Distal radius fractures: What are the effects of ulnar styloid fracture and face-toface rehabilitation on the functional outcome?

OBJECTIVE: This study aimed to investigate the effects of the accompanying ulnar styloid fracture and 2 different postoperative rehabilitation protocols on the final outcomes following surgical treatment of distal radius fractures. METHODS: In this retrospective study, 47 patients (11 male, 35 female; mean age=52.6 years, age range=24-85) who underwent plate fixation for distal radius fractures were divided into 4 groups based on the presence of an ulnar styloid fracture and type of rehabilitation. To evaluate clinical outcomes, wrist range of motion (ROM), grip strength, lateral pinch strength, disabilities of the arm, shoulder, and hand (DASH) questionnaire scores and visual analog scale (VAS) scores were obtained at the final follow-up. The rehabilitation exercises of the patients in groups 1 and 2 were carried out in the physical therapy room by the hand therapist during the postoperative 2 months. Patients in groups 3 and 4 were supplied with videos of the exercises of each phase and instructed to carry out those exercises at home routinely. RESULTS: Patients who received home rehabilitation programs demonstrated greater grip strength loss. Patients without accompanying ulnar styloid fractures had better DASH and VAS scores. Final wrist ROM and the duration for return to preinjury activity level did not differ among groups. CONCLUSION: This study has suggested that accompanying ulnar styloid fractures may worsen the functional outcomes after plate fixation of distal radius fractures. Home-based programs may provide patients with adequate overall wrist function with certain drawbacks compared to rehabilitation under direct supervision.

Treatment of Tibial and Femoral Bone Defects With Bone Transport Over an Intramedullary Nail.

OBJECTIVES: To evaluate the results of the bone transport over an intramedullary nail (BTON) technique for the treatment of segmental bone defects. DESIGN: Retrospective review of case series. SETTING: Level 1 trauma center. PATIENTS/PARTICIPANTS: We included 40 patients who underwent reconstruction of the lower limb with BTON technique between 2000 and 2018. The technique was performed in the tibial segments in 21 patients and in the femoral segments in 19 patients. INTERVENTION: The surgical technique was performed in 2 stages for patients with infected nonunion. Infection was eradicated in all patients at the first stage. For the BTON at the second stage, monolateral external fixators and circular external fixators were used for femoral and tibial defects, respectively. In cases of defects without any infection, debridement with a single-stage BTON was performed. MAIN OUTCOME MEASUREMENTS: Complications as well as radiological and clinical results were evaluated according to the criteria of Paley-Maar. RESULTS: Minor complications occurred in 11 patients: pin site problems (9), cellulitis (1), and skin detachment due to Schanz screw (1). Major complications occurred in 8 patients: docking site nonunion (4), early consolidation and Schanz screw failure (1), knee flexion contracture (1), and ankle equinus contracture (2). Four patients had osteomyelitis as residual sequelae. Bone score was excellent in 27 patients. Excellent functional results were obtained in 31 patients. CONCLUSIONS: The BTON technique is associated with low cost because of the short treatment period, low complication risk, and rapid rehabilitation and is not limited by the amount of bone transport. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

[An unusual complication after syndesmotic injury: retrotibial heterotopic ossification]. / Sindezmoz yaralanmasi sonrasi siradisi bir komplikasyon: Retrotibial heterotopik ossifikasyon.

A 27-year-old male patient sustained an isolated syndesmotic injury in the right ankle following a fall. His complaints subsided gradually within the first six weeks of conservative treatment. At the end of the third month, he returned to follow-up with posterior ankle pain. Radiological examinations revealed heterotopic ossification adjacent to the posterior inferior tibiofibular ligament and posterior capsule. His complaints disappeared only after local excision of the ossification. Heterotopic ossification may be a cause of persistent pain after ankle ligament injuries.

Comparison of postoperative pain after open and endoscopic carpal tunnel release: A randomized controlled study.

BACKGROUND: Results of open and endoscopic carpal tunnel surgery were compared with many studies done previously. To the best of our knowledge, difference in pain after endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR) has not been objectively documented in literature. The aim of the study was to compare the pain intensity in the early postoperative period in patients undergoing OCTR versus those undergoing ECTR. MATERIALS AND METHODS: Fifty patients diagnosed with carpal tunnel syndrome were randomized into two groups using "random number generator" software (Research Randomizer, version 3.0); endoscopic surgery group [(21 female, 1 male; mean age 49 years (range 31-64 years)] and open surgery group [(25 female, 3 male; mean age 45.1 years (range 29-68 years)] and received carpal tunnel release. Surgery was performed under regional intravenous anesthesia. The patients' pain level was assessed at the 1(st), 2(nd), 4(th), and 24(th) postoperative hours using a visual analog scale (VAS) score. RESULTS: Mean age, gender and duration of symptoms were found similar for both groups. Boston functional scores were improved for both groups (P < 0.001, P < 0.001). Pain assessment at the postoperative 1(st), 2(nd), 4(th) and 24(th) hours revealed significantly low VAS scores in the endoscopic surgery group (P = 0.003, P < 0.001, P < 0.001, P < 0.001). Need for analgesic medication was significantly lower in the endoscopic surgery group (P < 0.001). CONCLUSION: Endoscopic carpal tunnel surgery is an effective treatment method in carpal tunnel release vis-a-vis postoperative pain relief.

A Knotless Labro-Bicipital Repair Technique for SLAP Lesions.

Fixation methods for SLAP lesions are still controversial, and the strength of the fixation, suture and knot irritation, and placement and number of anchors are still being discussed. This uncertainty is directly related to the function and anatomy of the superior labrum and attached biceps. Knotless fixation methods close to the biceps anchorage at the 12-o'clock position are favored in recent literature. We describe a practical SLAP repair technique, with a mattress configuration through the biceps anchorage, using a single knotless anchor. Fixing the biceps attachment instead of the labrum alone, in proximity to the biceps, without sutures or knots left in contact with the other intra-articular structures is the superiority of the described technique.

Results of surgical management of valgus-impacted proximal humerus fractures with structural allografts.

OBJECTIVE: The aim of this study was to clinically and radiologically evaluate patients treated with plate osteosynthesis with structural allografts for severely valgus-impacted fractures of the proximal humerus. METHODS: The study included 10 patients (average age: 57 years; range: 34 to 77 years) with valgus-impacted Neer Type 4 proximal humerus fractures. Fractures were classified according to the Robinson classification. Patients were called for an up-to-date examination and evaluated radiologically and clinically with Constant and DASH scores. RESULTS: Average follow-up period was 22.5±12.2 (range: 12 to 50) months. Average DASH score at the final follow-up was 7.6±4.5 (range: 2.5 to 16.7) and average Constant score was 87.7±4.4 (range: 83 to 94). None of the cases had early or late head collapse. There was no avascular necrosis. One early screw penetration was observed. CONCLUSION: Surgical treatment of valgus-impacted proximal humerus fractures achieved successful results. However, the cavity under the humeral head may lead to failure due to mechanical insufficiency. Plate osteosynthesis with structural allografts warrants initial mechanical support until union, thus avoiding complications related to head collapse.

Tibial torus and toddler's fractures misdiagnosed as transient synovitis: a case series.

INTRODUCTION: The high incidence of transient synovitis in early childhood makes it the first suspected pathology in a limping child. Trauma, which has long been regarded as a causative factor for transient synovitis, may be underestimated in a non-cooperative toddler.After excluding most serious conditions, such as septic arthritis, a speculative diagnosis of transient synovitis can be made, and this can easily mask a subtle musculoskeletal injury. CASE PRESENTATIONS: We report the cases of three Caucasian patients (two boys, aged 20-months- and three-years-old, and one girl, aged two-years-old), with tibial torus and toddler's fractures which were late-diagnosed due to an initial misdiagnosis of transient synovitis of the hip. CONCLUSION: In a non-cooperative child musculoskeletal trauma can be mistaken as a simple causative factor for transient synovitis of the hip and this can easily prevent further investigation for a possible subtle musculoskeletal injury of the lower extremities.Our experience with the presented cases suggests the need to be more vigilant in the differential diagnosis of transient synovitis in young children.

Rice body mass formation mimicking a neoplastic disease around the trochanteric bursae of the hip.

Multiple rice body formation is an uncommon inflammatory process. Sometimes it leads to a big mass in unusual locations. Although sometimes associated with bursitis and systemic diseases, such as rheumatoid arthritis, the pathophysiology of this rare entity is still obscure. We present a 29-year-old woman with multiple rice body mass formation in the trochanteric bursa of the left hip. She was operated, and had no recurrence at 18 months after the surgery.

Unrecognized anterior compartment syndrome following ankle fracture surgery: a case report.

A 35-year-old male sustained a lateral malleolar fracture while playing football. The fracture was treated by open reduction and internal fixation with a tourniquet. The next day, the patient returned with pain and swelling of the ankle and was admitted again to the hospital with a suspected diagnosis of cellulitis. Ten hours later, the patient developed the symptoms of anterior compartment syndrome. Emergency open fasciotomy of the anterior compartment was performed. The retrospective analysis of the patient's history was suggestive of a predisposition to an exercise-induced compartment syndrome. We think that exertional increase of the compartmental pressure before the injury and the tourniquet used during surgery contributed together to the development of compartment syndrome. Physicians should be vigilant in identifying the features of compartment syndrome when managing patients injured during a sporting activity.

[The calcaneal angles in the Turkish population]. / Türk toplumunda kalkaneus açilari.

OBJECTIVES: The purpose of this study was to determine the calcaneal angles on radiograms of individuals without a calcaneal fracture. METHODS: We retrospectively analyzed a total of 308 digital records of lateral ankle or foot radiographs taken from 268 patients (106 males, 162 females; mean age 42 years; range 18-79 years) without a calcaneal fracture. On these radiographs, the reference lines were drawn with the use of an angle measurement software with a sensitivity of 1/100 mm and the Böhler (BA) and Gissane (GA) angles were measured. The distribution characteristics of the angles with respect to age, gender, and side of the body were analyzed and compared with those of previous studies. RESULTS: The mean BA was 33.8 + or - 4.8 degrees (range 20 degrees to 46 degrees) and the mean GA was 115.0 + or - 6.5 degrees (range 100 degrees to 133 degrees). There were no significant differences for both angles with respect to measurements obtained from the right and left sides (for BA, p=0.198; for GA, p=0.601) and from both sexes (for BA, p=0.177; for GA, p=0.412). The highest (35.2 degrees) and lowest (32.3 degrees) means of BA were seen in the age brackets of 41-50 and 61-83 years, respectively. The corresponding age brackets for GA were 21-30 and 51-60 years with 115.7 degrees and 114.4 degrees , respectively. There were no significant differences between the age groups for both angles (for BA, p=0.086; for GA, p=0.955). Of note, the mean BA was significantly higher than those reported in previous studies. There was no correlation between BA and GA (r=0.018; p=0.76), nor between the calcaneal angles and age (for BA, r=-0.092; p=0.11 and for GA, r=-0.070; p=0.22). CONCLUSION: The calcaneal angles show considerable variations in diverse ethnic groups and populations in terms of normal range, age, gender, and side. The ranges herein reported (20-46 degrees for BA, 100-133 degrees for GA) can be used as reference values for the Turkish population.