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This study highlights the advantages and disadvantages of Anterolateral Thigh (ALT) free flap using the brachial artery as the recipient vessel in large posterior defects of the elbow with early mobilization.Eight patients with a soft tissue defect on the posterior elbow underwent reconstruction with an ALT free flap. Average age and follow-up were 29.5 years (range, 18-43 years) and 54 months (range, 35-76 months), respectively. All defects were on the posterior side, and brachial arteries on the anterior side were used as the recipient artery in all cases. Four defects were created by tumor excision, four were exposed with hardware after fixation of distal humeral and/or proximal ulna fractures. The dimensions of defects were between 80 and 352 cmAll flaps except one survived and met the tissue quality anticipated from this reconstruction. In the bigger flaps, an apparent ugly scar at the donor site was the main problem. The flap on the posterior, and recipient artery on the anterior had no adverse effects on early motion of the elbow. Two cases with fractures had minimal restriction of elbow movement due to post-traumatic stiff elbow. There was one case of partial flap loss after myocardial infarction. After the patient was medically stable, the remaining distal defect was closed with a pedicled radial forearm flap.ALT free flap has numerous advantages in covering defects at the posterior elbow such as being pliable, thin and durable skin, with a long and reliable pedicle reaching the brachial artery without causing any problem in early motion and surgical reconstruction can be easily completed in the supine position.

Objectives The aim of this study was to evaluate the functional outcomes of patients with free gracilis muscle transfer (FGMT) for the restoration of elbow flexion. Patients and methods Between January 2012 and January 2019, a total of 16 patients (13 males, 3 females; mean age: 27.3±11.7 years; range: 18 to 53 years) who underwent FGMF to achieve elbow flexion after traumatic brachial plexus palsy (TBPP) were retrospectively analyzed. Data including demographic and clinical characteristics of the patients, etiology, affected side, injury level, accompanying injuries, time between injury and surgery, follow-up time, complications, whether nerve reconstruction and artery repair were performed previously, and details of the procedure were recorded. The outcome measures were elbow range of motion in degrees, muscle strength, and Disabilities of the Arm, Shoulder and Hand (DASH) and Short Form-36 (SF-36) scores. Results The mean follow-up was 30±11.5 (range, 24 to 42) months. Two patients had C5-C8 injuries, two patients had C6-T1 injuries, and all other patients had injuries to the C5-T1 roots. Muscle strength was M3/M4 in 11 (68.8%) patients, M2 in two (12.5%) patients, and M0 in one (6.2%) patient. The median active range of motion of the elbow joint in patients with successful results (M3 and above) was measured as 75 (range, 30 to 100) degrees. A statistically significant improvement was observed in the pre- and postoperative DASH scores and in some SF-36 subscale scores of patients with successful results. Conclusion Free gracilis muscle flap is a reliable option in the restoration of elbow flexion in patients with TBPP. Although there is an improvement in functional results, disability, and quality of life, there may be no change in patients' mental status and pain.

This study investigated the effectiveness of a relative motion flexion orthosis (RMFO) for increasing the range of motion for boutonniere deformity.We included 28 patients aged 13-62 years with chronic boutonniere deformity who could complete 0° proximal interphalangeal (PIP) joint extension with the pencil test and were stage 1 according to the Burton classification of boutonniere deformity. At the initial hand therapy appointment, the RMFO was made. The duration of the orthosis usage at the initial therapy session, after stopping the use of the orthosis (posttreatment), and at the follow-up period were noted.The mean time for orthosis usage of all patients was 11.7 weeks (6-40 weeks). The mean initial active distal interphalangeal joint flexion was 47° (0° to 90°) and improved to 66.8° (5° to 110°). The mean initial extension lag of the PIP joint was 22.5° (5° to 55°) and improved to 12° (0° to 30°). This did not change between discontinuation of the orthosis and final follow-up.The use of RMFO is effective in increasing active distal interphalangeal joint flexion and improving PIP extension in patients with Burton stage 1 chronic boutonniere deformity. TYPE OF STUDY/LEVEL OF EVıDENCE: Therapeutic IV.

The aim of this study was to compare the symptomatic, functional and satisfaction outcomes of patients with different temperaments undergoing carpal tunnel surgery by a single surgeon. Dominant temperaments of 171 patients with carpal tunnel syndrome were determined using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A). Patients were divided into six temperament groups, and the impact of their respective group measured against preoperative and postoperative symptom severity and functional capacity using the Boston Carpal Tunnel Questionnaire (BCTQ] and satisfaction using the Patient Evaluation Measure (PEM). Patients in the depressive group had the largest improvement in symptoms (BCTQ score change, –2.2) as well as a significant improvement in function (BCTQ score change, –2.1), yet had the lowest postoperative satisfaction (mean PEM score 9). Determination of patient temperament before surgery for carpal tunnel syndrome (CTS) may be useful as an ancillary technique to help predict postoperative satisfaction, which may in turn help guide preoperative communication and expectation setting. Level of evidence: III

Highlights • Our study is the third case report about radial styloid fracture accompanying with first extensor compartment muscles rupture. • Our study will be the first study in this issue because of some privileges. • Other case report did not have long term follow-up time, mean that just 8 month follow-up time. • Our study also has preoperative MRI views and intraoperative photographs. • First case report; which was about this issue, muscle strength test was not applied by authors., Introduction Radial styloid fracture and concomitant first dorsal compartment proximal musculotendinous avulsion is extremely rare injury. This togetherness is difficult to diagnose fully on routine physical examination. Presentation of case In this study, we present a thirty nine year old male patient who suffered musculotendinous avulsion injury of the extensor pollicis brevis (EPB) tendon and abduc- tor pollicis longus (APL) tendon that is rarely accompanied by a closed, non-displaced radial styloid fracture developed following an in-car traffic accident. Diagnosis of avulsion was made with preop- erative magnetic resonance imaging (MRI) and the fracture was fixed with open reduction. The measurements of isometric APL and EPL muscle strength for two thumb were performed using a digital hand dynamometer, no statistically significant difference was found between the muscle strengths of the affected and non-affected thumbs at the postoperative second year follow- up (p > 0.05). Discussion The literature does not hold enough cases to establish the grounds for hypotheses related to the injury mechanism in the 1 st extensor tendon musculotendinous injuries ac- companying radial styloid fractures. Although the diagnosis of the injury in our case was inadver- tently made with preoperative MRI, the routine application of MRI does not seem to be cost-effec- tive. Conclusion We suggest that checking and assuring the intactness of the 1 st extensor compartment with a gentle traction during surgery should be a routine step in the treatment of radial styloid fractures treated with open reduction.

Described in this article is diagnosis and treatment of mixed type of thoracic outlet syndrome (TOS) resulting from scalene muscle hypertrophy. Many diseases should be considered in the differential diagnosis to definitively diagnose this syndrome, and it is necessary to ask about activities of daily life, in addition to adding provocative tests to physical examination and examining electrophysiological and imaging results. Once diagnosed, even if complaints decrease with conservative treatment, surgery may be required. However, in patients diagnosed late, despite decrease in complaints after surgery, neurological deficit may remain.

Retrospective study of one surgeon’s experience with arthroscopic release in obstetrical brachial plexus palsy. Over a four-year period, 6 patients who presented with a shoulder contracture secondary to obstetric palsy before the age of 8 years were treated arthroscopically. Small arthroscopy instruments, small shaver blades, including a 2.7-mm, 30° angled scope, and 90° radiofrequency probe, were used for this surgery. Patient selection for this approach was based on the lack of bone deformity and targeted soft tissue release. Postoperative brace immobilization for 6 weeks was used in all patients. Functional status of the patients was evaluated pre- and postoperatively with the assessment of external rotation. The case series consisted of 2 girls and 4 boys with a mean age of 5.1 years (range, 3–8 years). No patient was lost to follow-up, and all patients completed a minimum 1 year of clinical and radiographic follow-up. Increases in external rotation were observed in all patients. There was no intra- or postoperative complications. Arthroscopic treatment of the shoulder contracture in obstetric palsy was found to be a safe and effective procedure in patients who are likely to undergo future tendon transfer or bone surgery.

Described in this article is diagnosis and treatment of mixed type of thoracic outlet syndrome (TOS) resulting from scalene muscle hypertrophy. Many diseases should be considered in the differential diagnosis to definitively diagnose this syndrome, and it is necessary to ask about activities of daily life, in addition to adding provocative tests to physical examination and examining electrophysiological and imaging results. Once diagnosed, even if complaints decrease with conservative treatment, surgery may be required. However, in patients diagnosed late, despite decrease in complaints after surgery, neurological deficit may remain.

The purpose of this study is to define the function of the pronator quadratus muscle after plating of a distal radius fracture using anterior (volar) approach. Fourteen cases with volar plating after for a distal radius fracture were included in the study. Sixteen healthy volunteers were selected to determine the effect of dominant arm on pronation torque of the forearm for the control group. Biodex System 4 PRO (Biodex Medical Systems Inc., New York) torque meter was used for pronation torque measurement. In healthy volunteer group, there was no statistically significant difference in mean pronation torque values between the dominant arm and nondominant arms. The mean loss of pronator strength was 18.5 % and the mean loss of pronator durability was 12.9 % indicating a pronator insufficiency in the cases operated by a volar approach compared to uninjured forearm. Two patients among the operated group, who had further strengthening exercises beyond their own rehabilitation regimes, had improved pronator torque compared to uninjured forearm. In conclusion, the results of this study indicate that following volar plating of distal radius fractures, there is a significant loss in pronator strength of the forearm. As the two of the patients had improved pronator strength of their operated forearm, further rehabilitation regimes should be considered to prevent pronator weakness following volar plating for distal radius fractures.