Surgical Treatment of Dorsal Carpal Ganglions: A Retrospective Clinical Trial.

Objectives Our primary goal in this study was to investigate whether the surgical treatment we performed on the patients with dorsal carpal ganglion was effective rather than evaluating preoperative and postoperative functional results. Methods The retrospective study included patients who were operated with open technique due to dorsal wrist ganglion at a single center between March 1, 2015, and December 1, 2017, and were followed for at least six months. Thirty-three wrists of 32 patients (31 unilateral and 1 bilateral) were operated. During follow-ups, complication rates, patient satisfaction, and recurrence rates were evaluated. Results Of the 32 patients, 19 were females and 13 were males. Mean age of the patients was 38.6 ± 13.0 years (min-max = 19-60 years). Excision was performed on 28 right and 5 left wrists. The follow-up period of patients varied between 6 months and 38 months (mean = 21.7 ± 9.4 months). Recurrence was detected in four (12.5%) patients during the postoperative period. Complex regional pain syndrome occurred in two (6.25%) patients. Joint stiffness developed in six (18.75%) patients during the postoperative period. When recurrent cases were excluded from our cases, the satisfaction rate was 87.5%. Conclusions Open surgical excision has satisfactory results that cannot be achieved with conservative treatment in the treatment of symptomatic dorsal ganglia. In order to keep the recurrence rate at the minimum level after surgery, it is critical to excise the ganglion and pedicle without leaving any residual tissue. Proper surgical technique improves patient satisfaction by eliminating pain and cosmetic discomfort.

The Effect of Hamatum Curvature Angle on Carpal Tunnel Volumetry: A Mathematical Simulation Model.

In carpal tunnel volume measurements, the angle of the hamatum curvature is not considered a variable, and its effect on carpal tunnel volume has not been investigated. We hypothesize that a change in the anatomical angle of the hamatum curvature changes the carpal tunnel volume. To prove our hypothesis, we used a mathematical simulation model considering the carpal tunnel as a truncated cone. We reviewed the wrist CT scans of 91 adults (>18 years of age), including 51 men and 40 women. We measured the angle of the hamatum curvature in the CT scans. We measured cross-sectional areas at the outlet of the carpal tunnel at the level of the trapezium and hook of hamate (r1) and at the inlet at the level of the scaphoid and pisiform (r2) and the length (h) of the carpal tunnel. We attempted to calculate the effect of 2 degree by 2-degree changes in the angle of the hamatum curvature between the angles of 98° and 140° on the carpal tunnel volume. The mean angle of the hook of hamatum of the subjects was 122.55° ± 8.20° (range, 97.20° - 139.31°). No suitable cutoff point was found for the angle values. There was no difference between the gender groups according to the angle value. The data clearly show that there is a high correlation between carpal tunnel volume and the angle of hamatum curvature. The results of our study emphasize the importance of taking into account the anatomical features of the hamatum bone, especially the angle of curvature, which may play a predisposing role in idiopathic carpal tunnel syndrome.

Long-term results of total hip arthroplasty in developmental dysplasia of hip patients.

OBJECTIVES: This study aims to report the physiological and radiological long-term results of total hip arthroplasty (THA) combined with or without subtrochanteric osteotomy in a group of developmental dysplasia of hip (DDH) patients. PATIENTS AND METHODS: This retrospective study included 90 hips of 59 patients (3 males, 56 females; mean age 45.7±10.9 years; range, 24 to 67 years) who underwent THA between January 1979 and March 2006. Thirteen patients needed subtrochanteric shortening. The evaluation was performed through Harris hip scores, physical examination, and radiological imaging. RESULTS: The follow-up period ranged from 5 to 32 years, and the mean follow-up period was 10.3±6.4 years. Revision was required in 17 hips out of 90. Twelve revisions were needed because of aseptic loosening of femoral or acetabular component, three were for fracture of the femoral stem, and two for protrusio acetabuli. Four patients had transient nerve palsy, and one had permanent nerve function loss. In one patient, nonunion was observed around the femoral osteotomy site. Harris hip score was remarkably improved compared to top preoperative values (48 vs. 88.2, p<0.01). CONCLUSION: Although revision rates tend to increase in long-term follow-up, THA is one of the best treatment options in DDH patients to relieve pain, improve daily activity levels, and minimize the damage of the knee and lumbar region.

Evaluation of patellar tendon with shear wave elastography after anterior cruciate ligament reconstruction using hamstring tendons.

OBJECTIVES: This study aims to evaluate the characteristics of patellar tendons (PTs) of patients who underwent anterior cruciate ligament reconstruction (ACLR) with hamstring tendon autograft using shear wave elastography (SWE). PATIENTS AND METHODS: This prospective study was conducted between August 2017 and February 2018. We performed brightness mode (B-mode) ultrasound and SWE on 21 patients (20 males, 1 female; mean age 32 years; range, 19 to 42 years) who underwent ACLR with a single-bundle transtibial technique using quadruple hamstring autografts and 14 healthy controls (13 males, 1 female; mean age 35 years; range, 25 to 47 years). Length and thickness of the PT were evaluated with B-mode ultrasound, while elasticity values were evaluated with SWE in the patient and control groups. RESULTS: The mean SWE value of the patient group on the operated side was 25.30 (min-max=16.60-46.20) and on the non-operated side 23.20 (min-max=12.40-44). There were no statistically significant differences regarding PT elasticity, thickness, or length between the groups (p>0.05). CONCLUSION: There were no differences regarding elasticity, length, or thickness between the operated and healthy knees detected with SWE. Upcoming research should focus on tendon biopsy and biochemical analyses for the identification of possible intrastructural changes of the tendon due to collagen synthesis after ACLR with hamstring autograft.

Epineural ganglion causing cubital tunnel syndrome: A case report.

Although ganglions are the most common cause of ulnar tunnel syndrome, they are one of the rare causes of cubital tunnel syndrome (CuTS). In this article, we report a 49-year-old female patient admitted to the outpatient clinic complaining of numbness and tingling in the ring and little fingers of the right hand. There was no history of systemic disease or previous trauma. The patient was diagnosed with CuTS in the light of clinical examination and nerve conduction studies. Simple cubital tunnel decompression was performed under general anesthesia and microsurgical exploration revealed a 2x2 cm epineural ganglion cyst compressing the ulnar nerve. The cyst was excised without damaging the ulnar nerve and cutaneous nerves. Histopathology also confirmed the ganglion cyst. In the postoperative period, the patient's clinical improvement was more satisfactory than nerve conduction studies. The diagnosis of CuTS is established by physical examination, provocative test, and nerve conduction studies. In patients who cannot achieve a satisfactory outcome by conservative treatment, the cyst should be kept in mind among etiologic factors. Magnetic resonance imaging should be requested for accurate diagnosis and preoperative surgical planning.

Understanding the causes behind coracoid graft osteolysis in latarjet procedure (finite element analysis and comparison of three fixation methods).

BACKGROUND: Latarjet is one of the most common surgical procedure performed on patients with shoulder instability with osseous defects, some complications include coracoid bone graft osteolysis, osteoarthritis, graft detachment, and malpositioning were previously reported. Several studies investigated potential causes of graft osteolysis but still, it remains a crucial area of investigation. We aim to use finite element analysis to examine the potential correlations between three modes of fixation methods used in the Latarjet procedure (screw, wedge plate, and endobutton), and the coracoid graft osteolysis. HYPOTHESIS: Finite element analysis tested the hypothesis that there is a linear relationship between the compression stress on graft which was generated by fixation methods used in the latarjet and the coracoid graft osteolysis. MATERIAL AND METHODS: Boundary conditions and inhomogeneous material properties were carefully assigned within the material of the scapula and coracoid interface. For the screw and wedge plate fixations, an applied torque in the range of 1-1.5Nm was used to characterize the surgeon's insertion torque during the surgical operation, while a 100N compressive force was selected for the endobutton fixation. RESULTS: Relatively lesser stress magnitudes were observed with endobutton fixation method rather than screw and the wedge plate fixation. Statistical analyses revealed significant differences between the groups (p<0.05). DISCUSSION: Excessive compressive stresses within the coracoid graft regions may be responsible for osteolysis due to negative effects over biological factors such as blood flow. Our study emphasizes the importance of taking into account the fixation method while performing the Latarjet procedure. We concluded that the mode of fixation used within the Latarjet procedure has a correlation on the coracoid graft osteolysis. LEVEL OF EVIDENCE: I.

Median nerve and carpal tunnel volume changes after two different surgical methods: A comparative magnetic resonance imaging study of mini-open and endoscopic carpal tunnel release.

OBJECTIVES: This study aims to compare endoscopic carpal tunnel release versus mini-open carpal tunnel release regarding volume changes in the carpal tunnel and median nerve by magnetic resonance imaging (MRI). PATIENTS AND METHODS: The study included 17 wrists of 13 patients (1 male, 12 females; mean age 55 years; range, 51 to 64 years) who were diagnosed with carpal syndrome. Ten wrists underwent mini-open carpal tunnel release, while seven wrists underwent uni-portal endoscopic carpal tunnel release. Carpal tunnel and median nerve volumetric changes were evaluated by MRI pre- and postoperatively. RESULTS: Surgical section of transverse carpal ligament significantly increased the postoperative volume of the carpal tunnel and median nerve compared to preoperative (p<0.05). However, the endoscopic and mini-open carpal tunnel techniques had no superiority over one another regarding volume expansion (p>0.05). CONCLUSION: Both methods can be preferred to release the transverse carpal ligament in patients with idiopathic carpal tunnel syndrome. The surgeon should decide on which method to use considering the advantages and disadvantages reported in the literature.

Biochemical markers decrease and increase disproportionally in A1 pulley tissue of type 2 diabetic trigger finger patients.

OBJECTIVES: This study aims to detect the levels of some biochemical markers in A1 pulley tissue of type 2 diabetic trigger finger patients to enlighten the mechanisms leading to cellular complications. PATIENTS AND METHODS: The study included 35 trigger finger patients (5 males, 30 females; mean age 53.9±9.15 years; range, 37 to 71 years). We measured total thiol (total-SH) levels to determine the status of the non-enzymatic antioxidant defense system and advanced oxidation protein product (AOPP) levels to determine levels of oxidative protein modification in pulley tissues of trigger finger patients with or without diabetes. Extracellular matrix degradation was assessed by measuring levels of sialic acid (SA) in the pulley tissue. RESULTS: Total-SH values for the groups with and without diabetes were 22.7±1.6 vs. 38.9±5.2 nmol/mg protein, respectively, while AOPP values were 472.5±131.6 vs.175.6±9.9 mmol/g protein, respectively. The SA levels of diabetic and nondiabetic patients were 0.4±0.0 vs. 0.63±0.1 nmol/mg protein, respectively. CONCLUSION: Our results revealed that tissue SA levels and tissue SH levels decreased and AOPP levels increased disproportionally in the A1 pulley tissue of diabetic patients, which may indicate the role of oxidative protein damage and extracellular matrix changes in diabetic trigger finger etiology.

Soft-Tissue Mallet Injuries: A Comparison of Early and Delayed Treatment.

PURPOSE: To compare the results of early and delayed extension orthosis fabrication in closed tendinous mallet injuries. METHODS: Between March 1992 and May 2011, 45 patients with isolated closed tendinous mallet finger injuries were treated with orthosis fabrication. The patients were classified into 2 different groups based on their date of presentation. Group 1 consisted of 28 patients who presented within 2 weeks of sustaining the trauma, and group 2 consisted of 17 patients who received treatment beginning between 2 and 4 weeks after sustaining the trauma. During the final assessments, the patients were assessed clinically using the Crawford classification scale and satisfaction ratings. RESULTS: The mean delay between initial injury and presentation to our center was 3 days (range, 1-14 d) in group 1 and 19 days (range, 15-30 d) in group 2. There were no significant differences between the groups regarding their ages, initial extension lag, and arc of flexion. According to the Crawford classification criteria, 72% of the patients in group 1 had excellent results, and 59% of the patients in group 2 had excellent results. There was no significant difference between the groups. CONCLUSIONS: The treatment results of patients with different presentation times have been reported for heterogeneous groups of osseous and nonosseous mallet finger injuries. Our results suggest that conservative management of tendinous mallet finger injuries that have been neglected for 2 to 4 weeks can be treated as well as those injuries in patients presenting within the first 2 weeks of injury with low long-term complication rates. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.