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Recent studies on fibular osteotomy for varus gonarthrosis and possible subsequent biomechanical changes have attracted increasing attention to the topic. Existing studies have focused mainly on proximal fibular osteotomy with short follow-up periods. The aim of this study was to investigate changes in the alignment of the coronal plane of the ankle and knee joints in patients who underwent vascularized fibula graft harvest (VFGH). The evaluation was based on functional outcomes and radiological measurements.In the comparison between the VFGH side and the contralateral side, no significant differences in the knee inclination (KI) or talar inclination (TI) angle, knee medial clear space (K-MCS) or ankle medial clear space (A-MCS) distance were noted. However, a significant difference in the hip knee (HKA) angle was observed between the operated and nonoperated sides (0.3° ± 1.8° and 1.5° ± 1.9°, respectively [p = 0.019]). Statistically significant differences in both the knee society score (KSS) and the AOFAS scores were found between the ipsilateral donor limb and the contralateral healthy limb. Although the contralateral healthy side had better clinical scores than the VFGH side, the outcomes of the VFGH side were still satisfactory or excellent.

Objective:Diabetic neuropathy is one of the most common complications of diabetes mellitus. Recovery from peripheral nerve blocks in diabetic patients with neuropathy may be delayed because of axonal degeneration and segmental demyelination. The aim of this study is to compare the infraclavicular brachial plexus block durations in patients with and without diabetes mellitus type 2.Methods:This prospective observational study included 60 patients who were aged 40-80 years, with American Society of Anesthesiologists I-IV physical status and scheduled for elbow, forearm, and/or hand surgery under infraclavicular brachial plexus blocks. All 30 patients in Group DM (patients with diabetes mellitus type 2 diagnosis) and 29/30 patients in Group NODM (patients without diabetes mellitus diagnosis) completed the study successfully. The sensorial block duration was documented as the primary outcome, and the motor block duration, time-to-first pain, numeric rating scale scores at rest/during mobilization, rescue analgesic use, and total consumed doses through the first 2 postoperative days were all documented as the secondary outcomes.Results:Sensorial block duration in Group DM (505 [315-1020] minutes) was longer than in Group NODM (440 [160-780] minutes) (P =.016). Motor block duration was also longer (488.7 ± 153.8 minutes vs 379.2 ± 118.9 minutes; P =.003), and time-to-first pain was prolonged (625 [360-1200] minutes vs 520 [300-900] minutes; P =.004) in Group DM. The highest NRS scores at the 6th hours, 12th hours, and rescue analgesic consumption through the first 2 postoperative days were lower in Group DM (P < .05).Conclusion:This infraclavicular brachial plexus block study highlights the current literature on diabetic patients with respect to longer block durations, prolonged time-to-first pain, lower pain scores, and less analgesic consumption.

Osteoarthritis is a chronic disease that causes serious pain and limitations in activities. Intraarticular corticosteroid injections combined with pharmacological treatment and physiotherapy have been used for years to control the local inflammation and relieve pain in the patients with osteoarthritis. There are several animal experiments which suggested that the intraarticular corticosteroid injections impair cartilage protein synthesis. However, there are no serious evidences suggesting the increase of cartilage impairment. The aim of our study was to compare the efficacy of placebo and intraarticular corticosteroid agents in the patients with symptomatic knee osteoarthritis. One hundred and twenty patients with painful knee osteoarthritis were included in the prospective, randomized, controlled study. The patients were randomized into four groups. Each group consisted of thirty patients. Intraarticular single dose of methylprednisolone acetate (40 mg, 1 ml), Betametazone disodium phosphate (3 mg, 1 ml), Triamsinolon acetonate (40 mg, 1 ml), and serum physiological (0.09% NaCl, 1 ml) were administrated to the groups, respectively. The patients were evaluated by Visual Analog Scale (0–10 cm [VAS]) for the pain severity, and by Lequesne Functional Index for functional state before treatment, and at the 1st, 3rd, 6th, and 12th weeks. Our results showed that single doses of three agents provided symptomatic and functional relief and their effects reduced at the 12th week. However, methylprednisolone acetate was a statistically more effective analgesic as compared to the other agents until the sixth week.

Objective: This study was designed to define fracture lines and comminution zones in OTA/AO 23C3 distal radius fractures from axial computed tomography (CT) images that would influence surgical planning, development of new classifications, and possible implant designs. Methods: Thirty-four consecutive OTA/AO 23C3 fractures treated by a single surgeon between January 2014 and December 2014 were analyzed. For each fracture, maps of the fracture lines and zones of comminution were drawn. Each map was digitized and graphically superimposed to create a compilation of fracture lines and zones of comminution. Based on this compilation, major and minor fracture lines were identified and fracture patterns were defined. Results: All major fracture lines were distributed in the central region of the radius distal articular surface. There is a recurrent fracture pattern with a comminution zone including the scaphoid and lunate fossa; Lister’s tubercle; and ulnar, volar, and radial zones. Conclusion: It is important for the practicing surgeon to understand these four main fragments. Knowledge of this constant pattern should influence the development of new classifications and possible implant designs.

Objective: Bone grafts and even bone substitutes do not meet all of the requirements of bony reconstructions. The aim of this study was to generate bone tissue from autologous adipose tissue-derived mesenchymal stem cells (ATDMSCs) and decellularised bone allografts. Methods: A 1.5 cm bone defect developed in the middle third of the rabbit’s ulna. Reconstructions were carried out using miniplate and screws and interpositional autogenous bone grafts according to the designs of the groups: (1) No touch, (2) cryopreserved, (3) decellularised and (4) ATDMSCs-implanted decellularised bones. Before implantation, ATDMSCs in the last group were labelled with Q-dot and identified microscopically. Results: Graft recovery and irregular callus formation were observed in the first, second and forth groups. In the first group, the organisation of Haversian systems, the structure of the lacunae and the presence of canaliculi ossiums were observed; in the second group, approximately 40% of the Haversian canals contained blood vessels, and canaliculi ossiums in the form of thin filaments were found in 90% of the microscopically examined areas; in the third group, most Haversian canals were empty, most osteocyte canals were devoid of cells, and canaliculi ossiums were absent; in the fourth group, some of the Haversian canals contained blood vessels, and there were partly lacunae containing cells due to decellularisation, whereas in approximately 50% of the examined microscope areas, the presence of canaliculi ossiums with evidence of mesenchymal stem cells differentiated into osteocytes was demonstrated by Q-dot traced cells. Conclusion: In this study, the establishment of a proper niche environment for adipose-derived mesenchymal cells promotes their development into osteogenic cells.

We investigated the use of extracorporeal shock wave therapy (ESWT) in patients with Dupuytren's Disease (DD) palmar nodules in an attempt to reduce the contracture, alleviate the pain (if any), increase the range of motion and quality of life, and delay a probable surgery in the long term. Patients with DD who presented to our hand surgery clinic and fulfilled the inclusion criteria were enrolled. The treatment was performed by the same physician using the ESWT device once a week for six weeks. The patients were evaluated with the VAS score, Quick-DASH questionnaire, and MAYO wrist score, and their grip strength was measured using a Jamar dynamometer. The mean age of the 23 patients included in the study was 51 years. There was a significant improvement in the second measurement of VAS and DASH scores compared with the preoperative values. The increase in the second and final follow-up measurements of the MAYO score and grip strength results compared with the preoperative values was found significant. The table-top test results turned negative in 16 patients. We can suggest that ESWT in the early term can be preferred over costly injections and surgical intervention options as it increases the quality of life and delays the recurrence of contractures.

Objective: Arthroscopically assisted reduction of distal radius fractures was accomplished with fluoroscopic control to obtain precise reduction. The frequency and severity of accompanying intra-articular pathologies were investigated, and functional outcomes were prospectively evaluated. Methods: Twelve adult patients with irreducible or unstable intra-articular distal radius fractures were included. Wrist joints were distracted by bridging external fixators. Articular surfaces restored arthroscopically and stabilized with K-wires under fluoroscopic controls fixators were locked. Clinical evaluations were performed with disabilities of the arm, shoulder and hand (DASH) questionnaire, Sarmiento modification of the Gartland and Werley score (GWSM) and modified Mayo wrist score (MWSM). Results: Triangular fibrocartilage complex (TFCC) tears in six (50%) patients and scapholunate interosseous ligament (SLIL) lesions in five patients (41.6%) were observed. Four TFCC tears accompanied the SLIL lesions. The follow-up period was 1.5 years (16-23 months). No dorsal angulation, loss of radial inclination, and loss of radial length were found at the final radiographs. The DASH scores were approximately 6.1 (0-15.4). The GWSM results were excellent in nine and good in three patients, and the MWSM results were excellent in eight and good in four patients. Conclusion: Anatomical articular surface restoration of the distal radius can be achieved by arthroscopically assisted osteosynthesis under fluoroscopic control. Arthroscopy can be used to determine the intra-articular ligamentous and chondral lesions, and debridement or repair can also be performed when needed to avoid long-term complications.

Objective: In this study, the results of open release surgeries performed for the stiff elbows which were caused by intrinsic, extrinsic or by combination of both factors were evaluated. Methods: Twenty-three elbows of 22 patients who could not perform functional elbow motions were surgically treated between January 2005 and December 2012. The mean age was 30.6±11.4 years (16 to 67 years), and the average follow-up period was 81 months (58 months to 12 years). Elbow arc of motions was recorded pre- and postoperatively. Patients were evaluated clinically by using quick Disabilities of the Arm, Shoulder and Hand (DASH) self-report questionnaire, and MAYO elbow performance scores. Results: The mean preoperative elbow arc of motion was 42 degrees (0-90), and it became 109 degrees (70-140) postoperatively after at least 58-month follow-up. The average increase was 67.8±25 degrees (30-125). The mean Quick DASH score was 18.2±12.7 (6.8 to 63.6). According to MAYO elbow rating system, one patient who had experienced infection following the initial fracture treatment had poor result, three patients had fair results, 17 patients had good results, and one patient who had bilateral elbow stiffness had excellent results. Conclusion: Although good results can be achieved by open release of the stiff elbows, one must keep in mind that preventing the stiffness rather than solving this problem would bring better results. As 15 patients with stiff elbows in this study had a previous surgery performed for an elbow region fracture, stabile fixation, meticulous hemostasis, shorter immobilization period and early rehabilitation can be considered as the most important steps for avoiding elbow stiffness where surgery is indicated.

Objective: We aimed to present the clinical and functional results of the surgical treatment for fractures of the thumb metacarpal base. Methods: Patients who were operated at our clinic for unstable thumb metacarpal intra-articular base fractures with closed reduction and percutaneous pinning and who completed their follow-ups were included in the study. Patients with open fractures, fractures or injuries in the hands or same extremities were excluded from the study. The type of the fracture, its relativity with the joint, demographic data, number and configuration of the wires used, time of surgery, postoperative time to fixation, and complications were evaluated. In the objective evaluation, intra-articular step-off, presence of post-traumatic pain, and pinch and gripping strengths compared with the uninjured side were investigated. Results: The mechanism of injury in 28 patients [26 males and 2 females; mean age, 31 y (range, 19–61 years); 11 left-sided and 17 right-sided] was noted as fall in 27 and motorcycle accident in 1. Mean time to operation was 7 d (range, 1–18 days). K-wires were used for fixation in all cases. A loss of 20% in the pinching and gripping strength was observed in two and one patient, respectively, compared with the uninjured side. Revision surgery was performed in one patient due to fixation failure. Superficial pin tract infection was observed in two patients; both cases resolved with wound dressing and oral antibiotics. Conclusion: Unstable fractures of the thumb base are common in hand surgery practices, and treatment using closed reduction and percutaneous K-wire fixation provides safe and satisfactory results.

Sir, Digital photography is an extensively used tool for documentation of the clinical presentation of patients and medical and surgical procedures, and it is important from both scientific and medicolegal point of view. Best photographs are captured by professional photographers in standard conditions. The staff can hold the stick with both hands and lessen the tremor. [...]we think that selfie stick can be a helpful accessory to take intraoperative pictures without endangering sterile surgical site...