Arteriography and Histopathology of Vascular Beds in Traumatically Amputated Fingers.

BACKGROUND: The success of replantation following traumatic amputation is determined by the quality of the vascular anastomoses. The purpose of this study was to assess the vascularity of injured arteries from traumatically amputated digits using arteriographic and histopathological analysis. METHODS: 25 amputated digits were included in the study. Crush and avulsion injuries were evaluated according to the Venkatramani classification. The amputated arteries were dissected under a microscope, and the arterial route determined with a transducer. Arteriography using fluoroscopy was evaluated by a radiologist. The area thought to be damaged was dissected and 2-mm slices taken for histopathological examination, and scored using the parameters of fibrin accumulation, oedema, separation, and bleeding. RESULTS: Arterial flow was observed in 6 of 7 in the avulsion group. In the crush group, arterial flow was observed in 11 of 16 cases. On histopathological examination in all cases there were 2 or more findings of either oedema, fibrin formation, bleeding or hernia. These findings were more common in the crush group then the avulsion group. CONCLUSIONS: The intravascular introduction of radio contrast agents to amputated digit prior to replantation may give further information particularly in avulsion amputations.

Effect of oxytocin administration on nerve recovery in the rat sciatic nerve damage model.

BACKGROUND: Growth factors such as nerve growth factor (NGF) and insulin-like growth factor-1 (IGF-1) have been shown to play a role in the healing process of nerve injury. Recent researches have also shown that oxytocin administration activates these growth factors of importance for the healing of nerve tissue. The objective of the present study was to evaluate the effects of oxytocin on peripheral nerve regeneration in rats. METHODS: Twenty-four male Sprague-Dawley rats were underwent transection damage model on the right sciatic nerve and defective damage model on the left sciatic nerve. The animals were assigned to one of two groups: control group or treatment group (received 80 mg/kg oxytocin intraperitoneally for 12 weeks). The sciatic nerve was examined, both functionally (on the basis of climbing platform test) and histologically (on the basis of axon count), 3, 6, 9, and 12 weeks after the injury. Also, stereomicroscopic and electrophysiological evaluations were carried out. RESULTS: Significantly greater improvements in electrophysiological recordings and improved functional outcome measures were presented in the treatment group at 12-week follow-up. Stereomicroscopic examinations disclosed prominent increases in vascularization on proximal cut edges in the oxytocin group in comparison with the control group. Higher axon counts were also found in this group. CONCLUSION: Intraperitoneal oxytocin administration resulted in accelerated functional, histological, and electrophysiological recovery after different sciatic injury models in rats.

Histomorphological comparison of immobilization and denervation atrophies.

OBJECTIVE: The aim of this study was to compare the histomorphological changes in the muscle tissue after immobilization and denervation atrophies in an animal model. METHODS: The study included 30 Ross-800 hybrid chickens (60 legs) divided into two study (immobilization and denervation) and two control groups. The knee and ankle joints were fixed with a Kirschner wire in the immobilization atrophy group and sciatic nerve resection was performed in the denervation group. The unaffected side of each group was used as controls. The weight, volume, height, diameter and the rate of elongation of the Achilles tendons, and the amount of fat deposition, degeneration and fibrosis were compared between the two groups at the end of 3 weeks. Hematoxylin-eosin staining was performed for a histopathological assessment of the muscles. The Mann-Whitney U-test was used for comparisons. RESULTS: Loss of the volume, weight and muscle length was significantly lower in the denervation group than the immobilization group (p<0.05). Differences between the diameter of the Achilles tendon and length and diameter of the short heads were not statistically significant. There were statistically significant differences in fat deposition, degeneration and fibrosis between the degeneration group and the immobilization group (p<0.05). Pixel counting revealed a significant difference in the number of pixels in the fatty tissue area (white area) between the denervation group and the immobilization group (p<0.05). CONCLUSION: Our results showed that histomorphological changes were more in the denervation group than the immobilization group in an experimental chicken model.

Treatment of reverse Hill-Sachs lesion by autograft reconstruction.

Reverse Hill-Sachs lesion is a defect caused by the anterior compression fracture of the humeral head in posterior shoulder dislocation. We present a 34-year-old male patient with pain and limited joint mobility in the right shoulder due to a fall following electric shock 2 days prior to admission. Radiography and CT of the shoulder revealed posterior dislocation of the shoulder with a reverse Hill-Sachs lesion. The patient underwent open reduction of the humeral head, elevation of the depressed osteochondral surface, reconstruction using autograft, and repair of the posterior surface of the glenohumeral joint capsule 5 days following trauma. At the 5th year follow-up, the patient had a perfect outcome when evaluated using the Constant score.

A case of ingrown toenail accompanied by extreme soft tissue hypertrophy to the extent of invisible nail.

Ingrown nails occur when the nail fold grows inwards into the nail bed. This condition affects daily life and causes a loss of labor, and therefore, should be meticulously tackled and immediately treated. Ingrown nail is categorized in three stages based on pain, erythema, infection, drainage, and the presence of granulation tissue. We present hypertrophic tissue excision and bilateral partial matrix excision in an unclassified case of ingrown toenail in which the bilateral side wall hypertrophy covered the entire nail; normal tissue of the nail was invisible, along with first year follow-up results.

[Assessment of the effects of surgical treatment options for cubital tunnel syndrome on the ulnar nerve by USG and EMG]. / Kübital tünel sendromunda cerrahi tedavi seçeneklerinin ulnar sinir üzerine etkilerinin USG ve EMG ile degerlendirilmesi.

OBJECTIVES: The morphology and functional results of the ulnar nerve were evaluated in patients treated with simple decompression and anterior subcutaneous transposition due to the diagnosis of cubital tunnel syndrome. PATIENTS AND METHODS: Thirteen elbows of 13 patients (8 males, 5 females; mean age 41 years; range 25 to 56 years) treated with simple decompression and anterior subcutaneous transposition due to the diagnosis of cubital tunnel syndrome were investigated. The involvement was on the dominant side in six patients. There was a 25° cubitus valgus deformity in one patient. No significant etiologic cause was found in the other patients. Seven patients were treated with anterior subcutaneous transposition and six with simple decompression. During the follow-ups, the atrophy magnitude, the new pressure areas and the intrinsic structure of the nerve tissue along the ulnar nerve path were evaluated by using soft tissue ultrasonography (USG). The flow rate of the artery supplying the ulnar nerve by Doppler mode USG and ulnar nerve conduction rate by electromyography (EMG) were assessed. Functional results were evaluated according to the Akahori's criteria and the modified Bishop scoring system. The average follow-up time was two years (range 12-44 months). RESULTS: In the Doppler USG examination, no arterial blood flow supplying the ulnar nerve was found in five of seven patients who underwent anterior transposition. A blood flow decrease of approximately 20 cm/s was found in two patients. A blood flow decrease of 10 cm/s on average was found in six patients who underwent simple decompression. There was a significant difference between the two groups (p<0.05). The control EMG revealed an increase of 9 m/s in the ulnar nerve conduction rate in the transposition group (p>0.05) and an increase of 17 m/s in the simple decompression group compared to the preoperative values (p<0.05). In seven patients who underwent anterior subcutaneous transposition, five excellent and two good results and an average of 8.2 points were achieved according to the Akahori's criteria and the modified Bishop scoring system, respectively. In six patients who underwent simple decompression, five excellent results, and one good result and an average of 8.1 points were achieved according to the Akahori's criteria and the modified Bishop scoring system, respectively. There was no statistically significant difference between functional results of both surgical techniques (p>0.05). CONCLUSION: Although the functional results of the cubital tunnel syndrome surgery are good, it must be noted that the blood supply to the nerve may be distorted, especially during anterior transposition. If there is no additional requirement, simple decompression may be considered as the first option.

Interposition arthroplasty in the treatment of hallux rigidus.

OBJECTIVES: We evaluated the outcomes of interposition arthroplasty performed for the treatment of hallux rigidus. METHODS: The study included 19 feet (4 left, 15 right) of 17 patients (14 females, 3 males; mean age 61+/-5 years; range 55 to 71 years) who were treated with interposition arthroplasty for hallux rigidus. According to the grading system of Coughlin and Shurnas, 18 feet were grade 3, one foot was grade 4. One-third of the base of the proximal phalanx was resected at surgery. Preoperative and postoperative radiographic assessments included the measurements of the joint space width of the first metatarsophalangeal (MTP) joint, hallux valgus angle, and intermetatarsal angle. Clinical evaluations were made using the AOFAS (American Orthopaedic Foot and Ankle Society) hallux metatarsophalangeal-interphalangeal scale. Postoperative satisfaction levels of the patients were questioned. The mean follow-up period was 21 months (range 9 to 32 months). RESULTS: According to the AOFAS scale, the results were excellent in seven feet (36.8%), good in nine feet (47.4%), and fair in three feet (15.8%), with excellent and good results accounting for 84.2%. The mean total AOFAS score increased by 24.6 points postoperatively (p<0.05). The mean range of motion of the first MTP joint improved significantly from preoperative 24.2+/-5.4 degrees (range 10 degrees to 30 degrees) to postoperative 54.3+/-9.4 degrees (p<0.05). The mean joint space width of the first MTP joint was 1.0+/-0.3 mm (range 1 to 2 mm) preoperatively, it increased to 3.0+/-1.1 mm (range 1 to 5 mm) on final radiographs (p<0.05). The mean hallux valgus angle decreased from preoperative 13.8 degrees (range 9 degrees to 17 degrees) to postoperative 10.2 degrees (range 4 degrees to 13 degrees), and the mean intermetatarsal angle increased from preoperative 10.5 degrees (range 8 degrees to 14 degrees) to postoperative 11.2 degrees (range 8 degrees to 15 degrees). Patient satisfaction levels were very good in nine feet (47.4%), good in seven feet (36.8%), moderate in one foot (5.3%), and poor in two feet (10.5%). Complications included metatarsalgia aggravated by long walks (n=11, 57.9%), hypoesthesia of the big toe (n=3, 15.8%), and loss of ground contact of the big toe (n=15, 79%). The push-off power of the big toes was measured as 3/5 in five cases, 4/5 in 11 cases, and 5/5 in three cases. None of the patients developed infection or osteonecrosis postoperatively. CONCLUSION: Interposition arthroplasty is an appropriate surgical treatment method for hallux rigidus for elderly patients with low functional capacity.

The effect of head trauma on fracture healing: biomechanical testing and finite element analysis.

OBJECTIVES: We aimed to evaluate the effect of head trauma on fracture healing with biomechanical testing, to compare the results obtained from a femur model created by finite element analysis with experimental data, and to develop a finite element model that can be employed in femoral fractures. METHODS: Twenty-two Wistar albino rats were randomized into two groups. The control group was subjected to femoral fracture followed by intramedullary fixation, whereas the head trauma group was subjected to femoral fracture followed by intramedullary fixation along with closed blunt head trauma. Bone sections obtained with computed tomography from rat femurs were transferred into a computer and a 3D mathematical model of femur was created. At the end of week 4, femurs were examined by biomechanical testing and finite element analysis. RESULTS: The mean maximum fracture load was significantly higher in the head trauma group than in control group (p<0.05). Maximum strain values were also significantly high in the head trauma group (p<0.05). There was no significant difference between the groups with regard to maximum deformation (p>0.05). The head trauma group had significantly higher mean bending rigidity than the control group (p<0.05). The head trauma group showed no significant difference from the control group in terms of strain energy and elasticity module (p>0.05). There was no significant difference between experimental biomechanical test and finite element analysis (p>0.05). CONCLUSION: Noninvasive methods such as finite element analysis are useful in examination of the mechanical structure of bones. Experimental biomechanical test and finite element analysis methods suggest that head trauma contributes to fracture healing.