Demographic and clinical characteristics of inpatient stroke patients in Turkey.

Objectives: This study aims to assess the stroke rehabilitation facilities provided by university hospitals (UHs) and training and research hospitals (TRHs) and to evaluate the geographical disparities in stroke rehabilitation. Patients and methods: Between April 2013 and April 2014 a total of 1,529 stroke patients (817 males, 712 females; mean age: 61.7±14.0 years; range, 12 to 91 years) who were admitted to the physical medicine and rehabilitation clinics in 20 tertiary care centers were retrospectively analyzed. Demographic, regional and clinical characteristics, details of rehabilitation period, functional status, and complications were collected. Results: The median duration of stroke was five (range, 1 to 360) months. The ratio of the patients treated in the TRH in the Marmara region was 77%, but only 25% of the patients were living in the Marmara region. Duration of hospitalization was longer in the TRHs with a median of 28 days compared to those of UHs (median: 22 days) (p<0.0001). More than half of the patients (55%) were rehabilitated in the Marmara region. Time after stroke was the highest in the Southeast region with a median of 12 (range, 1 to 230) months and the lowest in the Aegean region with a median of four (range, 1 to 84) months. Conclusion: This study provides an insight into the situation of stroke rehabilitation settings and characteristics of stroke patients in Turkey. A standard method of patient evaluation and a registry system may provide data about the efficacy of stroke rehabilitation and may help to focus on the problems that hinder a better outcome.

Metacarpal squeezing reduces grip strength.

Unduly tight plaster hand casts may narrow the metacarpal joint space, hindering rehabilitation. This study investigated how metacarpal narrowing affects grip strength. Forty-two adult volunteers with no other pathology were included. Dominant and non-dominant hand grip strength was measured with a digital hand dynamometer (Jamar plus, China). Metacarpal width was measured with a metal caliper, and the caliper was then fixed at 10% narrowing of the joint space, and a second measurement of grip strength was taken. The measurements were thus taken twice each in the dominant and non-dominant hand, and the average of the two was recorded. A total 336 measurements were taken in the dominant and non-dominant hands of 42 individuals at two time points. There was no significant difference in grip strength between dominant and non-dominant hands (p = 0.183). After 10% narrowing, both the dominant and the non-dominant hand showed a mean 33.4% reduction in grip strength: i.e., squeezing the metacarpus with a caliper significantly reduced grip strength in both dominant and non-dominant hands (p = 0.01). The study thus showed that grip strength will decrease significantly when the metacarpus is squeezed by a tight cast. Although the patient does not feel the 10% narrowing of the metacarpus, it is clear that hand muscle mass may be adversely affected in the long term.

Synostosis after fracture of both forearm bones treated by intramedullary nailing.

This study evaluated the risk of radioulnar synostosis after fracture of both forearm bones at the same level. We hypothesized that (i) the incidence of synostosis in both-bone forearm fractures at the same level is low with intramedullary nailing (IMN); (ii) the type of fracture (open/closed) and type of reduction (open/closed) affect time to union. Seventy-eight patients who had been treated with IMN for fracture of both forearm bones and had at least 1 year of follow-up were included in the study retrospectively. All the patients were treated by IMN following closed reduction or open surgery. Patients were followed clinically and radiologically. Age, open or closed fracture, time to union, and occurrence of synostosis were documented. The mean age of the patients was 33.4 years. Fifty-three (68%) patients were male. Forty-eight (61.5%) patients had high velocity injuries. The mean follow-up was 26.4 (12-46) months. According to the Grace and Eversmann scoring system, 95% had good or excellent outcomes. The mean DASH score was 10.5 (0-56). Union rate was 100%. Only one patient (1.2%) had a radioulnar synostosis at middle third level. IMN is a safe method that yields a high union rate and contributes to a low incidence of synostosis. Open fracture and open reduction during surgery have no effect on time to union.

Distal phalanx fracture in adults: Seymour-type fracture.

Seymour's fracture is an extra-articular, transverse, physeal, and juxta-epiphyseal open fracture of the distal phalanx seen in childhood. In this study, we present 10 adult cases of fractures localized to the metaphyseal region, 1-2 mm distal to the insertion of the extensor tendon. Mean age was 38 years. Four patients were treated conservatively with a mallet finger splint. Closed reduction and osteosynthesis with Kirschner wires (K-wires) was performed in three of the patients. Three of the patients had open fractures in whom closed reduction could not be performed. They underwent open reduction and osteosynthesis with K-wires. We recommend that extra-articular distal phalanx fractures mimicking mallet finger in adults are called Seymour-type fracture to establish a common language among clinicians to define this type of fracture. These fractures generally occur by hyperflexion of the distal phalanx and can be treated by conservative or surgical methods. The outcomes of conservative and surgical management of Seymour-type fractures depend on the appropriate reduction as well as efficient physical therapy.

Posterior fixation of type IV humeral capitellum fractures with fully threaded screws in adolescents.

PURPOSE: Humeral capitellum fractures comprise approximately 1% of all elbow fractures. In this study, we examined the clinical, radiographic, and functional outcomes following operative stabilization of Bryan and Morrey type IV fractures of the capitellum in adolescents. We applied headless cannulated screws in a posteroanterior direction without damaging the articular cartilage surface of the fractures. METHODS: Eight adolescent patients (six male, two female) with a mean age of 15 ± 2.1 years (range 13-18 years) were treated for type IV (McKee) humerus capitellum fractures. In the preoperative radiological evaluation, anteroposterior and lateral radiographs and computed tomography (CT) images were performed. A lateral surgical approach was used, and cannulated fully threaded headless screws were applied in a posteroanterior direction as fixation materials in the fracture reduction. The Mayo Elbow Performance Score was used in the evaluation of elbow joint functions. RESULTS: Patients were followed up for a mean of 24.6 months. Fracture union was achieved at a mean of 5 ± 0.92 weeks (range 4-6 weeks). The mean elbow extension flexion arc was 135° ± 13.47° (range 110°-150º) and the mean pronation supination arc was 156° ± 4.43° (150°-160°). In one patient, there was nonconformity in the humerus trochlea and in another patient, there was keloid formation on the surgical scar. All patients attained excellent results according to the Mayo Elbow Performance Score. CONCLUSIONS: In the treatment of type IV capitellum fractures in adolescents, open reduction with a lateral surgical approach and fixation using posteroanterior directed, cannulated, fully threaded, headless screws is a reliable method to achieve a pain-free functional elbow joint.

Effects of glutaraldehyde on synovial tissue.

This study investigated the effect of glutaraldehyde on the synovial tissue of rabbits. Four different concentrations of glutaraldehyde solution were injected into one knee and the contralateral glenohumeral joint of rabbits in group A to group D. The concentration levels used in group A and group B were 1000 ppm and 100 ppm, respectively. For group C and group D, samples of rinsing solutions obtained by rinsing arthroscopic equipment with 1 l or 2 l of isotonic saline, respectively, after immersion in 2% glutaraldehyde were used. The contralateral knee and ipsilateral glenohumeral joint of the same rabbits were injected with saline and used as control sites. Rabbits were sacrificed after 1 day, 7 days or 15 days and the histopathological changes in the synovial tissues were compared. The most dramatic inflammatory changes were observed in group A and group B. The histopathological changes were greater after 7 days than after 1 day or 15 days. Group C and group D showed no significant differences when compared with normal synovium. A correlation between the concentration of the glutaraldehyde solution and the number of inflamed joints was observed. Very few or no inflamed joints were seen when samples from rinsing solutions of 1 l or 2 l of saline, respectively, were used.

Anatomical characteristics of the tibial medullary canal and their implications for intramedullary fixation.

The use of intramedullary fixation methods in the tibia is limited by the anatomical characteristics of this bone. In this study, the shape and degree of axial lateral rotation of the medullary canal were determined in 45 human dry cadaver bones using X-ray and computed tomography examinations and direct measurement of rotation in inserted nails. Forty bones (88.8%) had slight and five bones (11.1%) had excessive anterior bowing along the tibial shaft. Six of the 45 bones (13.3%) had an extremely narrow medullary canal. Axial lateral rotation was demonstrated in the middle third of the medullary canal, being on average (+/- SD) 32.35 +/- 16.25 degrees (range 10-75 degrees). This study revealed that extreme narrowing of the medullary canal, axial lateral rotation of the medullary canal, and extreme anterior bowing of the tibial shaft are the anatomical characteristics most likely to cause difficulties when using intermedullary fixation in the tibia.

Flexor tendon injuries of children in zone 2 (FDS repair or not).

Twenty flexor tendons in 13 children with a mean age of 7 years old (range from 9 months to 14 years) were treated by primary suture between 1994-1999. Both tendons were repaired in 12 (60%) digits and only FDP in 8 (40%) with excision of FDS. Mean follow-up was 19 months (from 6 to 55 months). In the 12 fingers with FDS repair, the results were excellent in 2, good in 4, fair in 3 and poor in 3. In the 8 fingers with FDS excision, 2 rated excellent, 5 good and 1 poor. In conclusion, repair of FDP alone with regional excision of FDS simplifies the operative procedure and reduces the number of tendon sutures inside the sheath.

Entrapment of the sensory branch of the radial nerve (Wartenberg's syndrome): an unusual cause.

Isolated neuropathy of the cutaneous branch of the radial nerve is a rarely recognized pathology. It was described in 1932 by Wartenberg, who suggested the name cheiralgia paraesthetica. The syndrome is described as known the entrapment of the superficial branch of the radial nerve. Many different etiologic factors for chronic nerve entrapment have been described, however our case has an unusual cause. A 52 year old man had pain and paresthesia in the area over the lateral aspect of the wrist, thumb and first web six months after Colles' fracture. The patient underwent bony spike resection after five months with ineffective conservative treatment. He has satisfied after this operation. The case was presented because of disappearing his preoperative complaints after the operation with respect to Wartenberg's syndrome constituted a rare cause of bone spike which has not been mentioned in the literature.

Congenital true complete symphalangism of all proximal interphalangeal joints of hands with carpal anomalies: a case report.

Symphalangism is a rare condition which manifests in either PIP or DIP joint congenital fusion. Symphalangism may be with some other skeletal deformities. In our case, all PIP joints of both hands were fused with bilateral hypoplasia of carpal bones and Minaar type III lunatotriquetral coalition congenitally. No motion was detected in PIP joints with absence of cutaneous creases over all PIP joints. Radiologically, carpal hypoplasia and lunatotriquetral coalition were seen in all fingers with the absence of PIP joints. The patient's skeletal survey revealed no other pathology. He had no complaints related to his hands. So, regular follow-up was recommended. This pathology was presented as rarely observed although clinical problem is usually not so much.

[Total bilateral carpal coalition with carpometacarpal fusion: one case]. / Synostose bilatérale complète des os du carpe avec synostose carpo-métacarpienne.

Carpal coalition may involve more than two carpal bones which is more common when coalition occurs as part of a syndrome of congenital malformations. We describe an unusual case of congenital complete entire carpal coalition with massive carpometacarpal coalition except the first carpometacarpal joint and abnormal distal radioulnar joint bilaterally. In addition, radiocarpal joint surfaces were slightly irregular but compatible. There were abnormal distal radioulnar joints and ulnar styloids articulated with the ulnar side of the lunate of the both wrists.

Bilateral median nerve compression at the level of Struthers' ligament. Case report.

Struthers' ligament syndrome is a rare cause of median nerve entrapment. Bilateral compression of the median nerve is even more rare. It presents with pain, sensory disturbance, and/or motor function loss at the median nerve's dermatomal area. The authors present the case of a 21-year-old woman with bilateral median nerve compression caused by Struthers' ligament. She underwent surgical decompression of the nerve on both sides. To the authors' knowledge, this case is the first reported bilateral compression of the median nerve caused by Struthers' ligament. The presentation and symptomatology of Struthers' ligament syndrome must be differentiated from median nerve compression arising from other causes.

[Symptomatic triangular bone. A case report]. / Os triangulaire pathologique. A propos d'un cas.

Os triangulare is an accessory bone found in the triangular cartilage of the wrist just distal to the end of the ulna and is generally asymptomatic. A case report of symptomatic Os triangulare is reported. Treatment associated immobilization and anti-inflammatory medication.

Mathematical relations between the lengths of the metacarpal bones and phalanges: surgical significance.

The mathematical relationship between the lengths of the metacarpals and phalanges is important in hand surgery because of its role in determining the lengthening of the tubular bone size or the length of a prosthesis. The purpose of the present study is to perform the measurements on the hand radiographs, and to determine possible mathematical relations between the lengths of the metacarpals and phalanges. The lengths and widths of metacarpals and phalanges were measured in millimeters on hand roentgenograms of 100 normal voluntary subjects (50 men, 50 women) and the results were evaluated with a descriptive analysis test. The relations between the lengths of the metacarpals and phalanges were mathematically investigated on several sets of data. Unchangeable proportions between the metacarpals and phalanges lengths were found and formulated. Because any defects or faults of the hand, especially shortness, can corrected with current improved surgical techniques, a knowledge of the morphometric relations between the lengths of metacarpals and phalanges may be useful for such surgical interventions.

Variations of abductor pollicis longus and extensor pollicis brevis muscles: surgical significance.

To investigate variations of the abductor pollicis longus and the extensor pollicis brevis muscles, an anatomic study was performed on 15 cadaver forearms. Some variations were observed as reported in previous studies. An unusual insertion of the abductor pollicis longus muscle and the extensor pollicis brevis muscle also was encountered during the dissection. Both tendons of these muscles were found to have inserted into the inferior side of the base of the first metcarpal bone together, instead of dorsal side. Our study suggested that the extensor pollicis brevis muscle and the abductor pollicis longus muscle differentiate from a common muscle.