The effect of elbow position at the time of tourniquet inflation on clinical outcomes.

OBJECTIVE: The aim of this study was to prospectively investigate the effects of elbow position on perioperative and postoperative clinical outcomes during tourniquet inflation. PATIENTS AND METHODS: The patients were divided into two groups based on their elbow position during tourniquet inflation: patients with elbows extended group E (30 patients), patients with flexed elbows group F (30 patients). Both groups were compared in terms of perioperative bloodless surgical field, tourniquet pain, time to onset of pain, and pain in the tourniquet area on the first postoperative day, plus elbow-forearm range of motion deficit on both the perioperative and postoperative first day. RESULTS: The bloodless surgical field provided by the tourniquet was 0.46 (0-5) in Group E and 0.4 (0-4) in Group F. Perioperative tourniquet pain started in an average of 51 (33-71) minutes in 4 patients in Group E and 49 (31-74) minutes in 5 patients in Group F. Pain was present in 2 patients in both groups in the postoperative tourniquet area. When the preoperatively measured elbow flexion-extension and forearm supination-pronation deficits were compared with the perioperative values, the deficits were 1%, 2%, 1%, 1% in Group E, and 1%, 1%, 2%, 1% in Group F, respectively. When compared with the postoperative values, 1%, 3%, 1%, 1% in Group E and 1%, 2%, 1%, and 1% in Group F were observed, respectively. CONCLUSIONS: There was no statistically significant difference between the two groups, but since repositioning the elbow after the tourniquet is inflated will cause an additional shearing effect on the tissues under the cuff, we recommend inflating the tourniquet in that position in which the operation will be performed in upper extremity surgeries.

A retrospective comparison of total versus partial cross-bone resection in surgical management of congenital cleft hand.

This study aimed to compare clinical and radiographical results of total or partial resection of the cross-bone in the management of children with cleft hand. Nine children with 10 cleft hands who underwent resection of the cross-bone were retrospectively identified and divided into two groups based on type of resection: Group T (total resection) including 5 children (5 affected hands; 3 boys; mean age = 3.5 (range, 2-5) years), and Group P (partial resection) including 4 children (5 affected hands; 3 boys; mean age = 3.2 (range, 2-5) years). Mean follow-up was 68 (range, 60-85) months in group T and 47 (range, 40-60) months in group P. To assess clinical status, postoperative cosmetic satisfaction was evaluated by asking the parents, and cosmetic appearance was rated using a visual analogue scale (VAS) at the follow-up. In the radiographical evaluation, change in cleft divergence following reconstruction was assessed as the metacarpal divergence angle between the index and the ring finger metacarpals. Overall, cosmetic satisfaction was rated "very satisfied" or "satisfied" in 7 of the 10 hands, and functional satisfaction as "very satisfied" or "satisfied" in all. Mean postoperative cosmetic aspect on VAS was 6.4 (range, 5-8) in group T, and 6.2 (range, 4-8) in group P (p = 0.99). Mean metacarpal divergence angle significantly decreased from 42.2° (range, 35-52°) and 40.2° (range, 36-46°) preoperatively to 21.2° (range, 15-35°) and 19.8° (range = 12-31°) at 3-year follow-up in groups T and P, respectively (p < 0.001 for each group). Both total and partial cross-bone resection provided satisfactory clinical and radiographical medium-term results for of children with cleft hand.