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PURPOSE: This study aimed to assess the diagnostic accuracy of smartphone photographs, taken at the emergency department (ED) and shared with hand surgeons, in identifying critical circulatory issues and neurovascular bundle injury, as well as tendon and bone injuries. METHODS: The photographs of hand injuries of 50 patients who were referred to our ED between January 2020 and January 2022 were used to design a questionnaire. This questionnaire, including closed-ended questions about the injured structures, was shared with a group of hand surgeons via a WhatsApp group in Turkey. The experience levels of the surgeons were categorized as 0-5 years, 5-10 years, and above 10 years. Diagnostic accuracy was assessed by comparing the results with surgery notes as the reference standard. RESULTS: A total of 94 hand surgeons participated in the study. The accuracy of predicting critical circulatory issues in the hand/fingers from the smartphone photographs was 81.9%, with a sensitivity of 48.0% and a specificity of 91.4%. For neurovascular bundle injuries, the accuracy was 63.0%, with a sensitivity of 63.9% and a specificity of 61.5%. The accuracy of predicting tendon injuries was 64.9%, with a sensitivity of 81.1% and a specificity of 42.5%. The accuracy of predicting fracture was 74.7%, with a sensitivity of 70.9% and a specificity of 79.9%. CONCLUSIONS: Identifying critical circulatory issues solely based on the shared photograph is inadequate. Similarly, evaluation based only on the photograph was insufficient for the detection of neurovascular bundle injuries, tendon ruptures, and fractures. CLINICAL RELEVANCE: Digital images acquired in an ED setting and subsequent review of these images by hand surgeons may not be an adequately reliable strategy for determining the necessity of patient transfer.
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Recent studies on fibular osteotomy for varus gonarthrosis and possible subsequent biomechanical changes have attracted increasing attention to the topic. Existing studies have focused mainly on proximal fibular osteotomy with short follow-up periods. The aim of this study was to investigate changes in the alignment of the coronal plane of the ankle and knee joints in patients who underwent vascularized fibula graft harvest (VFGH). The evaluation was based on functional outcomes and radiological measurements.In the comparison between the VFGH side and the contralateral side, no significant differences in the knee inclination (KI) or talar inclination (TI) angle, knee medial clear space (K-MCS) or ankle medial clear space (A-MCS) distance were noted. However, a significant difference in the hip knee (HKA) angle was observed between the operated and nonoperated sides (0.3° ± 1.8° and 1.5° ± 1.9°, respectively [p = 0.019]). Statistically significant differences in both the knee society score (KSS) and the AOFAS scores were found between the ipsilateral donor limb and the contralateral healthy limb. Although the contralateral healthy side had better clinical scores than the VFGH side, the outcomes of the VFGH side were still satisfactory or excellent.
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Articulação do Tornozelo , Fíbula , Articulação do Joelho , Humanos , Fíbula/transplante , Fíbula/cirurgia , Masculino , Feminino , Pessoa de Meia-Idade , Articulação do Joelho/cirurgia , Adulto , Articulação do Tornozelo/cirurgia , Transplante Ósseo/métodos , Extremidade Inferior/cirurgia , Extremidade Inferior/irrigação sanguínea , Osteotomia/métodos , Resultado do Tratamento , Coleta de Tecidos e Órgãos/métodos , IdosoRESUMO
Flexor tendon injuries of the hand have devastating consequences when primary tendon repair fails or left untreated in the first place. Flexor tendon reconstruction is a substantial treatment option to obtain functional digit. In this study, we aimed to compare the functional outcomes and technical feasibility of fingertip-to-palm and fingertip-to-forearm tendon reconstruction methods. Thirty-five patients were divided into two groups according to the proximal attachment site of the free tendon grafts. Group I consisted of 18 patients whose tendon grafts were placed from fingertip-to-palm (zone III). Group II consisted of 17 patients whose tendon grafts were placed from fingertip-to-forearm (zone V). The mean of 39.6 months (range, 6-52 months) of follow-up with complete clinical data were obtained for all the cases. The mean length of the tendon grafts used in group I and group II was 9.7 ± 1.4 cm and 15.9 ± 1.2 cm, respectively. Significantly shorter tendon grafts were needed in group I (p < 0.001). Both mean DASH score and mean Michigan score were significantly improved postoperatively in both groups (p = 0.0001, p = 0.0001), but there was no significant difference between two groups based on postoperative DASH score (p = 0.112) and Michigan score (p = 0.151). No statistically significant difference was observed between two groups in terms of Strickland's scores (p = 0.868). This study demonstrates that comparable results can be obtained with fingertip-to-palm and fingertip-to-forearm staged tendon reconstructions. Fingertip-to-palm tendon reconstruction seems to be more advantageous when multiple flexor tendon injuries aimed to be reconstructed, in which requirement of tendon graft can be fulfilled with less donor site morbidity.Abbreviations: DASH: disabilities of the arm, shoulder and hand.
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Antebraço , Traumatismos dos Tendões , Humanos , Tendões/cirurgia , Traumatismos dos Tendões/cirurgia , Mãos , Extremidade SuperiorRESUMO
OBJECTIVES: In this study, we aimed to compare functional outcomes and complication rates of tripod technique and locked plate fixation used in Mason type 3 radial head fractures. PATIENTS AND METHODS: Between January 2012 and December 2019, a total of 27 patients (16 males, 11 females; median age: 43.2 years; range, 20 to 68 years) with Mason type 3 radial head fractures were retrospectively analyzed. The patients were divided into two groups according to fixation method used. Group 1 consisted of 12 patients who were treated with tripod technique, and Group 2 consisted of 15 patients who were treated with locked plate fixation. Operation time, follow-up period, length of hospital stay, union time, Disabilities of Arm, Shoulder and Hand (DASH) scores, range of motions and complications were recorded. RESULTS: The median time to bone union was 46.7 days in Group 1, which was significantly shorter than Group 2 (p<0.001). The median forearm pronation-supination arc was 123.75° (range, 30° to 180°) in Group 1 and was 94° (range, 45° to 180°) in Group 2. There was no significant difference in the forearm rotation between the groups. The median elbow flexion-extension arc was 99.17° (range, 65° to 130°) in Group 1 and was 80.33° (range, 30° to 130°) in Group 2. No statistically significant difference was found in the flexion-extension and pronation-supination arc degrees. There was no significant difference in the postoperative DASH scores between the groups (p=0.464). CONCLUSION: Our study results demonstrate that comparable results can be achieved in both techniques regarding functional outcome and range of motion. With a shorter union time and less complication rates, the tripod technique should be considered as the primary treatment method for the comminuted radial head fractures without a metaphyseal defect.
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Fraturas da Cabeça e do Colo do Rádio , Fraturas do Rádio , Feminino , Masculino , Humanos , Adulto , Estudos Retrospectivos , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Extremidade Superior , MãosRESUMO
OBJECTIVES: This study aims to compare the usefulness of two systems in classifying thumb duplication cases and give some examples of the cases we believe that are unclassifiable. PATIENTS AND METHODS: Between January 2011 and January 2018, a total of 50 patients (29 males, 21 females; median age: 46.4±68.3 months; range, 1 to 318 months) with thumb duplications as assessed according to the Wassel and Rotterdam classification systems were included. RESULTS: Duplication was present in the right hand in 28, in the left hand in 21, and in both hands in one patient. According to the Wassel classification system, 45 patients could be allocated in any of the types; however, five patients could not be classified. According to the Rotterdam classification, 47 cases fell into one of the classifications; however, three cases could not be classified. CONCLUSION: Despite efforts to find the best classification system for thumb duplications, the proposed systems may not fully cover the presented radial polydactyly cases, and additions to the system are required.
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Polidactilia , Polegar , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Polidactilia/diagnóstico , Polidactilia/genéticaRESUMO
BACKGROUND: With the advances in medicine, an increasing number of the ageing population are a public health concern in terms of age-related complications. Among them, displaced neck fractures often require surgical intervention or arthroplasty to achieve the mobilization of the elderly and good life quality. The aim of the study is to monitor the changes in bone mineral density (BMD) around the femoral stem and the effects on functional outcomes in patients treated with cementless hemiarthroplasty following femoral neck fracture. MATERIALS AND METHODS: Seventy-one patients aged 70 years or older who were treated with cementless hemiarthroplasty for a displaced femoral neck fracture were prospectively followed for 2 years. The percent change in the periprosthetic BMD in each Gruen zone was compared to the baseline using dual-energy X-ray absorptiometry (DEXA). Demographic factors [age, body mass index (BMI), and sex] that could possibly influence BMD and the clinical outcome were evaluated. RESULTS: Fifty-one patients were available for the final follow-up. The mean age was 76.5 (range 70-89) years. The mean BMI was 28.9 (range 22.7-37.2). The mean Harris hip score at the final follow-up was 84.3 (range 72-93). There was a significant decrease in BMD in all Gruen zones (p < 0.001), except in zone 3 (R3, p = 0.547). The reduction in BMD was highest in the calcar and the greater trochanter region. The femur diaphysis was relatively spared, with zone 3 showing no significant bone mineral loss. The age and BMI of the patients were not correlated with the postoperative change in BMD in any of the Gruen zones. The degree of reduction in bone density was not correlated with the clinical outcome. CONCLUSIONS: Cementless hemiarthroplasty for the treatment of femoral neck fracture in elderly patients achieves a good clinical outcome despite significant bone loss around the femoral stem. The reduction in BMD is more pronounced in the metaphyseal region.
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OBJECTIVE: The aim of this study was to analyze the survivorship and clinical outcome of Cementless Spotorno (CLS) stem in young patients. METHODS: A total of 99 consecutive hip arthroplasties using CLS stem were performed on 84 patients younger than 50 years of age between 1993 and 2001. 63 patients were available for final follow-up (mean age: 39 ± 7.8 (range: 22-50)). Patients' Harris Hip Scores (HHS) and survivorship estimates were calculated. Radiographs were analyzed for acetabular implant status, canal fill index (CFI), stem alignment, osteolysis, and stress shielding. RESULTS: Mean follow-up time was 18 years (13-3), and mean HHS was 88.7 (58-100). Patients with femoral neck fracture had a more favorable functional outcome (p = 0.027), while those with stems in varus had lower scores (p = 0.017). 31 stems (49%) were undersized and 30 hips (47%) had perifemoral osteolysis. Acetabular impairment was strongly associated with osteolysis in Gruen zones 1 and 7 (p < 0.01). Seventeen of the osteolytic lesions occurred in Gruen zone 1, 4 lesions in zone 2, 9 in zone 6 and 22 in zone 7. Forty nine stems were well aligned, 10 were in varus and 5 in valgus. Six patients presented with grade 1 stress shielding, 42 with grade 2, 9 with grade 3 and 7 with grade 4. Pedestal formation was evident in 13 cases. Kaplan-Meier survivorship estimates at 18 years with revision for any reason as the end point and with septic revisions excluded were 91.2% (95% CI: 83.7%-98.7%) and 95.1% (95% CI: 89.5%-100%), respectively. There was no difference between survival estimates of patients with different etiologies. CONCLUSION: CLS stems in young patients have high survival estimates in the long term with good-excellent results. Spotorno stems perform equally well in all etiologies with no difference in terms of survivorship. LEVEL OF EVIDENCE: Level IV Therapeutic study.
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Artroplastia de Quadril , Prótese de Quadril/efeitos adversos , Osteólise , Complicações Pós-Operatórias , Falha de Prótese , Adulto , Idoso , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/métodos , Feminino , Fraturas do Colo Femoral/complicações , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteólise/etiologia , Osteólise/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Desenho de Prótese , Radiografia/métodos , Reoperação/métodos , Reoperação/estatística & dados numéricos , Resultado do Tratamento , TurquiaRESUMO
Hair tourniquet syndrome (HTS) is a rare, painful condition that results when hair or pieces of thread become wrapped tightly around toes, fingers, or other appendages, occluding blood flow and causing strangulation or amputation. Although the aetiology of HTS is unclear, we postulate that washing baby socks in a washing machine without turning them inside out might be a cause. Mothers should be informed about HTS and this simple prevention method should be suggested to them. Here, we present two cases of HTS and discuss possible causes.
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Vestuário , Lavanderia , Dedos do Pé/lesões , Torniquetes , Feminino , Humanos , LactenteRESUMO
This report presents the first case of a knee dislocation following septic arthritis after arthroscopy. A 65-year-old woman had an arthroscopy with irrigation and debridement (I&D) of the joint and microfracture for the chondral lesions. She had complaints of postarthroscopic infection but non-steroidal anti-inflammatory medication and local ice compression was recommended. She revisited her physician twice and at the last visit she had a large purulent effusion in her knee. The gram stain of the joint fluid aspirate demonstrated gram-positive cocci and the cultures grew methicilline-sensitive Staphylococcus aureus. She underwent arthroscopic assisted I&D and received intravenous antibiotics. I&D was repeated after two weeks. Intravenous antibiotherapy was continued for one more week and was changed to oral antibiotherapy for six weeks. At the third month visit's physical examination, a deformity at the knee was noticed and was referred to us for further treatment. A posterior knee dislocation with no neurovascular deficit was detected. The patient had a history of knee sprain but did not seek medical advice immediately. The blood samples showed no abnormality. The patient underwent a surgery with a cemented hinged revision total knee prosthesis following the exclusion of the active knee joint infection. Intraoperative frozen sections were also taken to exclude the active infection. The patient's knee is pain-free with full range of motion after 3 years. The objective of this report was to highlight the importance of early diagnosis, prompt appropriate treatment of septic arthritis following arthroscopy and the awareness of the knee dislocation as a rare dreadful complication of postarthroscopic infection particularly in elderly patients.
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Antibacterianos/administração & dosagem , Artrite Infecciosa , Artroplastia do Joelho/métodos , Artroscopia/efeitos adversos , Desbridamento/métodos , Luxação do Joelho , Infecções Estafilocócicas , Staphylococcus aureus , Administração Intravenosa , Idoso , Artrite Infecciosa/complicações , Artrite Infecciosa/microbiologia , Artrite Infecciosa/terapia , Feminino , Humanos , Luxação do Joelho/diagnóstico , Luxação do Joelho/etiologia , Luxação do Joelho/fisiopatologia , Luxação do Joelho/cirurgia , Articulação do Joelho/cirurgia , Amplitude de Movimento Articular , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/etiologia , Infecções Estafilocócicas/terapia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/isolamento & purificação , Irrigação Terapêutica/métodos , Resultado do TratamentoRESUMO
OBJECTIVE: The aim of this study was to compare the radiological and functional results of posterior cruciate ligament (PCL) - retaining and posterior-stabilized total knee arthroplasties in patients with severe varus gonarthrosis. METHODS: Medical records of 112 knees of 96 patients who underwent total knee arthroplasty for severe varus (≥15°) were reviewed. PCL-retaining and PCL-stabilizing groups consisted of 58 and 54 knees, respectively. Mean follow-up time was 56.6 months (range: 24-112 months). Knee Society (KS) clinical rating system was used in clinical evaluation. Range of motion, degree of flexion contracture, postoperative alignment, and complication rates were compared between the groups. RESULTS: Mean preoperative mechanical tibiofemoral angle was 20.1° in varus alignment, and was restored to 4.6° in valgus postoperatively. No statistically significant differences were found between PCL-stabilizing and PCL-retaining groups when KS knee scores, function scores, and flexion arc were evaluated. Two patients in PCL-retaining group underwent revision surgery due to aseptic loosening of tibial component. One patient in PCL-stabilizing group needed arthrotomy due to patellar clunk syndrome. CONCLUSION: There were no notable differences between the 2 groups and PCL-retaining design had outcomes as good as PCL-stabilizing total knee implant in osteoarthritic knees with severe varus deformity. LEVEL OF EVIDENCE: Level III, Therapeutic study.
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Artroplastia do Joelho/métodos , Articulação do Joelho/fisiopatologia , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Ligamento Cruzado Posterior/cirurgia , Adulto , Idoso , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico , Período Pós-Operatório , Radiografia , Amplitude de Movimento Articular , Reoperação , Tíbia/cirurgiaRESUMO
BACKGROUND: Among the many factors that determine the outcome following anterior cruciate ligament (ACL) reconstruction, the position of the femoral tunnel is known to be critically important and is still the subject of extensive research. OBJECTIVE: We aimed to retrospectively compare the outcomes of arthroscopic ACL reconstruction using transtibial (TT) or anteromedial (AMP) drilling techniques for femoral tunnel placement. METHODS: ACL reconstruction was performed using the TT technique in 49 patients and the AMP technique in 56 patients. Lachman and pivot-shift tests, the Lysholm Knee Scale, International Knee Documentation Committee (IKDC) score, Tegner activity scale and visual analog scale (VAS) were used for the clinical and functional evaluation of patients. Time to return to normal life and time to jogging were assessed in addition to the radiological evaluation of femoral tunnel placement. RESULTS: In terms of the Lysholm, IKDC, Tegner score, and stability tests, no significant differences were found between the two groups (p > 0.05). Statistical analysis revealed reduced time to return to normal life and jogging in the AMP group (p < 0.05). The VAS score was also significantly reduced in the AMP group (p < 0.05). The position of the femoral tunnel was anatomically appropriate in 51 patients in the AMP group and 5 patients in the TT group. CONCLUSION: The AMP technique is superior to the TT technique in creating anatomical femoral tunnel placement during single-bundle ACL reconstruction and provides faster recovery in terms of return to normal life and jogging at short-term follow-up.
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Metatarsal stress fractures are common overuse injuries in athletes, military recruits, and ballet dancers, usually occurring in the second, third, and fourth metatarsals, respectively. Such fractures may also occur in a variety of other individuals, regardless of demographic characteristics, sex, or profession, and they are highly associated with excessive activity. Moreover, these types of fractures are usually diagnosed late and have poor outcomes. To our knowledge, there has been only one case report of an individual with stress fractures of all three central metatarsals in the same foot. We describe herein a racehorse training jockey who presented with multiple simultaneous metatarsal stress fractures in the same foot. We also discuss the possible mechanisms by which this entity occurred, as well as its management and outcome.
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Transtornos Traumáticos Cumulativos/complicações , Dança/lesões , Fraturas de Estresse/diagnóstico , Ossos do Metatarso/lesões , Traumatismo Múltiplo , Adulto , Transtornos Traumáticos Cumulativos/diagnóstico , Fraturas de Estresse/etiologia , Humanos , Masculino , Ossos do Metatarso/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: Polyethylene (PE) wear debris after total hip arthroplasty (THA) may cause formation of a soft tissue mass due to inflammatory reaction. To the best of our knowledge we report the first case in whom the diagnosis was made after examination of the hip, pelvis and lumbar spine with detailed radiological methods and the plain radiographs showed no signs of loosening of the THA. PRESENTATION OF CASE: We report a 52 years-old woman who presented with a cyst causing sciatic irritation in her gluteal region due to wear debris after THA. Magnetic resonance imaging (MRI) was useful in detecting the cyst. Resolution of the cyst occured after subtotal cystectomy and revision of the acetabular components. DISCUSSION: Although plain radiographs can show signs of the underlying pathology; such as osteolysis, loosening of the components and wear of the PE liner, they are unable to detect cystic lesions. Cystic lesions may be an early sign of wear debris. CONCLUSION: This case shows us that sciatic neuropathy with no evidence of nerve root impingement on lumbar MRI in a patient with THA requires also examination of the hip and pelvis with detailed radiological methods, such as MRI, in addition to plain radiography. Removal of the source of debris via revision surgery following subtotal cystectomy leads to the resolution of the remaining portion of the cyst and also relief of the symptoms of sciatic nerve compression.