Comparison of functional metacarpal splint and ulnar gutter splint in the treatment of fifth metacarpal neck fractures: a prospective comparative study.

BACKGROUND: Fifth metacarpal fractures are the most common fractures of the hand. These fractures are generally treated with conservative methods. The aim of this study was to compare the radiological and clinical outcomes of two conservative treatment methods, functional metacarpal splint(FMS) and ulnar gutter splint(UGS), for the treatment of fifth metacarpal neck fractures. METHODS: A prospective comparative study was designed to assess the conservative treatment of isolated and closed stable fractures of the fifth metacarpal neck. In total, 58 patients were included in the study and were treated with FMS or UGS after fracture reduction in a consecutive order. Angulation, shortening and functional outcome (QuickDASH scores and grip strengths) were evaluated at the 2nd and 6th months. RESULTS: Forty patients returned for follow-up. Twenty-two patients were treated with FMS, and 18 patients were treated with UGS. The average age was 28 years (SD ± 12, range;18-43) in the FMS group and 30 years (SD ± 14, range;18-58) in the UGS group. After reduction, significant correction was achieved in both groups, but the average angulation was lower in the FMS group(16 ± 7) compared with the UGS group (21 ± 8)(p = 0.043). However, this better initial reduction in FMS group(16 ± 7) could not be maintained in the 1st month follow-up (21 ± 5) (p = 0.009). In the FMS group, the improvement in QuickDASH scores between the 2nd and 6th month follow-up was significant (p = 0.003) but not in the UGS group(p = 0.075). When the expected grip strengths were calculated, the FMS group reached the expected strength values at the 2nd month follow-up, whereas the UGS group still exhibited significantly lower grip strength at the 2nd month follow-up(p = 0.008). However, at the end of the 6th month follow-up, both groups exhibited similar reduction, QuickDASH and grip strength values. CONCLUSIONS: In stable 5th metacarpal neck fractures, FMS is adequate to prevent loss of reduction and yields faster improvement in clinical scores with earlier gain of normal grip strength compared with UGS. However, in the long term, both FMS and UGS methods yield similar radiological and clinical outcomes. Patient comfort and compliance may be better with FMS due to less joint restriction, and these findings should be considered when deciding the treatment method. TRIAL REGISTRATION: ISRCTN79534571 The date of registration: 01/04/2019 Type of study/level of evidence: Therapeutic, II.

Unusual entrapment of deep peroneal nerve after femoral distal extension osteotomy.

The lateral exposure of the supracondylar femur includes the risk of damaging the neurovascular structures or tightening of the neurological structures within the popliteal fossa may occur as a complication of the osteotomy. Although different pathways of common peroneal nerve (CPN) have been reported throughout the literature, division of deep and superficial branches above the supracondylar femur level has not been reported. A 15-year-old boy with bilateral knee flexion contracture and spastic diplegic cerebral palsy underwent bilateral femoral distal extension osteotomy. The authors found an unusual higher division of CPN above the supracondylar femur level. This report is aimed at warning surgeons about the division of the CPN at a higher level and highlighting a need for a high-powered cadaveric research.

Neurological complications after supracondylar femoral osteotomy in cerebral palsy.

BACKGROUND: Knee flexion contracture in children with cerebral palsy (CP) is very common and functional impairment leads to a crouch gait. Correction of the knee flexion contracture and improvement of the gait pattern by supracondylar femoral extension osteotomy seems to be a more effective method than distal hamstring procedures in long-standing severe crouch. Only a small number of publications reported the neurological complications of this surgical technique. This study was planned to identify the risk factors leading to neurological complications after supracondylar femoral extension osteotomy in patients with CP. METHODS: Supracondylar femoral osteotomies performed for a primary diagnosis of CP with rigid knee flexion deformity of 10 to 30 degrees were included in the study. Supracondylar femoral extension osteotomy was performed in 28 patients (total: 48 cases). Neurological complication was not detected in 43 cases (group 1) and detected in 5 cases (group 2). Previous surgical operation, concomitant operations on the same extremity, application of a brace or long leg cast after operation, preoperative and postoperative popliteal angle, amount of correction, radiologic correction, tourniquet time, level of malnutrition, and emotional state were reviewed. RESULTS: There were 18 boys and 10 girls. The mean age was 12±4 years in group 1 and 13±1 years in group 2. Except 6 patients, all patients had concomitant operations (38 cases in group 1 and 4 cases in group 2). Postoperatively, long leg cast was used in 38 cases and brace in 10 cases. In group 1 mean correction was 23±3.8 degrees and in group 2 it was 19±5.7 degrees. CONCLUSIONS: Correlation was not found between the incidence of neurological complications and amount of correction and deformity. After supracondylar femoral extension osteotomy, all patients must be suspected of neurological complication, and measures taken to alleviate the stretch at once if nerve palsy is diagnosed. LEVEL OF EVIDENCE: Level IV.

Isolated foot metastasis of squamous cell carcinoma of the lung: a rare location.

Squamous cell carcinoma of the lung usually presents as a local rather than a metastatic disease. We present a 55-year-old male who was referred to the orthopedics and traumatology clinic for evaluation of pain and discomfort around the left ankle 2 months after diagnosis of locally advanced non-small cell (squamous cell) lung cancer. Physical examination revealed nonspecific pain and tenderness around the ankle. T2-weighted MR images showed lesions like a bone marrow edema around the talar head and neck. Whole body dynamic bone scan revealed a metastatic lesion only in the foot. The patient died 4 months after diagnosis of the metastasis. Early diagnosis of foot metastasis may be challenging and delays in diagnosis of up to 24 months have been reported. Foot metastases are usually associated with advanced metastatic disease and survival rates are poor. Although metastatic disease of the foot is rare, it should be considered in the diagnosis of a painful foot in the elderly lung cancer patients. Palliative treatments such as pain relief medications should be chosen for patients with an expectancy of short survival whereas aggressive approaches may be applied for those with longer survival expectations.