Mustafa Uslu

Mini-open technique for the achilles tenotomy in correction of idiopathic clubfoot: a report of 25 cases.

Achilles tenotomy is performed for the residual equinus deformity in the Ponseti method of clubfoot treatment. In the present article, we describe a mini-open Achilles tenotomy technique to prevent complications that could occur during tenotomy. This technique was performed on 15 patients (25 feet) during a 3-year period in our clinic on patients whose equinus deformities could not have been corrected by manipulations. Clear improvement (mean angle, 30 degrees ) was observed in equinus in our patients, and we have not seen any complication in this method. We conclude that direct visualizing of the tendon with mini-open incision may reduce the risk of neurovascular injury, especially for surgeons who are not experienced.

Middle phalangectomy: a functional and aesthetic cure for macrodactyly.

Macrodactyly is a rare congenital anomaly of the extremities. Some treatments such as debulking, epiphysiodesis, stripping or resection of the digital nerve, shortening of the fingers, amputation, and angulation osteotomy have been tried. We describe a patient with a giant digit in the hand, and present middle phalangectomy as a suitable treatment.

Postoperative dynamic extension splinting compared with fixation with Kirschner wires and static splinting in contractures of burned hands: a comparative study of 57 cases in 9 years.

Skin grafting is widely used for the treatment of postburn contractures. Their main disadvantage, a tendency to contract again, can be reduced and better outcomes achieved by postoperative splinting. In this study we compared the outcomes of dynamic and static splinting postoperatively. Of the 57 patients managed by split grafts, 36 (44 hands) had Kirschner (K) wires applied with static splints, whereas 21 (26 hands) had dynamic splinting. The mean age was 11 (range 2–37) and 15 (range 2–50) years in the two groups. Before and after the operation, basic hand functions were evaluated clinically, and the results analysed statistically. The mean follow-up times were 18 and 14 months respectively, and recurrence rates were 22% and 14%. We think that the postoperative dynamic splinting is superior to fixation with K-wires with or without static splints.

Comparison of anti-edema effects of iloprost and diclofenac sodium on traumatic rat paw edema

OBJECTIVES The aim of this study was to compare the anti-edema effects of a stable prostacyclin analogue, iloprost, with parenteral and local forms of a non-steroidal anti-inflammatory drug, diclofenac sodium, on traumatic soft tissue edema. METHODS Thirty-two adult male rats were randomly divided into 4 equal groups. Traumatic edema in one paw of each rat was produced by established protocol. Different drugs were then administered to each group: intraperitoneal (i.p.) saline (group 1, control group), topical diclofenac gel (group 2), i.p. diclofenac sodium (group 3), and i.p. iloprost (group 4). The volume of the paws was measured at baseline (before trauma) and at 1 hour, 2 hours, 4 hours, 8 hours, 24 hours, 48 hours, and 72 hours after trauma. The anti-edema effects of these 3 drugs (diclofenac gel, diclofenac sodium i.p., iloprost i.p.) were compared to each other and to the control group. RESULTS The greatest increase in paw edema in the first, second and fourth hours was seen in the control and iloprost groups. At the 4-hour measurement, edema levels were all equal except control group. Following 4- and 8-hour measurements, edema began to decrease in all groups. After 8 and 24 hours, the fastest decrease in edema was in iloprost group, with complete resolution of edema by 72 hours. The next fastest decrease in paw volume was seen with i.p. diclofenac sodium, followed by diclofenac gel. CONCLUSION Iloprost has experimentally higher anti-edema effect than diclofenac sodium for the conservative treatment of the traumatic soft tissue edema.

A New Method in Tendon Repair Angular Technique of Interlocking (ATIK)

Background:The risk of adhesion following flexor tendon repair, despite provision of rehabilitation by mobilization of the tendon with passive exercises without the risk of rupture, is not negligible. Active mobilization of tendons has recently been more frequently recommended to prevent adhesions of tendons. The tendon repair zone, which should withstand active traction forces, should maintain its strength until complete recovery of the tendon. For this purpose, a new treatment method named angular technique of interlocking (ATIK) has been developed. This method was compared with the Modified Kessler method, in vivo and in vitro. Materials and Methods:In four groups, each consisting of 10 chickens, severed flexor tendons repaired with the Modified Kessler and ATIK techniques were compared for biomechanical properties. Results:Although there were no differences between these techniques in vitro, this new techniques superiority was statistically significant in in vivo studies. Conclusions:The second and third postoperative weeks are periods during which the number of fibroblasts and the amount of collagen are the highest. In these periods, edema resolves and sutures begin to loosen. In this situation, the force withstanding the active movements is the support of the suture materials and the degree of recovery of the tendon. Following this recommended suture technique and active movements, the healing potential of the tendon increases and the risk of tendon rupture owing to decrease in the force exerted per unit area decreases.

Cohesive Taping and Short-Leg Casting in Acute Low-Type Ankle Sprains in Physically Active Patients

BACKGROUND Cohesive taping is commonly used for the prevention or treatment of ankle sprain injuries. Short-leg cast immobilization or splinting is another treatment option in such cases. To determine the clinical efficacy and antiedema effects of cohesive taping and short-leg cast immobilization in acute low-type ankle sprains of physically active patients, we performed a preliminary clinical study to assess objective evidence for edema and functional patient American Orthopaedic Foot and Ankle Society (AOFAS) scores with these alternative treatments. METHODS Fifty-nine physically active patients were included: 32 in the taping group and 27 in the short-leg cast group within a year. If a sprain was moderate (grade II) or mild (grade I), we used functional taping or short-leg cast immobilization for 10 days. We evaluated the edema and the functional scores of the injured ankle using the AOFAS Clinical Rating System on days 1, 10, and 100. RESULTS In each group, edema significantly decreased and AOFAS scores increased indicating that both treatment methods were effective. With the numbers available, no statistically significant difference could be detected. CONCLUSIONS Each treatment method was effective in decreasing the edema and increasing the functional scores of the ankle. At the beginning of treatment, not only the level of edema but also the initial functional scores of the ankle and examinations are important in making decisions regarding the optimal treatment option.