Better short-term outcomes of mini-open rotator cuff repair compared to full arthroscopic repair.

BACKGROUND: Rotator cuff tears commonly cause shoulder pain and functional impairment, prompting surgical intervention such as miniopen and arthroscopic methods, each with distinct benefits. This study aimed to compare the clinical outcomes and complications of these two approaches. METHODS: A retrospective analysis was conducted on 165 patients who underwent rotator cuff repair using either arthroscopic-assisted mini-open or full arthroscopic approaches. Patient demographics, tear characteristics, clinical outcomes, and complications were assessed, with statistical analyses conducted to discern differences between the groups. RESULTS: Among the patients, 74 (53.2%) received the mini-open approach, while 65 (46.8%) underwent arthroscopic repair, with a mean follow-up of 19.91 months. The mini-open group exhibited significantly higher postoperative American Shoulder and Elbow Surgeons (ASES) scores compared to the arthroscopic group (P=0.002). Additionally, the mini-open group demonstrated a more significant improvement in ASES scores from preoperative to postoperative assessments (P=0.001). However, the arthroscopic method had a significantly longer operative time (P<0.001). Complications, including anchor placement issues, frozen shoulder, infection, and re-rupture, occurred in 17.3% of patients overall. Re-rupture rates were 13.5% for mini-open and 6.2% for full arthroscopic repair, with no significant difference between the two methods (P=0.317). CONCLUSIONS: Both the mini-open and arthroscopic methods yielded favorable clinical outcomes for rotator cuff tear treatment, but the mini-open group exhibited superior results. Surgeons should consider patient characteristics, tear attributes, and surgical expertise when selecting the appropriate technique. Level of evidence: III.

Open Reduction and Plate Fixation, External Fixator, and Conservative Treatment for Intra-articular Distal Radius Fractures.

Background Distal radius fractures are common fractures. Treatment of intra-articular fractures is controversial, with treatment modalities including closed reduction and casting, open reduction and plating, and closed reduction and fixation with an external fixator. In this study, we compared the clinical and radiological outcomes of our patients treated with three different methods for intra-articular distal radius fractures. We hypothesize that open reduction and plate application are superior. Methodology Adult patients with intra-articular (AO type B and C) fractures of the distal radius and treated with closed reduction-casting, volar locking plate, and external fixator were identified. Radiologically, joint stepping at the end of treatment, radial inclination, radial height, volar tilt, and distal ulna fracture were examined. For clinical scoring, Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) scores were computed. Obtained data were compared statistically between groups. Results A total of 164 patients were included in the study. Overall, the treatment modality was conservative in 61, volar with plating in 78, and external fixation in 25. The mean age of the patients was 53.7 years (range = 20-82 years). Overall, 39.6% of the patients were male and 60.4% were female. The mean follow-up period of the patients was 16.7 months (range = 12-28 months). No statistically significant difference was found between Q-DASH scores in the statistical evaluation (p > 0.05). There was a statistically significant difference between the groups in the radiological evaluation. When conservative treatment and the volar plate group were compared, the volar plate was superior in all radiological parameters (p < 0.05). Compared with conservative treatment and external fixation, only volar tilt and radial inclination angle were different. External fixation was better (p < 0.05). Radial length, volar compared to plate and external fixation tilt, and ulnar variance were better in the plate group (p < 0.05). Regarding joint stepping and radial, there was no difference in inclination between the two groups (p > 0.05). Reflex sympathetic dystrophy was seen in a total of 10 (6.1%) patients. Pin-site infection was seen in three (12%) patients in the external fixator group. Implant removal was performed in seven (9.0%) patients who developed plaque due to irritation and tenosynovitis. Early arthrosis was seen in three (4.3%) patients. Conclusions The treatment of distal radius intra-articular fractures should be evaluated and decided individually for each patient. No single method is directly superior to other methods. However, in some cases, the best results radiologically in the treatment of comminuted intra-articular fractures have been obtained in patients with volar plates.

The effect of biceps tenotomy on superior humeral migration in arthroscopic repaired full-thickness supraspinatus tears.

Background: Lesions of the long head of the biceps (LHB) tendon are a prevalent injury that frequently coexists with rotator cuff injuries. This study aimed to assess the effect of supraspinatus (SST) repair with concurrent LHB tenotomy on superior migration of the humeral head. The acromiohumeral distance (AHD) was determined via ultrasound to evaluate the superior migration of the humeral head. Methods: The study population was retrospectively recruited from patients who underwent unilateral arthroscopic repair of isolated degenerative full-thickness SST tears between January 2017 and December 2019. Patients were divided into 2 subgroups based on whether they underwent LHB tenotomies during arthroscopy. While 37 patients underwent arthroscopic single-row SST repair, the other 33 patients underwent arthroscopic single-row SST repair with LHB tenotomy. The subject group consisted of people who had undergone arthroscopic shoulder surgery. Contralateral shoulders without rotator cuff injuries were included in the control group. The AHD and SST thicknesses of patients were examined via the ultrasound in both groups and subgroups. Results: The mean age in the SST repair group was 55.52 ± 4.58 years (range, 46-63 years), whereas it was 58.24 ± 3.98 (range, 52-73 years) in the SST repair + LHB tenotomy group. In the SST repair group, 57.6% of patients were female and 42.4% were male, whereas 56.8% and 43.2% were in the SST repair + LHB tenotomy group, respectively. The mean body mass index was 28.06 ± 1.31 kg/m2 (range, 25.7-31.2 kg/m2) in the SST repair group and 28.95 ± 1.79 kg/m2 in the SST repair + LHB tenotomy group. Groups were not different for sex, surgery side, dominant side, tear size, and follow-up time; however, the SST repair + LHB tenotomy group had significantly higher mean age and body mass index than the SST repaired group. The mean AHD value and SST thickness were significantly less in both the rotator cuff repair group and the rotator cuff repair + LHB tenotomy group compared to the healthy shoulder. The mean AHD value was significantly lower in the SST repaired + LHB tenotomy group than in the SST repair group (P = .02). Conclusion: The AHD was narrowed in patients who underwent LHB tenotomy and radiologically demonstrated the depressor effect of the LHB tendon on the humeral head. As a secondary outcome, we demonstrated that regardless of tenotomy, AHD could not be restored in patients who underwent arthroscopic single-row SST repair.

A new modified pararectus approach and visualization: an anatomical study.

INTRODUCTION: The aim of our study was to visualize all the windows used in the pararectus approach with detailed cadaver images to facilitate better understanding of orthopedic surgeons and, in addition, was to modify the incision used in the pararectus approach to a more cosmetic bikini incision. MATERIALS AND METHODS: In total, 20 cadavers fixed in 10% formalin were used in this study. Of these cadavers, 14 were male and six were female, with a mean age at death of 57 (42-82 years). The four windows were defined as follows in all the cadavers: pubic, quadrilateral, sacroiliac, and iliac windows. RESULTS: The most important structure at risk in the pubic window was the corona mortis, as it was observed in 12 (60%) cadavers. In men, the spermatic cord was an important structure at risk in the pubic window. The obturator vessels and nerves were the structures at most risk in the quadrilateral window due to their close location with the quadrilateral surface. The obturator nerve on the medial side and at the entrance of the pelvis through the linea terminalis and lumbosacral truncus were the structures at most risk close to the sacroiliac joint in the sacroiliac window. CONCLUSION: This anatomical study includes highly instructive visual shapes and cadaver images for the acetabulum and pelvis, whose anatomical structures are quite complex. We have found that this modified pararectus approach provides excellent access to the internal pelvic rim. CLINICAL RELEVANCE: The anatomical data regarding the modified pararectus approach in this study will assist orthopedic surgeons in the surgical management of acetabular and pelvic fractures.

Comparison of extension block pinning technique versus pin orthosis-extension block pinning technique for acute mallet fractures: a prospective randomized clinical trial.

INTRODUCTION: The extension block pinning technique (EBPT) is a popular surgical treatment for mallet fractures; however, it has several drawbacks. The purpose of this randomized clinical trial was to compare EBPT to the pin orthosis-extension block pinning method (PO-EBPT) in the treatment of mallet fractures involving more than one-third of the joint surface but without primary joint dislocation. MATERIALS AND METHODS: Sixty-five patients with mallet fractures were randomized into two groups between June 2017 and January 2020: Group I (33 patients) was treated with EBPT and group II (32 patients) was treated with PO-EBPT. Five patients were lost to follow up due to lack of follow-up and death. There were no significant differences in the clinical and demographic characteristics of both groups. Patients were evaluated according to fracture union, extension lag, distal interphalangeal (DIP) joint range of motion, Crawford's criteria, and complication rates. The patients were followed-up post-operatively at 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and annually thereafter. RESULTS: A total of 60 patients were randomized into two groups: one (30 patients) was treated with EBPT and the second (30 patients) with PO-EBPT. There were no significant differences between the two groups in terms of fracture union and active DIP joint flexion (P = 0.743 and P = 0.059, respectively). The mean extension lag of the DIP joint in the EBPT group was significantly greater than the PO-EBPT group (10° ± 9.47° vs. 4.17° ± 7.2°, P = 0.009). According to the Crawford criteria, the PO-EBPT group showed significantly better outcomes (P = 0.005). The complication rates were similar between groups (P = 0.45). CONCLUSION: In comparison to the EBPT technique, the group of patients operated with PO-EBPT had superior clinical outcomes and less loss of extension at the DIP joint according to the Crawford's criteria.

Evaluation of bilateral acromiohumeral distance on magnetic resonance imaging and radiography in patients with unilateral rotator cuff tears.

INTRODUCTION: The aim of this study was to evaluate the difference in the acromiohumeral distance (AHD) between the shoulders with full-thickness rotator cuff tear and contralateral healthy shoulders of the same patients on magnetic resonance imaging (MRI) and radiograph. MATERIALS AND METHODS: We included 49 patients with unilateral full-thickness rotator cuff tears. The mean age of the patients (29 women and 20 men) was 54.57 ± 7.10 years. The shoulders were divided into those with a full-thickness rotator cuff tear and healthy shoulders. The mean AHDs on radiograph and MRI were calculated by two radiologists experienced in the musculoskeletal system. Shoulders with rotator cuff tears on coronal plane and sagittal MRI were divided into 3 (Patte I, II, III) and 4 subgroups (S: superior, AS: anterosuperior, PS: posterosuperior, APS: anteroposterosuperior), respectively. The relationship between the groups and the subgroups was statistically investigated. RESULTS: The mean AHDs on radiograph were 6.93 and 9.11 mm and on MRI were 5.94 and 7.46 mm in the patient and control groups, respectively. The mean AHDs were 6.47, 6.03, and 4.95 mm in Patte I, II, and III, respectively. The difference between the subgroups was statistically significant. According to the sagittal plane topography, the mean AHDs (mm) were 6.39, 6.44, 5.8, and 4.6 mm in the superiorly, anterosuperiorly, posterosuperiorly, and anteroposterosuperiorly localized lesions, respectively. The relationship between S and AS was not statistically significant, and those between S and PS, AS and PS, S and APS, and PS and APS were significant. CONCLUSIONS: In patients with unilateral full-thickness rotator cuff tear, AHD narrowing was observed on the törnekler side after evaluating the bilateral acromiohumeral distance on MRI and radiograph. AHD was significantly reduced by increasing the degree of supraspinatus tendon retraction in the coronal plane MRI and by the posterosuperior and anteroposterosuperior location of the rotator cuff tear in the sagittal plane MRI.

Extra-Articular Nonhemophilic Hemosiderotic Synovitis of the Hand: A Case Report.

Hemosiderotic synovitis is a rare distinctive type of synovial proliferative disorder. Hemosiderotic synovitis develops in men with hemophilia who are at risk of hemarthrosis, especially of the knees, associated with severe degenerative articular cartilage disease. It appears to be exceedingly rare in individuals without hemophilia and has been reported in case reports. We describe a case of trauma-related nonhemophilic hemosiderotic synovitis, located in the hand in an otherwise healthy young male construction worker, with no systemic illness, inflammatory arthritis, or any bleeding disorder. We report the first case of nonhemophilic hemosiderotic synovitis located in the hand. To the best of our knowledge, a case of extra-articular nonhemophilic hemosiderotic synovitis has not been previously described in the literature.

Bilateral brachial artery infiltration by tumoral calcinosis: A case report.

We, herein, presented a rare case of bilateral brachial artery infiltration by tumoral calcinosis located on both elbows. A 58-yearold man presented with a history of painless, palpable solid mass restricting the range of motion of both elbows. These masses were located on the anterior aspect of the elbows and gradually enlarged. After clinical, laboratory and radiological examinations, tumoral calcinosis was suspected, and excisional biopsy was planned for a definite diagnosis. Surgery was first performed on the left elbow. The median nerve was found to be compressed but not infiltrated by the mass. Interestingly, the brachial artery was totally infiltrated throughout the entire mass. Occlusion was observed in the brachial artery located within the mass. The tumor on the left elbow, 8.5 × 5.5 × 2.5 cm in size, was totally excised with approximately 12-cm brachial artery segment. The artery was resected until the healthy tissue was reached. The defect was reconstructed with saphenous vein graft obtained from the ipsilateral lower extremity. The same surgical procedure was performed on the right elbow after 3 months. The tumor size on the right elbow was 7 × 3.5 × 1.7 cm. Approximately 15-cm brachial artery segment was excised, and the defect was reconstructed with saphenous vein graft. Tumoral calcinosis is a rare benign condition that can be located in close relationship with neurovascular structures. In such cases, detailed neurologic and vascular examination, including imaging modalities, for arterial flow is essential to establish a more accurate surgical plan and avoid any unexpected situation during surgery.

The Evolution of Publications in the Field of Scoliosis: A Detailed Investigation of Global Scientific Output Using Bibliometric Approaches.

AIM: To carry out an in-depth bibliometric analysis of scoliosis literature. MATERIAL AND METHODS: This study used the Web of Science database to identify relevant articles for analysis. The literature search used the keyword ?scolio*? and focused on the period between 1980-2019. Bibliometric network visualizations and mapping of specific results were done using VOSviewer software. RESULTS: The literature search yielded 9706 publications on scoliosis between 1980 and 2019. Of these, 6975 (71.9%) journal articles were included in the bibliometric summary. Orthopedics was the most common area of research (4581 articles, 65.67%), and the United States of America (USA) exhibited the highest publication productivity (2327 articles, 33.36%). Nanjing University in China had the highest number of publications among institutions (n=219, 3.13% of the total literature), and there were a total of 60130 citations in 6975 articles. Fifty-five articles had a minimum of 100 citations, and the journal with the highest number of publications was ?Spine? (number of article: 1628, 23.3%). CONCLUSION: This bibliometric analysis may be regarded as a summary and evaluation of global scientific output on scoliosis and can, therefore, be used a guide for researchers, clinicians and students. Furthermore, the keyword analysis can aid professionals in the field when planning new studies.

C-Reactive Protein to Albumin Ratio May Predict Mortality for Elderly Population Who Undergo Hemiarthroplasty Due to Hip Fracture.

BACKGROUND: Although the relationship of preoperative C-reactive protein (CRP) and albumin levels to mortality in elderly patients who have undergone surgery due to hip fracture has been previously investigated, the CRP to albumin ratio (CAR) has not been investigated. This study aimed to investigate the relationship between preoperative CAR and mortality. METHODS: A total of 254 patients (mean age, 78.74 years) were retrospectively analyzed using the following data: age, gender, fracture type, American Society of Anesthesiologists (ASA) score, type of anesthesia, time between fracture and surgery, time between fracture and discharge, length of hospital stay, preexisting comorbidities, preoperative CRP and albumin levels, and mortality. The serum CRP level was divided by the serum albumin level to calculate the preoperative CAR. Multivariate logistic regression was used to evaluate the association between risk factors and 1-year mortality. RESULTS: One-year mortality was 22.8% (58 patients). Age >85 years, male gender, ASA score ≥3, presence of ≥3 comorbidities, and CAR ≥2.49 were identified as mortality risk factors in the univariate analysis. The following factors were included in the binary logistic regression analysis to determine the major predictors of 1-year mortality: ASA score ≥3, presence of ≥3 comorbidities, and CAR ≥2.49. CONCLUSION: Detection of CAR above 2.49 is a strong indicator for 1-year mortality in patients operated due to hip fracture in the elderly population. ASA score ≥3 and presence of ≥3 comorbid diseases were also related to mortality.

Treatment of scaphoid nonunion with 1,2 intercompartmental supraretinacular artery vascularized graft and compression screw fixation.

PURPOSE: Aim of the present study was to evaluate the clinical, functional, and radiological outcomes of 1,2-intercompartmental supraretinacular artery (1.2-ICSRA) vascularized graft technique together with compression screw fixation for the management of scaphoid nonunions. METHODS: A retrospective study was designed to evaluate the medical records of the 21 patients treated with 1,2-ICSRA vascularized graft for established scaphoid nonunion of the waist or proximal pole between 2015 and 2018. Seventeen patients who met the criteria were included in the study. The retrospectively analysed demographic parameters included age, gender, injured hand (dominant/non-dominant), aetiology of the injury, delay between injury and operation, initial treatments following the fracture, tobacco use, and background diseases that may affect healing (diabetes, vasculopathy etc.). Radiological and clinical examinations were routinely performed 2 weeks, 6 weeks, 3 months and 6 months after surgery and during the final follow-up. Postoperative clinical and functional outcomes at the latest follow-up were evaluated by measuring active wrist range of motion, grip strength, Turkish version of Quick Disabilities of the Arm, Shoulder and Hand Questionnare (Quick DASH) and Mayo Wrist scores and comparing them with preoperative values. RESULTS: All 17 patients were male with an average age of 26.82 ± 4.08 years (range 20-35 years). The fracture site was located in the scaphoid waist and proximal pole in 5 (29.4%) and 12 (70.6%) patients, respectively. Avascular necrosis was observed in 13 patients (2 at the waist, 11 at the proximal pole). The mean follow-up duration was 18.88 ± 11.98 months (range 6-44 months). No graft extrusion occurred, and no other complication was observed in any of the patients. Amongst the 17 patients, 15 (88.2%) achieved union. The total wrist motions of patients were better postoperatively than preoperatively. However, only improvement in wrist extension was found to be statistically significant. Quick DASH and Mayo Wrist scores of the patients and grip strength were significantly improved postoperatively. CONCLUSION: The 1,2-ICSRA vascularized graft technique together with compression screw fixation offers an easy and reliable option for the treatment of scaphoid nonunions with a high union rate and good functional and clinical outcomes. LEVEL OF EVIDENCE: IV Therapautic.

Surgical Treatment of Solitary Enchondromas of the Hand.

OBJECTIVE: The present retrospective study evaluated the clinical and radiologic results of patients who underwent complete curettage and autologous bone grafting for hand-located isolated enchondromas with a minimum follow-up period of one year. PATIENTS AND METHODS:  Thirty-two patients with a follow-up period of at least 12 months who underwent operation between August 2010 and October 2018 due to the presence of solitary enchondroma of the hand were included in the study. All patients underwent complete curettage and filling of the defect via autologous bone grafting. Autologous bone graft was harvested from the iliac crest and distal radius in 24 and eight patients, respectively. The patients underwent radiography on the first postoperative visit and at six weeks, 12 weeks, and annually. The range of movement of the finger joint was evaluated by comparing it with the healthy contralateral side. Functional outcomes and radiologic outcomes were evaluated. The frequency of complications and recurrences were established. RESULTS: Twelve patients were male and 20 were female. The average age was 34 (range: 16-56) years. The most common digit involved was the little finger (nine cases, 28.125%); the proximal phalanx was the most common location (17 cases, 53.125%). Control radiography in the sixth week revealed graft consolidation in all patients. No case of nonunion or recurrence was detected clinically or radiologically, with a mean follow-up period of 54 (range: 12-96) months. Functional outcomes were classified as excellent in 28 patients and as good in four patients. The final radiographic appearances included Tordai's group 1 in 28 bones and group 2 in four bones.  Conclusion: Curettage and autologous bone grafting are safe, costless, and effective treatment options for hand enchondroma, with satisfactory functional and radiographic outcomes. Harvesting bone graft from the distal radius provides a shorter length of hospital stay and lower complication rates compared to obtaining the graft from the iliac crest.

Associations between initial injury severity in acute hand, wrist or forearm injuries and disability ratings and time to return to work.

BACKGROUND: This study aimed to examine the relationships between the initial anatomic severity of hand, wrist and forearm injuries, as evaluated by the Modified Hand Injury Severity Score (MHISS), and each of the following parameters: disability rating and time to return to work. METHODS: In this study, 94 patients who underwent operations due to acute hand, wrist and forearm injuries were included. MHISS was used to assess the severity of the injury. Disability rates of the patients were calculated six months after injury in accordance with the 'Regulation on Disability Criteria, Classification and Health Board Reports to be Given to Disabled People'. The time to return to work was defined as the length of time (in days) between the injury and the patient's return to work. Spearman rank correlation analysis was performed to analyse correlations between the MHISS and each of the following: disability rates and time to return to work. RESULTS: The mean overall MHISS was 125.23 (5-880). The mean overall upper extremity disability ratio (UEDR) was 17.64±22.6 (range: 0-94), and the mean overall total body disability ratio (TBDR) was 10.57±13.45 (range: 0-56). Among the study population, 87 (92.6%) patients were able to return to their jobs. The mean overall time to return to work was 138.69 (range: 35-365 days). A statistically significant correlation was found between MHISS and UEDR, TBDR and time to return to work and UEDR, TBDR (p<0.001). CONCLUSION: As a result, as the initial injury severity increased, greater disability remained and the time to return to work increased. Predicting prognosis by determining the injury severity in the initial evaluation of patients may be important in predicting a patient's future permanent disability level, which can contribute to maintaining patient expectations at a reasonable level, thereby aiding in psychosocial support.

Distribution of intramuscular giant lipomas in the functional compartments of the forearm: a report of 12 cases.

PURPOSE: The aim of this study was to investigate the distribution of intramuscular giant lipomas in the functional compartments of the forearm and to compare their clinical, radiological and histopathological features with those reported in the current literature. METHODS: The study included 12 patients who were surgically treated for intramuscular lipomas > 5 cm in size located in the forearm that had been confirmed histopathologically between April 2006 and March 2017. Data about the patients with respect to age, sex, affected side, localisation of the lipomas in the forearm functional compartments, size, histopathological features and recurrence were collected. According to the clinical complaints, direct radiography and magnetic resonance imaging were applied. RESULTS: The average diameter was 6.5 cm (range: 5.5-9 cm). All lipomas had a well-defined border. All the patients presented with soft-tissue masses that were painless in seven patients. Five patients had nerve compression symptoms. When the lipomas were classified according to the functional compartments of the forearm, six of them were located in the superficial volar compartment, two in the deep volar compartment, two in the deep dorsal compartment and two in the lateral compartment. All lipomas were surgically removed by marginal excision. None had complications or recurrence at a mean of 6.5 years follow-up (range: 1-12 years) after surgery. CONCLUSIONS: Intramuscular lipoma is a relatively uncommon tumour, especially in the forearm. Because of the proximity to the neurovascular structures in the forearm, excision of lipomas should be performed with care and include wide incisions. Additionally, knowing the anatomical features of the compartment where the lipoma is localised in the forearm is important in planning surgery to enable easier dissection of the lipoma and lessen the risk of damage to adjacent neurovascular structures. LEVEL OF EVIDENCE: Level 4.

Global Scientific Outputs of Microsurgery Publications: A Bibliometric Approach About Yesterday, Today, and Tomorrow.

Introduction Although there have been important developments in microsurgery in recent years, there is no current and comprehensive bibliometric study in the literature. In this study, we aimed to present a summary of the articles published on microsurgery between 1980 and 2019 with bibliometric analysis. Methods Articles published on microsurgery between 1980 and 2019 were withdrawn from the Web of Science database and analyzed by bibliometric methods. Citation analysis was performed to identify effective journals and articles. Keyword cluster and trends analyses were performed for a detailed analysis of the researched topics. Relationships between the article numbers of the countries and gross domestic product (GDP) and human development index (HDI) values were investigated using Spearman's correlation coefficient. A linear regression analysis was used to estimate the number of articles to be published in the future. Results A total of 3,537 publications related to microsurgery were found. Bibliometric analyses were performed in 2,063 articles (58.3%) of these publications. The most active countries in publishing were the United States (504), Germany (286), and Italy (154), respectively. A statistically significant correlation was found between the article numbers and the GDP and HDI sizes of the countries (r = 0.758, p <0.001, r = 0.659, p <0.001). Conclusion The economic size and development levels of the countries were an important factor in academic productivity in microsurgery. Undeveloped countries should be encouraged by performing multidisciplinary studies in this regard.

Extension-block pinning to treat bony mallet finger: Is a transfixation pin necessary?

BACKGROUND: Extension-block pinning is a popular treatment for mallet fractures, but it is associated with several pitfalls. Of note, transfixation Kirschner wires used to fix the distal interphalangeal (DIP) joint may cause iatrogenic nail bed injury, bone fragment rotation, chondral damage, or osteoarthritis. The objective of this study was to determine whether a transfixation pin was necessary for extension-block pinning in the treatment of bony mallet fracture. METHODS: Patients were treated with a pin-orthosis extension-block technique if they had been diagnosed with a type IVB mallet fracture according to Doyle's classification. Radiological outcomes were evaluated based on postoperative X-ray results, and functional outcomes were evaluated using Crawford's criteria. RESULTS: Thirteen patients (9 males and 4 females) with a mean age of 26 years were included. The mean time between the injury and surgery was 3.3 days, and the mean follow-up period was 8.2 months (range: 4-12 months). Radiographic bone union was achieved in all patients within an average of 5.1 weeks (range: 5-6 weeks). At the final follow-up, the DIP joint had an average degree of flexion of 76.1° (range: 65°-80°) and an average extension deficit of 3.84° (range: 0°-15°). According to Crawford's criteria, 8 patients had excellent results, 4 patients had good results, and 1 patient had a fair result. No patient reported pain at the final follow-up. CONCLUSION: Satisfactory clinical and radiological outcomes were obtained with the pin-orthosis extension-block technique. Future prospective and randomized studies are justified to confirm the efficacy of this technique.

Superficial radial nerve compression due to fibroma of the brachioradialis tendon sheath: A case report.

Fibroma of the tendon sheath (FTS) is a rare benign tumour that usually develops in the upper extremity, particularly in the fingers, hands and wrists. Herein, we present the case of a patient with an unusually localised FTS compressing the superficial branch of the radial nerve. A 62-year-old woman presented with a superficial radial nerve compression due to FTS of the brachioradialis. Histopathological diagnosis was confirmed as a FTS after marginal excision. The patient who had compression-related symptoms in the superficial branch of the radial nerve recovered completely at one month after surgery. One year later, the patient remained free of symptoms and no recurrence was observed.

Microsurgery training with smartphone.

Microsurgery is widely used in experimental research models and clinical surgery. However, microsurgical applications require precise technical skills and continuous training. Here, we proposed a low cost, practical microsurgery model, which can be easily applied using smartphones at home or at office. Test platform was created using latex gloves, and a phone holder was then positioned at one side of a table. A smartphone with 10x magnification was secured on the phone holder. Microsurgical device habit, stitching and knotting exercises by making cuts at different angles on the glove model were performed, which was recorded live under the 10x magnification of the phone camera.We believe that the practical microsurgery model presented in this study can form an important part of basic microsurgery education and also act as an alternative training model owing to its ease of application, easy accessibility and low cost.

A biological tube technique for the repair of peripheral nerve defects using 'stuffed nerves'.

BACKGROUND: Presently described is research examining the "stuffed nerve" technique to repair peripheral nerve defects. METHODS: Twenty-one male Wistar Albino rats were divided into 3 groups of 7, and standard 10-mm defects were created in the sciatic nerve of all subjects. Rats were treated with autogenous nerve graft (Group 1), hollow vein graft (Group 2), or vein graft stuffed with shredded nerves (Group 3). After 12 weeks, electrophysiological and histomorphological analyses were performed to evaluate axonal regeneration. RESULTS: Rat groups were compared in terms of latency period and peak-to-peak potential. Latency period was significantly shorter and peak-to-peak potential was significantly greater in Group 1 than in Group 2. However, latency period and peak-to-peak potential did not differ significantly between Groups 1 and 3 or between Groups 2 and 3. To evaluate axonal regeneration, number of axons, axon diameter and myelin sheath thickness was compared between groups. Results indicated that axonal regeneration was similar in Groups 1 and 3, and was better than results seen in Group 2. CONCLUSION: The stuffed nerve technique is an alternative to autogenous nerve grafting and produces similar electrophysiological and histomorphological properties.