Mustafa Kürklü

The prevalence of absence of the palmaris longus: a study in Turkish population

IntroductionIt is well known that there is a wide variation in the reported prevalence of the palmaris longus (PL) absence in different ethnic groups. This prospective study was conducted to determine the prevalence of absence of PL and correlate it with gender and body side in Turkish population.MethodIn total, 1,350 randomly selected adult patients (675 men and 675 women) who admitted to our outpatient clinic were examined for the absence of PL using Schaeffer’s test and Mishra’s second test. The absence of PL on both sides, results of the first and second examination tests, age, gender and dexterity were recorded and analyzed statistically.ResultsThe overall prevalence of absence of PL (unilateral or bilateral) was 26.6% in Turkish population. The absence of PL in women was statistically more common than men. Bilateral absence of PL was statistically frequent than unilateral absence. The prevalence of absence of PL was statistically similar between the body sides.ConclusionMishra’s second test which involves resisted abduction of the thumb, may be better in demonstration of the PL where the muscle was feebly developed, particularly in women.

Coccygectomy with or without periosteal resection

The purpose of this study was to compare the clinical outcomes and wound complications in coccygectomy with or without subperiosteal resection. This retrospective study included 25 patients who underwent coccygectomy. Resection of all mobile coccygeal segments including the periosteum was performed in 11 patients (group 1) and resection was performed subperiostally sparing the periosteum in the remaining 14 patients (group 2). A visual analogue scale was used for pain assessment before and after the surgery both in sitting and standing positions. A questionnaire to evaluate subjective patient satisfaction was also used. The two groups were statistically similar in terms of age, sex, aetiology, duration of symptoms before surgery and follow-up time. Both surgical techniques resulted in a statistically similar clinical outcome. Overall, 84% of patients who underwent coccygectomy benefited from surgery. We observed four wound infections (two superficial and two deep) that caused delayed wound healing in group 1. The rate of infection in group 1 was statistically higher than in group 2. The results of this study suggest that periosteal preservation and closure are related to low risk of infection.

First ray reconstruction with distraction osteogenesis

Disarticulation of the thumb at the metacarpophalangeal joint level is not beneficial either aesthetically or functionally without additional surgery because it requires a bulky and an unacceptable prosthesis to be made for this amputation level. In this study, the authors have presented our experience of 12 metacarpal distractions in thumb amputated patients. Twelve male patients who had thumb amputation due to gunshot wounds were included in the study. Before the operation, aesthetic hand prostheses were made for 5 of the12 patients. Callus distraction was performed with the use of a mini Ilizarov type external fixator in 7 cases and uniplanar dynamic mini external fixator in 5 cases too. External fixators were removed after the completion of the radiographic consolidation. Five patients whose prosthesis had been made before the operation wore their prosthesis for an average 6.8 months (5 – 14) due to poor appearance and poor construction. Union of the lengthened segment was observed in all cases. Average lengthening was 28.9 mm (range from 25 – 37). Average healing time was 2.1 months (range from 1.8 – 2.5). Average healing index was 0.73 month/cm (range from 0.65 – 0.88). Pin tract infection was seen in 7 cases (58.3%). Volar angulation developed after removing the external fixator in 1 case. Webplasty was performed in all cases. Patients were evaluated by means of Disability of the Arm, Shoulder and Hand (DASH) score and pick-up test. It was concluded that the metacarpus lengthening by callus distraction technique may be a functionally and cosmetically effective reconstruction method for traumatic thumb amputations. It is believed that the possibility for a functionally and aesthetically acceptable fabrication of a thumb prosthesis, by providing a suction suspension with distraction and/or webplasty procedures.

Comparison of the postoperative analgesic efficacy of an ultrasound-guided fascia iliaca compartment block versus 3 in 1 block in hip prosthesis surgery.

OBJECTIVES In this study, we aimed to compare the postoperative analgesic efficiency of an ultrasound-guided fascia iliaca compartment block and a 3 in 1 block in patients who underwent hip prosthesis surgery as a result of hip fracture. METHODS With approval from the local ethics committee, 70 patients, aged 20 to 80, undergoing hip prosthesis surgery under elective conditions were included in this randomized, prospective, controlled study. They were informed of the patient-controlled analgesia (PCA) device and visual analog scale (VAS). All patients were separated randomly into three groups. Anaesthesia induction was standardized for all groups. An ultrasound guidance fascia iliaca compartment block (FICB) was applied to the first group before anaesthesia induction. For the second group, a 3 in 1 block was applied, while for the control group no block was applied. After incision on all patients, 20 mg tenoxicam and 1 mg/kg tramadol were injected intravenously. Following surgery, IV tramadol PCA was begun on all patients routinely. In our study, the presence of cortisol and ACTH levels, hemodinamical parameters, nausea and sedation were determined. RESULTS We observed a decrease in VAS values and opioid consumption, no adverse effects on nausea and sedation, and a suppression of stress hormones in both the ultrasound-guided FICB and 3 in 1 block groups. CONCLUSION We believe that the safe and efficient application of the ultrasound-guided 3 in 1 block and the FICB is necessary in multimodal analgesic treatment in order to enable postoperative analgesia in hip prosthesis surgery.

Chair method: a simple and effective method for reduction of anterior shoulder dislocation

OBJECTIVE The ideal reduction method for anterior shoulder dislocation is defined as a practical technique applied without any assistance and minimizing patient interference. The aim of this study was to evaluate the outcomes of patients with shoulder dislocations reduced using the chair method in the emergency department and show that the chair method is one of the ideal methods. METHODS Seventy-four patients with anterior shoulder dislocation were treated using the chair method. Data from patients were recorded and analyzed. RESULTS All dislocated shoulders were successfully reduced using the chair method without any complication or difficulty. Thirty patients had first time dislocation and 44 patients had previous dislocation. Mean duration between dislocation and reduction was 3 (range: 1 to 6) hours. Mean duration of reduction was 13.9 (range: 3 to 45) seconds. CONCLUSION The chair method is an effective and successful reduction method for shoulder dislocation. We believe that orthopedists and emergency department physicians should be familiar with this simple technique which does not have to be performed under general anesthesia.

Stress fracture of bilateral tibial metaphysis due to ceremonial march training: a case report

Stress fractures are caused by repetitive microtraumas that occur during unusual or increased activities. Clinical suspicion is essential for the diagnosis. A twenty-years old soldier was presented with bilateral knee pain and restriction of knee movements after a period of training for ceremonial march. Although plain X-rays were normal, scintigraphy and MRI revealed stress fractures at metaphyseal region of both tibias. History of a patient presenting with persisting joint or bone pain after an unusual repetitive activity should be delicately inquired. Typical history, although pain might be localized to unusual sites, should raise the suspicion of a stress fracture.

Anterosuperior calcaneal process fracture or OS calcaneus secundarius

A 36-yr-old woman was admitted to our emergency department after having sustained an inversion injury of her right ankle. On physical examination, there was diffuse swelling and ecchymosis on the dorsolateral aspect of her foot. The ankle joint movements were in normal range without laxity. The anteroposterior and lateral x-rays of the right foot were considered to be normal by the emergency physician. The patient was diagnosed with simple ankle sprain and was treated accordingly with classical RICE protocol and a nonsteroidal antiinflammatory drug. Four weeks after the initial trauma, the patient presented to our orthopedic outpatient clinic with persistent complaint of right foot pain on weight bearing. On physical examination, severe pain on the dorsal part of the calcaneocuboid joint was present. The initial anteroposterior and lateral x-rays were reevaluated, and a fracture was suspected at the anterior calcaneal process (Fig. 1A). Medial oblique foot x-ray revealed a bony fragment located between the anterosuperior calcaneal process and the cuboid (Fig. 1B). In the differential diagnosis, anterosuperior calcaneal process fracture and OS calcaneus secundarius were considered. Further computed tomography imaging delineated the anatomy of the fragment better, while the ovoid shape, well corticated margins, regular interface, and blunt edges of the fragment supported the diagnosis of OS calcaneus secundarius, wide proximal base and considerably large size favored the anterosuperior calcaneal process fracture. Magnetic resonance imaging was eventually performed and, with the presence of bone marrow edema adjacent to the fracture line, an anterosuperior calcaneal process fracture rather than an OS calcaneus secundarius was confirmed at diagnosis (Fig. 2). She was treated with a medial longitudinal arc support, and after 1 mo, she was free of pain during mobilization. OS calcaneus secundarius and anterosuperior calcaneal process fractures are two similar clinical syndromes, both of which present with anterior ankle pain. The differentiation of these two entities may be quite challenging only with physical examination or classical x-rays. Herewith, we imply that the distinction may be possible when oblique x-rays or, even better, magnetic resonance imaging is performed. This is important because the treatment of each syndrome is different.

Adjunctive hyperbaric oxygen therapy in the treatment of atrophic tibial nonunion with Ilizarov external fixator: a radiographic and scintigraphic study in rabbits*

OBJECTIVE The aim of this experimental study was to determine the effects of adjunctive hyperbaric oxygen therapy (HBO) on atrophic tibial nonunion treatment using Ilizarov external fixator. METHODS Twenty New Zealand white rabbits were randomly divided into two equal groups. A circular external fixator was applied to the right tibia of all the rabbits. A 5-mm bone block was resected and a tibial pseudarthrosis was obtained after a 6-month waiting period. The experimental group rabbits (n=10) underwent daily 2.5 ATA HBO therapy for 2 hours for 20 days and the control group rabbits (n=10) did not receive any corresponding treatment. Osteoblastic activity was evaluated with bone scintigraphy on days 30 and 90. Fracture healing was evaluated by plain radiographs on days 30 and 90. RESULTS On Day 30, radiological scores were statistically similar in both groups (p=0.167). However, on Day 90, the experimental group displayed significantly higher radiological scores (p<0.001). Osteoblastic activity was also higher in the experimental group on both scintigraphic assessments (p=0.005 and p=0.001). CONCLUSION The results of this study suggest that HBO can be used as a supplementary therapy in the management of atrophic tibial nonunion.

Burst fracture of the lumbar vertebra due to a landmine injury: a case report

IntroductionThe reason we report this case is that spine injuries may well occur due to landmines similar to other injuries like traumatic limb amputations and more over they may be overlooked.Case presentationThe patient was 29-years-old Turkish male and was a member of the military. He detonated the landmine that caused his injuries while in a conflict zone. He had a right below knee and left above knee traumatic amputations. He had also mild intermittent pain in his lower back. There were no focal neurological findings such as weakness, altered sensibility, or alteration in the function of the bowel or bladder. Radiographs of the lumbar spine revealed an L2 burst fracture. Computed tomography scans and magnetic resonance imaging of the lumbar spine demonstrated a burst fracture of the L2 vertebrae and moderate compression in the anterior portion of the thecal sac due to the fracture fragment. Because of the stabile nature of the L2 burst fracture and lack of neurological disturbance, operative decompression, instrumentation and fusion was not performed. After healing of the stumps, the patient was mobilized with immediate prostheses and a thoracolumbosacral brace.ConclusionSpine injuries should not be overlooked when evaluating patients after landmine explosions. After the patient has been stabilized, the secondary screening and radiographic evaluations should also comprise the thoracic, thoracolumbar and lumbar spine when treating patients after landmine injuries.

Ilizarov external fixation without removal of plate or screws: effect on hypertrophic and oligotrophic nonunion of the femoral shaft with plate failure.

Summary: Patients with hypertrophic and oligotrophic nonunion of the femoral diaphysis associated with plate failure can be treated by Ilizarov external fixation without plate removal. Advantages of this technique include a lack of damage to the blood supply and simultaneous deformity correction.