Oguz Ozdemir

Schwannomas of the hand and wrist: long-term results and review of the literature

Purpose. To review the long-term results of 14 cases of histopathologically confirmed schwannoma of the hand and wrist treated with intracapsular tumour removal. Methods. All operations were performed under loupe magnification and microsurgical dissection, and the tumour was removed after capsular (including endoneurium) incision. Patients were assessed for any residual symptoms. Sensory testing of light touch and pain was carried out. Results. The mean age of the patients at the time of operation was 38.4 years (range, 11–78 years), and the mean follow-up period was 12.6 years (range, 3–36 years). Ten of the tumours were located in the median nerve distribution, whereas 4 in the ulnar nerve distribution. Four tumours were at the wrist level, 3 at the palm level, and 7 at the digital level (3 in the index finger). Only 5 patients were correctly diagnosed preoperatively. Neurological loss was not recovered in one patient in whom the tumour was resected with the digital nerve. No recurrence or muscle atrophy was noted at the latest follow-up. Conclusion. Meticulous dissection with magnification can achieve complete tumour removal without neurological loss or recurrence. Intracapsular tumour removal provides good results with a low complication rate.

Reliability and reproducibility of classifications for distal radius fractures

OBJECTIVE The aim of this study was to evaluate the interobserver reliability and intraobserver reproducibility of the Universal, AO, Fernandez and Frykman classifications for distal radius fractures. METHODS Fifty standard sets of posteroanterior and lateral roentgenograms of displaced distal radius fractures were classified two times by two groups of evaluators at 2-month intervals. The first group consisted of 10 orthopedic surgeons with a minimum of 5 years of experience. The second group consisted of 10 orthopedic residents in their first two years of practice. Interobserver reliability and intraobserver reproducibility were assessed using Cohens kappa test. RESULTS None of the classifications achieved good- very good reliability levels. The Fernandez classification had a moderate and the others had a fair interobserver agreement kappa coefficient. All classifications had fair kappa intraobserver agreement although the Frykman and Fernandez classifications had better results. CONCLUSION None of the classification systems were superior in terms of reliability and reproducibility. The reliability and reproducibility rates of all four classifications were insufficient.

Evaluation of the risk factors for acute occupational hand injuries

OBJECTIVES To evaluate the effect of demographic and occupational factors on the severity of the acute occupational hand injuries. METHODS Patients with acute hand injuries presenting to the emergency department of the Ege university hospital between 01.08.2008 and 27.02.2009 were included. A questionnaire investigating demographic and occupational factors of the patients and their injuries was filled out for each patient. Modified Hand Injury Severity Score (MHISS) was used to assess the severity of the injury. RESULTS A total of 144 subjects were included. Forty-three patients had occupational hand injuries. Age at injury, occupation, and main earning status did not alter the MHISS score significantly. Also, the mechanism of injury, occupational experience, timing of the injury, glove use, safety training did not have a significant effect on the injury severity. The injury pattern was found to have a statistically significant effect on the MHISS score. CONCLUSION The potentially modifiable factors such as the working conditions, safety training and use of gloves are important in the etiology of occupational acute hand injury. Most probably, in this study the size of the sample was not large enough to be able to demonstrate any relation between these and the injury severity. However, attempts to modify these factors by various strategies may reduce the incidence of acute hand injury at work. Precautions and widespread educational programs can prevent occupational acute hand injury.

The effect of excisional arthroplasty with palmaris longus tendon on carpal height ratio in Stage 3 Kienböck’s disease

OBJECTIVE Treatment methods in Kienböcks disease remain controversial despite the long-term awareness of the disease by orthopedic surgeons. Currently, excisional arthroplasty with a palmaris longus tendon ball is one of the most frequently used treatment methods. The aim of this study was to evaluate the long-term results of thirty-eight patients who had been treated with excisional arthroplasty and palmaris longus tendon ball, as well as the effect of this method on carpal height. METHODS In this study, we retrospectively evaluated 38 patients (mean age: 30.4 years; range: 17-64 years) with Stage 3 Kienböcks disease who underwent excisional arthroplasty between 1978 and 2008. According to the Lichtman classification, 8 patients were classified as Stage 3a and 30 patients were classified as Stage 3b in Kienböcks disease. The mean duration of follow-up after surgery was 81.3 (range: 25 to 264) months. The outcomes were evaluated with joint range of motion, grip strength and functional assessment of Nakamura and radiographic changes in carpal height. RESULTS According to the Nakamuras scoring system the results were excellent in 22 (57.9%) patients, good in 13 (34.2%) and moderate in 3 (7.9%). Comparison of pre and postoperative range of motion of the wrist revealed an average increase in wrist extension of 10° (p<0.05), and an average decrease in ulnar deviation of 4° (p<0.05) after the operation. No significant difference was observed when comparing other joint range of motion parameters. Dynamometric grip strength measurements revealed significant differences between the healthy and operated sides (67.6 kgf vs. 45.9 kgf, respectively; p<0.05). The decrease in the revised carpal height ratio were significant. CONCLUSION According to patient satisfaction rate and clinical results, the outcome of excisional arthroplasty with palmaris longus tendon ball in Stage 3 Kienböcks disease is satisfactory. However, carpal height reduction and development of degenerative changes may be expected in long-term follow-up.

Tumeur à cellules géantes de la main: Résultats du traitement : 5 cas au recul moyen de 7,8 ans

PURPOSE OF THE STUDY Giant-cell bone tumors are benign but have great potential for recurrence. Frequently observed in epiphyseal areas of tubular bones, these tumors are rarely found in hand localizations. We examined the characteristic features of giant-cell tumors of the hand and analyzed the pertinence of surgical treatment. We noted complications, consequences of recurrence and later operations on the same tumor site in five cases. CASE REPORTS Five patients treated between 1973 and 2000 for giant-cell tumors involving the hand bones were reviewed retrospectively. Mean age was 41.6 years and mean follow-up was 7.8 years. The surgical procedure was curettage for two, curettage with bone graft for two and amputation for one. The Enneking score was noted. RESULTS Pain was the main symptom, with local swelling in several cases. At 7.8 years follow-up recurrence was noted for four of the five tumors. Two patients were treated for a second recurrence. Amputation of the forearm was required for one recurrence affecting soft tissue. Mean time between two consecutive recurrences was three months. In all six episodes of recurrent tumor were treated. These five patients had a total of ten operations. There were no cases of metastasis nor multicentric foci. DISCUSSION Treatment of giant-cell tumors involving the hand bones is designed to eradicate the tumor and also protect hand function while keeping in mind the aggressive nature of these benign tumors. Surgical alternatives for radical treatment can include wide resection, resection of the ray and amputation.

Fracture bilatérale de l'os pisiforme

Resume L’os pisiforme est tres rarement fracture par rapport aux autres os carpiens ; la lesion est souvent meconnue en urgence a cause de l’anatomie complexe de la region carpienne. Chute au sol poignet en hyperextension, accident de la voie publique et traumatisme direct sont les circonstances habituelles de la fracture. Le but de ce travail etait de presenter un cas de fracture bilaterale de l’os pisiforme, rare par le mecanisme etiologique et la bilateralite. Une patiente âgee de 34 ans s’est presentee avec des douleurs sur les bords ulnaires des deux poignets suite a une chute. Le mecanisme fracturaire avait ete un traumatisme direct sur les deux mains etendues en inclinaison radiale. Le diagnostic en a ete tardif et le traitement conservateur, apres une immobilisation simple de six semaines, le resultat clinique et fonctionnel a ete excellent. La situation anatomique du pisiforme fait qu’il est expose aux traumatismes et un diagnostic tardif pourrait exposer a des sequelles arthrosiques sur l’articulation pisotriquetrale.

The value of short segment conduction studies in localizing ulnar neuropathy of the elbow

Objectives: The aim of this study was to examine the localizing value of short segment conduction studies (SSCSs) by comparing pre-surgical SSCS findings with intraoperative findings in patients with ulnar neuropathy of the elbow. Patients and Methods: Pre-surgical SSCSs were performed in 20 patients and compared with the intraoperative findings. Functional and electrophysiological recoveries were assessed at postoperative month 3. Overall, compressed nerve segments identified by SSCSs were compatible with the intraoperative findings in 90% of patients. Results: The success rate of surgery was higher in the patients with SSCS-determined single-level compression as compared to multi-level compression. SSCS abnormalities persistent in six patients with poor functional recovery. Conclusion: SSCSs are valuable for localizing compressed segments, thus they can be used as a guide for minimalist surgical techniques. These studies also appear valuable for predicting surgical outcome in patients with ulnar neuropathy of the elbow.

Comparative outcomes of in situ decompression and anterior transposition in McGowan stages II-III of cubital tunnel syndrome

Aims: The purpose of this study was to retrospectively compare clinical and functional outcomes of subcutaneous anterior transposition and in situ decompression performed in similar patient groups diagnosed with McGowan Stages II and III cubital tunnel syndrome. Patients and methods: Patients operated on with the diagnosis of idiopathic cubital tunnel syndrome in two different centers between January 2006 and January 2011 were retrospectively evaluated. Anterior subcutaneous transposition group consisted of 15 patients (mean age 41,3, mean followup 34,6 months), in situ decompression group consisted of 16 patients (meanage 46,1, meanfollowup 13,5). Eleven patients were McGowan stage 3 and four patients were stage 2 in anterior transposition group. Eleven patients were stage 3 and five patients were stage 2 in decompression group. Postoperative clinical results were evaluated according to the modified Bishop and Akahori functional evaluation system. Quick DASH questionnaire completed to all patients at the final control. Results: There were no significant difference between two groups according to clinical outcomes and Quick DASH scores. According to Akahori classification good and excellent results were obtained in 12 out of 15 patients in anterior transposition group and 11 out of 16 patients in decompression group. We found a strong statistical correlation between Bishop and Quick DASH scores. (p