnitine, and their combination on nerve regeneration in experimental peripheral nerve injury.Rats were randomly divided into five groups - sham-operated (S), sciatic nerve crush injury (C), C + acetyl-l-carnitine (ALCAR), C + erythropoietin (EPO), and C + EPO + ALCAR. ALCAR (50 mg/kg/day) was administered intraperitoneally, and EPO (5000 U/kg) was injected subcutaneously for 10 days. Functional recovery was evaluated using walking track analysis (sciatic functional index [SFI]), somatosensory evoked potentials (SEPs), thiobarbituric acid reactive substance (TBARS) assay, and caspase-3 and S100 immunoreactivities.In SFI analyses, delayed functional recovery was observed in the C group, whereas the functional recovery of rats treated with EPO and ALCAR significantly improved. The latencies of the SEP components were significantly prolonged in C group. In the treatment groups (C + EPO, C + ALCAR, and C + EPO + ALCAR), all recorded values of SEP components significantly decreased. TBARS levels in C group were significantly higher than those in the S group. EPO and ALCAR administration significantly decreased TBARS levels. Caspase-3 immunoreactivity was increased in the C group, whereas it was decreased in the treatment groups. S100 immunolabelling was significantly decreased in the C group. EPO and ALCAR administration caused an increase in the amount of S100-positive cells in all treatment groups.EPO and ALCAR administration could accelerate sciatic nerve repair by reducing apoptosis and lipid peroxidation and promoting myelinization. Although both EPO and ALCAR had positive effects on nerve healing, their combined efficacy had no statistically significant effect on peripheral nerve regeneration.

The JHand is an easy-to-understand questionnaire that includes questions that exclude hand dominance. It was developed to evaluate patients with hand and elbow disorders. However, JHand has not been translated and validated in the Turkish language. The aim of this study is to investigate the psychometric properties of the culturally adapted Turkish version of the JHand for Turkish patients. A total of 262 patients were included in the study. JHand, Disabilities of the Arm, Shoulder, and Hand Questionnaire, and Hand20 were used to evaluate patients. Internal consistency and test-retest analyses were applied to determine the reliability of the Turkish version of the JHand. Confirmatory factor analysis and similar scale validity were used to determine its validity. The Turkish version of the JHand showed high levels of internal consistency and excellent test-retest reliability (Cronbach α = 0.907, ICC = 0.923). The model fit indices of the Turkish version of the JHand had good and acceptable fit with reference values. Statistically positive and very strong correlations were found between JHand and DASH (r = .825, p < .001) as well as the JHand and Hand20 (r = .846, p < .001). The Turkish version of the JHand had excellent internal consistency and test-retest reliability as well as a high level of validity.

Objective The aim of this study was to determine the diagnostic value of Doppler ultrasound (DU) in predicting arterial injuries following the penetrating trauma of the forearm, by comparing preoperative diagnosis made by DU and that made by physical examination (PE) with the intraoperative diagnosis. Methods In this retrospective study, 48 patients (44 men, 3 women; mean age = 30 ± 12.5 years) who underwent surgical treatment due to a suspected arterial injury following a penetrating trauma in the forearm from 2016 to 2018 were included. The DU examination was frequently done before an orthopedic examination. In the orthopedic PE, the knowledge as to whether an arterial injury occurred or (if present) which artery was injured was noted. Preoperative diagnoses by PE and DU were first compared with each other, and then with the intraoperative diagnoses. The specificity, sensitivity, negative and positive predictive values were calculated. Results While the DU findings from 24 patients (50%) matched their intraoperative results, the result from the remaining 24 patients (50%) did not. Nine (18.75%) were considered false-positive and 15 (31.25%) were false-negative. Whereas the PE findings from 30 patients (62.5%) matched their intraoperative results, the remaining 18 patients (37.5%) did not. Six (12.5%) were considered false-positive and 12 (25%) were false- negative. No significant difference was found between the diagnoses of DU and PE, and there was good agreement between the DU and PE findings (P = 0,065, κ = 0,504). While the DU findings were significantly different from the intraoperative findings (P = 0.004), the PE findings were not significantly different from the intraoperative findings (P = 0.302). Sensitivities of DU and PE were both 75% for the diagnosis of radial artery injury as well as 63.3% and 70% for the ulnar artery injury, respectively. Specificities of DU and PE were 83.3% and 91.66% for the diagnosis of radial artery injury as well as 77.77% and 72.22% for the ulnar artery injury, respectively. Conclusion The PE seems more sensitive and useful than the DU in predicting arterial injuries following the penetrating trauma of the forearm. Level of evidence Level IV.

Çapkın, Sercan ( Aksaray, Yazar ), Purpose: Aim of the present study was to evaluate the clinical, functional, and radiological outcomes of 1,2-intercompartmental supraretinacular artery (1.2-ICSRA) vascularized graft technique together with compression screw fixation for the management of scaphoid nonunions. Methods: A retrospective study was designed to evaluate the medical records of the 21 patients treated with 1,2-ICSRA vascularized graft for established scaphoid nonunion of the waist or proximal pole between 2015 and 2018. Seventeen patients who met the criteria were included in the study. The retrospectively analysed demographic parameters included age, gender, injured hand (dominant/non-dominant), aetiology of the injury, delay between injury and operation, initial treatments following the fracture, tobacco use, and background diseases that may affect healing (diabetes, vasculopathy etc.). Radiological and clinical examinations were routinely performed 2 weeks, 6 weeks, 3 months and 6 months after surgery and during the final follow-up. Postoperative clinical and functional outcomes at the latest follow-up were evaluated by measuring active wrist range of motion, grip strength, Turkish version of Quick Disabilities of the Arm, Shoulder and Hand Questionnare (Quick DASH) and Mayo Wrist scores and comparing them with preoperative values. Results: All 17 patients were male with an average age of 26.82 ± 4.08 years (range 20–35 years). The fracture site was located in the scaphoid waist and proximal pole in 5 (29.4%) and 12 (70.6%) patients, respectively. Avascular necrosis was observed in 13 patients (2 at the waist, 11 at the proximal pole). The mean follow-up duration was 18.88 ± 11.98 months (range 6–44 months). No graft extrusion occurred, and no other complication was observed in any of the patients. Amongst the 17 patients, 15 (88.2%) achieved union. The total wrist motions of patients were better postoperatively than preoperatively. However, only improvement in wrist extension was found to be statistically significant. Quick DASH and Mayo Wrist scores of the patients and grip strength were significantly improved postoperatively. Conclusion: The 1,2-ICSRA vascularized graft technique together with compression screw fixation offers an easy and reliable option for the treatment of scaphoid nonunions with a high union rate and good functional and clinical outcomes.

Suture-button suspensionplasty has been popularized in the treatment of thumb carpometacarpal (CMC) arthritis in recent years. The surgical technique of this method was well defined previously. The most challenging and important part of this technique is the tensioning of the suture-button system to preserve first metacarpal height after trapeziectomy. In present study, we would like to present a technical trick about adjusting the tension while performing suspensionplasty using suture-button device in thumb CMC joint osteoarthritis. In the original technique, trapeziectomy is performed prior to fixation and tensioning of suture-button system. However, it is quite difficult to recreate the original trapezial space, since first metacarpal subsides after trapeziectomy. The trick in our technique is that trapezium remains in its anatomic position up to the end of the operation. Thus, we do not need to make effort to adjust the thumb ray height and use fluoroscopic imaging to ensure its position. In conclusion, we believe that our technique simplifies the most challenging part of the operation, shortens the operation time, preserves the original first ray height and diminishes the exposure of ionizing radiation as it reduces the need for fluoroscopy.Die Suture-button-Resektionssuspensionsarthroplastik für die Behandlung der Daumensattelgelenksarthrose erfreut sich seit ihrer Einführung einer gewissen Beliebtheit. Allerdings ist es schwierig die Spannung des Suture-button-Systems so einzustellen, dass eine Proximalisierung des ersten Mittelhandknochens sicher vermieden wird. Wir haben eine Technik entwickelt, die dies erleichtert. Dabei wird im Gegensatz zur Originaltechnik die Resektion des Trapeziums nicht zu Beginn der Operation durchgeführt, sondern erst nach Einbringen des Suture-button-Systems.

Amaç: İzole küretaj ya da küretaj ve greftleme ile tedavi edilmiş elin enkondromlarının demografik değerlendirmesini ve dağılımlarını sunmak. Gereç ve Yöntemler: 2007-2019 yılları arasında el tümörü nedeniyle opere edilen ve patolojik tanısı aynı hastanede konulan 798 hasta retrospektif olarak değerlendirildi. Enkondroma tanısı konulan ve bu sebeple opere edilen, en az bir yıl süre ile takip edilen hastaların yaşı, cinsiyeti, etkilenen tarafları ve tümör yerleşimi değerlendirildi. Bulgular: Toplam 33 hasta ve onların 34 elde yerleşen enkondroması dahil edildi (Ortalama 36,4 yıl; 6-77 aralığında). 33 hastanın 15’i (%45) erkek, 18’i (%55) kadındı. 33 hastanın 20’sinin (%61) enkondroması sağ elde, 13’ününki (%39) sol elde yerleşimliydi. Bir hastanın (%3) iki parmağında enkondroma mevcuttu. 17 hastanın (%52) enkondroması proksimal falanksta, yedi hastanınki (%21) orta falanksta, yedi hastanın (%21) distal falanksta (toplam sekiz distal falanks) ve iki hastanınki (%6) metakarplarındaydı. Bir hastanın enkondroması (%3) başparmakta, altı hastanınki (%18.2) 2.parmakta, beş hastanınki (%15,1) 3.parmakta, 11 hastanınki (%33,3) 4.parmakta ve dokuz hastanınki (%27,3) ise 5.parmakta idi. Sonuç: Enkondromlar genellikle sağ elin ulnar tarafında, sıklıkla proksimal falankslarda görülür ve patolojik kırıklara sebep olabilir.

Glomus tumors are rare vascular pathologies characterized by a triad of symptoms: tenderness, pain and cold intolerance. In the hand they are highly concentrated under the nail bed. In this retrospective study, we aimed to present a topographic map of the location of glomus tumors in the nail bed and a map-based surgical approach algorithm to the subungual glomus tumors.We prepared a nail bed map with 6 zones and named these zones as ulnar distal, ulnar proximal, central distal, central proximal, radial distal and radial proximal. With respect to the tumor location and the used surgical approach we retrospectively evaluated the intraoperative photos and the hospital records of patients who were operated between 2008-2019 and had the pathological diagnosis of glomus tumor. The examination records of the postoperative first year were evaluated for each patient retrospectively. A descriptive statistical analysis was performed. In addition we analyzed the described surgical approaches to excise a glomus tumor in the nail bed. The described approaches and the approaches used by us were matched with the localisation of the tumors in this study developing an algorithm for the surgical approach depending on the localisation of the nail bed glomus tumor.Finally 44 patients had inclusion criteria. The distribution of the glomus tumor was as follows: 2 were on ulnar distal (4.5 %), 9 on ulnar proximal (20.5 %), 1 on central distal (2.3 %), 18 on central proximal (40.9 %), 4 on radial distal (9.1 %) and 10 were on the radial proximal zones (22.7 %). 4 lateral approaches, 1 nail sparing and 39 transungual approaches were performed. We had one recurrence in a male patient operated by transungual approach.Glomus tumors are mostly located on the central proximal part of the nail bed. Our glomus map and the algorithm we described might be helpful for the selection of the surgical approach for the glomus tumor.ZIEL: Glomustumoren sind seltene vaskuläre Tumoren ausgehend von Glomuskörperchen. Die klinische Symptomatik ist gekennzeichnet durch: Berührungsempfindlichkeit, Schmerzen und Kälteintoleranz. An der Hand sind Glomustumoren häufig unter dem Nagelbett lokalisiert. In dieser retrospektiven Studie haben wir die Lokalisation von Glomustumoren des Nagelbettes analysiert und darauf basierend einen Algorithmus für den chirurgischen Zugang zur Exzision entwickelt.Das Nagelbett wurde in 6 Zonen unterteilt: ulnar-distal, ulnar-proximal, zentral-distal, zentral-proximal, radial-distal und radial-proximal. Retrospektiv wurden die Krankenakte und die intraoperativen Fotos von 44 Patienten, die zwischen 2008 und 2019 bei histologisch gesicherter Diagnose eines Glomustumors des Nagelbettes operiert wurden, im Hinblick auf die Tumorlokalisation und den verwendeten Zugang ausgewertet. Des Weiteren wurden die Nachuntersuchungsergebnisse ein Jahr postoperativ ausgewertet und eine deskriptive Statistik durchgeführt. Die in der Literatur beschriebenen chirurgischen Zugänge zur Exzision eines Glomustumors des Nagelbettes wurden erfasst. Unter Berücksichtigung der beschrieben Zugänge und der von uns verwendeten Zugänge wurde unter Berücksichtigung der in dieser Untersuchung gefundenen Lokalisationen der Glomustumoren ein Algorithmus für den chirurgischen Zugang abhängig von der Tumorlokalisation entwickelt.Die Verteilung der Glomustumoren war wie folgt: 2 fanden sich ulnar-distal (4,5 %), 9 ulnar-proximal (20,5 %), 1 zentral-distal (2,3 %), 18 zentral-proximal (40,9 %), 4 radial-distal (9,1 %) und 10 radial-proximal (22,7 %). Es wurden 4 laterale, 1 nagelschonender und 39 transunguale Zugänge verwendet. Nach einem Jahr fand sich ein Rezidiv bei einem Mann, der transungual operiert wurde.Glomustumoren des Nagelbettes finden sich meist im zentralen proximalen Teil des Nagelbettes. Der die Lokalisation der Tumoren berücksichtigende Algorithmus für den chirurgischen Zugang möge bei der Wahl des Zugangs zur Exzision von Glomustumoren des Nagelbettes hilfreich sein.

Objectives This study aims to document a detailed investigation on the sesamoid bones (SBs) of Turkish subjects from different parts of Turkey in a multi-center study, in both hands, according to gender, frequency and divisions of the bones' coexistence and bilaterality by radiography. Patients and methods This retrospective and three-centered study was performed between June 2010 and April 2012. Sesamoid bones were examined by anteroposterior and oblique X-rays of 1,444 hands of 772 subjects (367 males, 405 females; mean age 42.7 years; range, 18 to 87 years). All X-rays were evaluated by at least two independent observers. In controversial circumstances, at least three observers together gave the final decision by consensus. Results Metacarpophalengeal (MCP) joint of the thumb (MCP 1) had sesamoid in all subjects (100%) and it was seen bilaterally. The prevalence of the SB was 42.8% in the second MCP joint (MCP 2) in 772 subjects and 36.6% in 1,444 hands, 1.6% in the third MCP joint (MCP 3) for the subjects and 1.1% for the hands, 0.1% in the fourth MCP joint (MCP 4) for the subjects and 0.1% for the hands, and 72.5% in the fifth MCP joint (MCP 5) for the subjects and 62.5% for the hands. The prevalence of SB in the first interphalangeal joint (IP 1) was 21.8% and SB was detected in 18.6% of the hands. Sesamoid bones of the MCP 2, MCP 5, and IP 1 was recorded more frequently in females. Sesamoid bone of the same joints (MCP 2, MCP 5 and IP 1) was detected more frequently bilaterally than unilateral right side and more frequently unilaterally on right side than unilateral left side. Conclusion The distribution of SBs varies according to hand regions, gender, and side. Having knowledge of the locations and the rate of bilaterality of SBs may assist clinicians in both clinical and radiological diagnoses.

Objectives This study aims to evaluate the distribution and prevalence of pediatric hand tumors and tumor-like lesions according to age and gender. Patients and methods We retrospectively examined the details of hospital records of 646 patients who were operated for hand mass between January 2009 and January 2019 and whose pathological diagnosis was established in the same hospital. A total of 54 patients (18 males, 36 females; mean age 12.07 years; range, 3 month to 17 years) under 18 years of age who had been operated for the wrist or hand mass were included in the study. Results Out of 54 tumors, 53 were benign (98%) and one was malignant (2%). There were 42 soft tissue tumors (78%) and 12 bone tumors (22%). The most common soft tissue mass was ganglion cyst (n=12). Six out of 12 ganglion cysts were on the dorsal side of hand or wrist and six were on the volar side. The distribution of the tumors according to gender was not statistically significant (p=0.73). We had two recurrences: one patient with giant cell tumor of the tendon sheath and one with palmar fibromatosis. Conclusion Pediatric hand/wrist masses are mostly benign tumorous conditions. The location of the pathologies may be different from the adults. Diagnosis of the tumor should be established carefully clinically and radiologically while malignant tumors should be kept in mind by both pediatricians and orthopedic surgeons.

Objective Knowledge concerning treatment and care of hand lesions is often based on small case series, case reports and a few large general case series. The aim of this study is to present our experience with hand tumors' and tumor-like lesions' incidence, age range and localizations. Material and method Between 2006-2016, 402 patients operated and histopathologically diagnosed with bone and soft tissue tumorous conditions of the hand were evaluated retrospectively. Results Three hundred sixty one out of 402 cases (89.8%) were soft tissue tumors and 41 cases (10.2%) were osseous tumors of the hand. A total of 10 malignant tumors (2.5%) were encountered in the hand. The average age of the patients was 41.9 years (ranged from 1 to 83 years). Among 361 soft tissue tumors, only 6 cases (1.6%) were malignant and they were squamous cell tumors (n=5) and synovial sarcoma (n=1). The most common soft tissue pathology was ganglion cyst (n=125). The most common bone tumor was enchondroma, diagnosed in 26 patients (6.4% of all patients). Primary malignant bone tumors were extremely rare in the hand; one osteosarcoma and one chondrosarcoma were reported. Metastatic tumors to the hand were seen in two patients; and they were lung carcinoma and chondrosarcoma metastasis. Conclusion Up-date knowledge and a thorough understanding of the nature and demographic characteristics of the tumorous conditions of the hand are crucial for accurate diagnosis and appropriate treatment.

Background and aims Brain cortex controls movement but the influence of peripheral component of movement on cortex is not known. functional magnetic resonance imaging(fMRI) studies in volenteers, investigate cortex areas activated during execution and imagination of complex movements. We hypothesized that cortex areas activated to remember, organize and order to do a movement can be isolated from areas activated during performing the motor component of movement when the limb is peripherally blocked. We also aimed to show if there is bilateral cortex activity during acute peripheral motor block as seen in stroke patients and amputated patients. Methods We performed brain fMRI in 3 right-handed patients scheduled to undergo right-hand surgery with peripheral block anaesthesia as a pilot-study. Ethics approval and written informed consent from all patients were obtained. fMRI screening was performed before the surgery day and just before surgery after the block. Patients were screened when executing the task (figure 1) (after the block they just attempt), during rest and during they imagine doing the task. Results The activation areas decreased after right-hand block during both blocked and intact hand execution trials (figure 2) and imagination trials (figure 3). We propose that the difference between the areas of right hand represent the motor component of movement. Conclusions In this report, we describe a model that shows the activation areas during the effort of execution and imagery of complex hand movements during peripheral-nerve-block. There are many unknowns in the interactions between the brain-peripheral organ during movement. Identification of motor activation areas will help to perform more effective stroke rehabilitation and neurophatic pain therapies.

Background The purpose of the study was to investigate the long-term outcomes of the all-inside arthroscopic medial reefing (AAMR) procedure for patellar instability and the factors that affect successful outcome. Methods In this retrospective study, AAMR with suture was performed in 16 knees of 15 patients who had at least one patellar dislocation and did not experience a decrease in pain and who did not have a major radiological bony abnormality. Preoperatively, Tegner and Lysholm scales were used; for the final evaluation Tegner, Lysholm, Kujala and Knee injury and Osteoarthritis Outcome Score (KOOS) were used. Results The average age of the patients at the time of operation was 18 years (range: 11–36 years). The average follow-up time was 118.3 months (range: 85–143 months). Six of the 16 knees (37.5%) exhibited re-dislocation. Preoperatively, the mean Lysholm and Tegner were 66.5 and 4.0, respectively; and postoperatively increased to 89.3 (P = .001) and 4.66, respectively. At the final follow-up, mean Kujala was 89.3 (good), and mean KOOS was 91.4. In all patients with re-dislocation, fewer than four knots were used, and none of the patients with four knots exhibited re-dislocation. Re-dislocations occurred in two, two, one and one patients at two, three, five and eight years, respectively. Conclusions The AAMR technique is associated with minimal incisional scarring and an increase in functional scores. It is also associated with a high risk of re-dislocation compared with other methods. If the technique still needs to be used, despite the high re-dislocation rate, at least four knots should be applied.

Objectives: This study aims to identify the optimal follow-up method for evaluation of the surgical outcome for carpal tunnel syndrome (CTS). Patients and methods: Between January 2006 and December 2010, 61 hands of a total of 46 patients (7 males, 39 females; mean age 56.0 +/- 10.4 years; range, 20 to 71 years) with a diagnosis of CTS were retrospectively analyzed. All operations were performed by a single surgeon with a mini-incision distal to the transverse carpal ligament. At a mean follow-up of seven years after surgery, electromyography (EMG) was repeated for all patients. The Boston Carpal Tunnel Questionnaire (BCTQ), Boston Symptom Severity Scale, Boston Functional Status Scale, palmar pinch strength, grip strength, and EMG of the patients were compared before and after surgery. Results: The mean follow-up was 84410 (range, 72 to 104) months. There were significant improvements in the Boston Symptom and Functional Scale scores postoperatively, as well as in the grip and pinch strength. After surgery, EMG findings improved in 83.6% of the patients. However, there was no significant correlation between pre- and postoperative Boston Symptom Severity Scale scores, functional status, pinch and grip strengths, and pre- and postoperative EMG results. Conclusion: Our study results demonstrate that the symptom severity and functional status scores of the BCTQ are favorable, and this tool is reliable and easy-to-apply for the diagnosis and follow-up of CTS surgeries.

Purpose: Deep palmar tumors of the hand are very rare, and reported cases are usually benign. The most important issue is frequent anatomical variations with challenging surgical exposure and excision of these lesions. Some case reports or a small series of patients have been reported in the literature. The aim of this study was to present our experience with the deep palmar tumors of the hand. Patients and Methods: In the study, retrospective analyses of 43 patients treated with deep palmar tumors of the hand between January 1998 and June 2015 were evaluated. Tumors and tumor-like pathologies of the deep palmar space of the hand were retrospectively evaluated according to age, gender, localization, preoperative symptoms, size, site, treatment methods, histopathology, and early and late complications. Statistics and data analyses were also performed. Results: All 43 pathologies were benign, and histopathologic diagnoses were 10 lipomas, 8 ganglions, 5 giant cell tumor of the tendon sheath, 4 schwannomas, 3 hemangiomas, 3 palmar fibromatosis, 2 epidermal cysts, 2 neurofibroma, 1 angiolymphoid hyperplasia with eosinophilia, 1 granuloma, 1 calcifying aponeurotic fibroma, 1 digital fibroma, 1 foreign body granuloma, and 1 lipofibromatous hamartoma. The most common complication was temporary numbness and paresthesias of the digits. Marginal excision was performed in 40 patients, excision with nerve grafting in 2 patients (with neurofibroma) and carpal tunnel release in one patient with lipofibromatous hamartoma. Conclusion: In the deep palmar space of the hand, pathologies are closely associated with tendons, muscles, and neurovascular structures. Preoperative magnetic resonance imaging is helpful for the preoperative diagnosis, evaluating tumor extension, and successful surgical planning. Level of Evidence: IV Therapautic

Proximal humerus fractures and acromioclavicular joint dislocation are the most common reasons for minimally invasive shoulder surgery. A fall (often low energy) is the most common mechanism. The rehabilitation approach that is used for patients following proximal humerus fractures and acromioclavicular joint dislocation differs depending on fracture type, pattern, and surgical approach. The postoperative management of the shoulder is as important as intraoperative care. Although each patient receives an individualized program, the basic goals are the same.

Acromioclavicular (AC) joint is commonly involved in traumatic injuries to the shoulder, and these injuries force surgeons in the diagnostic and therapeutic sense. The AC joint injury constitutes 30–50% of athletic shoulder injuries and represents 8% of all joint dislocations in the body. These injuries can be seen as a result of direct or indirect forces. The most common mechanism of injury is a direct trauma, caused by fall or blow to the lateral aspect of the shoulder with the arm in adduction. Indirect mechanisms of AC joint injuries are rare and may occur by falling on out-stretched hand or elbow in adducted position. This results in superior displacement of humeral head, leading to a pushing force against acromion.

Objectives: The aim of this study is to decrease scar discomfort and pillar pain of carpal tunnel syndrome surgery results which were performed with mini invasive surgery. We preferred to use mini invasive method to preserve the pillar area which is one of the most intensive area for subcutaneous nerve and which is containing most contact area within the hand. Methods: The study included 200 hands of 160 patients with carpal tunnel syndrome at Akdeniz University in between January 2006 - December 2010. All hands were operated by the same surgeon with mini incision which was made through distal of transvers carpal ligament at midpalmar region. Two-hundred hands evaluated with Boston symptom severity and functional state scale, grip and pinch strength, patient satisfaction results. Results: We achieved statistically significant improvement with grip and pinch strength .In postoperative period we achieved significant improvement according to Boston symptom severity and functional state scale. Patient's satisfaction of the procedure was 96.5%. Conclusion: Successful results can be achieved with midpalmar mini-incision method which is a reliable, cheap and effective method. [Hand Microsurg 2013; 2(1.000): 23-27]

Purpose To describe a technique for covering defects of the fingertips: the innervated digital artery perforator (IDAP) flap. Methods A total of 17 patients were treated with an IDAP flap. The size of the flaps varied between 2 ×1 cm and 3.5 × 2 cm. Postoperative evaluation of the patients consisted of the Semmes-Weinstein Monofilament test, static 2-point discrimination, patient satisfaction, extension loss, and an investigation into complications. Results All IDAP flaps survived completely, and no patients required secondary interventions. The mean follow-up period was 7 months (range, 6–10 mo). The Semmes-Weinstein monofilament test results ranged from 3.22 to 3.84. The static 2-point discrimination in the flaps ranged from 2 mm to 4 mm (mean, 3.4 mm) compared with a range of 2 mm to 3 mm (mean, 2.7 mm) on the contralateral hand. There were no joint contractures in the reconstructed fingertips, although 2 patients developed mild hook nail deformity. One patient experienced mild cold intolerance, and 1 patient exhibited mild postoperative hypersensitivity. Conclusions The advantages of the IDAP flap include minimally invasive surgery; a reliable, versatile flap; and the ease of the technique for different-sized fingertip defect reconstructions with few complications. The IDAP flap may be useful in fingertip amputations when the amputated part is not suitable for replantation. Type of study/level of evidence Therapeutic IV.

Carpal tunnel decompression is one of the most common surgical procedures in hand surgery. Cutaneous innervation of the palm by median and ulnar nerves was evaluated to find a suitable incision preserving cutaneous nerves. A morphometric study was designed to define the safe-zone for mini-open carpal tunnel release. Sixteen fresh-frozen (8 right, 8 left) and 14 formalin-fixed (8 right, 6 left) cadaveric hands were dissected. Anatomy of the palmar cutaneous branch of the median and the ulnar nerve, motor branch of the median nerve, superficial palmar arch were evaluated relative to the surgical incision. We also identified the motor branch of the median nerve. Detailed measurements of the whole palmar region are reported in this study. The motor branch of the median nerve was extraligamentous as 60%, subligamentous as 34%, transligamentous as 6%. The palmar cutaneous branches of the median and the ulnar nerves in the palmar region were classified as Type A (34%), Type B (13%), Type C (13%), Type D (none), Type E (40%) according to forms of palmar cutaneous innervation originating from the ulnar and median nerves. Injury to the palmar cutaneous branch of the median nerve (PCBMN) is the most common complication of the carpal tunnel surgery. Various techniques were described to decrease post-operative morbidity. Based on these anatomic findings mini incision between the superficial palmar arch and the most distal part of the PCBMN in the palmar region is the safe-zone for carpal tunnel surgery.

Objectives: We evaluated the results of a new technique developed for aneurysmal bone cysts centrally located in the proximal humeral metaphysis leading to widespread destruction.Methods: The study included seven patients (5 boys, 2 girls; mean age 12.8 years; range 9 to 15 years) who were treated with cortical collapsing and massive fibular autograft for centrally located aneurysmal bone cysts in the proximal humeral metaphysis leading to widespread destruction. All the patients had type II and active tumors according to the criteria of Capanna et al. and Campanacci et al., respectively. Final evaluations included six patients because one patient was lost to follow-up. The mean follow-up period was 49 months (range 12 to 105 months).Results: No complications were seen in the early postoperative period. Radiographic examination showed partial recurrence in two patients; of whom, one patient underwent curettage and bone grafting in the postoperative second year because of pain and discomfort. No deformity was observed. One patient developed shortening of 0.5 cm. Radiographically, all the patients exhibited metaphyseal remodelling one year after surgery. Function of the shoulder joint was near-normal in all the patients.Conclusion: In this technique, cortical collapsing reduces the amount of bone graft used, and massive fibular strut grafting provides structural support to prevent deformities., Amaç: Bu çalışmada, humerus proksimal metafizine santral olarak yerleşmiş, geniş destrüksiyon yapmış anevrizmal kemik kistleri için geliştirdiğimiz yeni bir tekniğin sonuçları değerlendirildi.Çalışma planı: Humerus proksimal metafizinde santral olarak gelişen ve geniş destrüksiyona neden olan, klinik ve radyografik olarak anevrizmal kemik kisti tanısı konan yedi hasta (5 erkek, 2 kız; ort. yaş 12.8; dağılım 9-15) kortikal çöktürme ve fibuladan alınan masif otogreft ile tedavi edildi. Tüm olgularda Capanna ve ark.nın sınıflandırmasına göre tip II, Campanacci ve ark.nın sınıflandırmasına göre aktif tümör vardı. Bir olgu takipten çıktığı için çalışma dışı bırakıldı. Hastaların ortalama takip süresi 49 ay (dağılım 12-105 ay) idi.Sonuçlar: Ameliyat sonrası erken dönemde hiçbir olguda komplikasyon görülmedi. Radyografik değerlendirmede iki olguda kısmi nüks saptandı; bu olgulardan birine, ağrı yakınması nedeniyle ameliyat sonrası ikinci yılda küretaj ve greftleme uygulandı. Olgularda deformite izlenmedi. Sadece bir olguda 0.5 cm’lik kısalık saptandı. Ameliyattan yaklaşık bir yıl sonra metafizer bölgenin anatomik görünümde yeniden şekillendiği gözlendi. Tüm olgularda omuz eklem fonksiyonu normale yakın bulundu.Çıkarımlar: Uyguladığımız teknikte, kortikal çöktürme ile greft ihtiyacı azalmakta, fibular greft de yapısal destek oluşturarak deformite oluşumunu engellemektedir.

The aim of this study is to search if there is any proprioceptive difference between auto and allograft anterior cruciate ligament (ACL) reconstructions, and also to determine if there is any relationship between instrumented anterior knee laxity and proprioception after an ACL reconstruction. The following four groups were constituted for this purpose: group I, control group; group II, autograft reconstructions; group III, allograft reconstructions and group IV, people with injured ACLs. Each group consisted of 20 patients/volunteers. Two subgroups were constituted according to the findings of KT-1,000 laxity testing in group II and III; patients/volunteers found to have a laxity of 3 mm or less were enrolled in the normal subgroup and those with a laxity of more than 3 mm were enrolled in the lax subgroup. Two proprioceptive tests were used: threshold to detect passive motion (TDPM) and joint position sense (JPS) by using Cybex Norm dynamometer. Patients underwent ten tests and the discrepancy in degrees was averaged for ten trials. Comparisons were made to evaluate the proprioceptive differences between groups/subgroups; ANOVA and t test was used for comparisons where appropriate, and the significance was set at P0.05. There was a significant difference in degrees between patients with injured ACLs and the other three groups in TDPM evaluations (injured: 1.93 degrees vs. control: 1.03 degrees , autograft: 1.01 degrees , allograft: 0.96 degrees ; P0.001). Auto and allograft reconstructions were not different from each other and controls. Allo and autograft ACL reconstructions are not different from each other according to proprioceptive measurements. Also, proprioception is not correlated to postoperative anterior knee laxity; many variables involve joint proprioception and mostly the anterior knee laxity may not be the sole determining element, and a lax ACL still may fulfill some of its afferent arc functions as long as it bridges the femur and tibia.

Purpose To demonstrate the advanced use of innervated digital artery perforator (IDAP) flaps for fingertip reconstruction. Methods From August 2011 to May 2014, 65 fingers (59 patients) underwent fingertip or finger stump reconstruction using IDAP flaps. Sixty-one fingers from 55 patients who were followed up for more than 6 months were included in this study. The objective outcomes of patient evaluations consisted of the results of static 2-point discrimination tests, Semmes Weinstein monofilament tests, and extension loss tests. The subjective patient outcome evaluations consisted of the results of hypersensitivity and cold intolerance tests and patient satisfaction. Results All flaps survived completely, and no patients required early secondary interventions. The mean follow-up period was 18 months (range, 6–36 months). The static 2-point discrimination in the flaps ranged from 2 to 6 mm (mean, 3.5 mm) compared with a range of 2 to 3 mm (mean, 2.5 mm) in the contralateral hands. The Semmes Weinstein monofilament test results ranged from 0.07 to 1.4 g compared with 0.04 to 0.4 g for the contralateral hand. One patient exhibited mild extension loss in the reconstructed finger, 4 patients experienced mild cold intolerance, and 2 patients exhibited mild hypersensitivity. Conclusions The IDAP flaps are sensitive, reliable, and versatile and should be considered for reconstructing acute fingertip defects. The use of IDAP flaps for revisions of previously reconstructed defects is also possible. Type of study/level of evidence Therapeutic IV.

Objective: The aim of this study was to present our findings for the use of the digital artery perforator (DAP) flap in the covering of digital pulp defects.Methods: The study included 15 patients who underwent reconstruction of the fingertip using a DAP flap between July 2007 and February 2012. The blood supply of the perforator island flap was based on the distal and either radial or ulnar sides of the digit. Donor sites were closed using skin grafting in all cases. Static two-point discrimination (s2PD) and Semmes-Weinstein monofilament (SWM) testing was performed at the final follow-up to determine extension loss and sensorial improvement.Results: Mean follow-up was 22 (range: 7 to 62) months. Flaps size was between 2x1 cm and 2.5x1.5 cm. Temporary venous congestion was observed in 12 of the 15 patients and was without complication. All patients returned to their normal daily activities and work within an average of 39 (range: 30 to 45) days. Mean two-point discrimination was 5.3 mm and SWM test results were between 3.61 and 4.56 at the final follow-up.Conclusion: The DAP flap appears to be a reliable procedure with several advantages as a single-stage operating procedure, easy to harvest, good sensory recovery and preservation of digital arteries., Amaç: Parmak ucundaki doku kayıplarının rekonstrüksiyonunda zorluklar gözlenebilir. Bu klinik ça¬lışmanın amacı parmak ucu doku kayıplarında dijital arter perforator (DAP) flepleriyle olan deneyi¬mimizi sunmak ve avantajlarını tartışmaktır.Çalışma planı: Temmuz 2007 ile Şubat 2012 tarihleri arasında parmak ucu doku kaybının rekons¬trüksiyonu için 15 hastaya DAP flep uygulandı. Perforatör ada flebi radial yada ulnar taraftan uygun olan kaldırıldı. Tüm olgularda donor alan cilt greftiyle kapatıldı.Bulgular: Flep Boyutları 2x1 cm- 2.5x1.5 cm arasındaydı. Hastaların büyük çoğunluğunda (15 has¬tanın 12’sinde) geçici venöz yetmezlik izlendi, ancak ek bir tedavi gereksinimi olmadan iyileşti. Tüm fleplerde greftlenen donor sahalar sorunsuz bir şekilde iyileşti. Ortalama takip süresi 22 aydı(7-62 ay). Tüm hastalar normal günlük aktivitelerine ve işlerine ortalama 39 gün (30-45 gün) içerisinde dön¬düler. Son değerlendirmede İki nokta ayrımı testinin ortalama değeri 5.3 mm ve Semmes Weinstein Monofilament testinin sonuçları ise 3,61 ile 4,56 arasındaydı.Çıkarımlar: Tek aşamalı, kolay uygulanabilen, iyi duyusal iyileşme gösteren, dijital arterleri koruma gibi bir çok avantajı olan güvenilir bir yöntemdir.

The purpose of this study was to identify a reliable reference point for measuring anterior intermeniscal ligament thickness and to investigate the morphological characteristics of the ligament at its attachment site to anterior horns of both menisci by MRI. MRI was performed in 98 knees of randomly chosen patients. The anterior intermeniscal ligament was detected in 61 knees (62.2%). The average ligament length was 29.8 mm. Men had significantly longer anterior intermeniscal ligament than women patients (32.5 vs. 27.8 mm). The thickness of anterior intermeniscal ligaments at their attachment sites to menisci was usually less than 3 mm; a thickness of 3 mm or more at the attachment site to anterior horns of the meniscus was defined as "cordlike." It is suggested that the "cordlike" pattern is a variation of the anterior intermeniscal ligament's attachment characteristics, and that this might have a significant role in meniscal translations during knee motion, and also that the "cordlike" pattern could be clinically important with respect to its relationship to the anterior horn of medial meniscus. The attachment site of the ligament is a reliable reference point for measuring its thickness.

In B ri ef T HE TERM SESAMOIDS WAS USED FIRST BY Galen to describe the resemblance of the small rounded digital bones to sesame seeds. Sesamoid bones are usually round or oval-shaped bones, a few millimeters in diameter, that developed from their own ossification center. They are partially or totally embedded in the substance of a corresponding tendon. Most people have five sesamoid bones in each hand; two at the metacarpophalangeal (MCP) joint of the thumb, one at the interphalangeal (IP) joint of the thumb, one at the MCP joint of the index finger (MCP-II), and one at the MCP joint of the small finger (MCP-V). There can be different variations in each hand, however (Fig. 1). The incidence of sesamoid bones of the thumb is reported to be between 98% and 100% in the MCP joint and 22% and 73% in the IP joint. The prevalance and distribution of sesamoids in the hands is also variable between different populations and ethnic groups. Pathological conditions of the sesamoid bones are clinically underestimated. Physicians may pay little attention to sesamoid bones and consider them clinically unimportant anatomic variations, although they can become symptomatic. Trauma (fractures, dislocations), degenerative disorders, tumors, and avascular necrosis are the most common disorders of the sesamoid bones. This article describes the clinical importance of the sesamoid bones and possible pathological conditions. Understanding the possible disorders of the sesamoid bones of the hand can lead to a more accurate diagnostic process.

A 16-year-old boy with a 4-month history of pain and a palpable mass in the right wrist was presented to our clinic. Preoperative diagnosis was a ganglion cyst according to symptoms and physical examination. The lesion was removed by marginal resection and histopathologic examination revealed a juxta-articular myxoma. No recurrence was detected at 1-year follow-up evaluation. We report a case of juxta-articular myxoma of the wrist joint.

Purpose: Tumorous conditions of the hand are frequently encountered by hand surgeons. Deep palmar tumors of the hand are very rare, reported cases were usually benign, but the most important issue is frequent anatomical variations with challenging surgical exposure and excision of these lesions. When we review the literature, only case reports or small series of patients were reported. The aim of this study was to demonstrate our experience with the deep palmar tumors of the hand. Materials and Methods: A multicenter retrospective analysis was designed. Medical records were reviewed with searching the database of two hospitals. Fifty-one cases were identified who were operated between the period of January 1998 to May 2015, and patients were invited for final examination. Forty-three patients who were available for the final follow-up examination were included in the study. All patients were evaluated with physical examination and preoperative magnetic resonance imaging (MRI) for surgical planning; x-ray studies were obtained if necessary. Recurrences were confirmed with physical examination and MRI. The analyzed parameters include age, gender, localization, preoperative symptoms, size, site, treatment methods, histopathologies, complications of surgery, and recurrences. Palmar space was divided in to five zones: thenar, carpal tunnel, hypothenar, distal radial, and distal ulnar. Statistical analyses were performed. Results: The mean age at the operation was 38.5 (9-83). Twenty-one (49%) male and 22 (51%) female participants were included in the study. Nineteen (44%) right and 24 (56%) left hands were involved. The most common preoperative symptom was enlarging mass in all patients (100%) followed by nerve compression in 24 patients (44%; 2 motor involvement at Guyon canal), functional impairment in 12 patients (28%), pain in 5 patients (12%), and pruritus in 1 patient (2.3%). The mean follow-up period was 56.7 months (12-168). All 43 pathologies were benign, and there were 10 lipomas (23.3%), 8 ganglions (18.6%), 5 giant cell tumor of the tendon sheath (11.6%), 4 schwannomas (9.3%), 3 hemangioma, 3 palmar fibromatosis, 2 epidermal cysts (4.6%), 2 neurofibroma (4.6%), 1 angiolymphoid hyperplasia with eosinophilia (ALHE) (2.3%), 1 granuloma, 1 calcifying aponeurotic fibroma (CAF), 1 digital fibroma, 1 foreign body granuloma, and 1 lipofibromatous hamartoma. The most common complication was temporary numbness, and paresthesias of the digital nerves were detected in 10 (23%). Only 3 (7%) recurrences (2 ganglions and a lipoma) were observed in the postoperative first year. Two cases were re-operated and one case with ganglion was refused reoperation and followed up with the recurrence. Iatrogenic arterial injury in 2 patients (4.6%) were primarily repaired intraoperatively, local tenderness in one patient (2.3%), weakness of fifth finger adduction in one patients, and stiffness of index finger in one patient. Conclusion: Updated knowledge and understanding nature and demographic characteristics of the tumorous conditions of the hand is crucial for an accurate diagnosis and appropriate treatment. In the deep palmar space of the hand, tumors usually occurs close relationship between tendons, muscles, nerves, and vascular structures. Preoperative MRI is essential for the diagnosis and the successful surgical planning.

Congenital dislocation of the extensor tendon is extremely rare. We report a case of bilateral dislocations in an 8-year-old boy, which were treated successfully with reconstruction of the sagittal band. We describe the technique and 18 months' result.

Discoid lateral meniscus is a rare disorder and its association with other variations in the knee joint has been reported. The anterior intermeniscal ligament has also been described as connecting the anterior convex margin of the lateral meniscus to the anterior horn of the medial meniscus. In the normal population, it was observed at 53-94%. Although the functional properties of the anterior intermeniscal ligament are not yet clarified, two distinct types of the ligament have been described according to their morphological characteristics as cord-like and membranous types. The purpose of this study was to evaluate any possible association between morphologic types of anterior intermeniscal ligament and discoid lateral meniscus. A retrospective study was designed; 20 discoid lateral menisci were operated using routine arthroscopic examination. Upon arthroscopic examination the thickness of the ligament and associated morphological changes were recorded systematically. The cord-like anterior intermeniscal ligament was an associated structure in 15 of the 20 knees with discoid lateral meniscus (75%). Patients with discoid lateral meniscus apparently have cord-like type anterior intermeniscal ligament, thus we conclude that cord-like type of anterior intermeniscal ligament is a frequent accompanying structure to discoid lateral meniscus and may have a potential stabilizing effect on its anterior stability.

Patellofemoral pain syndrome is one of the most common knee joint disorders in current practice. Several imaging methods have been described for pathologies of patellofemoral joint and evaluation of patellofemoral pain. We consider that both scintigraphy and quantitavite computed tomography (QCT) exhibiting bone metabolism (dynamic) and bone density changes in subchondral bone are useful methods especially for evaluating of minor instabilities by which no pathology can be demonstrated by other imaging methods.

Accessory ossicles are the skeletal variations of the ankle and foot that can cause painful syndromes. The accessory navicular bone is one of the most common accessory ossicle of the foot (4-21%) and is also known as os tibiale, os tibiale externum and os naviculare secundarium. This bone can be adjacent to the posteromedial tuberosity of the navicular bone or can be separated and may cause various diseases in the foot and mimic fractures of foot bones. The aim of this study was to document a detailed investigation of incidence and types of accessory navicular bones of Turkish subjects according to sex in both extremities. The accessory navicular bone was detected (11%) via the posterior-anterior radiographs of 650 subjects in the radiological examination. The incidences of accessory navicular bones were identified as 6.1-4.9% in female and male participants. Accessory navicular bones were classified into three groups as Type I, Type II and Type III and the incidences of these bones were determined as 3.3, 3.1, 4.6%, respectively. Each group was also divided into subgroups. The incidences of the subgroups are as Type Ia 0.6%, Type Ib 1.5%, Type Ic 1.2%, Type IIA/a 0.8%, Type IIA/b 0.4%, Type IIA/c 0%, Type IIB/a 1.1%, IIB/b 0.3%, IIB/c 0.5%, Type IIIa 1.5%, Type IIIb 1.4%, Type IIIc 1.7%. Finally, the types of accessory navicular bones were discussed and the imaging modalities for diagnosis were presented.

Partial meniscectomy is the most widely used intervention in the arthroscopic treatment of meniscal disorders. Despite improved arthroscopic techniques and instrumentation, surgery of the lateral compartment is still challenging. The "wheel track" technique, first described here, will facilitate partial meniscectomy in cases where surgical intervention presents difficulties, in particular at the corpus or the anterior horn of the menisci, and the discoid meniscus. In this technique, an incomplete groove resembling a "wheel track" is created on the surface of the meniscus with the use of the tip of electrocautery. This hollow pathway on the surface of the meniscus will help prevent any unintentional divergence of the punch forceps and enable meniscectomy to be completed along the desired direction. Moreover, the technique offers considerable advantages such as ease of application through the standard portals, low cost, and avoidance of iatrogenic chondral injuries due to technical difficulties.

Metastatic malignancies of the hand are rare and they usually develop from lung, breast, and kidney tumors. Metastases to the bones of the hand can cause pain, swelling, soft tissue ulceration, and osteolytic destruction. We presented three patients with metastatic tumors of the hand, whose ages were 58 (male), 42 (female), and 40 (male) years. Metastases developed in the thumb and the big toe, metacarpal bone, and the nail bed following treatment for primary tumors of the bladder, colon, and chondrosarcoma of the proximal femur, respectively. One patient underwent amputation of the thumb and the big toe followed by systemic chemotherapy, one patient with metacarpal involvement was treated with Ray amputation, and the latter underwent a biopsy. Histopathological diagnoses were consistent with primary tumors.

This is a case report of two children with congenital dislocation of the knee. They have been treated surgically with Z-lengthening of the quadriceps tendon and additional reconstruction of the quadriceps tendon with Achilles tendon allograft to fill in the remaining average 6 cm gap of the tendon. The patients were two girls, 6 and 9 years old. One of them had an operative treatment previously with a tendon lengthening procedure and it was failed and the other patient was untreated before. Preoperatively, untreated case was unable to walk. The other patient was limping. None of them was able to flex their knees beyond the neutral extension position. Postoperatively, both patients were able to walk and the knees were reduced to a range of motion of 0 degrees -95 degrees of flexion. The mean follow-up time was 20 months.

Endoscopic carpal tunnel release using Menon's technique has been shown to reduce recovery time, although previous studies have shown that there is still a considerable risk of nerve complications. The purpose of this study was to evaluate data from 227 hands of 191 patients who underwent releases with Menon's technique.Prospective study.Endoscopic releases were performed as an outpatient intervention by one surgeon. Follow-up evaluations included were analysis of satisfaction, quantitative measurements of grip strength, return to work time, and complications. After the surgery on the first 50 hands in 41 consecutive cases, the technique was modified. Prospectively, changes in the technique are due to difficulties maintaining the knife within the center of the cannula's slot and a relatively high complication rate. In the modified technique, a 2.7-mm 25 degrees endoscope and a triangular diamond-tipped knife were used to allow for more room for the instruments and a more safe procedure.During the first month after the surgery, 91% of the patients had better subjective satisfaction scores and by 12 weeks, 81% obtained 75% to 100% or greater grip strength. Within 3 weeks, 70% of the patients had returned to work. Twelve of 50 hands operated on using the original technique had nerve disturbance diagnosed at follow-up. Three of these 12 patients developed reflex sympathetic dystrophy. One patient had partial median nerve injury that was repaired at the time of the index operation. There was no serious complication observed in 177 hands of 150 cases operated on using the modified Menon's technique, except one postoperative hypoesthesia along the long and ring fingers that improved with time.The procedure is suitable for outpatient surgery and the risk of inadvertent damage to the neurovascular structures can be dramatically reduced with the modifications to the technique.Level IV.

An arthroscopic study was made on the presence and anatomic features of the anterior intermeniscal ligament with regard to its thickness and attachment patterns to the anterior horn of the menisci, together with its relationship with associated non-traumatic intraarticular disorders of the knee.This multicenter study included 136 consecutive patients (80 males, 56 females; mean age 40 years; range 15 to 74 years) in whom the presence of anterior intermeniscal ligament was sought during arthroscopic examination of the knee. Arthroscopic features of the ligament was evaluated by probe.The anterior intermeniscal ligament was detected in 80 knees (58.8%). Its presence did not differ significantly with respect to sex (33 females, 58.9%; 47 males, 58.8%; p0.05). A cord-like appearance was observed in 19 cases (14%), whereas a membranous-like structure was identified in 61 cases (44.9%), 34 (55.7%) of which could only be detected following synovial abrasion. Attachment patterns according to the Nelson and LaPrade's description showed type A in 47 cases (58.8%), type B in 23 cases (28.8%), and type C in 10 cases (12.5%). Type A was more common among cord-like intermeniscal ligaments, although this did not reach significance (p0.05). No significant association was found between the presence of the ligament and intraarticular disorders. The detection of discoid lateral meniscus was significantly associated with the presence of a cord-like intermeniscal ligament (p0.05). Of eight cases with discoid lateral meniscus (5 complete, 3 incomplete), five patients exhibited a cord-like anterior intermeniscal ligament.This is the first arthroscopic study to define the anatomy and the incidence of the anterior intermeniscal ligament. Functional features of the ligament should be more clearly demonstrated biomechanically.

Effective joint distraction is crucial in arthroscopic ankle surgery. We describe an effective and controlled intra-articular ankle distraction technique that we have studied by means of a fresh-frozen cadaver model. Using a kyphoplasty balloon, which is currently used in spine surgery, we tried to achieve a controlled distraction. After the fixation of the cadaver model, standard anteromedial and anterolateral portals were used for ankle arthroscopy. From the same portals, the kyphoplasty balloon was inserted and placed in an appropriate position intra-articularly. The necessary amount of distraction was achieved by inflating the kyphoplasty balloon with a pressure regulation pump. All anatomic sites of the ankle joint were easily visualized with the arthroscope during surgery by changing the pressure and the intra-articular position of the kyphoplasty balloon. Ankle distraction was clearly seen on the arthroscopic and image intensifier view. The kyphoplasty balloon is simple to place through the standard portals and the advantage is that it allows easy manipulation of the arthroscopic instruments from the same portal.

Objective: Kienböck disease is an avascular necrosis of the lunate which can lead to progressive wrist pain, loss of function of the wrist joint and intercarpal arthrosis. Treatment of Kienböck disease is still debated today. There are several treatment options, based on the patient’s age, stage of disease, distal radio-ulnar joint, presence or absence of arthritic changes and expectations of the patient. The aim of this study was to evaluate the clinical outcomes of the patients treated with radial shortening osteotomy. Material and Methods: Sixteen patients 7 women, 9 men with Kienböck disease who were treated with radial shortening osteotomy between May 2008 and March 2014 were reviewed. The average age of the patients was 27.2 years. The affected wrists were the left side in 6 cases and the right side in 10 cases. The mean follow-up period was 31 months. Patients’ preoperative and postoperative range of wrist motions, grip strength, pain level using visual analogue scale VAS and radiographic progression were evaluated.Results: At follow up, the mean grip strength of the patients was 26.5 kg, while it was 21.5 preoperatively. The mean range of wrist motion was 86.5 degrees preoperatively and 125.5 degrees at the last examination postoperatively. All patients showed improvement in grip strength and range of motion. The average VAS score was 2.6 postoperatively and 7.5 preoperatively. GIRIŞ ve AMAÇConclusion: Radial shortening osteotomy is an effective and reliable technique with less morbidity in the treatment of patients with Lichtman stage 2, 3A and 3B Kienböck disease and negative ulnar variance, Amaç: Kienböck hastalığı, el bilek ekleminde ilerleyici ağrı, fonksiyon kaybı ve uzun dönemde karpal kemikler arasında yaygın artroz oluşumuna neden olan, lunatumun avasküler nekrozu ile karakterize bir klinik tablodur. Günümüzde halen kabul edilmiş standart bir tedavi protokolü mevcut değildir. Kienböck hastalığının tedavisinde birçok teknik tanımlanmıştır. Tedavinin planlanmasında hastanın yaşı, hastalığın evresi, distal radio-ulnar eklem ilişkisi, el bilek eklemindeki artrozun derecesi ve hastanın beklentileri önemlidir. Bu çalışmamızda, radial kısaltma yöntemi ile tedavi edilen hastalarımızın klinik sonuçlarını sunmayı amaçladık.Gereç ve Yöntemler: Mayıs 2008 ile Mart 2014 tarihleri arasında Kienböck hastalığı nedeniyle 16 olgu 7 kadın, 9 erkek volar yaklaşımla radial kısaltma osteotmisi yöntemi ile tedavi edildi. Hastaların ortalama yaşı 27,2 idi ve 6 hastada sol, 10 hastada sağ el bileği etkilenmişti. Hastaların ortalama takip süresi 31 aydı. Hastaların ameliyat öncesi ve sonrasındaki eklem hareket genişlikleri, kavrama gücü, görsel ağrı skalası ile ağrı düzeyleri ve radyolojik ilerlemesi değerlendirildi. Bulgular: Ameliyat öncesi ölçülen ortalama kavrama gücü 21,5 kg iken, son ölçümde ortalama 26,5 kg olduğu ve tüm hastalarda arttığı gözlendi. Ameliyat öncesi hareket genişliği 86,5 derece, ameliyat sonrası son değerlendirmede ise 125,5 derece olarak ölçüldü. Ameliyat öncesi ortalama 7,5 olan VAS skoru ameliyat sonrası dönemde ortalama 2,6 olarak bulundu. Sonuç: Radial kısaltma tekniği; ulnar varyansı negatif, Lichtman evre 2, 3A, 3B Kienböck hastalığı olan hastalarda etkin, morbiditesi düşük ve güvenilir bir yöntemdir