Mustafa Isik

Percutaneous release of the trigger thumb: is it safe, cheap and effective?

Percutaneous release of the trigger finger and trigger thumb has recently gained popularity. The aim of this study was to determine the clinical results and safety of percutaneous release in trigger thumbs. Twenty-five thumbs of 21 patients were relased percutaneously in the polyclinic under local anaesthesia. Steroid injection was performed following the release procedure using the same needle. The thumb function was evaluated by a patient questionnaire, and functional thumb scores (VAS) were calculated in the preoperative and postoperative periods. At the 1 week follow-up, four patients had signs of discomfort and triggering because of incomplete release. These patients underwent open A1 pulley release. Three superficial tendon lacerations were seen during these open procedures. There were no wound complications or signs of digital nerve or artery injury in any of the patients. The preoperative mean VAS was 26.62 (18–36). This decreased to 2.57 (0–5) at the first postoperative month (P<0.001) and to 2.19 (0–3; P<0.001) at the sixth month. When the VAS scores at the first and sixth months were compared, the difference was statistically significant. We concluded that percutaneous release of trigger thumbs is a cheap, safe and effective procedure with a low rate of complications.

A case of isolated giant plexiform neurofibroma involving all branches of the common peroneal nerve

Plexiform neurofibroma is generally considered as a component of neurofibromatosis 1, and a great majority of the cases with plexiform neurofibroma display other symptoms related to neurofibromatosis. Plexiform neurofibromas occur frequently in the head and neck region due to the rich innervation of the area, however appear rarely in the extremities. We report here an isolated giant plexiform neurofibroma involving the common peroneal nerve branches without symptoms related to neurofibromatosis in a 5-year-old case. Surgical excision was performed due to pain and numbness in the leg, and against the possibility of malignant transformation due to sudden growth observed in the tumor. One month following the excision of all the reachable tumoral tissues, tendon transfer surgery was performed for the ankle and toe extensions. Our case stands as the only reported case of isolated giant plexiform neurofibroma involving the common peroneal nerve in the pediatric age.

Review of Van earthquakes form an orthopaedic perspective: a multicentre retrospective study

PurposeThis is a descriptive analysis, of victims of Turkey’s October 23, 2011 and November 21, 2011 Van earthquakes. The goal of this study is investigated the injury profile of the both earthquakes in relation to musculoskeletal trauma.MethodsWe retrospectively reviewed medical records of 3,965 patients admitted to in seven hospitals. A large share of these injuries were soft tissue injuries, followed by fractures, crush injuries, crush syndromes, nerve injuries, vascular injuries, compartment syndrome and joint dislocations. A total of 73 crush injuries were diagnosed and 31 of them were developed compartment syndrome.ResultsThe patients with closed undisplaced fractures were treated with casting braces. For closed unstable fractures with good skin and soft-tissue conditions, open reduction and internal fixation was performed. All patients with open fracture had an external fixator applied after adequate debridement. Thirty one of 40 patients with compartment syndrome were treated by fasciotomy. For twelve of them, amputation was necessary. The most common procedure performed was debridement, followed by open reduction and internal fixation and closed reduction-casting, respectively.ConclusionsThe results of this study may provide the basis for future development of strategy to optimise attempts at rescue and plan treatment of survivors with musculoskeletal injuries after earthquakes.

Traumatic shoulder fracture-dislocation in a 7-year-old child: a case report

IntroductionIn contrast to adults, traumatic glenohumeral dislocation is a rarely observed condition among children. In some cases, success in durable reduction with conservative methods, and achieving lasting treatment, may not be possible.Case presentationIn this study, the case of a 7-year-old Turkish girl with a Salter–Harris type II fracture and glenohumeral dislocation of the proximal humerus due to a fall from a height of 1.5 meters who underwent open reduction surgery is presented along with a review of the literature.ConclusionOrthopedic surgeons should consider glenohumeral dislocation which is an extremely rare condition when they encounter proximal humerus fractures in pediatric trauma.

Clinical and functional outcomes and treatment options for paediatric elbow dislocations: Experiences of three trauma centres

Although elbow dislocations are seen rarely in children, their management remains controversial. In this study, over a 7 years period, we evaluated retrospectively the clinical and functional results of paediatric elbow dislocations managed in three different trauma centres. Pure dislocations and dislocations with associated injuries were evaluated separately. In total 56 patients met the inclusion criteria. The number of patients without additional injury was 22 out of which according to the Roberts criteria, 15 children (68%) had an excellent, four (18%) a good, one (5%) a fair, and two (9%) a poor outcome. From the thirty-four patients that had associated injuries, two (6%) had an excellent, 6 (18%) a good, 10 (29%) a fair and 16 (47%) a poor result. Overall, patients with pure dislocation were found to have a better range of motion compared to patients with dislocation and associated injuries. Prolonged follow ups, and effective rehabilitation programs are required in order to expect good outcomes.

A comparison of the effectiveness of low-, moderate- and high-dose ultrasound therapy applied in the treatment of myofascial pain syndrome

Abstract Objective. This study aimed to compare and evaluate the effects of ultrasound (US) treatment applied at low-, medium- and high-power-pain threshold (HPPT) doses to trigger points in the treatment of myofascial pain syndrome (MPS). Methods. The study comprised 61 (40 female and 21 male) patients diagnosed with MPS, aged between 18 and 60 years. The patients were randomly allocated to three groups for the US application at different dosages. Group I patients received treatment of medium-dose US (1.5 Watt/cm2), Group II received HPPT US, and Group III received low-dose US (0.5 W/cm2). The patients were evaluated pre-treatment and 3 weeks after treatment in respect of visual analogue scale (VAS) scores, number of trigger points (NTP), pressure pain threshold (PPT), Range of Tragus-Acromioclavicular joint (RT-AJ) and neck pain disability scores (NPDS). Results. A significant improvement was determined after treatment in all scores except PPT in Group I, in all scores in Group II, and only in the VAS score in Group III. When the groups were compared post-treatment in respect of improvement in NTP, VAS, RT-AJ and NPDS scores, Group II showed significant superiority over Group I, and Group I was determined to have significant superiority over Group III in respect of VAS, RT-AJ and NPDS scores (p < 0.05). Conclusions. In the treatment of MPS, US therapy at HPPT dose can be considered as an alternative therapy method, which is more economical and more effective than low-dose and conventional US therapy.

Intramedullary Nailing and Angulation Prevention in Distal Metaphyseal Tibial Fractures

Intramedullary nailing, which is preferred in tibial diaphyseal fractures, is also frequently used in distal third tibial fractures. Various angular deformities, including varus/valgus deformity, may be observed during postintramedullary nailing. Orthopedic surgeons use several methods to prevent this problem.In this study, at least 2 static locking screws were placed proximal and distal to the nail during intramedullary nailing of distal third tibial fractures. No additional supportive methods were used. The efficacy of this technique in the prevention of postoperative angular deformities was retrospectively investigated. Thirty-four patients with distal third tibial fractures who were treated with intramedullary nailing were included in the study. Angulations were measured in the anteroposterior and lateral planes on plain radiographs obtained preoperatively, on postoperative day 1, and after fracture union. Angulations measured on postoperative day 1 were compared with those measured after fracture union, and an increase was observed. Based on statistical analyses, the increase in the angulations was not significant.In distal third tibial fractures, when fixation was performed by placing 2 static screws distal and proximal to the intramedullary nail following adequate reduction, the angulations that developed during the period until union were not significant in terms of causing deformity, although additional fixation methods are not used.

Importance of radial head on elbow kinematics: radial head prosthesis

Dear sir, We would like to comment on the article by Wretenberg et al. [1] regarding radial head prosthesis after fracture of radial head with associated elbow instability. In the authors study, radial head prosthesis works well as a spacer and if the range of motion is much restricted post-operatively, the prosthesis can be removed for improving function [1]. They advocate that the prosthesis extraction is due to the restriction in motion, which results from an overestimated size of prosthesis [1]. The patient satisWed with the result after the radial head prosthesis extraction [1]. The treatment of complex fracture of radius head with elbow instability is a common problem for an orthopedic surgeon. Various treatment options have appeared in the current literature [2–4]. The clinical outcome studies of metallic radial head arthroplasty systems indicate that the radial head replacement is a reasonable option to oVer patients with comminuted radial head fractures and complex elbow trauma [5, 6]. Radial head is very important for elbow kinematics and radial head excision causes altered elbow kinematics and increased laxity [6]. Metallic radial head arthroplasty provides improved valgus stability [7]. The exact length of the radius is important to maintain normal kinematics in the elbow joint. Lengthening or shortening and radiocapitellar gap may alter elbow kinematics [8–10]. In conclusion, based on our experiences as well as others, we would recommend that proper balancing and adequate bone resection from radial head is mandatory for obtaining normal elbow kinematics during the radial head arthroplasty procedure.

Extra-articular Tenosynovial Chondromatosis Mimicking a Neoplastic Disease in the First Web Space of the Hand

Tenosynovial chondromatosis is a very rare disease. The most common symptom is a slowly enlarging soft tissue mass, which may be painful or cause limitation of joint motion. Plain radiograph may appear normal during early phases of the disease, but subsequent imaging may be necessary to exclude other pathologies. Nonoperative treatment may be elected for some patients, but a synovectomy and the removal of loose bodies are indicated for persistent symptoms. This report describe a case with a multinodular cartilaginous proliferation and rice body in the first web space of the hand, similar to synovial chondromatosis, but arising in the tenosynovial membranes.

Total hip replacement for an ochronotic patient: A technical trick.

Patient: Male, 46 Final Diagnosis: Akkaptonuria Symptoms: Hip pain Medication: — Clinical Procedure: Total hip replacement Specialty: Orthopedics and Traumatology Objective: Unusual or unexpected effect of treatment Background: Ochronosis is an inherited metabolic disease in which there is an accumulation of excessive amounts of homogentisic acid in the connective tissue. As the disease progresses, the chronic inflammation in the damaged tissue can cause degeneration and osteoarthritis. There is no specific treatment for ochronosis because it is a rare disease and arthroplasty is seldom performed. Case Report: We report the case of a 46-year-old male patient with ochronosis, who underwent an arthroplasty of the right hip due to osteoarthritis. The problems encountered during surgery are reported and discussed. Conclusions: Arthroplasty is a highly effective procedure for ochronotic patients. Particular attention to the surgical step is highly advised.