The Effect of Kinesio Taping Versus Splint Techniques on Pain and Functional Scores in Children with Hand PIP Joint Sprain.

Introduction: Due to the continual increase in the number of children engaging in sports today, physicians encounter finger injuries at an increasing frequency. This study sought to investigate the effectiveness of the method of Kinesio taping versus classic finger splint technique on pediatric patients with PIP (proximal interphalangeal) joint sprains of the fingers. Method: This is a retrospective cohort study. Forty-nine pediatric patients with PIP joint sprains were included in the study. The patients were divided into two groups, Group 1 being those treated with Kinesio taping and Group 2, those treated with splints. The area around the PIP joint was measured before and after treatment. Visual analog scale (VAS) evaluation: nighttime pain, numbness, pain at rest, and pain during activity were each separately evaluated before and after treatment. Also, flexion was measured at rest and in active motion before and after treatment. Results: The patients' periarticular measurements of the affected joint were statistically significant in both groups after treatment (p < 0.001). In the comparison between the groups, it was found that the group treated with Kinesio taping displayed a better outcome (p < 0.021). According to the VAS for PIP joint pain, it was observed that in both groups, pain at rest, pain during activity, nighttime pain, and numbness were statistically significant after treatment (p < 0.001). In the comparison of the groups, it was seen that the difference was statistically significant only in terms of nighttime pain (p < 0.013). Conclusions: The study conducted supported the literature that Kinesio taping method does not restrict the function of the extremity to which it is applied and also does not produce the complications reported in other treatment techniques. Kinesio taping was found to have a higher patient compliance and the outcomes were better in terms of edema and joint range of motion as well as night time pain when compared to the group treated with splint.

Crescent Technique with Dual C-Shaped Reconstruction Plates for Posterior Acetabular Wall Fractures.

Background: Here we have defined a novel technique for repairing posterior acetabular wall fractures called the "crescent technique," in which dual C-shaped reconstruction plates overlap at the distal ends and, if necessary, at the proximal ends. We also analyzed the efficacy and reliability of this method. Patients and Methods: This was a retrospective analysis of 27 patients undergoing the crescent technique. All of the fractures were treated by the senior author for a mean of 7.9 days (0-15 days) after the trauma. The mean follow-up period was 19 months (13-29 months). The clinical results were evaluated using the modified clinical grading system developed by Merle d'Aubigne and Postel, and then modified by Matta. The radiographs were graded according to the criteria described by Matta. Results: In the clinical grading, 16 (59%) of the patients were excellent and very good, 5 (19%) were good, 3 (11%) were moderate, and 3 (11%) were poor. According to the Matta radiological evaluation criteria, 19 (70%) were excellent, 4 (15%) were good, 4 (15%) were fair, and none were poor. Statistically significant consistency was seen between the clinical and radiological results (p = 0.002). Conclusions: The crescent technique is a dual plate technique modification that can provide a stable fixation. It appears to be an effective and reliable method for treating posterior wall fractures of the acetabulum.

Evaluation of arthroscopic rotator cuff repair results in patients with anterior greater tubercle cysts.

PURPOSE: The purpose of this study was to investigate the clinical results of arthroscopic rotator cuff repair in patients with anterior greater tubercle cyst in magnetic resonance imaging (MRI). METHODS: The cyst-present group comprised 38 patients with anterior greater tubercle cyst in MRI, and age- and sex-matched 30 patients without cyst in humeral head were included in the control group. The cystic group was divided into two groups, smaller than 5 mm (21 patients) and larger than 5 mm (17 patients), according to the cyst size. A total of three groups were created. In the evaluation of clinical outcomes, modified University of California at Los Angeles (UCLA) and the Western Ontario Rotator Cuff Index (WORC) were used. The visual analog scale (VAS) was used to assess pain. One-way analysis of variance was used to compare VAS, UCLA, and WORC scores among the groups. RESULTS: There was a statistically significant difference in the clinical results of VAS, UCLA, and WORC among the cystic and noncystic groups in the anterior greater tubercle ( p < 0.05). There was also a statistically significant difference in the clinical results of UCLA, WORC, and VAS scores according to the cyst sizes in the anterior greater tubercle cyst group ( p < 0.05). CONCLUSION: Anterior greater tubercle cysts have negative effects on rotator cuff repair results. If the anterior greater tubercle cyst size is greater than 5 mm, the negative effects of rotator cuff repair results are more pronounced. An understanding of anterior greater tubercle cysts has a critical importance for rotator cuff surgery planning.

Prospective evaluation of preoperative and postoperative sleep quality in carpal tunnel release.

Sleep disturbance is a frequent symptom of carpal tunnel syndrome. The aim of this study was to investigate the effect of median nerve decompression on sleep quality of patients with this condition. The study sample consisted of 41 patients with severe carpal tunnel syndrome who were admitted to our clinic and treated with open median nerve decompression. Sensation and functional recovery of the patients were followed using the Boston Function Questionnaire, the Semmes-Weinstein monofilament test and the two-point discrimination test. Symptomatic recovery of the patients was followed by the Boston Symptom Questionnaire. The tests were used before surgery and at three and six months afterwards. Sensory, functional and symptomatic recovery from the third month to the sixth month following surgery also affected sleep parameters and improved the sleep quality of patients with carpal tunnel syndrome. Level of evidence: IV.

Does the location of placement of meniscal sutures have a clinical effect in the all-inside repair of meniscocapsular tears?

BACKGROUND: Meniscocapsular separation (MCS) is a lesion of the area which is attached from the peripheral section of the meniscus to the capsule and is seen less often than other meniscus injuries. The aim of this study was to investigate which of the different side applications of all-inside MCS repair of the meniscus was better in respect of clinical and functional results. METHODS: In this retrospective study, 53 patients with MCS pattern in their knee joints were treated with arthroscopic meniscus repair made with the all-inside method. The patients were separated into three groups according to the surface from which the fixation was applied: group 1, from the femoral joint surface of the meniscus (n = 17), group 2, from the tibial joint surface of the meniscus (n = 21) and group 3, from the femoral and tibial joint surfaces of the meniscus (n = 15). The participants were assessed using the subjective International Knee Documentation Committee Scoring (IKDC), Lysholm Knee Scale, Tegner Activity Level Scale, Barrett criteria and Kellgren-Lawrence classification after a 45 ± 12.1 months (range, 24-70 months) follow-up. RESULTS: Postoperatively, all the groups exhibited significantly increased subjective IKDC score, Lysholm score and Tegner activity score compared with their preoperative results (p < 0.001). At 6 months postoperatively, a statistically significant difference was determined between the groups in respect of the subjective IKDC score, Tegner activity score and Lysholm score with group 2 showing better results than the other groups (p < 0.001). At the final follow-up examination, no statistically significant difference was determined between the groups in respect of the subjective IKDC score, Tegner activity score or Lysholm score. A statistically significantly lower level of pulling and stress sensation was determined in group 2 (p < 0.001). CONCLUSIONS: MCS repair made with the all-inside method is successful clinically and functionally and in respect of MRI findings. In addition, it was seen that the fixation method applied from the tibial surface of the meniscus does not disturb the anatomic position of the meniscus in MCS repair. The tibial joint surface is the most appropriate area for suturation in all-inside repair of MCS. LEVEL OF EVIDENCE: Level IV.

Can Achilles tendon be used as a new distal landmark for coronal tibial component alignment in total knee replacement surgery? An observational MRI study.

BACKGROUND: In total knee arthroplasty, it is better to use more than one reference point for correct alignment of the components. By measuring the distances of Achilles tendon (AT) and other conventional landmarks from the mechanical axis in magnetic resonance imaging (MRI) of the ankle, we aimed to demonstrate that, as a novel landmark which can help for correct alignment in the coronal plane, AT is a better option than other landmarks. MATERIALS AND METHODS: This retrospective study was done on 53 ankle MRIs that met the criteria for inclusion to the study among 158 ankle MRIs. After identification of the mechanical axis, the distances of distal landmarks, which were extensor hallucis longus tendon (EHLT), tibialis anterior tendon (TAT), dorsalis pedis artery (DPA), AT, extensor digitorum longus tendon (EDLT), and malleoli, were measured from the mechanical axis and were statistically evaluated. RESULTS: In proximal measurements, the distances of the landmarks to the mechanical axis (on average) were AT, 2.64±1.62 mm lateral; EHLT, 3.89±2.45 mm medial; DPA, 4.69±2.39 mm medial; TAT, 8.24±3.60 mm medial; and EDLT, 14.2±4.14 mm lateral (P<0.001). In distal measurements, the distances of the landmarks to the mechanical axis (on average) were AT, 1.99±1.24 mm medial; EHLT, 4.27±2.49 mm medial; DPA, 4.79±2.10 mm medial; TAT, 12.9±4.07 mm medial; and EDLT, 12.18±4.17 mm lateral (P<0.001). CONCLUSION: In this study, the mechanical axis line, which is the center of talus, passes through the AT. Our MRI investigations showed that the AT, EHLT, DPA, and malleolar center (3-5 mm medial) may help in correct alignment.

Preoperative and post-operative sleep quality evaluation in rotator cuff tear patients.

PURPOSE: The aim of this study was to examine the potential relationship between subjective sleep quality and degree of pain in patients with rotator cuff repair. METHODS: Thirty-one patients who underwent rotator cuff repair prospectively completed the Pittsburgh Sleep Quality Index, the Western Ontario Rotator Cuff Index, and the Constant and Murley shoulder scores before surgery and at 6 months after surgery. Preoperative demographic, clinical, and radiologic parameters were also evaluated. RESULTS: The study analysed 31 patients with a median age of 61 years. There was a significant difference preoperatively versus post-operatively in terms of all PSQI global scores and subdivisions (p < 0.001). A statistically significant improvement was determined by the Western Ontario Rotator Cuff Scale and the Constant and Murley shoulder scores (p Ë‚ 0.001). CONCLUSION: Sleep disorders are commonly seen in patients with rotator cuff tear, and after repair, there is an increase in the quality of sleep with a parallel improvement in shoulder functions. However, no statistically significant correlation was determined between arthroscopic procedures and the size of the tear and sleep quality. It is suggested that rotator cuff tear repair improves the quality of sleep and the quality of life. LEVEL OF EVIDENCE: IV.

Repair of isolated horizontal meniscal tears with all-inside suture materials using the overlock method: outcome study with a minimum 2-year follow-up.

BACKGROUND: This study aimed to consider the use of a meniscal repair in patients in order to close the horizontal cleavage extending up to the avascular zone. The hypothesis was to examine the clinical and arthroscopic outcomes following meniscal repair of degenerative horizontal cleavage tears with new-generation all-inside suture materials using the overlock method. METHODS: We retrospectively reviewed a consecutive series of 55 patients which had a horizontal pattern, and finally, 27 patients with a horizontal tear only which required no additional intra-articular surgical intervention were included in the study. Arthroscopic meniscal repair was performed using the overlock method. Functional outcomes were evaluated using Lysholm knee scoring scale, Cincinnati scores, subjective International Knee Documentation Committee (IKDC) criteria and Tegner activity scale. Assessment of meniscal healing was evaluated clinically by the presence of meniscal signs. The preoperative and postoperative MRIs were examined. RESULTS: The mean follow-up period was 29 months (range, 24-38). The mean Lysholm score improved significantly from 59.5 ± 12.4 points preoperatively to 90.0 ± 4.7 points postoperatively (P < 0.0001). The Cincinnati score increased from 14.8 ± 5.3 to 26.9 ± 1.6 (P < 0.0001). The Tegner activity score increased from 3.7 ± 1.4 to 6.4 ± 1.6 (P < 0.0001). The mean IKDC subjective score also improved significantly from 48.5 ± 9.8 preoperatively to 90.4 ± 5.0 postoperatively (P < 0.0001). CONCLUSION: Meniscal repair of degenerative horizontal tears using the overlock method resulted in improved Lysholm and IKDC subjective scores. With careful selection of the patients and the horizontal meniscus tears, the success of the meniscus repairs increases. Repair can be recommended for all horizontal meniscus tears which can be repaired arthroscopically.

Unusual Localization of a Primary Hydatid Cyst: Scaphoid Bone: A Case Report.

Because hydatidosis of the bone (echinococcus infection) is a rare parasitic infection, its diagnosis and treatment poses great difficulties. Radiologic imaging findings are generally helpful to make the diagnosis. But occurrence of disease in atypical places and lack of specific radiological findings may complicate differential diagnosis. Nevertheless, familiarity with imaging findings in patients living at endemic areas provides advantages for diagnosis and treatment.We present a cyst hydatic case in scaphoid bone which has been reported in the literature only once previously.

A neglected case of giant synovial chondromatosis in knee joint.

Synovial chondromatosis is a rare benign condition arising from the synovial membrane of the joints, synovial sheaths or bursae around the joints. Primary synovial chondromatosis typically affects the large joints in the third to fifth decade of life. The purpose of this case report is to document this rare synovial pathology, which required open synovectomy and debridement to eradicate it. In our case, the biggest sized SOC was 20x19x6 cm, although there were many joint mice. Our case had the biggest SOC ever extracted, which to the best of my knowledge has not been reported earlier.

Return to work in miners following anterior cruciate ligament reconstruction.

INTRODUCTION: The aim of the study is retrospectively investigated durations for returning to work following anatomic ACL reconstruction by hamstring autograft in miners and the reasons in patients who were delayed to return to work. METHODS: Miners with symptomatic anterior cruciate ligament rupture underwent arthroscopic reconstruction. Patients were evaluated in terms of range of motion (ROM) values; Lysholm, Cincinati and Tegner activity scales; laxity testing and complications. By modifying the method used by Fitzgerald et al. we decided for the criteria returning to work. RESULTS: Thirty three patients were evaluated with mean followup of 22.7 ± 8.3 months (range 13-46 months). Mean age at the surgery was 27.8 (18-38) years. Lysholm, Cincinati and Tegner activity scales were signifi cantly higher from preoperative scores (Lysholm scores: preoperative: 60.7 ± 12.5, postoperative: 90.3 ± 4.8 (P < 0.001); Tegner activity scores: Preoperative 3.5 ± 1.4, postoperative: 6.2 ± 1.5 (P < 0.001); Cincinati scores: Preoperative: 14.8 ± 5.3, postoperative: 26.9 ± 1.6 (P < 0.001). The average time for returning to work was determined as 15,3 ± 4 weeks. There was no significant difference for knee scores and time for returning to work between patients with meniscal injuries and don't have meniscus lesions. CONCLUSION: The reasons for delays in returning to work was work accident. Hematoma or effusion and pain inside the knee were the most significant reason which affected returning to work.

Periprosthetic proximal medial femoral cortical destruction caused by a femoral arterial pseudoaneurysm.

A femoral artery aneurysm is a very rare complication of hip surgery treatment. In this presentation, we report a rare case of bone destruction caused by the femoral artery aneurysm after a hip hemiarthroplasty operation as a late stage complication. A 77-year-old male patient presented with swelling and pain in the hip without any signs of ischemia. X-ray showed a 7 cm bone destruction in the medial cortex of the proximal femur. After ultrasound imaging, a femoral artery aneurysm was diagnosed. The patient was operated on by vascular surgeons, and a large amount of organized hematoma with artery aneurysm was removed. The diagnosis of femoral aneurysm after hip surgery treatment can be difficult. Femoral aneurysm is rare and usually secondary to trauma, infection, or iatrogenic injury. We assumed that this case occurred during the hemiarthroplasty operation, caused by a compressing effect to the bone causing destruction. The patient was followed for 2 years, during which time the preoperative symptoms reduced dramatically and Harris Hip Score improved. After a hip arthroplasty operation, it must be kept in mind that a femoral arterial aneurysm can cause persistent symptoms. This case illustrates the importance of considering a pseudoaneurysm as a possible cause of periprosthetic osteolysis, particularly if rapid progressive growth has occurred. If this vascular injury had not been correctly diagnosed, the method of treatment could have been much different, probably with catastrophic consequences.

Three-point index in predicting redisplacement of extra-articular distal radial fractures in adults.

INTRODUCTION: In distal radial fractures in adults, factors affecting instability have been investigated in many studies in an effort to shorten the preoperative waiting period for the fractures requiring surgery. Numerous factors, aside from the alignment-related indices, have been searched to predict redisplacement. Unlike as in paediatric counterparts, the casting technique and casting-related indices have not been appropriately considered in adults. The aim of this study was to determine the impact of the various previously investigated factors in addition to casting technique-related indices such as three-point index, cast index, padding index and gap index, in predicting the risk of redisplacement of extra-articular distal radial fractures in adults and the presence of the ulnar deviation of the cast. PATIENTS AND METHODS: Seventy-five patients over 18 years who were treated with a cast in our emergency department within 24h after a displaced distal radial fracture, were recruited into the study. Age, alignment-related indices, cast-related indices, extent of the ulnar deviation of the cast, having a non-anatomical reduction, co-existing ulnar fracture, dorsal comminution and obliquity of the fracture line were investigated. Casting technique according to three-point index, obliquity of the fracture line, degree of the ulnar deviation of the cast, and reduction accuracy were the significant factors affecting redisplacement. RESULTS: The three-point index had a sensitivity of 95.8%, specificity of 96.1%, positive predictive value of 92%, and negative predictive value of 98% in predicting redisplacement. Logistic regression revealed that having an inadequate cast according to the three-point index (p<0.001), degree of obliquity of the fracture line (p=0.018), decreased ulnar deviation of the cast (p=0.002), and having a non-anatomical reduction (p=0.029) were the significant predictive factors in redisplacement. CONCLUSIONS: Our results suggest that the casting technique plays a major role in the success of conservative treatment, which can best be examined with the three-point index. Ulnar deviation of the cast and fracture obliquity are the other dominant factors affecting redisplacement.

Factors affecting the fracture healing in treatment of tibial shaft fractures with circular external fixator.

This study aims to analyse the contribution of various risk factors for the delay of tibial shaft fractures treated by circular external fixator and predicting the high risk fractures for delayed union. 32 extraarticular tibial shaft fractures of 31 adult patients treated with circular external fixator were included. The patients were analysed according to age, energy of trauma, having an open fracture or not, AO classification, obliquity, use of supplementary fixation techniques in surgery, distance of fracture line to neighbouring rings, having a pin-track infection or not, reduction score, and smoking. There were eight delayed unions and two non-unions in our study. Consolidation time was significantly shorter (p=0.01) between the supplementary fixation group and the others. There was a significant difference in fracture healing time between pin-track-infected patients and the patients who did not have pin-track infection (p=0.037). In conclusion, our results indicate that non-union infection and not using supplementary fixation techniques are the major factors that delay the healing time. Supplementary fixation enhances the reduction rate and a low reduction score is related with the occurrence of a pin-track infection.