Ilhami Kuru

Use of a splint following open carpal tunnel release: A comparative study

This study was undertaken to compare the clinical effectiveness and costs of postoperative splintage and late rehabilitation with a bulky bandage dressing versus early rehabilitation after carpal tunnel release. In this comparative study, 46 patients were randomly divided into 2 groups. In each group, 3 patients were excluded because of improper follow-up, leaving a total of 40 patients. Group 1 used a splint (exercises given 3 wk postoperatively) and group 2 was given a bulky bandage (exercises provided immediately) after open release. Patients were assessed preoperatively and at the first and third postoperative months with the Questionnaire of Levine for Clinical Assessment of Carpal Tunnel Syndrome. The 2 groups were similar in terms of preoperative functional status scores and in controls at the first and third months (P=.549,P=.326,P=.190). When both groups were compared, no statistical significance was found regarding symptom severity scale scores preoperatively and at the first postoperative month (P=.632 vsP=.353). At the third month, scores were lower in favor of group 2 (P=.023). Additionally, 16 of 20 patients (80%) in group 1 reported a heavy feeling and discomfort caused by the splint. This problem was not reported by the patients in group 2. The cheapest splint on the market was 9 times more expensive than a bulky dressing. The investigators concluded that postoperative immobilization with a splint has no detectable benefits. Use of bulky dressings and abandonment of the use of postoperative splints may prevent unnecessary expenditures without sacrificing patient comfort or compromising the course of healing in carpal tunnel surgery.

Epithelioid sarcoma-like hemangioendothelioma: a case report.

Seven cases of an unusual low-grade vascular tumor were reported in a recent study. Despite its similarity to epithelioid sarcoma, this tumor was termed epithelioid sarcoma-like hemangioendothelioma because of the subtle histopathological and immunohistochemical differences. Another case of this rare entity in a 70-year-old woman who suffered from a painful mass on the anterior aspect of the right cubital fossa is presented here, together with a review of the relevant literature.

Radiographic evaluation and unusual bone formations in different genetic patterns in synpolydactyly

ObjectiveTo compare the radiological findings of heterozygous and homozygous subjects with synpolydactyly (SPD) and to discuss their unusual bone formations.Design and patientsFamilies with hand and foot SPD were examined. Genetic analysis was performed with blood samples and the pedigree was constructed. The affected individuals, especially those with distinctive phenotypic features, were invited to our orthopaedics clinic for further diagnostic studies. All participants underwent detailed clinical and X-ray examinations.ResultsOf the invited patients, 16 (five female and 11 male; age range 4–37 years, mean age 10.75 years) were included in our study, and hand and foot radiographs were obtained. All subjects had bilateral hand radiographs (32 hands), and 14 had bilateral foot radiographs (28 feet). Genetic analysis revealed 12 heterozygote (75%) and four (25%) homozygote phenotypes. Among patients enrolled into the study nine (three homozygotes, six heterozygotes) had SPD of both hands and feet bilaterally (tetrasynpolydactyly). Six unusual bone formations were observed in the hands and feet: delta phalanx, delta metacarpal/metatarsal, kissing delta phalanx, true double epiphysis, pseudoepiphysis and cone-shaped epiphysis. There were major differences in radiological and clinical manifestations of homozygote and heterozygote phenotypes. The homozygous SPD presented with very distinctive unusual bone formations.ConclusionThe existence and variety of unusual bones may indicate the severity of penetrance and expressivity of SPD.

Comparison of two different suture-passing techniques with different suture materials and thicknesses: Biomechanical study of flexor tendons for yield points, gap formation and early post-operative status -

Objective: The purpose of this study was to evaluate the biomechanical characteristics of two different suture-passing techniques with different suture materials and thicknesses and assess whether they could with stand passive and/or active mobilization in the very early post-operative period. Materials and Method: 192 flexor digitorum profundus communis tendons of similar diameters were obtained from sheep front limbs. Each tendon was transected completely at a point 6 cm from the distal end and each repaired by one of the following suture materials: polyester suture (Ethilon 3.0 and 4.0 (Ethicon, U.S.)) and polypropylene monofilament (Polypropylene 3.0 and 4.0 (Ethicon, U.S.)). The repair of the tendons was performed through employing two different techniques with each suture material - the Bunnel and Modified Kessler. The primary outcome measures for each repair combination was suture material, suture-passing type and suture thickness. Regarding post-operative early motion, the yield point differences between the suture materials and techniques were compared. Results: There was a statistically significant difference between suture materials used for the repair. Tendons repaired with Ethibond needed significantly greater amounts of force for rupture compared with tendons repaired with Polypropylene. There was a statistically significant difference between Ethibond and Prolene for all study groups. Conclusion: The yield points with higher forces is expected to be preferred, but their thicknesses can be 3-0 or 4-0. Oblique suture passing should be preferred rather than longitudinal passing. Obviously, suture strengthening methods, like epitendineous running sutures and core sutures, should be used. Without these measures, even passive wrist motion can result in gap formation at the repair site. The results of this study showed that tensile properties of the repaired vary considerably with differences in suture material and design.

Prevention of web creep using a new frame after synpolydactyly surgery.

The main goal in syndactyly surgery is to create a normal web space; however, it is difficult to achieve the best clinical results in older and complex cases with bony fusions and joint deformities requiring osteotomies. In these complex cases, proper postoperative wound care is difficult to achieve due to the web contractures and deformities. In our report, we introduce a new technique using a frame that we called the “Hittite Sun,” which helps in proper wound management to reduce wound healing problems that lead to web creep. Between 2002 and 2006, this frame was used in operations for 46 webs, and the results were compared with those of 30 operated webs in which conventional wound management technique was used. It was found that significantly lower complication rate and lesser web creep formation was seen in these patients, which were managed using the frame, compared with the cases with conventional wound care. The frame was found to be effective for prevention of severe web creep especially in complex synpolydactyly surgery.

Talonavicular Joint Approach to the Talar Body : A Cadaver Study

Background: Lesions of the talar dome or tumors within the talar body may require an open approach with medial or lateral malleolar osteotomies. The aim of this study was to evaluate the possibility and feasibility of a new minimally invasive approach without osteotomy, using the talonavicular joint (TJ) as the entry portal for lesions of the talar body. Materials and Methods: Nine cadaveric feet were used for this study. Using the TJ and a 5-mm skin incision we aimed to reach the superolateral, superomedial, inferolateral and inferomedial corners of the talar body under fluoroscopy. A 2-mm Kirshner wire and a 4-mm cannulated drill bit were used to reach the desired target area and an angled curette was used for curettage after reaching the target. The proximity of vascular structures to the entry portal was noted. The talar and navicular joint surfaces were checked for any damage. The articular areas of the talar heads and the defect areas were measured. Results: All 4 targets and even the posterior talus could be reached by this approach. The nearest neurovascular structures were the saphenous vein and the saphenous nerve. The navicular cartilage was not damaged in any specimen. The talar defect area corresponded to only 3.3% of the talar head cartilaginous area. Conclusion: The TJ approach can be used to reach lesions in all regions of the talar body without the need for an osteotomy. A mini-incision may be used to retract the saphenous nerve and vein. Damage to the talar head cartilage is minimal with this approach which requires no special equipments. Clinical Relevance: This study shows that talar dome lesions can be reached with a minimally invasive method.

Spinal Anestezi Sırasında Ortaya Çıkan Hipokalsemik Kriz

34 yasinda bayan hastada anterior krusiat ligamanin parsiyel rupturu ve lateral meniskus anterior ve medial meniskus posterior boynuzunda evre 2 dejenerasyon saptanmasi uzerine artroskopi planlandi. Lateral dekubit pozisyonda lumbal 3-4 araligindan girilerek 1.3 ml %0.5 hiperbarik bupivakain+ 0.2 ml 10 mg meperidin verildi. Duysal blok seviyesinin torakal 10 oldugu saptandiktan sonra operasyona baslandi. Operasyonun 110. dakikasinda hasta dudaklarinda ve ellerinde uyusmadan sikayet etmeye basladi. Hemen arkasindan hastanin ellerinde ebe eli (Trosseau bulgusu) gelisti. 10 mEq magnezyum, 20 mEq kalsiyum yavas infuzyonla intravenoz olarak verildi. Arteriyel kan gazinda dekompanze solunumsal alkaloz ve iyonize kalsiyum 0.83 mEq/l olarak geldi. Hastamizda organik bir hipokalsemi nedeni bulunamadi. Hastamizda solunumsal alkalozun neden oldugu hipokalsemi krizi dusunuldu. Sonuc olarak bu hastalarda sedasyon uygulanmalidir