Risk factors for brachial plexus injury and permanent sequelae due to shoulder dystocia.

Aim: The primary aim of this study was to determine the risk factors for the occurrence of brachial plexus injury in cases of shoulder dystocia. Secondly, it was aimed to determine the factors affecting the occurrence of permanent sequelae in cases with brachial plexus injury. Subjects and Methods: ICD-10 codes were scanned from the records of patients who gave birth between 2012 and 2018, and the records of patients with brachial plexus injury and shoulder dystocia were reached. Shoulder dystocia cases with brachial plexus damage were accepted as the study group, and shoulder dystocia cases without brachial plexus damage were considered the control group. Shoulder dystocia patients with brachial plexus injury and without injury were compared for 2-year orthopedics clinic follow-up reports, surgical intervention, permanent sequelae status as well as birth data, maternal characteristics, and maneuvers applied to the management of shoulder dystocia. Results: Five hundred sixty births with shoulder dystocia were detected. Brachial plexus injury was observed in 88 of them, and permanent sequelae were detected in 12 of these patients. Maneuvers other than McRobert's (advanced maneuvers) were used more and clavicle fracture was seen more in the group with plexus injury (P < 0.05, P < 0.05, respectively). Logistic regression analysis was performed to determine the risk factors of brachial plexus injury. Brachial plexus injury was observed 4.746 times more in infants who were delivered with advanced maneuvers and 3.58 times more in infants with clavicle fractures at birth. Conclusion: In patients with shoulder dystocia, the risk of brachial plexus injury increased in deliveries in which advanced maneuvers were used and clavicle fracture occurred.

Treatment alternative for irreparable rotator cuff ruptures: Arthroscopic biodegradable balloon.

BACKGROUND: The treatment of massive irreparable rotator cuff rupture has still no consensus among shoulder surgeons. It is assumed that symptomatic rotator cuff tendon rupture is accepted as irreparable if retraction amount of tendon is Patte stage 3 on MRI; degree of fatty atrophy is Goutallier stage 3 or 4; narrowing of acromiohumeral distance is lesser than 7 mm and excursion of tendon to repair has decreased and patient has severe pain. Biodegradable balloon is one of the newest methods for the treatment of irreparable massive rotator cuff ruptures. OBJECTIVE: The aim of this study was to assess shoulder function in the patients who underwent biodegradable balloon procedure for irreparable massive rotator cuff ruptures. MATERIALS AND METHODS: Arthroscopic biodegradable balloon method was carried out on the 12 patients, who presented with symptomatic irreparable massive rotator cuff rupture, from October 2010 to November 2013. RESULTS: Preoperative and postoperative mean constant score of patients were 25.8 and 75.4 respectively. The mean Oxford shoulder score of the patients were 21.3 and 42.9 respectively, and mean shoulder abduction degree of the patients were73.5 and 165 respectively. All the patients stated that they were satisfied with the treatment and there was significant regression in their complaints. CONCLUSION: If conservative treatment is insufficient for patients with irreparable rotator cuff tears, biodegradable balloon method has yielded favorable outcomes in terms of pain and functionality in comparison with other surgical methods. Moreover, lesser morbidity, short procedure time and absence of postoperative rehabilitation requirement can be considered as advantages of this method.

Lateral approach to the ankle and distal leg.

Fractures of the distal tibia are usually high-energy injuries and are well known for their soft tissue complications after surgery. Various factors have been studied regarding the possibility of them reducing the incidence of such damage, including timing of surgery, staged surgery, fixation method, and surgical approach. Less invasive surgical techniques with vascularity preserving approaches were proposed as reasonable solutions to this problem. The aim of this study was to investigate the presence of minor vascular structures, which can be preserved during anterolateral approach, possibly contributing to the success of the approach. Lateral approach for the distal tibia was performed in 22 cadaver feet. The mean distance between the lateral malleolus and the superficial peroneal nerve was 12.2 cm. Two different vascular pedicles, from peroneal vessels to muscles of the anterior compartment, were 4.3 and 8.2 cm away from the lateral malleolus, respectively. We conclude that preserving greater vascularity was possible in the lateral approach for the distal tibia, placing the plate in a completely submuscular plane.