Managing Severe Postburn Wrist Flexion Contracture by Proximal Row Carpectomy and Abdominal Interpolation Flap.

Introduction: Postburn upper extremity contractures can greatly diminish the quality of life. To successfully manage these contractures and achieve successful functional outcomes, an optimal surgical method should be planned to address all affected tissues on the extremities. Conventional soft tissue transfers after releasing the contracture, such as skin grafts or flaps, may be insufficient. In addition to capsulotomy, tendon release, and lengthening procedures, more aggressive modalities may be indicated. Methods: In this retrospective study, patients who developed wrist flexion deformities due to burn injuries and underwent proximal row carpectomy and abdominal interpolation flaps were included. Results: Between January 2019 and June 2020, 5 patients underwent surgery using this technique. All patients were male, 2 had thermal burns, 2 had electrical burns, and 1 had chemical burns. Preoperatively, all patients had severe flexion deformities ranging from 70° to 85°. There were no postoperative complications, and stable wrists with a good and functional alignment were achieved, although the preoperative and postoperative range of motion differences were limited, where a postoperative range of motions were ranging from 5 to 15 in terms of extension, 15 to 20 in terms of flexion. Preoperative QuickDash scores were between 79.5 and 95.5, postoperative scores ranged from 25 to 36.4. Conclusion Proximal row carpectomy shortens the length of the wrist, resurfaces the wrist joint, and provides a release in tendons and other soft tissues. Together with soft tissue transfer, this technique can be used for severe wrist flexion contractures.

Introduction: Les contractures du membre supérieur survenant à la suite d'une brûlure peuvent entraîner une importante altération de la qualité de vie. Pour gérer ces contractures avec succès et obtenir des résultats fonctionnels satisfaisants, une méthode chirurgicale optimale englobant tous les tissus affectés du membre doit être planifiée. Les transferts conventionnels de tissus mous après libération de la contracture, comme les greffes ou les volets cutanés peuvent ne pas suffire. Des modalités plus agressives peuvent être indiquées en plus d'une capsulotomie, de la libération des tendons et des procédures d'allongement. Méthodes: Cette étude rétrospective a inclus des patients ayant développé des déformations en flexion du poignet causées par des brûlures et ayant subi une carpectomie de la rangée proximale avec insertion de lambeaux abdominaux. Résultats: Cinq patients ont été opérés entre janvier 2019 et juin 2020 selon cette technique. Tous les patients étaient des hommes; deux avaient des brûlures thermiques, deux avaient des brûlures électriques et un avait des brûlures chimiques. En préopératoire, tous les patients avaient une déformation sévère en flexion allant de 70° à 85°. Il n'y a pas eu de complications postopératoires et des poignets stables avec un bon alignement fonctionnel ont été obtenus. Toutefois, les différences entre l'amplitude préopératoire et postopératoire étaient limitées: l'amplitude articulaire postopératoire était comprise entre 5° et 15° d'extension et entre 15° et 20° de flexion. Les scores QuickDash préopératoires étaient compris entre 79,5 et 95,5 et les scores postopératoires entre 25 et 36,4. Conclusion La carpectomie de la rangée proximale raccourcit la longueur du poignet, recrée la surface de l'articulation du poignet et procure une détente des tendons et autres tissus mous. Conjointement avec un transfert de tissu mou, cette technique peut être utilisée en cas de contractures en flexion sévères du poignet.

Wedge osteotomy combined with internal fixation in the treatment of Mayo IIB olecranon fractures.

OBJECTIVE: This study aimed to biomechanically compare the maximum rotational, axial movements, and compression forces between fracture fragments before and after 1-4 mm fracture site resorption among interlocking nails, compression nails, and newly designed compressive anti-resorption (CARES) nails compressed with tube and coil spring. METHODS: We determined the maximum axial/rotational movements and interfragmentary compression loads between fragments on 10 interlocking nails, 10 compression nails, and 10 CARES nails with 30 composite femurs. Using a compression-distraction testing device, 6 N·m external and internal torques were applied, and we evaluated the maximum rotational and axial displacement between fragments after 1-4 mm fracture site resorption. RESULTS: When 6 N·m of internal-external rotation torque was applied after 2 mm fracture site resorption, the maximum rotational displacement between fragments in the CARES nail was 3 ± 0.52 mm, 101% less than the 6.03 ± 0.83 value in the compression nail and 100% less than the 6 ± 1 mm value measured in the interlocking nail (P=.000). The compression between fragments was 298 ± 72 N in the CARES nail after 1 mm of resorption, while this value was measured as 0 in the other nails. There was a significant difference in rotational, axial stability, and interfragment compression among the different femoral nails after 1-4 mm fracture site resorption. CONCLUSION: The CARES nail having additional coil springs seems significantly biomechanically superior to compression nails and interlocking nails, providing maximum rotational, axial stability, and interfragment compression after fracture site resorption.

Comparison of the Miniaci and Dugdale techniques on functional outcomes in medial open wedge high tibial osteotomy.

PURPOSE: To compare the correction angles determined by the Miniaci and Dugdale techniques in patients treated with medial open wedge high tibial osteotomy (MOWHTO) and show their impact on clinical outcomes. METHODS: Seventy-four patients constituted the study group. The correction angles in Group 1 were measured using the Miniaci technique, and those in Group 2 were measured using the Dugdale technique. The clinical evaluations included the Tinetti Gait and Balance Assessment (TGBA), the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) scores, and the Visual Analogue Scale (VAS). The effect of the correction angle on the patient's clinical outcomes was evaluated. Measurement techniques were also changed between groups for comparison. RESULTS: Seventy-four patients (62 females, 12 males) with a mean age of 53.7 ± 4.9 years were followed up for a mean of 67.4 ± 5.5 months. The TGBA, WOMAC, and VAS scores were improved at the last follow-up compared to the preoperative scores (p < 0.05). The preoperative TGBA and WOMAC scores were not significantly different between the two groups, but the last follow-up TGBA and WOMAC scores in Group 2 were worse than those in Group 1 (p < 0.05). When measuring techniques were changed, the preoperative correction angle (PCA) value and the last follow-up correction angle (LFCA) value were lower in Group 1 measured with the Dugdale technique but higher in Group 2 measured with the Miniaci technique (p < 0.05). CONCLUSION: Since the correction angle values measured with the Miniaci technique in MOWHTO are higher than those measured with the Dugdale technique; the functional results are better. LEVEL OF EVIDENCE: Retrospective cohort study, III.

Results of arthroscopic treatment for anteroinferior shoulder instability using a single anterior working portal using birdbeak.

BACKGROUND: The shoulder joint is the joint with the most dislocations in all joints. The arthroscopic surgery method is considered the gold standard because it creates less soft tissue damage, shorter hospitalization and surgery time, and less restriction of movement after surgery in shoulder instability. Anterior single portal technique has become popular recently. In this study, it was aimed to evaluate the results of the anterior single portal repair technique using "birdbeak". We try to evaluate if this technique is a reliable technique and has the same or more advantages of two portal arthroscopic surgery and make the surgery easier for surgeons. METHODS: In the total of 40 patients who underwent arthroscopic surgery for traumatic recurrent anterior shoulder dislocation between January 2017 and February 2020, this study included 19 patients with the surgical technique of arthroscopic isolated anterior labrum tear repair using a birdbeak from the anterior single working portal. Clinical results were evaluated with the Simple Shoulder Test (SST), Rowe Score for Instability (RWS) and Oxford Shoulder Instability Score (OSIS) tests before and after surgery. The relationship between the time to surgery after the first dislocation and clinical outcomes was also examined in the study. Kolmogorov-Smirnov and Shapiro-Wilk tests were used to control the assumption of normality. In addition, Pearson correlation and Spearman correlation analyzes were used to test the relationship between the variables. RESULTS: The mean follow-up period of the 19 patients included in this study was 33.1 months. The mean time to surgery after the first dislocation was 18.4 months. The mean preoperative number of dislocations was 5.3. The mean number of anchors used in the repair was 2.1. No recurrent dislocations were observed after surgery. A significant difference was observed between preoperative and postoperative SST, RWS and OSIS scores (respectively, p = 0.000 < 0.001, p = 0.000 < 0.001, p = 0.000 < 0.001). There was no statistically significant relationship between the time elapsed after the first dislocation and the postoperative SST, RWS, OSIS scores (respectively, p = 0.43 > 0.05, p = 0.39 > 0.05, p = 0.31 > 0.05). CONCLUSION: It has been observed that the repair technique applied using the "birdbeak" from the anterior single working portal is a successful treatment, and further studies are required due to the limited literature.

A new femur intramedullary nail with tube and coil spring for maximum interfragmentary rotational and axial stability after fracture site resorption.

OBJECTIVE: This study aimed to biomechanically compare the maximum rotational, axial movements, and compression forces between fracture fragments before and after 1-4 mm fracture site resorption among interlocking nails, compression nails, and newly designed compressive anti-resorption (CARES) nails compressed with tube and coil spring. METHODS: We determined the maximum axial/rotational movements and interfragmentary compression loads between fragments on 10 interlocking nails, 10 compression nails, and 10 CARES nails with 30 composite femurs. Using a compression-distraction testing device, 6 N·m external and internal torques were applied, and we evaluated the maximum rotational and axial displacement between fragments after 1-4 mm fracture site resorption. RESULTS: When 6 N·m of internal-external rotation torque was applied after 2 mm fracture site resorption, the maximum rotational displacement between fragments in the CARES nail was 3 ± 0.52 mm, 101% less than the 6.03 ± 0.83 value in the compression nail and 100% less than the 6 ± 1 mm value measured in the interlocking nail (P=.000). The compression between fragments was 298 ± 72 N in the CARES nail after 1 mm of resorption, while this value was measured as 0 in the other nails. There was a significant difference in rotational, axial stability, and interfragment compression among the different femoral nails after 1-4 mm fracture site resorption. CONCLUSION: The CARES nail having additional coil springs seems significantly biomechanically superior to compression nails and interlocking nails, providing maximum rotational, axial stability, and interfragment compression after fracture site resorption.

Structural validity and internal consistency of the Shoulder Pain and Disability Index in Turkish patients with rotator cuff disease: A proposal of a new version.

BACKGROUND: The Shoulder Pain and Disability Index (SPADI) is a widely used patient-reported outcome questionnaire in patients with shoulder diseases; however, the structural validity and the internal consistency of the Turkish SPADI is unclear in rotator cuff disease. OBJECTIVE: To assess the internal structure of the Turkish SPADI in patients with rotator cuff disease. METHODS: A total of 109 patients with unilateral rotator cuff disease were assessed. The COnsensus-based Standards for the selection of health Measurement INstruments checklist was used for the methodological design of the study. A confirmatory factor analysis was performed, and the model fit was assessed by using the comparative fit index (CFI), the Tucker-Lewis index (TLI), the root mean square error of approximation (RMSEA), and the standardized root mean square residual (SRMR). The factor structure was examined with a principal component analysis. The internal consistency was assessed using Cronbach's alpha. RESULTS: The validity of the two subscales was not confirmed. The principal component analysis showed the Turkish SPADI consisted of one factor, and the one-factor model of the Turkish SPADI also was not confirmed. When two items were deleted, the one-factor model of the new version of the Turkish SPADI had a better fit (CFI = 0.978, TLI = 0.971, RMSEA = 0.058, SRMR = 0.043). The internal consistency of the new version of the Turkish SPADI was high (Cronbach's alpha = 0.92, 95% CI = 0.90-0.94). CONCLUSIONS: We suggest that the modified version of the Turkish SPADI should be used for patients with rotator cuff disease. The total score of the modified version should be considered.

Evaluation of Patients with Acromioclavicular Joint Separation Treated Using the Clavicular Hook Plate.

BACKGROUND: This study aimed to evaluate the outcomes of patients who underwent surgical treatment using the clavicular hook plate for diagnosed Rockwood Type 3 - Type 4 - Type 5 acromioclavicular joint separation. MATERIAL AND METHODS: Patients who were operated with the diagnosis of acute traumatic acromioclavicular joint separation between the years 2017-2021 were evaluated retrospectively. Patients' age, gender, mechanism of injury, time to surgery, follow-up duration, and complications were evaluated. Functional results were evalu-ated using pre-op and post-op VAS and the Constant-Murley Shoulder Score. RESULTS: A total of thirty patients admitted with the diagnosis of acromioclavicular joint separation were included. All patients underwent surgical treatment using the clavicular hook plate. Twenty (66.6%) patients were male and 10 (33.6%) were female. Seventeen of the patients were admitted due to sports injuries, 6 due to traffic accidents, and 7 due to workplace accidents. The patients were followed up for an average of 26.1 weeks. The Rockwood Classification was used for classification of injuries. Accordingly, 12, 13, and 5 of the patients had Type 3, Type 4, and Type 5 injury, respectively. While the mean pre-op VAS score was 7.4 (5-9), it was 1.8 (1-4) in the post-op period. The mean pre-op Constant-Murley score was 31.5 (22-42), compared to 85.1 (72-100) in the post-op period. The differences between the pre-op and post-op VAS and Constant-Murley Shoulder Scores were statistically significant. CONCLUSION: In this study, we achieved good functional results in the treatment of acromioclavicular joint separation by using a clavicular hook plate providing stable fixation and allowing early mobilization.

Use of single-layer artificial dermal template in patients with trauma and burns.

OBJECTIVE: Artificial dermal templates (ADTs), were designed initially to provide extracellular matrix and skin substitute for extensive burn injuries. Use of ADTs in a variety of other indications, has also been described in the literature. In this study, we describe our experience of using ADTs for different indications in burn contractures and wound coverage. METHOD: In this retrospective study, patients requiring burn scar contracture release, permanent wound coverage for acute traumatic wounds and temporary wound coverage to prepare for complex reconstructions, and where the ADT Pelnac (Gunze Ltd., Japan) was applied, were evaluated. Data regarding patient sex, age, type and location of injury, comorbidities, operations and complications were recorded. RESULTS: A total of 24 patients were included in the study, of whom 12 patients were operated on for burn contractures. ADTs were used with split-thickness skin grafts (STSGs) or Z-plasties in a single-stage procedure. In six patients, ADT and STSGs were used to cover defects with exposed bone or tendon. Of the patients, six had their wounds covered temporarily while they were stabilised for complex reconstructions or were awaiting definitive histopathological results. Revisional surgeries due to graft failures or insufficient contracture releases were required by 12 patients. All temporary wound coverage patients had successful flap reconstructions after stabilisation of their general status, had tumour-free margins in the histopathological examination, and no necrosis or infection was seen on follow-up. CONCLUSION: In this study, ADTs had positive effects on selected patients, but comprehensive and comparative clinical studies are needed for different indications to choose between these templates.

Efficacy of balance training on postural control in patients with rotator cuff disease: a randomized controlled study.

We evaluated the efficacy of adding balance training to a physical therapy program on postural control and health-related quality of life in patients with rotator cuff disease. Forty-two participants were randomly allocated to the control and intervention groups. Both groups received physical therapy (education, stretching, supervised strength training, and home exercise program) 3 days/week for 6 weeks. The intervention group was instructed to perform balance exercises at home. The primary outcomes were the stability index, the Fourier transformation (F5 and F6), the weight distribution index, and the fall index, as assessed by the posturography during eight conditions with different combinations of standing (solid surface, pillows, and different head positions) and vision (eyes open/closed). The secondary outcomes included the Western Ontario Rotator Cuff Index to assess the health-related quality of life, the Shoulder Pain and Disability Index, and the Numeric Pain Rating Scale. The adherence to in-person and home-based therapy was high (>83%). The intervention group significantly improved the stability index, F5, and F6 parameters but each in only one condition (P < 0.05). No significant improvement was found in the conditions for the other primary outcomes and in the health-related quality of life. (P > 0.05). We conclude that adding the balance training protocol to the physical therapy program does not improve postural control and health-related quality of life in patients with rotator cuff disease.

The associations of emotional health with pain, disability, and health-related quality of life in patients with rotator cuff disease.

BACKGROUND: Psychosocial factors have been associated with poor outcomes in patients with rotator cuff disease. Emotional health is one of these factors, and relationships between emotional health and outcome measures evaluated before and after physical therapy have not been reported. AIM: To investigate the associations of baseline emotional health status with pre-treatment, post-treatment, and pre-to-post changes in pain, disability and health-related quality of life in patients with rotator cuff disease. METHODS: Forty-one patients with rotator cuff disease were included. Emotional health was measured with the emotions domain of the Western Ontario Rotator Cuff Index (WORC). The outcomes were the WORC-total, the Shoulder Pain and Disability Index, and the numeric pain rating scale. All outcomes were measured at baseline and 6-week follow-up. RESULTS: The baseline emotional health score and the outcomes scores were moderate to strong, and weak to moderate correlated at baseline and at follow-up, respectively. There was no correlation between the baseline emotional health score and the changes in the outcome measures from baseline to follow-up. CONCLUSIONS: Lower baseline emotional health status was associated with worse outcomes in pain, disability and health-related quality of life at baseline and follow-up in patients with rotator cuff disease. However, the changes in these outcome measures from baseline to follow-up were not correlated with the baseline emotional health status. In clinical practice, an assessment of patients' emotional health status using standardised measures may help to predict post-treatment outcomes, and a multidisciplinary cooperation (e.g., among physical therapists and psychologists) may enhance outcomes.

An uncommon injury: Motorcycle chain injury of the hand, its socioeconomic outcome, and prevention.

INTRODUCTION: The aim of the study was to define the characteristics of motorcycle chain injuries leading to serious limb loss, evaluating its socioeconomic outcome. HYPOTHESIS: The severity of injury with motorcycle chain is associated with hospitalization day and morbidity. MATERIAL AND METHODS: Total of 3486 patients applied to the two Centers of the Hand Surgery Clinic and 42 of them with injuries originating from squeezed hands between the motorcycle chain and the rear sprocket were included. Injured extremities were evaluated with the MHISS. In the retrospective analyses, patients were divided into groups according to the severity of injury and compared and patients who underwent replantation, flap and primary repair treatment protocols were also compared. RESULTS: The number of patients with dominant hand injuries was 33 patients (78.5%). Inquiry of education level revealed that 24 (57.1%) patients graduated from primary school. According to MHISS, 76.2% of patients had major and severe injuries (mean: 95.05). Mean hospitalization time was 2.83 (range: 1-8) days. Mean time to returning to work was 2.71 (range: 1-5) months. The hospitalization days and return to work were longer in patients have major injury according to MHISS (p=0.006). The necrosis was observed three of the 9 (33.3%) replanted fingers. Flap necrosis was observed in two of the 15 (13.3%) cases. DISCUSSIONS: Most of these injuries are severe and major according to MHISS. As the severity of the injury increases, the duration of hospital stay and the return to work are prolonged. LEVEL OF EVIDENCE: IV; Economic/Decision Analysis.

Effect of boric acid on cartilage formation of osteochondral defects in rabbit knee: An experimental study.

BACKGROUND: The present study aimed to investigate the healing of articular cartilage with boric acid (BA) injection in an experimental cartilage defect model of rabbit knee. METHODS: Nine skeletally mature female New Zealand White rabbits were used. The right knees of the rabbits were assigned as the study group and injected with the BA solution and the left knees of the rabbits as the control group. Under anesthesia, a cylindrical full-thickness osteochondral defect (4 mm in diameter and 3 mm in depth) was formed using a drill on the anterior side of the articular surface of the medial femur condyle. The BA solution was administered to the right knees of rabbits in the form of an intra-articular injection (8 mg/kg) for 6 weeks, at the same day and hours each week. The animals were euthanized at the end of the 2nd month. RESULTS: In both macroscopic evaluation and microscopic evaluation, statistically significant differences were observed in the BA injection group compared with the control group (p<0.05). In the macroscopic examination of the defect area, statistically significant differences were observed between the groups in terms of degree of defect repair, integration to border zone, and macroscopic appearance (p<0.05). The averaged results of all evaluated parameters of the International Cartilage Repair Society visual histological assessment score were better for the BA group. CONCLUSION: The healing process of the cartilage injury could be improved by BA injection administration. In future, BA may safely be used as an additional treatment modality in clinical practice to enhance the healing process of cartilage injuries, which are commonly observed orthopedic problem.

Efficacy of calcium phosphate cementing in the surgical treatment of Sanders Type II and III calcaneal fractures using screw fixation with sinus tarsi approach.

OBJECTIVE: This study aimed to determine the effectiveness of calcium phosphate cementing in the surgical treatment of Sanders type II and III calcaneal fractures using screw fixation with sinus tarsi approach. METHODS: In this retrospective study, 85 feet of 84 patients (74 males, 10 females; mean age 43 [17-61] years) in whom screw fixation was performed using the sinus tarsi approach for Sanders type II or III calcaneal fractures were included. The mean follow-up was 28 (14-39) months. Patients were categorized into 2 groups on the basis of whether calcium phosphate cement (CPC) was used. Group 1 had 37 patients with CPC (38 calcaneal fractures) and group 2 had 47 patients without CPC (47 calcaneal fractures). In the clinical assessment, the American Orthopedic Foot Ankle Society (AOFAS) hind foot score and the Maryland Foot Score (MFS) were used at the final follow-up. In the radiological assessment, Bohler's angle on plain radiograph and posterior facet step-off on computed tomography were measured pre-and postoperatively. RESULTS: At the final follow-up, the mean Bohler's angle was 26.2° (20°-33°) in group 1 and 26° (17°-30°) in group 2 (P = 0.85). The mean posterior facet step-off was 1.6 (0-5) mm in group 1 and 1.5 (0-5) mm in group 2 (P = 0.85). The mean AOFAS score was 83.8 (59-100) in group 1 and 85.8 (60-100) in group 2 (P = 0.5). The mean MFS was 86.3 (66-100) in group 1 and 87.7 (66-100) in group 2 (P = 0.62). CONCLUSION: Evidence from this study have shown that CPC may have no significant effect on clinical and radiological outcomes in the surgical treatment of Sanders type II and III calcaneal fractures using screw fixation with sinus tarsi approach.

The relationship of range of motion and muscle strength to patients' perspectives in pain, disability, and health-related quality of life in patients with rotator cuff disease.

BACKGROUND: The literature emphasizes that a consideration of patients' perspectives is an important part of the assessment process; however, it is ignored by many clinicians because they believe physical impairment measures can reflect patients' perspectives about their symptoms. But the relevance of changes in physical impairments to changes in patient-reported outcome scores in rotator cuff disease is ambiguous. AIMS: The purpose of this study is to determine the relationship between changes in glenohumeral range of motion (ROM) and shoulder muscle strength and changes in pain, disability, and health-related quality of life scores before and after physical therapy in patients with rotator cuff disease. METHODS: This was a retrospective study of thirty-nine patients with unilateral rotator cuff disease. All patients received a 6-week physical therapy program. The outcome measures were glenohumeral ROM, shoulder muscle strength, pain and disability using the Shoulder Pain and Disability Index (SPADI), and health-related quality of life as measured by the Western Ontario Rotator Cuff Index. All outcomes were measured before and after the treatment period. RESULTS: There were weak correlations between the changes in abduction ROM and the SPADI-total score (r = - 0.32, p < 0.05), and the changes in external rotation strength and the SPADI-disability score (r = - 0.32, p < 0.05). There was no correlation between the changes in the other parameters. CONCLUSIONS: This study implies that the changes in glenohumeral ROM and shoulder muscle strength do not represent the changes in patients' perspectives in pain, disability, and health-related quality of life after the physical therapy program in patients with rotator cuff disease.

Evaluation of Flexor Pollicis Longus Tendon Rupture after Treatment of Distal Radius Fracture with the Volar Plate.

Background The aim of this study is to evaluate the frequency of flexor pollicis longus (FPL) tendon rupture and factors leading to this rupture during the follow-up of patients who underwent volar plate fixation because of distal radius fracture. Patients and Methods A total of 109 distal radius fractures of 102 patients treated with volar plate fixation and periodically followed up for at least 1 year between January 2013 and May 2018 were evaluated. Fractures were categorized according to the AO Foundation/Orthopaedic Trauma Association (AO/OTA) Fracture-Dislocation Classification and Soong's grading was used for classifying volar plate position. All patients operated were inquired retrospectively in terms of flexor tendon rupture. Results Gender distribution revealed 45 females and 57 males. Mean age was 47.9 (range: 17-88) years. Mean period of follow-up was 27 months. Distribution of fractures in accordance with the AO/OTA distal radius classification was 6, 8, 7, 12, 24, 33, 11, and 8 patients with types A2, A3, B1, B2, B3, C1, C2, and C3, respectively. When volar plate positions were analyzed with Soong's classification, it revealed that 79 (72.4%), 23 (21.1%), and 7 (6.5%) plates were grade 0, 1, and 2, respectively. In total, evaluating the three patients with FPL rupture, it revealed that the volar plate was positioned distally during fixation because the fracture line had advanced to the distal of the watershed line, the distal portion of the plate had lost complete connection with the bone, and at this portion, it was observed that the pronator quadratus muscle was not covering the plate entirely (Soong's classification grade 2). Patients did not have additional flexor tendon injury. Conclusion FPL tendon rupture is a rare but serious complication of volar plate fixation performed for distal radius fractures. We believe that appropriate choice of implant and careful surgical technique, along with the close follow-up of patients, with Soong's classification grade-2 volar positions would help in preventing this complication. Level of Evidence This is a Level 3a, differential diagnosis/symptom prevalence study.

The effect of implant choice on varus angulation and clinical results in the management of subtrochanteric fractures.

INTRODUCTION: The aim of this study was to evaluate the effects of implant choice on varus angulation in the management of subtrochanteric fractures. METHODS: Between 2011 and 2016, 58 patients were included in the study and femur locking plate (PF-LCP; Group 1 = 27) and proximal femoral nails (PFN; Group 2 = 31) were compared retrospectively. RESULTS: In group 1, femoral NSA was measured 131,37 ± 1,95 and last follow-up angle was 127,33 ± 2,40. (p = 0,025). The mean Harris hip score was 67.59 ± 17.74 and 63.29 ± 13.83 in Group 1 and Group 2, respectively (p = 0.406). CONCLUSIONS: Plate fixation is not as successful as proximal nails at preventing varus angulation.

Midterm Results of Tension Band Wiring Technique for Acute Rockwood Type III Acromioclavicular Joint Dislocation.

Background The aim of this study was to evaluate the clinical and radiological results of patients with acute type III Rockwood acromioclavicular joint (ACJ) dislocation treated surgically by employing tension band wiring. Methods The study included 24 patients with traumatic type III ACJ dislocations according to the Rockwood classification. The clinical and radiological outcomes of patients were assessed at the final follow-up visit. Implant failure and reduction loss were assessed using radiographs, whereas the Constant-Murley scoring system was used to assess the patients clinically. Results The mean follow-up period was 3.5 ± 1.3 years (range: 1-6 years). The mean age of the patients was 41.8 ± 11.7 years (range: 19-64 years) and the mean length of hospital stay was 2.3 days (range: 1-6 days). The fixation material was removed postoperatively at an average of 7.2 ± 9.9 months (range: 3-40 months). At the end of the follow-up period, the mean Constant-Murley score was 72.5 ± 12.8 (range: 50-90). The ACJ reduction was stable in 13 (54.2%) patients. Residual subluxation was detected in 11 (45.8%) patients. Distal clavicular osteolysis was noted in six (25%) patients. Acromioclavicular osteoarthritis was detected in five (20.8%) operated shoulders on follow-up radiographs. During the follow-up, Kirschner-wire migration and breakage occurred in four (16.6%) and seven (29.1%) patients, respectively. Conclusions This study showed that surgical treatment with the tension band wiring method provided functionally satisfactory results even if complications developed because of the presence of implants. Independent of age, we can recommend it as the primary treatment method for patients who do not have very high expectations regarding their shoulder function. Additionally, we think that reducing the duration of implant retention will reduce the incidence of complications.

Lateral Locked Plating or Dual Plating: A Comparison of Two Methods in Simple Bicondylar Tibial Plateau Fractures.

BACKGROUND: In this study, our aim was to compare the results of the dual locking plate fixation technique and lateral locking plate fixation technique for tibial bicondylar plateau fractures without posteromedial fragment. METHODS: We evaluated 20 patients who underwent surgical treatment due to bicondylar tibial plateau fracture between 2010 and 2015. Ten patients were included in group 1, in which a dual locking plate was employed, whereas 10 patients were included in group 2, in which a lateral locking plate was used. In both groups, functional and clinical outcomes after treatment were rated according to the Knee Society Knee Scoring System, Rasmussen functional score, and Rasmussen radiological score. RESULTS: The mean follow-up time was 24 months. There were no significant differences between the groups with respect to functional and radiographic outcomes at the final follow-up. CONCLUSIONS: In bicondylar tibial plateau fractures without posteromedial fragment, the lateral locking plate fixation technique showed the similar clinical and radiological outcomes as the dual locking plate fixation technique.

Traumatic Anteromedial Radial Head Dislocation in an Adult: A Case of Brachialis Tendon Entrapment.

Isolated traumatic anteromedial radial head dislocation is an uncommon injury in adults. The brachialis tendon interposition rarely interferes with the radial head reduction procedure. In the present paper, we report the case of an 18-year-old male who sustained an injury to his right elbow during a wrestling match and developed isolated anteromedial radial head dislocation. Open reduction had to be performed due to entrapment of the radial head at the brachialis tendon.

Is Subacromial Balloon Spacer Appropriate for Treatment of Irreparable Rotator Cuff Tears in Elderly Patients?

BACKGROUND: The aim of this study was to evaluate the clinical and radiographic results of surgical treatment of irreparable rotator cuff tears by subacromial balloon spacer insertion in patients over 65 years old. MATERIAL AND METHODS: Results of patients with failed conservative treatment for irreparable rotator cuff tears and who underwent subacromial balloon spacer insertion were evaluated retrospectively. The VAS and Quick-DASH scores were used for clinical and functional assessment. RESULTS: Eleven patients were included. Mean age of patients was 69.1 (range: 65-77) years old. Evaluation of anteroposterior shoulder x-rays revealed Hamada grade 2 and grade 1 arthropathy in 10 patients (91%) and 1 patient (9%),respectively. Mean duration of follow-up was 45.09 (±5.43,37-52) months. The difference in the subacromial space measured from standard AP shoulder x-rays in the preoperative period, in the 6th postoperative month, and at the end of follow-up was 5.44 mm (2.29), 6.51 mm (±2.23), and 5.08 mm (±2.13), respectively. Mean Quick-DASH score was 74.49(±14.36) in the preoperative period, compared to 72.19 (±14.38) at the end of follow-up. There was no statistically significant difference between preoperative period and end of follow-up scores in terms of mean Quick-DASH scores (p= 0.232). Mean VAS score was 7.09 (±0.831) in the preoperative period and 6.64 (±0.809) at the end of follow-up. No statistically significant difference was revealed in terms of mean VAS scores when preoperative and end of follow-up scores were compared (p=0.333). CONCLUSION: Clinical and radiographic results of subacromial balloon spacer insertion in the treatment of irreparable rotator cuff tears could not be evaluated as satisfactory.