S. Sinan Bilgin

Repair of neglected Achilles tendon ruptures: procedures and functional results

Surgical repair of neglected Achilles tendon ruptures presents the challenge of restoring the function of the Achilles tendon complex while repairing the large defect that is created by the delay in appropriate treatment. We present our preferred technique for delayed repair and the results of six patients who were available for complete follow-up evaluation. The combined surgical technique includes: V-to-Y gastrocnemius recession or advancement, excision of the fibroadipose defect, end-to-end anastomosis, gastrocnemius aponeurotic flap to reinforce the anastomosis. Each of six patients were interviewed and examined clinically and by Cybex II isokinetic strength testing. All six patients have been able to return to their pre-injury activities. Cybex II isokinetic strength testing demonstrated peak torque deficiencies in plantar flexion ranging from 2.5%–22% as compared with the unaffected limb. The overall results of the technique described indicate that very satisfactory functioning of a neglected Achilles tendon rupture can be obtained.

Reconstruction of proximal humeral defects with shoulder arthrodesis using free vascularized fibular graft.

BACKGROUND Treatment of proximal humeral bone loss resulting from tumor resection or from infection following shoulder arthroplasty represents a reconstructive challenge. Shoulder arthrodesis is an appropriate salvage procedure but is associated with a high rate of complications. The purpose of this report is to describe the surgical technique and report the functional outcomes in a series of patients treated with shoulder arthrodesis using free vascularized fibular graft. METHODS Nine patients were included in this study. Two-stage reconstruction was performed in three patients with a methicillin-resistant Staphylococcus aureus infection following primary shoulder hemiarthroplasty. The remaining six patients had an aggressive or malignant tumor of the proximal aspect of the humerus, and tumor resection included the rotator cuff in all of these patients and the axillary nerve in three. All nine patients underwent shoulder arthrodesis using free vascularized fibular graft; eight patients had fixation with two plate-screw constructs, and one patient had fixation with only one plate and screws. Clinical and radiographic evaluation of all patients was performed at a mean of sixty months postoperatively. The Musculoskeletal Tumor Society (MSTS) function score and the Toronto Extremity Salvage Score (TESS) were used to assess overall function of the upper limb. RESULTS Mean active shoulder abduction and flexion were both 80° (range, 60° to 100°). All but one patient could bring the hand to the mouth. The mean MSTS function and TESS values were twenty-four of thirty and 82%, respectively, representing a good functional outcome. Two of nine patients had a major complication. Union and fibular hypertrophy were achieved in seven of the nine patients. CONCLUSIONS Shoulder arthrodesis using free vascularized fibular graft with double plate fixation is a reliable salvage procedure in patients with major proximal humeral bone loss.

Clinical results versus subjective improvement with anterior transposition in cubital tunnel syndrome

This study was conducted to compare the results of anterior transposition methods and to determine the time needed to attain subjective well-being in patients with cubital tunnel syndrome. A total of 49 cases were retrospectively evaluated. Patients were called for follow-up, completed a questionnaire, and were reexamined. They were assigned to one of 3 groups: subcutaneous transposition (SCT), submuscular transposition (SMT), or intramuscular transposition (IMT). The McCowan classification and Wilson-Krout criteria were used for classification and outcomes assessments. Categorical variables were analyzed with the χ2 test, and metric variables by analysis of variance or through Kruskal-Wallis variance analysis. Improvement of at least 1 McCowan grade was observed in 87.63% of patients. The least responsive group was assigned a McCowan grade of III. The most effective procedure for resolving clawing was SMT. Clinical results were excellent in 26 patients (53.06%), good in 12 (24.48%), fair in 4 (8.16%), and poor in 7 (14.28%). At the latest follow-up, overall grip and pinch strength had improved by 23% and 34%, respectively, compared with the contralateral side. Thirty-six patients exhibited an improvement in grip power and 38 in fine dexterity. Complete resolution of numbness was observed in 32 patients, and complete resolution of pain was noted in 30 patients. The preoperative mean visual analog scale score of 6.82 improved to 3.36 postoperatively. Clawing improved in 4 patients and atrophy in 7. The mean time to subjective improvement was shortest in the SMT group and longest in the IMT group. The greatest pain relief was reported in the IMT group and the least in the SMT group. One case with IMT required reoperation because of recompression of the nerve. The most frequent complication in the SMT and IMT groups was muscular tenderness. In conclusion, SCT offers an alternative to other anterior transposition methods because of its simplicity and quicker recovery time, especially in mild to moderate cases.

Correction of nascent malunion of distal radius fractures

OBJECTIVE Early correction of malunion of distal radius fractures may be necessary in young, active patients. The aim of this study was to report the advantages and disadvantages of early correction of distal radius malunion. METHODS Eleven patients (10 male, 1 female; average age 36 years, range: 20 to 54 years) with nascent malunion of distal radius fractures were included in this study. The malunions occurred after initial conservative treatment of unstable distal radius fractures. Mean interval between injury and corrective surgery was 12 (range: 8 to 15) weeks. Two patients had intra- and extra-articular malunion and 9 had an extra-articular malunion. Volar correction was made in seven patients and dorsal correction in four. Results were evaluated radiologically and functionally using the Mayo wrist score. RESULTS Bony healing was established after correctional osteotomies at an average of 8 (range: 5 to 16) weeks. The average preoperative dorsal deformity was 28° and was corrected to 4° of volar tilt postoperatively. Patients had a positive ulnar variance with an average of 5 mm initially and less than 1 mm postoperatively. Radial inclination was corrected from an average of 9° preoperatively to an average of 20° and the average postoperative Mayo wrist score was 82.5. Tenotomy of brachioradialis was useful for the correction of radial inclination, especially in old cases. Structural (corticocancellous) grafting was used in one patient. All patients returned to their previous functional level. CONCLUSION Advantages of early corrective osteotomy include anatomic restoration at the original fracture line, a shortened healing period and a decreased need for structural bone grafting. Disadvantages are that the recreation of the original fracture line is technically demanding and patients must be cooperative to achieve a successful outcome.

Posterior tibial nerve as a tendon transfer for drop foot reconstruction: a devastating complication

Iatrogenic peripheral nerve injuries can result from numerous medical procedures, particularly transection, stretching, compression, injections, heat, radiation, and the use of anticoagulant agents. Late diagnosis may lead to atrophy of the motor endplate and result in poor outcomes. We report a case in which the posterior tibial nerve was accidentally sectioned as the posterior tibial tendon for transfer to the anterior tibial tendon in the reconstruction of drop foot. This iatrogenic complication ultimately required foot amputation. Physicians must be aware of the anatomy of the posterior tibial nerve in order to avoid such complications.

Immediate emergency free anterolateral thigh flap after car-tyre friction injury: A case report with eight years follow-up

The car-tyre friction injury has differences from other injuries. The components of injury which are burn, crushing, shearing, and degloving occur. Many treatment options can be performed for coverage of wound which are Vacuum Assisted Closure system (V.A.C), skin grafting, free flaps, local flaps and cross leg flap.

reconstruction of Proximal Humeral Defects with Shoulder Arthrodesis Using Free Vascularized Fibular Graft : surgical Technique

Introduction We describe upper-extremity reconstruction after proximal humeral bone loss by means of glenohumeral arthrodesis using a vascularized fibular graft and double plate fixation. Step 1 Preoperative Evaluation and Planning Use preoperative imaging to estimate the length of the humeral defect, the absence or presence of a glenoid defect, and the available length of fibular graft. Step 2 Position the Patient Place the patient in the beach-chair position, securing him/her with side supports. Step 3 Expose and Prepare the Shoulder The approach is a typical anterior approach to the shoulder following an anterolateral approach to the humeral shaft. Step 4 Harvest the Fibular Graft Harvest the full length of the fibula, after leaving 6 cm proximally and distally for ankle and knee stability. Step 5 Prepare the Humerus and Recipient Vessels in the Upper Arm Ream the humeral medullary canal by hand to avoid fracture and prepare the profunda brachii or brachial artery as recipient vessels. Step 6 Insert the Fibula Into the Proximal Part of the Humerus and Complete the Vascular Anastomosis Insert the bare osseous fibula into the humeral canal, pass the graft pedicle through the loose tunnel, and anastomose the vessels. Step 7 Double Plate Fixation It is very important to bend the lateral plate to match the contour of the osseous surfaces. Step 8 Follow-up and Rehabilitation Immobilize the shoulder until union is achieved and then start scapula-thoracic exercises. Results We recently reported on a retrospective series of nine shoulder arthrodeses performed with use of a free vascularized fibular graft. What to Watch For IndicationsContraindicationsPitfalls & Challenges.

Morganella Morgagni tarafından meydana getirilen felon komplikasyonu vaka sunumu

A felon is abscess on the pulp of any digit and it differs from the other abscess in body with local anatomic compartments of pulp. Without appropriate therapy felon can cause widespread necrosis.Morganella morgagni is found in natural flora of gastrointestinal system and is a rare cause of infectionwithout a predisposing factor. It appears as a cause of nosocomial infection or superinfection on a base ofimmune suppression. Infection caused by MM is generally a slowly progressive ongoing process with remissions and attacks. Herein the authors report a felon caused by MM. Patient without an underlying disease or an immunesuppressive condition. Delay in seeking further intervention resultedin necrosis of her distal and middle phalanx and extensive surgery indicated.