Search

The aim of this retrospective cross-sectional study was to assess vascular repair modalities and function in type IV ring finger replantations. Thirty-seven of 43 patients with complete ring avulsion amputations were replanted. After resection of the damaged arterial segments under microscopic magnification the arterial flow pattern was evaluated. The type of repair was chosen according to the adequacy of arterial flow and the defect between the vessels. The methods of bridging the arterial defect consisted of digital artery transfer from adjacent digit in 21 fingers, vein graft interposition in six fingers and end to end anastomosis in ten fingers. Thirty-one of the 37 fingers survived. The failures were due to four arterial and two venous insufficiencies. In our opinion, radical resection of damaged zones of vessels is important to evaluate the proximal flow pattern and decide which treatment modality is necessary for healthy vascular anastomosis. [ABSTRACT FROM PUBLISHER]

A variety of flaps have been described to treat longitudinal soft tissue defects located on the dorsal aspect of the fingers. We report 13 dorsal soft tissue defects in four patients in which unipedicle laterodigital transposition flaps were used for reconstruction. This flap is especially useful for the reconstruction of long and narrow defects located on the dorsal region of the fingers in multi-digit injuries. [ABSTRACT FROM PUBLISHER]

Background: Palmar finger or pulp defects require coverage with glabrous tissue to achieve a good match with the lost tissue. The management of multiple finger palmar or pulp defects is challenging because these defects may not always be suitable for local or pedicled flaps. In such situations, syndactylizing free or pedicled flaps can be used., Patients and Methods: We evaluated the results of free glabrous flaps syndactylizing across multiple finger defects. The two flaps used were the superficial branch of the radial artery (SUPBRA) flap and hypothenar free flap. Seven syndactylized glabrous free flaps were used to cover the defects in 16 fingers. The functional results and complaints were also assessed., Results: Mean flap size was 14.35 cm 2 . Six flaps survived. Postoperative evaluation data were obtained for the 13 fingers. All the patients returned to their previous work. All patients had a diminished protective sensation of at least 4.31 according to the SWM test. The mean two-point discrimination score of the patients was 9.9 mm (7-14). One finger had a PIP joint flexion contracture of 30°, no donor-site complaints were observed., Conclusion: The advantages of these flaps include single operation site, strong glabrous tissue coverage, low risk of flexion contracture, and adequate tissue size for large defects. Disadvantages include two-stage and complex microsurgical operations, prolonged treatment, and hospital stay., (© 2024 Wiley Periodicals LLC.)

Background: We created patient-based 3D finite-element (FE) models that simulate the congruent-arc Latarjet (CAL) and traditional Latarjet (TL) procedures and then compared their stress distribution patterns with different arm positions and glenoid defects., Methods: The computed tomography data of 10 adult patients (9 men and 1 woman, ages: 18-50 years) were used to develop the 3D FE glenohumeral joint models. Twenty-five and 35% bony defects were created on the anterior glenoid rim, and the coracoid process was transferred flush with the glenoid by the traditional and congruent-arc techniques using two half-threaded screws. A load was applied to the greater tuberosity toward the center of the glenoid, and a tensile force (20 N) was applied to the coracoid tip along the direction of the conjoint tendon. The distribution patterns of the von Mises stress in the traditional and congruent-arc Latarjet techniques were compared., Results: The mean von Mises on the graft was significantly greater for the TL technique than for the CAL. While the von Mises stress was greater in the distal medial part of the graft in the TL models, a higher stress concentration was observed in the distal lateral edge of the coracoid graft in the CAL models. The proximal medial part of the graft exhibited significantly lower von Mises stress than the distal medial part when compared according to technique, defect size, and arm position. Increasing the glenoid defect from 25 to 35% resulted in a significant increase in stress on the lateral side of the graft in both models., Conclusion: The stress distribution patterns and stress magnitude of the coracoid grafts differed according to the procedure. Due to placing less stress on the proximal-medial part of the graft, the CAL technique may lead to insufficient stimulation for bone formation at the graft-glenoid interface, resulting in a higher incidence of graft osteolysis. Clinical relevance The CAL technique may lead to a higher incidence of graft osteolysis., Level of Evidence: Basic Science Study; Computer Modeling., (© 2022. The Author(s).)

Objective: The aim of this study was to analyze and classify hypertrophy seen in vascularized fibula flaps used for reconstruction of tubular bone defects., Methods: Thirty-three patients who underwent a vascularized fibula flap for the reconstruction of massive bone defects of the upper or lower extremity long bones were retrospectively reviewed and included in this study. There were 24 lower extremities (21 tibial and 3 femoral) and 9 upper extremities (4 humeral, 2 radial and 3 ulnar) reconstructions in this series. The mean age was 32.7 (range= 10- 59) years. The mean length of bony defect following initial debridement was 10.3 (range= 4-25) cm. The fibula was inserted as a single strut in 29 patients, and as a double barrel construct in 4 patients. The degree of fibular hypertrophy was calculated based on anteroposterior (AP) and lateral X-ray measurements of fibular flaps at an average postoperative period of 52 months. The difference in thickness between the initial and final x- ray measurements were expressed as percentage of hypertrophy. The variances seen in this period were defined and classified., Results: When bony consolidation of the 33 cases were examined in detail, 4 different modes of flap hypertrophy were defined: type 0- absence of hypertrophy, type 1- limited hypertrophy, type 2- marked hypertrophy triggered by stress fracture, and type 3- massive hypertrophy enhanced by peripheral bone production., Conclusion: Fibular hypertrophy follows different modes based on vascularity of the flap, amount of stress imparted on the flap, site of reconstruction, and whether the periosteal sleeve is retained at the reconstruction site. Determination of these factors at the initial period may help the surgeons to predict the final hypertrophy that will be seen at the end of flap maturation Level of Evidence: Level IV, Therapeutic Study.

Objectives: The aim of this study was to evaluate the functional results of delayed open reduction and Kirschner wire (K-wire) fixation procedures in patients with delayed presentation of bony mallet finger., Patients and Methods: Between February 2009 and November 2019, a total of 19 patients (15 males, 4 females; median age: 24.8 years; range, 14 to 47 years) who were diagnosed with a delayed bony mallet finger and treated with dorsal block pin, direct pinning, or the umbrella handle technique were retrospectively analyzed. The Crawford criteria were used to evaluate the outcomes. The degrees of range of motion (ROM) were measured by a goniometer., Results: The median time from injury to surgery was 41 (range, 28 to 90) days. The median DIP joint extension limitation was 7.63 (range, 0 to 40) degrees and the median ROM of the DIP joint was 66.3 (range, 20 to 90) degrees. There was no statistically significant difference in the postoperative ROM, compared to the uninjured side (p>0.05). The Crawford score was excellent in 11, good in four, fair in three, and poor in one patient. Bone union was achieved in all patients., Conclusion: Delayed open reduction and K-wire fixation of chronic bony mallet finger injuries yield successful functional outcomes with low complication rates. Extension lag can be eliminated in most patients by making the joint surface anatomical. The most optimal method should be selected depending on the size of the fracture fragment.

Objective: The aim of this study was to analyze the outcomes of revision surgery following replantation of single digital amputations., Methods: In this study, first, a total of 403 patients (339 male, 64 female; mean age=28 years; age range=1-76) in whom a single finger replantation was performed were retrospectively reviewed, and then 60 patients with arterial or venous insufficiency in whom revision surgery was performed were reanalyzed. The second finger was observed to be the most injured one (32.8%). Injury type was classified as clean cut (25.3%), local crush (38.7), extensive crush (7.9%), and avulsion (28.1%). When taking the levels of injuries of the artery-only finger replantations into account, one finger (0.8%) was nail distal third, 70 fingers (56%) were nail distal third to lunula, 43 fingers (34.4%) were lunula to distal phalanx basis, 10 fingers (8%) were distal interphalangeal (DIP) joint, and one finger (0.8%) was middle phalanx. Operative revision was performed on 60 (14.9%) fingers. The need for operative revision was arterial insufficiency in 37 fingers (61.7%) and venous insufficiency in 23 fingers (38.3%). The average revision time was 43 (range=6-144) hours. While the average elapsed time for artery procedures was 35.3 (range=8-110) hours, the average elapsed time for vein procedures was 47.1 (range=6-144) hours. Finger survival rates were examined. Injury mechanism, amputation level, the number of artery/vein repairs and methods were examined in all patients and revision patients separately., Results: After the replantations, according to survival analysis, while 342 (84.9%) fingers were operated upon successfully, 61 (15.1%) fingers developed necrosis. In the patients with revision surgery, the survival rate was 78.3%. The need for revision was arterial insufficiency in 37 fingers (61.7%) and venous insufficiency in 23 fingers (38.3%). The revision rate was significantly lower than other injury types in clean-cut cases. In terms of levels of injury, no revisions were required from distal to lunula level, and the highest revision rate was observed at the proximal interphalangeal (PIP) joint level., Conclusion: The results of the present study have shown that early re-exploration can provide a 78.3% success rate and can increase the survival rate from 67.6% to 84.2% following replantation of single digital amputations. Surgical re-exploration seems to be a reasonable salvage for replanted fingers with vascular insufficiency., Level of Evidence: Level IV, Therapeutic study.

Purpose: To compare five different repair techniques for extensor tendon zone III modified Kessler (MK), double-modified Kessler (DMK), modified Kessler epitendinous (MKE), double-modified Kessler epitendinous (DMKE), and running-interlocking horizontal mattress (RIHM) in terms of shortening, stiffness, gap formation, and ultimate load to failure., Methods: A total of 35 human cadaver fingers were randomly assigned to five suture techniques with 7 fingers each and were tested under dynamic and static loading conditions., Results: DMK was found to be superior over MK in terms of ultimate load to failure (36 N vs. 24 N, respectively), shortening (1.75 vs. 2.20 mm, respectively) and gap formation. However, these two methods had similar characteristics in terms of stiffness. The addition of epitendinous sutures to the repair methods resulted in approximately 40% increase in ultimate load to failure, whereas epitendinous sutures had no effect on shortening. DMKE was found to be superior over MKE in terms of shortening (1.77 vs. 2.22 mm, respectively). However, these two methods had similar characteristics in terms of mean ultimate load to failure and stiffness. RIHM was found to be superior over the other four methods in terms of ultimate load to failure (89 N), stiffness, and shortening (0.75 mm)., Conclusion: RIHM was found to be stronger and more durable for extensor tendon zone III than the other techniques in terms of ultimate load to failure and stiffness.

Purpose: If there are no veins available in a distal amputation, an artery-only replantation is performed, and an external bleeding method is commonly used. We conducted a survival analysis in a large series of artery-only replantations and compared 2 different external bleeding methods in artery-only distal replantations: nail matrix or hyponychial area bleeding and pulp skin area bleeding, which we have called the crater method., Methods: Two hundred twenty-eight artery-only distal finger replantations in 199 patients were included in the study. The replanted digits were divided into 2 groups according to the external bleeding methods. One group (n = 94; 41.2%) included the patients in whom the external bleeding was performed using a traditional nail bed incision and the second group (n = 134; 58.8%) included the patients in whom external bleeding was performed using the crater method. The finger survival rates and postoperative circulatory problems were examined. The impact of the injury mechanism, injury level, and external bleeding method on survival were evaluated., Results: Clinical findings indicating venous insufficiency were observed in 198 (86.8%) replanted fingers. One hundred eighty-two (79.8%) survived, and complete necrosis developed in 46 (20.2%). Viability was maintained in 84% of patients treated with the nail bed bleeding method and 76.9% of patients treated using the crater method. Clean-cut cases had the best results and subzone 3 cases had the worst results., Conclusions: The artery-only replantation was associated with a 79.8% survival rate. The method of achieving venous outflow did not appear to have an impact on survival., Type of Study/level of Evidence: Therapeutic IV., (Copyright © 2020 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

We present the treatment course of a 29-year-old male patient with for a Type 3 FDP avulsion (Jersey's finger) of a fifth finger treated with umbrella handle technique. The patient had a volar base fracture of distal phalanx with dorsal subluxation of DIP joint after a fall. Following open reduction of the FDP avulsion fracture and fixation was achieved with a 0.9 mm one edge hooked Kirschner wire under fluoroscopy control. The straight edge of the wire was driven out in a central position in sterile nail matrix just distal to lunula. The wire was removed at the fifth week when the complete union of the fracture was observed. The patient achieved full flexion in DIP joint without an extension lag., (Copyright © 2018 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.)

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., (Copyright © 2018 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.)

Introduction  The purpose of this retrospective study, is to evaluate the clinical and functional results of early surgical fixation of the ipsilateral distal radius and scaphoid fractures in 22 of 21 patients. Patients and Methods  Overall, 22 combined ipsilateral scaphoid, and distal radius fracture treatments between 2002 and 2015 were evaluated. The mean age was 34.9 (range: 19-82) years. One patient had bilateral injuries. In 17 patients the injury was due to a fall from a height, and in 4 patients due to a motorcycle accident. According to the AO classification, there were 2 type B and 20 type C fractures of the distal radius. The volar locking plate fixation technique was applied in 14 wrists, screw fixation technique in 1, external fixation combined with Kirschner wires (K-wire) stabilization technique was used in 3 wrists, and only K-wire pinning technique was used in 4 wrists. All scaphoid fractures were type B (21 type B2, 1 type B1) according to the Herbert-Fischer classification. K-wire fixation was applied in 2 and cannulated screw fixation was performed in 20 fractures. Clinical evaluation was performed with measuring the pinch power, grip power, and range of motions. Functional evaluation was performed using patient-rated wrist evaluation score (PRWE). Results  The average follow-up period was 25 (range: 12-97) months. All radius and scaphoid fractures healed. The mean active wrist motions were found to be 45 degrees of flexion, 48.5 degrees of extension, 20 degrees of radial deviation, and 43 degrees ulnar deviation. Mean grip/pinch strengths were 31/8.5 kg. Mean PRWE score was 5.5 (range: 0-8.5). All patients returned to preoperative activity level and can do preinjury jobs. Conclusion  Combined ipsilateral fractures of distal radius and scaphoid are complex and rare injuries due to high energy traumas. Stable early primary fracture fixation in these injuries can be expected with good functional results. Level of Evidence  Level IV.

We report techniques and survival incidence of three subtotally and nine completely degloved fingers in seven patients. We performed end-to-end arterial repairs in seven fingers, vein graft repairs for arteries in two fingers, arteriovenous anastomoses in three fingers. End-to-end vein anastomosis was performed in all fingers. One finger requred re-exploration. Soft tissues in the eight degloved fingers survived completely, two failed completely, and two were partially necrotic. We conclude from our results that following revascularization, the skin from a completely degloved finger skin will survive in approximately two cases out of three., Level of Evidence: IV.

Objective: The purpose of this study was to document a new complication in volar locking plating of the distal radius., Methods: Between January 2007 and January 2014, 223 patients were identified from the department's surgical database with retrospective chart and radiographic review. Sixty-eight patients were over 60 years of age. All fractures were operated with Acu-Loc® (Acumed, Hillsboro, OR, USA) wrist volar locking plating systems. Longitudinal fracture lines (LFL) beneath volar plate-extending proximal shafts were documented. Correlations between age groups and LFLs were investigated. Radiographs with LFLs were assessed at final follow-up for the following parameters: volar tilt, radial inclination and radial length., Results: Twenty-eight of 68 patients over age of 60 years had LFLs. Correlation was significant for age groups (p<0.05). The effect of these fracture lines on radiographic parameters was not significant (p>0.05)., Conclusion: Surgeons should be aware of the complications that may occur with volar locking plates. Understanding of potential complications and their results are important. As a result of aging, thinning, and weakening, the near cortex may become more brittle. When the plate is reduced on the bone with a nonlocking screw, the conical head of diaphyseal locking screws can extend over plate thickness and penetrate the near cortex, acting as a screwing wedge. Additional divergent configuration may promote this effect and crack the cortex.

Venous flaps are flaps by which tissue perfusion is accessed through the venous network. Despite originally being questioned due to potential perfusion problems, as the dynamics of tissue perfusion have been more fully comprehended, venous flaps appear to have a far wider range of application than first thought. In our study, we analyzed the clinical results of the applications of free arterialized venous flaps along with the factors that can affect flap survival. Forty-one flaps were assessed retrospectively. Type of the trauma, traumatized area, the time duration between trauma and application of the flap, donor area, type and count of the anastomosis, encountered complications, and flap survival rates were analyzed. Regression and classification trees were used to study the relationship between flap surface area, anastomosis count, and flap survival. Circulatory abnormalities such as early congestion and edema were seen in 53.6% of the applied flaps. A total of four flaps (9.7%) developed necrosis which presented as full thickness in three flaps and partial thickness in one flap. It can be said that there was a weak but positive correlation between the size of the flap area and the number of anastomosis. Although the results of arterialized venous flaps are inconsistent in the literature, those flaps can be preferred as an alternative treatment option in single finger defects where tissue compatibility and cosmetic results are quite impressive. In the meantime, syndactylized venous flaps are the preferred method regarding multiple finger soft-tissue defects., (Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Multiple soft tissue finger defects in different shapes and locations are usually difficult to manage. Such defects commonly involve tendons and bones. Palmar soft tissue defects may also lead to vascular compromise. In this retrospective report, we report the results of seven patients with multiple soft tissue finger defects that were covered by syndactylizing arterialized venous flaps. Six of the patients suffered hot-pressing machine and crushing injuries, one patient had a rolling belt injury. All patients presented with soft tissue defects on palmar or dorsal sides involving at least two digits. The palmar forearm was donor site for all patients. At least one afferent artery and two efferent veins were selected for the anastomosis. Lengths of afferent and efferent veins were long enough to perform healthy anastomosis outside the injury zone. The afferent vessels were anastamosed to the digital arteries with the largest possible diameter or to the common digital arteries to maximize flow. The efferent veins were anastamosed to dorsal veins. Separations of the digits were performed after three weeks by longitudinal incisions. The mean follow-up period was 12 months. None of our patients suffered a flap loss. Syndactylizing arterialized venous flaps may be used for composite or single tissue reconstruction for multiple finger defects with satisfactory cosmetic and functional outcomes., (© 2014 Wiley Periodicals, Inc.)

Traumatic hemipelvectomy is a severe, life-threatening injury, mainly occurring due to machinery injury or traffic accident. Few cases have been published in the literature. Treatment requires a rapid, multidisciplinary team approach which will result in the saving of the patient's life. We present the outcome of a male patient with traumatic hemipelvectomy.

Objective: The aim of this study was to review the results of patients with Wassel type IV thumb duplication, treated with a single reconstructive procedure., Methods: The mean follow-up period was 76.9 months. Objective assessments were carried out using Horii modification of Tada scoring system and ALURRA scoring system. Thumb length, thumb girth, range of motion of metacarpophalangeal (MCP) and interphalangeal (IP) joints and angular deformities at MCP and IP joints were evaluated., Results: The mean ALURRA score was 21 (range; 16-24) and Tada Score 5.25 (range; 2-7). The length of the operated thumb was approximately 95%, the girth 89% and nail width 80% of the non-operated side. The mean range of motion was 75.1% of the unaffected thumb in interphalangeal joint and 80.1% in metacarpophalangeal joint. Metacarpophalangeal joint malalignment had shown statistically significant negative correlation with the scores of Tada, ALURRA and VAS., Conclusion: Surgical reconstruction may provide a functional and stable thumb in Wassel type IV thumb duplications. The satisfaction of patients is affected by angular deformity of thumbs and cosmetic outlook.

Objective: The aim of this study was to evaluate the results of limb salvage and primary amputation treatments in patients with Type 3C tibia fractures and compare with normative population data., Methods: Limb salvage was performed in 20 patients and primary amputation in 14 patients with Type 3C tibia fractures between 1993 and 2009. Mean follow-up period was 5.3 years. Treatment times, complications, number of operations and return-to-work status of groups were compared. The Short Form-36 (SF-36) was used to assess quality of life and domains were compared among the patient groups and normative data., Results: Limb salvage patients had longer treatment periods with more operations and complications than the primary amputation group. Return-to-work percentage was 59% in the limb salvage group and 71% in the amputation group. There was no statistical difference in all SF-36 domains for limb salvage and primary amputation patients. Physical functioning, social functioning, limitation due to emotional problems and pain were statistically lower in all patients than in the general population., Conclusion: Type 3C tibia fractures treated with both limb salvage and primary amputation have negative effects on quality of life. Patients should be informed about limited functional capacity, pain complications and problems with return-to-work at the end of treatment. In addition, high rates of limb salvage can be achieved with proper conditions in suitable patients.

Objective: The aim of this study was to sonographically evaluate the anatomy of the transverse carpal ligament (TCL) after open surgical release in the treatment of carpal tunnel syndrome (CTS) and to establish new ultrasonographic criteria for the completeness of TCL release., Methods: Thirty-six patients who underwent open surgical release for CTS were recruited prospectively. Patients were evaluated with physical examination and ultrasonography before and after the operation., Results: All patients' symptoms resolved after surgery. TCL was found to be diffusely thickened and to have lost its smooth form after surgery. Postoperative TCL thickness showed a statistically significant increase when compared with preoperative values (p<0.05)., Conclusion: Sonography is a capable imaging method for assessment of the TCL after open release surgery. In addition, ultrasound may be considered as a complementary tool to exclude diagnosis of incomplete transection of TCL in patients with persistent symptoms.

The aim of this retrospective cross-sectional study was to assess vascular repair modalities and function in type IV ring finger replantations. Thirty-seven of 43 patients with complete ring avulsion amputations were replanted. After resection of the damaged arterial segments under microscopic magnification the arterial flow pattern was evaluated. The type of repair was chosen according to the adequacy of arterial flow and the defect between the vessels. The methods of bridging the arterial defect consisted of digital artery transfer from adjacent digit in 21 fingers, vein graft interposition in six fingers and end to end anastomosis in ten fingers. Thirty-one of the 37 fingers survived. The failures were due to four arterial and two venous insufficiencies. In our opinion, radical resection of damaged zones of vessels is important to evaluate the proximal flow pattern and decide which treatment modality is necessary for healthy vascular anastomosis.

Background: The aim of this study was to define the risk factors for occupational hand injuries and explore the relationship between the machines and the fingers injured, based on the records of a hospital in Turkey specialized in hand and microsurgery., Methods: Five thousand twenty seven occupational hand injuries treated at a hand and microsurgery hospital between 1992 and 2005 were included in the study. All the injuries were retrospectively recoded according to ICD-10, (ICECI) and ILO recommendations. Logistic regression and chi-square for trend analysis were used to evaluate the risk factors for occupational injuries., Results: The most frequent injuries were traumatic amputation of wrist and hand (53.2%), open wound of wrist and hand (46.3%). Considering all injuries, 60.9% of agricultural machines, 52.7% of metal working machines, 54.7% of transmission machinery, and 42.8% of wood and assimilated machines affected the right hand. Powered wood cutters, presses, planning and milling machines, and machine belts were the most frequent five machines involved in injuries, each having a different finger pattern. The proportion of machinery among all hand injuries was significantly decreasing with time., Conclusion: A stricter and more frequent supervision of the use of protective equipment and prohibition of the purchase of machinery not complying with the regulations could contribute to the prevention of hand injuries., (Copyright © 2012 Wiley Periodicals, Inc.)

Objective: The aim of this study was to evaluate the effect of surgical repair of the medial collateral ligament and ulnar nerve release in cases of terrible triad injuries of the elbow., Methods: This study included 16 patients (average age: 34 years) who underwent surgery following a diagnosis of terrible triad injury of the elbow between 1996 and 2007. Average follow up was 34.5 months. In all cases, the radial head was first fixed or replaced and the anterior capsule/coronoid complex and lateral collateral ligament were repaired. The medial side of the elbow was addressed (medial collateral ligament repair and ulnar nerve release) in 8 cases and not addressed in the remaining 8 cases. Range of motion, pain, stability, ulnar nerve symptoms, functional Mayo Elbow Performance Index, and Disabilities of the Arm, Shoulder and Hand scores were documented. Serial X-rays were used to confirm ulnohumeral arthritis and development of ectopic calcification. Ultrasonography or MRI was used to detect ulnar nerve entrapment., Results: Range of motion was slightly more limited in cases where the medial side was not addressed. Ulnohumeral range of motion and flexion degrees were higher in the cases where the medial side was addressed (p<0.05). Serial X-rays demonstrated impending ectopic calcification located at the proximal insertion of medial collateral ligament in patients who did not undergo medial side repair. MRI or ultrasonography confirmed these findings, revealing swollen displaced nerves resembling findings similar to cubital tunnel syndrome., Conclusion: Ulnar neuropathy is a common complication after medial collateral ligament injury and prophylactic release will facilitate overall results and postoperative patient satisfaction.

Objective: The purpose of this study was to retrospectively evaluate the clinical and functional results of nerve grafting and end-to-end peroneal nerve repair between sciatic bifurcation and distal branching., Methods: The study included 26 patients (22 men, 4 women; mean age: 19.9 years; range: 5 to 46 years) who underwent peroneal nerve repair between 1992 and 2009. Open nerve injuries were seen in 21 patients and closed injuries in 5. Surgical repair was performed with sural nerve grafting in 19 patients and end-to-end in 7. Mean nerve graft length was 5.42 (range: 2 to 15) cm with a mean 3.1 (range: 2 to 4) nerve cables used. Mean follow-up was 33 (range: 13 to 96) months. The British Medical Research Council (BMRC) scale was used for the evaluation of the tibialis anterior and peroneal muscles and Semmes-Weinstein monofilaments were used for protective sensation evaluation., Results: Adequate and full recovery was observed in 19 patients (73%). Mean follow-up time was 39.3 months in patients undergoing nerve grafting and 30.1 months in end-to-end nerve repair. Fifteen of 19 patients with nerve grafting and 4 of 7 patients with end-to-end nerve repair had an adequate or full recovery. Posterior tibial tendon transfer to dorsal foot was applied in 3 of 7 patients without recovery. Protective sensory recovery was determined in 16 of 22 patients., Conclusion: Good results in both end-to-end repair and in repair with grafting is possible in peroneal nerve repair.

Objective: In this study, we aimed to compare the clinical and functional results of patients treated with dorsal or volar percutaneous screw fixation for acute scaphoid fractures., Methods: We retrospectively evaluated 27 wrists of 26 patients (24 males, 2 females; mean age: 33.1 years) who underwent dorsal or volar percutaneous screw fixation for acute scaphoid fractures between 2000 and 2009. The dorsal approach group contained 13 wrists and the volar approach group 14 wrists. Splint was removed and wrist exercises initiated on the 10th postoperative day. Pinch power, grip power and range of motion were evaluated using the contralateral wrist as controls. Functional evaluation was performed using the patient-rated wrist evaluation score (PRWE) and Mayo wrist scoring system., Results: According to the Herbert and Fisher's classification system there were 9 B2, 3 B3 and 1 B1 fractures in the dorsal approach group, and 12 B2 and 2 B1 fractures in the volar approach group. Fracture union was achieved in all patients. There was no significant difference between the two groups according to functional and clinical results (p>0.05). All patients returned to their jobs in an average of 4.2 weeks and there was no significant difference between the groups (p=0.437). Wrist flexion was significantly better in the control wrists in both groups (p=0.009). In one patient, the screw was removed due to ongoing pain and asymptomatic screw head displacement in the scaphotrapezoid joint was detected in another., Conclusion: The surgical approach does not affect the clinical and functional outcomes in percutaneous screw fixation of Type B scaphoid fractures. Percutaneous fixation is a valuable treatment method for Type B scaphoid fractures as it enables early wrist motion and high patient satisfaction.

Objectives: This study aims to compare the functional results of dynamic compression plates (DCP) and interlocked retrograde intramedullary nails (IRIN) used for the treatment of humeral shaft nonunions., Patients and Methods: Twenty-six patients (12 males, 14 females; mean age, 42.8 years; range 21 to 61 years) who underwent surgical treatment of humeral shaft nonunion either with DCP (n=13) or IRIN (n=13) between October 1999 and January 2008, were retrospectively analyzed. Treatment consisted of removing previous implants and DCP or IRIN fixation with additional autogenous bone grafts for atrophic nonunions. Union time, range of motion, radiographic length difference, Constant-Murley Scale (CMS), Disabilities of the Arm, Shoulder and Hand (DASH-T) and Mayo Elbow Performance Score (MEPS) were evaluated at a mean follow-up time of 59.5 months (range; 17 to 125 months)., Results: There was a statistically significant correlation among the functional scores of DASH-T, MEPS and CMS. No statistically significant difference was observed in the functional outcome between the groups (DCP and IRIN). Range of motion of the elbow joint was significantly impaired in three patients who were plated for distal shaft nonunions., Conclusion: Both DCP and IRIN provide satisfactory functional outcomes in the treatment of humeral shaft nonunions. Distal shaft nonunions may demonstrate a decrement in elbow motion associated with distal placement of plates.

Objective: The aim of this study was to analyze the complications and functional and radiographic results of volar locking plating in the treatment of unstable distal radius fractures., Methods: Forty-six patients (mean age: 48.7 years) with Type C distal radius fractures were treated with volar locking plates and evaluated over a mean follow-up period of 19 months. Range of motion, strength, DASH questionnaire and MAYO wrist score were assessed. Shortening, inclination and palmar tilt were recorded on standard radiographs and tenosynovitis and tendon ruptures were assessed using ultrasound. The uninjured wrists were examined as controls. Statistical analysis was made using t-tests., Results: All fractures achieved union. Postoperative MAYO scores revealed 14 excellent results, 11 good, 20 satisfactory and one poor result. The mean postoperative DASH score was 15.9 (range: 0 to 72). Active wrist motion averaged 52.3 degrees of flexion, 57.7 degrees of extension, 79.2 degrees of supination and 79.3 degrees of pronation. Mean grip strength was 82% of the uninjured side and mean loss of radial inclination was 0.6 degrees and palmar tilt was 6.6 degrees as compared to normal side. Carpal tunnel syndrome was observed in one patient, flexor tenosynovitis in one patient, extensor tendon rupture in one patient and extensor tenosynovitis in eleven patients. Functional and clinical limitations were most evident in the patients with tendon tear or tenosynovitis., Conclusion: Fixation of unstable distal radius fractures with volar locking plates provides sufficient stability, and satisfactory clinical outcomes. However, these systems have complication potential that may limit better outcomes.

Objective: The aim of this study was to evaluate the results and complications of free vascularized fibular grafting (FVFG) for the reconstruction of bone defects in Gustilo Type 3 open tibia fractures., Methods: Free vascularized fibular grafting was performed on open tibia fractures with a bone defect of an average of 10 (range: 6 to 18) cm in 21 patients (19 males, 2 females; mean age: 32 years; range: 16 to 47 years). Primary FVFG was performed for 15 patients with open fractures and secondary FVFG in 6 patients with osteomyelitis due to open fractures or defective nonunions. Bony unions were evaluated retrospectively. At a mean follow-up time of 74 (range: 18 to 216) months, 18 patients were examined for malalignment, shortness, and range of motion. Quality of life was evaluated using the Short Form 36 (SF-36)., Results: Mean bony union times for the proximal and distal fibula were 19 (range: 16 to 24) weeks and 20 (range: 16 to 28) weeks, respectively. Proximal nonunion was detected in three patients. Mean external fixation removal time was 6.3 (range: 3 to 14) months. Stress fractures occurred in 15 patients following fixator removal. Malalignment of over 5 degrees was detected in 7 patients and shortness over 2 cm was detected in 4 patients. SF-36 scores were significantly lower in the domains of physical functioning, role limitation due to physical problems, bodily pain, general perception of health, social function, and role limitation due to emotional problems. Mental health, energy and vitality were similar to the healthy reference group., Conclusion: Free vascularized fibular grafting appears to be a reliable and effective method for reconstructing bone defects and soft tissue defects in a single session in open tibia fractures.

Background: Several treatment modalities which targeted partial matrixectomies, including chemical, laser matrixectomy, and partial nail avulsion, have been used in the dermatology, podiatry, and orthopaedic literature. We report our experience with surgical matrixectomy., Methods: We treated 224 patients with severe ingrowing toenails. Segmental wedge resection of involved margin was performed. Followup time was a minimum of 10 months., Results: Statistical analysis of recurrence and disease parameters such as stage of disease, infection, involved margin, previous surgery, followup time, and age showed no significant correlation (p>0.05). Twenty-two patients (9.8%) had a recurrence. Revision surgery was performed in 16 patients (7.1%)., Conclusion: We recommend the Winograd technique with a few modifications especially for severe Stage 2 and 3 cases. Both loupe magnification and observation of soft tissue in the postoperative period were important details.

We analysed 6549 hand injuries treated between 1992 and 2005 at a specialist hospital in Turkey to identify risk factors for amputations. There were 2899 (44%) hand amputations. Left-side injuries were more prone to amputation. The risk of amputation was higher in men, workers and those in the 15-24 and 45-54 year-old age groups. Compared to home, commercial areas were the places with highest risk, followed by farms and industrial/construction areas. The majority of amputations occurred in industrial/construction areas (87%). Among objects/substances producing injury, watercraft led to the highest risk of amputation and contact with machinery was the mechanism with highest risk. Press machines were the most frequent objects causing amputation both in men and women, followed almost equally by powered wood cutters in men. Doors were the most frequent objects of amputation in children, followed by powered wood cutters. Education, enforcement, and improved engineering are the keys to prevent amputations. Precluding illegal child labour is essential.

Fixation of unstable distal radius fractures with palmar locking plates provides a stable reduction and early return of function, but complications arising from unrecognized dorsally prominent screws penetrating the extensor compartments are increasingly reported. Standard radiographs and fluoroscopy may not adequately visualize screw lengths, owing to the complex shape of the dorsum of the distal radius. We examined 46 distal radius fractures treated with palmar locking plates by ultrasound. Of the total 230 locking screws, 59 protruded from the dorsal cortical surface by 0.5 mm or more (range 0.5-6.1 mm). The first extensor compartment was violated by one screw, the second compartment by 22 screws, the third compartment by 15 screws, and the fourth compartment by 21 screws. Asymptomatic tenosynovitis was detected in four and symptomatic tenosynovitis in 14 of the 59 prominent screws. Ultrasound imaging may be useful in cases where intra-articular and/or comminuted fractures require distal plate placement and engagement of screws in the dorsal cortex.

A variety of flaps have been described to treat longitudinal soft tissue defects located on the dorsal aspect of the fingers. We report 13 dorsal soft tissue defects in four patients in which unipedicle laterodigital transposition flaps were used for reconstruction. This flap is especially useful for the reconstruction of long and narrow defects located on the dorsal region of the fingers in multi-digit injuries.

Objective: This study aimed to evaluate the functional results of end-to-end repairs in radial nerve injuries., Methods: The study included 18 (15 males, 3 females) patients who underwent middle level end-to-end radial nerve repair and who responded to our final follow-up call. Patients' average age was 30 (range: 16 to 43) years. The average time lapse between injury and repair was 25.1 days (range: 1 day to 13 months). Pinch and grip strength measurements were graded according to the modified Verga classification. The Highet classification was used for the evaluation of sensorial recovery. Functional outcome were assessed with the DASH-T score. Average follow-up time was 62.5 (range: 24 to 156) months., Results: Motor function according to the Verga classification was excellent in 16 patients and poor in two. Pinch and grip power measurement comparison of the two sides in the 16 patients with excellent results showed a respective 24.1% and 14.3% decrease on the affected side. According to Highet's classification, sensorial evaluation was S4 in seven patients, S3+ in four, S3 in three, S2+ in one, S2 in one, and S1 in two patients. The average DASH-T score of patients with excellent results was 7.3., Conclusion: Radial nerve repairs, if done end-to-end using an appropriate technique, may lead to nearly full recovery in younger patients.

Objective: In this study we aimed to evaluate the results of the direct-flow neurovascular island flap (NIF) transfers in pulp defects., Methods: We reviewed the records of 96 patients with 115 NIF transfers performed for pulp defect reconstruction. The injury mechanism was crush type injury in 70 patients (72.9%). Ninety-three patients (97%) were emergency cases. Pulp reconstruction was performed by means of pedicled island flap transfer. The results were evaluated with proximal interphalangeal joint range of motion, the Semmes Weinstein monofilament test, static two-point discrimination and cold intolerance assessments. The relations between the injury mechanism, patient satisfaction, cold intolerance and scar problems were analyzed. Also, the association between skin grafting and hook nail deformity was investigated. The level of significance was set at p<0.05., Results: All flaps survived. The mean follow-up time was 41±20.3 (range: 12-108) months. We observed proximal interphalangeal joint flexion contracture in 11 (9.5%) cases. In seven of these, the limitation was less than 10 degrees. Hook nail deformity was seen in 8 fingers (7%). Cold intolerance was found in 16 (17%) cases. Semmes Weinstein monofilament and static-two point discrimination tests of flaps revealed satisfactory results. There was no relation between the injury mechanism and cold intolerance, patient satisfaction and scar problems (p>0.05). Among patients, 91.7% were satisfied with their results., Conclusion: The transfer of direct-flow island flaps, from the same finger, causes minimal morbidity on the donor site and appears to be a safe method, providing satisfactory functional and aesthetic results in the reconstruction of pulp defects.

Objective: The aim of this study was to retrospectively review the results of homodigital reverseflow proximal or middle phalanx dorsal skin island flaps., Methods: We reviewed the overall results of 67 dorsal skin flap reconstructions performed on 61 proximal phalanxes and 6 middle phalanxes at our hospital during an 11 year period. The results were evaluated with static two point discrimination, Semmes-Weinstein monofilament test, occurrence of nail deformities, loss of interphalangeal joint motion, scar appearance of flap donor area, the incidence of vascular insufficiency in postoperative period, and subjective evaluation of patient satisfaction., Results: The highest incidence of defect types were palmar oblique pulp defects in 18 patients (26.8%), transverse pulp defects in 16 patients (23.8%), and hemipulp oblique amputations in 11 patients (16.4%). Crush injuries were the cause of injury in 66% of patients. The average followup time was 40 months and long-term results were available in 21 patients. Total necrosis of flap in one patient (1.4%), superficial epidermolysis in 4 patients (5.9%), and nail deformity in 4 patients (5.9%) were seen. According to Semmes-Weinstein monofilament test results, protective sensation was achieved in 76% of patients. Static two point discrimination data showed variable distribution between 2 mm and 11 mm. The subjective patient satisfaction level was 95%., Conclusion: Homodigital reverse-flow proximal or middle phalanx dorsal skin island flaps give satisfactory cosmetic and sensorial results outside the pinch area, even if the dorsal branch of the digital nerve is not included.

Objectives: The aim of this study was to evaluate the epidemiology of injuries treated at a hand and microsurgery hospital between 1992 and 2005., Methods: This is a descriptive retrospective study based on medical records of a hand and microsurgery hospital in İzmir for the years 1992-2005. A total of 8,946 injuries involving 8,817 patients were included. Data on diagnosis were recorded according to ICD-10. Intent, activity when injured, mechanism of injury, object/substance producing injury, and place of injury were recoded according to International Classification of External Causes of Injury (ICECI)., Results: The most common types of injury were amputations (32.3%), fractures (23.7%), and open wounds (19.9%) of the wrist and hand. Most injuries were sustained by males; 28.4% of injuries occurred during summer. According to activity, 76.3% were injured during paid work, 10.4% during transportation, 9.1% during unpaid work, and 3.8% during leisure time sports and exercise. Injuries most commonly occurred while operating a machine. The risk of hand injury was elevated in those younger than 35 years of age, males, persons outside İzmir province, and in Social Security Instution (SSI) insured workers (p<0.001). The riskiest activity for hand injuries was paid work. Compared to baseline, the risk of hand injuries was 29 times [95% confidence interval (CI) 16.36-50.40] as high in industrial or construction areas, and 50 times (95% CI 17.29-143.96) as high in commercial places, Conclusion: Hand injuries are important because of their consequences, such as permanent disability and their high treatment costs. This study points out many important risk factors, and has contributed the development of hypotheses about injury types, under-notification of occupational injuries, and child labour. The inclusion of medical records from such specialized hospitals into national databases will aid in the prevention of these injuries, and induce developments in diagnosis and treatment.

Objectives: The purpose of this study was to determine the validity of ultrasonography (USG) with surgical confirmation in surgically treated zone 2 flexor tendon injuries., Methods: Between 2003 and 2008, zone 2 flexor tendon repairs of 30 patients were evaluated with real-time USG when there was a loss of motion and prediagnosis of rupture or adherence in follow-up. The mean duration between injury and USG evaluation was 81.5 days (range 10-240 days). USG demonstrated rupture in 15 patients, adherence in 14 patients, and tenosynovitis in one patient. After clinical examination, surgery was performed in 27 of the patients., Results: Fifteen patients with diagnosis of rupture in USG were operated, and diagnosis was confirmed in 14 patients. Eleven patients in the adherence group were also surgically treated. Eight of them received only tenolysis, and three were repaired with tendon grafts-one for rerupture and two for insufficiency after tenolysis. One patient who was diagnosed with tenosynovitis also had a re-ruptured tendon. Therefore, USG resulted in one false finding out of the 15 patients in the rupture group, one false finding out of 11 patients in the adherence group, and one false finding in tenosynovitis group. In total, validity of USG was confirmed in 24 of 27 patients., Conclusion: USG is a dependable diagnostic aid in operated zone 2 flexor tendon injuries when there is uncertainty of rupture or adherence.

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.

Objectives: The aim of this study was to evaluate long-term clinical and functional results of major upper extremity replantations., Methods: We retrospectively evaluated 26 male patients (mean age 27 years; range 3 to 69 years) who underwent major upper extremity replantations and had a mean follow-up of 11.3 years (range 5 to 19 years). The levels of the replantations were transmetacarpal (n=6), wrist (n=4), forearm (n=5), elbow (n=4), and arm (n=7). Amputations were of clean-cut, crush, and avulsion types in seven, eight, and 11 patients, respectively. Secondary operations were performed in 19 patients. Functional results were assessed using the Chen's criteria and the Turkish version of the DASH questionnaire (Disabilities of the Arm, Shoulder and Hand) was administered., Results: The mean surgical shortening was 37.2 mm, and the final mean radiographic shortening was 52.2 mm. The mean grip and pinch strengths on the affected side were 12.3 kg and 3.6 kg, compared to the strengths of 37.6 kg and 8.7 kg on the normal side, respectively. Monofilament testing showed sensory recovery in 20 patients. Two-point discrimination could be made by 18 patients for the median nerve, and by 17 patients for the ulnar nerve. According to the Chen's criteria, the results were very good or good in 17 patients (65.4%), moderate in three patients (11.5%), and poor in six patients (23.1%). Functional results were correlated with the level (r=0.71) and type (r=0.65) of injury, with injuries at the elbow level and avulsion injuries being associated with a worse outcome. The mean DASH score was 6.7 (range 0 to 32.5) and the mean scores of Chen's grade I-II and grade III-IV patients differed significantly (p<0.05)., Conclusion: Lower DASH scores show increased satisfaction of the patients and improved use of their replanted extremities as the helper arm whereby functional deficiency is somewhat compensated.

Objectives: We evaluated the indications and disadvantages of percutaneous technique for proximal humerus fractures in relation to complications encountered in osteoporotic elderly patients and the importance of patient selection., Methods: The study included 18 patients (10 men, 8 women; mean age 48 years; range 14 to 89 years) who underwent percutaneous fixation (closed reduction and pin fixation with K-wires or Schanz screws) for proximal humerus fractures. Eight patients were beyond 60 years of age. According to the Neer classification, five patients had two-part, 13 patients had three-part neck fractures. The patients were evaluated with range of motion of the shoulder, radiographs, and the Disability of Arm Shoulder and Hand questionnaire (DASH). The mean follow-up was 23 months (range 8 to 60 months)., Results: The mean shoulder abduction was 134 degrees (range 30 degrees to 160 degrees) and the mean elevation was 118 degrees (range 30 degrees to 140 degrees). Full range of motion of the shoulder was achieved in 11 patients (61.1%), including all with two-part fractures. Abduction losses of 60 degrees to 130 degrees and less than 30 degrees were seen in four patients and three patients, respectively, all of whom were older than 60 years. The mean DASH score was 18 (range 0 to 77). Fourteen patients having a score of less than 10 had no pain or functional complaints. Four patients with a score of more than 10 were older than 70 years. Pin migration was observed in seven patients (38.9%), all of whom were over 60 years of age. One patient required revision with partial prosthesis. Nonunion was seen in one patient (5.6%) and malunion with a varus/valgus deformity occurred in four patients (22.2%). None of the patients developed avascular necrosis., Conclusion: Percutaneous fixation may be preferred in the treatment of two-part and carefully-selected three-part proximal humerus fractures. Due to high complication rate, patient selection is of primary importance among elderly patients.

Introduction: This study involves the results of open elbow arthrolysis performed on a series of patients having fixed joint contracture., Patients and Methods: Eighteen patients were treated with open arthrolysis. Eleven patients had very severely stiff elbows (flexion arc less than 30 degrees ), five patients had severely stiff elbows (31 degrees -60 degrees ) and two patients had moderately stiff elbows (60 degrees -90 degrees ). Fixed flexion deformity was observed in nine patients preoperatively.The mean interval between the trauma and arthrolysis was 14.8 months. The mean age was 27 years. After radiological examination, lateral kocher incision was used on 13 patients, medial and lateral incision on 3 patients, transolecranon approach on 1 patient and anterior and posterior approach on 1 patient. External fixator was applied on four patients. Fasia lata interposition was performed in three patients. Additional procedures were as follows, bone fixation in five patients, bone grafting in two patients, nerve grafting in one patient, subcutaneous ulnar nerve transposition in three patients. The average follow-up time was 47 months., Results: At the final evaluation, the mean extension deficit had improved from 55 degrees to 32 degrees . The mean end flexion increased from 81 degrees to 124 degrees postoperatively. The flexion arc of three patients in whom heterotopic ossification was excised had increased to 65 degrees . Infection was diagnosed in two patients (11%)., Conclusion: The importance of this study is that the patients have fixed deformities and a long follow-up time. Severely stiff elbow is one of the main indications of open arthrolysis in the patients without muscle atrophy. We suggest sequential arthrolysis as an effective way to obtain good range of motion especially in severe stiff elbows as well as to maintain the ligamantous stability of the elbow joint.

Objectives: We compared two mini skin incision techniques utilized in the treatment of carpal tunnel syndrome (CTS)., Methods: Twenty-seven patients who underwent surgery for CTS were evaluated in two groups according to the site of the mini incision performed for surgical release. A single mini skin incision was performed over the transverse carpal ligament in 12 patients (group 1; 17 hands; 1 man, 11 women; mean age 55 years; range 38 to 66 years), and on the distal side of the ligament in 15 patients (group 2; 17 hands; all women; mean age 54 years; range 34 to 71 years). The two groups were compared with regard to improvement in pain and numbness, rigidity and sensitivity of the scar tissue, time to use the hands, and palmar pinch and grip strengths. The mean follow-up was 26.6 months in group 1, and 23.7 months in group 2., Results: Complete disappearance of symptoms was obtained in 14 wrists (82.4%) in group 1, and in 15 wrists (88.2%) in group 2, with no significant difference between the two groups (p>0.05). Rigidity and sensitivity of the scar tissue were seen in nine wrists (52.9%) in group 1, and in two wrists (11.8%) in group 2 (p<0.05), which lasted 3.5 months and 1.5 months, respectively. In group 2, time to use the affected hand for basic needs (9 days) and normal function (21 days) was significantly shorter, compared to 18 days and 35 days in group 1, respectively (p<0.05). The mean differences of grip and pinch strengths of the two hands were -2.78 kg and -0.60 kg in group 1, and -0.77 and -0.46 kg in group 2, respectively (p>0.05)., Conclusion: Although both methods of release yield satisfactory results in the mid- and long-term, mini skin incision performed on the distal side of the transverse carpal ligament is associated with less incision-related morbidity.

Laceration of the deep intrinsic motor branch of the ulnar nerve below the Guyon canal is rarely seen in penetrating injuries of the hand. We report three patients (1 woman, 2 men) who underwent microsurgical repair for isolated injuries to the motor nerve branch of the ulnar nerve due to penetrating injuries to the hypothenar area of the hand. Two patients had normal sensation. All the patients had intrinsic muscle paralysis and claw deformity of some fingers, with significantly weakened grip and pinch strengths. Exploration showed isolated severance of the deep intrinsic motor branch of the ulnar nerve. One patient underwent end-to-end repair with epiperineural suture technique. Two patients required bridging with a sural nerve graft from the leg for 2-cm and 4-cm gaps, respectively, that occurred following nerve excision. During the follow-up period, grip and pinch strengths of all the patients approximated to the values of the normal side. Intrinsic muscle function and abduction and adduction of fingers recovered in two patients, whereas in one patient finger adduction was not reversible and claw deformity persisted in one finger even after two years.