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Objectives This study aims to present the early-period outcomes of patients with Dupuytren's contracture (DC) treated with percutaneous needle aponeurotomy technique. Patients and methods This retrospective study included 28 patients (20 males, 8 females; mean age 63 years; range, 44 to 88 years) (75 fingers) treated with percutaneous aponeurotomy due to DC between November 2011 and December 2015. Patients were evaluated according to their demographic characteristics, presence of additional disease, family history, history of drug use, complication rate, recurrence development, postoperative patient satisfaction, reoperational request, postoperative Disability of Arm Shoulder and Hand Questionnaire and visual analog scale scores. Results Mean follow-up duration was 29 months (range, 12 to 60 months). In the postoperative satisfaction questionnaire, 92.9% (n=26) of patients stated that they were satisfied. In the questionnaire of reoperation request, 82.1% (n=23) of patients accepted the reoperation. While the complication rate was 39.3%, recurrence rate was 35.7%. Conclusion Percutaneous needle aponeurotomy technique may be an effective, simple, and safe method for the treatment of DC.

Objectives: We aimed to present preliminary result of one portal endoscopic assisted release of first dorsal compartment at wrist in a case series with de Quervain disease as a minimal invasive surgical method. Materials and methods: The patients, who underwent an endoscopic-assisted release of the first extensor compartment for de Quervain's disease by same hand surgeon between 2015 and 2017, were retrospectively analyzed. Operative treatment was considered if the patients did not respond to non-operative treatment including oral anti-inflammatory medications, splinting, and steroid injection. Surgical release was recommended after minimum four months of unsuccesful non-operative treatment, including a steroid injection. 10 wrists were treated with one portal endoscopic assisted release. All patients were evaluated at an average of 16.1 months follow-up using visual analog scale (VAS) pain ratings and the Disabilities of Arm, Shoulder and Hand (DASH) score. Results: The mean operating time was 13.9 min (range, 10–21min). The mean VAS and DASH scores were improved from 8.2 to 1.9 and 70.51 to 2.81 respectively. No significant difference was found between operated and non-operated arms in postoperative pinch and strengths. Transient superficial radial nerve paresthesia (two wrists) and significant scar tenderness (one) were identified in three cases. There was no patient that complain of unsightly scar and tendon subluxation. Conclusions: One portal endoscopic assisted release of the extensor compartment is an effective and safe minimal invasive procedure with similar complication rates reported previously in open and endoscopic procedures in patients with de Quervain's disease who are unresponsive to non-operative treatments. Level of Evidence: Level IV Therapeutic Study Keywords: De Quervain's disease, Stenosing tenosynovitis, One portal, Endoscopy, Wrist

Summary Purpose Open surgical release of posterior interosseous nerve (PIN) has been well defined in literature with different surgical approaches. In this retrospective study, we aimed to present outcomes of endoscopic assisted retrograde release of posterior interosseous nerve. Methods From 2015 to 2017, 10 patients with radial tunnel syndrome and concomitant lateral epicondylitis treated endoscopic assisted retrograde posterior interosseous nerve release. Results Mean follow-up time was 24,6 months. Eighty percent of the patients had excellent and good results in final follow-up using the Roles and Maudsley criteria. All of patients but one were satisfied from the surgery in terms of the symptom relief and improved functional state. Conclusion Our study showed that our endoscopic assisted technique could be a good alternative to open techniques. Complication rate of this new technique was similar to open techniques.

In this case report, we aimed to share our experience of arthroscopic finding of chondral lesion can be helpful to detect the location of pellet that between brachial muscle and capsule in a 15 years male subject with left elbow gunshot injury. [Med-Science 2015; 4(2.000): 2271-5]

With the development of microsurgical techniques and successfull multidisciplinary approach; many injuries that require amputation can be treated success fully by extremity preventing surgery. We present a case that admitted to our clinic with open fracture and although had amputation endication, treated with extremity reconstruction surgery.between the total average points of the pre-test and the re-test of the scale was not found statistically significant (p=0.30). As a result of the Turkish version of the scale of the values obtained from the PU is defined to be a reliable and valid scale. Key Words: Amputation, extremity reconstruction, prevention Ozet Mikrocerrahi tekniklerin gelismesi ve basarili multidisipliner yaklasim sayesinde amputasyon ile sonuclanabilecek pek cok yaralanma ekstermite koruyucu cerrahi ile tedavi edilmektedir. Klinigimize acik kirik ile basvuran; amputasyon endikasyonuna ragmen ekstremite rekonstruksiyon cerrahisi yapilarak takip edilen hastanin klinik seyrini sunduk. Anahtar Kelimeler: Amputasyon; ekstremite rekonstruksiyonu, onleme

Background: The anterior cruciate ligament (ACL) is one of the major stabilizing factor of the knee that resist anterior translation, valgus and varus forces. ACL is the most commonly ruptured ligament of the knee. The graft fixation to bone is considered to be the weakest link of the reconstruction. According to the parallel forces to the tibial drill hole and the quality of tibial metaphyseal bone is inferior to femoral bone stock, graft fixation to the tibia is more difficult to secure. AperFix system (Cayenne Medical, Inc., Scottsdale, Arizona, USA) which consists femoral and tibial component that includes bioinert polymer polyetheretherketone (PEEK) is one of the new choice for ACL reconstruction surgery.aim of this study was to assess the clinical outcomes and fixation durability of the AperFix (Cayenne Madical, Inc., Scottsdale, Arizona, USA) system and to determine the effect of patient′s age in arthroscopic reconstruction of the anterior cruciate ligament. Materials and Methods: Patients with symptomatic anterior cruciate ligament rupture underwent arthroscopic reconstruction. Patients were evaluated in terms of range of motion (ROM) values; Lysholm, Cincinati and Tegner activity scales; laxity testing and complications. Femoral tunnel widening was assessed by computer tomography scans. Early postoperative and last followup radiographs were compared. Results: Fifty one patients were evaluated with mean followup of 29 months (range 25-34 months). Mean age at the surgery was 26.5 ± 7.2 years. Lysholm, Cincinati and Tegner activity scales were significantly higher from preoperative scores (Lysholm scores: Preoperative: 51.4 ± 17.2, postoperative: 88.6 ± 7.7 [P < 0.001]; Tegner activity scores: Preoperative 3.3 ± 1.38, postoperative: 5.3 ± 1.6 [P < 0.001]; Cincinati scores: Preoperative: 44.3 ± 17, postoperative: 81.3 ± 13.9 [P < 0.001]). The mean femoral tunnel diameter increased significantly from 9.94 ± 0.79 mm postoperatively to 10.79 ± 0.95 mm (P < 0.05). The mean ROM deficit (involved vs. contra knee) was −7.2 ± 16 (P < 0.001). There was no significant difference for knee score, ROM deficits (30 years −7.06 ± 19) and femoral tunnel enlargement (30 years 0.87 ± 0.43) of the patients with below and above 30 year. There was no significant difference for knee scores and femoral tunnel enlargement between patients with meniscal injuries and don′t have meniscus lesions. Conclusion: The AperFix system gives satisfactory clinical and radiological results with low complication rate. However, long term clinical and radiological results are needed to decide the ideal anterior cruciate ligament reconstruction method.

Background: Osteochondral ankle injuries commonly affect the dome of the talus, and these injuries are a common cause of athletic disability. Various treatment options are available for these injuries including intra-articular hyaluronic acid (HA) and platelet-rich plasma (PRP) injections. The purpose of this study was to compare the effects of HA and PRP as adjunct therapies after arthroscopic microfracture in osteochondral lesions (OCLs) of the talus. Methods: In this prospective, randomized blinded study, 40 patients with talar OCLs in their ankle joints were treated with arthroscopic debridement and a microfracture technique. Thirteen randomly selected patients received PRP, 14 patients received HA, and the remaining 13 patients received saline as a control group. The participants were assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) and visual analog pain scale (VAS) scores after a 15.3-month (range, 11-25 months) follow-up. Results: Postoperatively, all the groups exhibited significantly increased AOFAS scores and decreased VAS scores compared with their preoperative results ( P < .005). The AOFAS scores were significantly increased in the PRP group versus the HA and control groups ( P < .005), although the increased AOFAS scores in the HA group versus the control group were also significant ( P < .005). Similar to the AOFAS scores, the decrease in the VAS scores was significantly lower in the PRP group versus the HA and control groups ( P < .005). In addition, the HA group had significantly lower VAS scores than the control group ( P < .005). Conclusion: Both PRP and HA injections improved the clinical outcomes of patients who underwent operation for talar OCLs in the midterm period and can be used as adjunct therapies for these patients. Because a single dose of PRP provided better results, we recommend PRP as the primary adjunct treatment option in the talar OCL postoperative period. Level of Evidence: Level I, prospective randomized study.

Gluteal compartment syndrome is a rather rare syndrome often leading to severe sequelae, sepsis, renal failure, and even death due to delayed diagnosis. Establishing early diagnosis is essential to prevent complications associated with ischemia. In this article, we report a 56-year-old male patient who developed gluteal compartment syndrome after incisional hernia and nephrectomy surgery in lateral decubitus position. Gluteal muscle insufficiency developing after fasciotomy and Trendelenburg gait improved within two years.

Cerebrotendinous xanthomatosis is a rare, autosomal recessive, lipid storage disease with accumulation of cholestanol in most tissues, particularly in the Achilles tendons. We described a 23-year-old female patient who had progressive painfull swelling of both Achilles tendons due to cerebrotendinous xanthomatosis. We performed surgery on both-side Achilles tendon tumors. Wide degenerative areas of the tendons were resected, and the flexor hallucis longus tendon was harvested and transferred to reconstruct motion function.

Objectives This study aims to investigate the effect of platelet-rich plasma (PRP) on femoral head osteonecrosis and compare it with bone marrow injection and core decompression. Materials and methods A total of 30 healthy, adult, male New Zealand white rabbits (mean weight 2.25±0.15 kg; range 2.0 to 2.5 kg) were used in the study. To create experimental osteonecrosis in all rabbits, 40 mg/kg methylprednisolone acetate was applied intramuscularly. Rabbits were randomly allocated into three groups with 10 rabbits in each: drilling group, PRP group, and bone marrow group. The non-drilled hips of the drilling group were identified as the control group. Results Rate of necrotic bone was lower in the PRP group compared to other groups. Highest rate of necrotic bone was detected in the control group. New bone formation rate was higher in the PRP group compared to other groups. Lowest new bone formation rate was determined in the control group. Inflammatory reaction rate was higher in the PRP group compared to other groups. Conclusion Platelet-rich plasma injection may play a positive role in the treatment of steroid-associated osteonecrosis in a rabbit model.

OBJECTIVES This study aims to evaluate clinical and radiological findings of a series of patients with avascular necrosis of the femur head (ANFH) treated by core decompression and vascular pedicled iliac crest grafting. PATIENTS AND METHODS This retrospective study included 26 hips of 22 patients (14 males, 8 females; mean age 36 years; range 16 to 48 years) with ANFH using the vascularized iliac bone grafting between March 2003 and July 2010 in our clinic. The main predisposing factor was steroid use in 13 patients. All patients were assessed clinically according to the Harris hip score and by radiographs by the Association Internationale de Recherche sur la Circulation Osseuse (ARCO) staging system. RESULTS The mean follow-up was 36 (range 14 to 62) months. Eleven hips (42%) had stage II and 15 hips (58%) had stage III ANFH. The mean Harris scores increased from 52 (range 31 to 63) to 82.8 (range 62 to 90) after surgery. Based on clinical outcomes, 18 hips (69%) were presented as excellent and good, while eight hips presented fair and poor. According to the ARCO staging system, satisfactory results were provided in 17 (65%) of the 26 hips. Two of four hips at preoperatively stage II progressed to stage III, two other hips to stage IV. Five hips at stage III preoperatively progressed to stage IV and these hips had to undergo hip replacement. CONCLUSION Our results suggest that core decompression and the vascular pedicled iliac bone grafting are effective in early stages of ANFH.

Aim: Physicians assessing newborns with risk factors for developmental dysplasia of the hip (DDH) have responsibility for early diagnosis. Written records of the fulfillment of such responsibility is required in medico-legal terms. The present study aims to examine the written records of the hospitals where patients with late-diagnosed DDH were born.Material and Methods: This retrospective study examined the records of the hospitals in which 53 DDH patients aged more than nine months were born. We investigated whether the requirements for the early diagnosis of these patients were recorded in written and interviewed with the obstetricians, pediatricians and family physicians who followed these patients. They were asked about their attitudes toward giving families informational documents about DDH and explaining protective measures verbally.Results: There was no written approved record that they have been informed about the disease in any institution and indicating that the responsibilities for the early diagnosis of these patients were fulfilled. The families were given informational documents in three of five private hospitals and in one university hospital. All of physicians informed the families about the early DDH diagnosis and the things to do, verbally. Conclusion: In case of late-diagnosed DDH, the society as well as the child and the child’s family get harmed socioeconomically. Therefore, it may pose a medico-legal problem. This risk increases more in countries where newborn screening policies are not adequately implemented. In conclusion, written documents taken from families about the early diagnosis of DDH will legally protect physicians and health care organizations.

Objectives This study aims to present our clinical results obtained in arthroscopic limited intercarpal fusion performed without using bone graft in patients with Kienbock's disease. Patients and methods The study included 11 patients with Kienbock's disease (6 males, 5 females; mean age 28.9 years; range 14 to 51 years) who were performed arthroscopic lunate excision and scaphocapitate fusion between November 2012 and December 2013. Bain and Begg Arthroscopic Classification was used for the staging of Kienbock's disease. Quick Disabilities of Arm, Shoulder and Hand and Mayo Wrist scorings were used for clinical evaluation. Results Intercarpal fusion was achieved in approximately 7.2 weeks. There was a statistically significant difference in Mayo Wrist scores of postoperative third and sixth months and pre- and postoperative Quick Disabilities of Arm, Shoulder and Hand scores. There was no postoperative complication. Conclusion According to our study findings, arthroscopic limited intercarpal fusion without using bone graft may be performed in patients with Kienbock's disease. Satisfactory clinical and functional results were obtained as a result of treatment with this method in stage 3 and 4 Kienbock's disease.

Musculoskeletal system is involved in about 20% of the patients diagnosed with tuberculosis. Although musculoskeletal tuberculosis generally affects spine and large joints (hip and knee), hand involvement of the tuberculosis is seen in 10% of the patients with musculoskeletal involvement and also isolated tuberculosis of hand or wrist is much rarer. In the following report, we discuss the case of a 23-year-old male patient who was diagnosed with isolated tuberculosis of the capitate and triquetrum bone. The patient presented with a nonhealing sinus on the left wrist joint. Imaging revealed lytic lesions of the capitate and triquetrum. The diagnosis of tuberculosis was confirmed by histopathological examination on the bone specimen obtained from the debridement and curettage. Antituberculosis therapy was started postoperatively and 1 month later, healing of the sinus was observed. There was no sign of reactivation seen at follow-up 22 months after treatment.

Sciatic nerve paralysis can be seen after hip joint traumatic dislocations and fractures of the posterior wall of acetabulum. In this article, we report sciatic nerve palsy due to heterotopic bone formation in early postoperative phase that was treated with heterotopic bone resection and sciatic nerve neurolysis in a patient who underwent open reduction and internal fixation for hip dislocation and fracture of posterior wall of right acetabulum. [Med-Science 2018; 7(2.000): 434-6]

Purpose: The aim of the present study was to evaluate the effect of microfracture and intraarticular autologous conditioned plasma (ACP) injection on cartilage regeneration in a focal full-thickness chondral defect model created in the knee joint. Methods: Full-thickness chondral defects of 3 × 6 mm(2) were surgically created in right medial femoral condyles (MFC) of New Zealand rabbits, and the rabbits were then divided into three groups according to treatment: Group 1 received only microfracture (mfx), Group 2 received mfx plus intraarticular ACP, and Group 3 received mfx; the defect was covered by the periosteum, and then, ACP was applied subperiosteally and intraarticularly. Twelve weeks after injection, the animals were sacrificed and the femoral condyles were evaluated macroscopically and histologically by hematoxylin-eosin staining. Then, histological sections were scored using the International Cartilage Repair Society (ICRS) visual histological scale. Results: Findings showed that in both mfx/ACP-treated groups, the defects were filled regularly and smoothly, the defects had a greater fill and good integration into the surrounding host tissue, and the repair matrix had more hyaline-like character. On the other hand, defects were filled with an irregular, fibrous cartilage in the mfx-treated group. Histological scores in Group 2 and Group 3 were better compared to Group 1. Conclusion: In the present study, we were able to demonstrate a beneficial effect of intraarticular administration of ACP as a coadjuvant of microfractures in order to regenerate hyaline-like cartilage in full-thickness chondral lesions in a rabbit model.

Background Fractures of the proximal humerus that limit function are quite common. The objective of this retrospective study was to compare deltoid splitting and deltopectoral approaches by using the same fixation method. Methods Eighty-six patients who underwent surgical treatment between September 2005 and July 2011 were included into the study group. Deltoid splitting approach was used by exploring the axillary nerve on Group A patients as described by Codman, and deltopectoral approach was used on Group B patients. Group A consisted of a total of fifty-six patients of whom twenty-two were male and thirty-four were female patients, with a mean age of 62.5 years (range, 26 to 90 years). Group B consisted of a total of thirty patients of whom fourteen were male and sixteen were female patients, with a mean age of 54.8 years (range, 24 to 84 years). PHILOS plate system was utilized as an internal fixation tool in all patients. Functional results and complications of the two groups were compared using Constant scores. Results It was observed that humeral head and tubercular fragment reduction were better with lateral deltoid splitting approach, and Constant shoulder scores were higher in the early stages (66.8-57.4 consecutively; p>0.05). Discussion Deltoid splitting approach, especially with AO/ASIF B and C type fractures, enables reduction and plate fixing under 270 degree control of the proximal humerus without forceful retraction and soft tissue damage, providing easy access to posterior tubercular fragment. Compared to deltopectoral approach, patients treated with deltoid splitting approach achieved higher Constant scores at an earlier stage. Lateral deltoid splitting approach, by exploring the axillary nerve, is a useful surgical technique which provides an expansive and multi-dimensional control without risking the deltoid muscle function and the axillary nerve.

Objective: The aim of this study is to report our institution’s experience regarding the use of open tibial inlay technique in patients undergoing single-stage combined posterior cruciate ligament (PCL) reconstruction. Methods: Records of 17 patients who underwent PCL reconstruction with tibial inlay technique were retrospectively reviewed. Patients with ipsilateral femoral or tibial osteochondral avulsion fractures or ipsilateral concomitant tibia and femur shaft fractures were excluded. Out of these 17 patients, six cases underwent anterior cruciate ligament (ACL) + PCL reconstruction, nine cases underwent ACL+ PCL + posterolateral corner reconstruction, one case underwent ACL + PCL + MCL reconstruction and one case underwent ACL+ PCL + posterolateral corner + MCL reconstruction. Mean follow-up was 14.27±6.77 (range: 6–30) months. Results: In preoperative assessments, all patients had 3+ posterior laxity in posterior drawer test; at final follow-up, 6 patients had 0 laxity, 7 patients had 1+ laxity, and 4 patients had 2+ laxity (p

Objectives: Tibial plateau fractures are complex injuries involving the weight bearing surface of the tibia. Open reduction and internal fixation with plates and screws is an established method of treatment for complex fractures (Schatzker types V–VI). Arthroscopically assisted techniques have been used successfully for simple fractures (Schatzker types I–III). Historically, arthroscopic-assisted reduction for lateral tibial plateau fractures have been performed through a laterally based metaphyseal window. We found this technique to have several limitations, including bone grafting through a short subchondral tunnel. Also, there was a risk of lateral vascular supply distrubtion. We proposed that medial window approach technique would provide a longer tunnel for subchondral support and aid in fracture reduction. We aimed to present our initial experiences in first seven cases approaching lateral tibial plateau fractures through a medial metaphyseal window. Methods: Our series involves 7 patients with 5 Schatzker type II and 2 Schatzker type III lateral tibial plateau fractures treated by a single surgeon, using a medial approach for the arthroscopic assisted fixation. There were 5 males and 2 females. The average age at the time of surgery was 34.2 years, (29-52). All of the patients underwent plain radiography and CT scanning in each knee Time from injury to surgery was 7.2 days (4-12 days). Length of follow up was 9 months (6-22 months). There was 2 lateral meniscus tear that treated with partial meniscectomy and 1 MCL injury that treated conservativeely. Surgery was performed in four steps. First step was diagnostic arthroscopy of the injured knee, , second step was reduction of the fracture using a sylindiric tube with fluoroscopic guidance, third step was the arthroscopic verification of the fracture reduction, and finally percutaneous osteosynthesis of the fracture.Care is taken to keep the flow to gravity or, if using a pressure controlled pump, to set the pressure at approximately 40 millimeters of mercury. This will help alleviate the risk of compartment syndrome. Compartment firmness should be continuously monitored throughout the procedure. Results: No complications related to the procedure were observed. All patients reported a relevant reduction in pain, were able to mobilize with full weight bearing in the average 12 weeks (9–15 weeks). No secondary loss of reduction was observed in radiological controls; No revision surgery was required. Functional assessment according to HSS (hospital for special surgery) of the patients were excellent in 5 cases, good in 2 cases. Conclusion: Because depressed fragments are elevated from distal cortical windows, the importance of an intact, or easily restored, “cortical envelope” is paramount. In most Schatzker Type II and III fractures, the cortical envelope is either intact or can easily be restored with a clamp. The main advantage of medial approach for these fracture patterns is the creation of a long tunnel for subchondral support, the ease of fracture reduction and saving the lateral vascular supply.

Surgical Results of Developmental Dysplasia of the Hip

We compared clinical and radiological results of two proximal tibial osteotomy (PTO) techniques: monoplanar medial open-wedge osteotomy and biplanar retrotubercle medial open-wedge osteotomy, stabilised by a wedged plate.We evaluated 88 knees in 78 patients. Monoplanar medial open-wedge PTO was performed on 56 knees in 50 patients with a mean age of 55 ± 9 years. Biplanar retrotubercle medial open-wedge PTO was performed on 32 knees in 28 patients with a mean age of 57 ± 7 years. Mean follow-up periods were 40.6 ± 7 months for the monoplanar PTO group and 38 ± 5 months for the biplanar retrotubercle PTO group. Clinical outcome was evaluated using the hospital for special surgery scoring system, and radiological outcome was evaluated by the measurements of femorotibial angle (FTA), patellar height and tibial slope changes.In both groups, post-operative HSS scores increased significantly. No significant difference was found between groups in FTA alteration, but the FTA decreased significantly in both groups. Patellar index ratios decreased significantly in the monoplanar PTO group (Insall-Salvati Index by 0.07, Blackburne-Peel Index by 0.07), but not in the biplanar retrotubercle PTO group. Tibial slopes were increased significantly in the monoplanar PTO group, but not in the retrotubercle PTO group.Biplanar retrotubercle medial open-wedge osteotomy and monoplanar medial open-wedge osteotomy are both clinically effective for the treatment for varus gonarthrosis. Retrotubercle osteotomy also prevents patella infera and tibial slope changes radiologically.

One of the complications of osteochondromas is the development of a bursa over the cartilaginous cap. We report a 15-year-old boy with a rapidly expanded adventitious bursitis overlying an osteochondroma of the humerus facing the thoracic wall, a location not previously reported for such bursa formation. Magnetic resonance imaging readily showed adventitious bursitis overlying the osteochondroma, thereby dispelling concerns for malignant transformation.

Objective: Neuroma is a psychologically and physically disabling problematic condition without any current standard therapy. For that reason, we investigated whether end-to-side anastomosis of the proximal end of the transected nerve into the adjacent nerve will prevent the development of neuroma in different types of nerve injuries. Study design: In this study, hind legs of 18 Sprague - Dawley female rats were used. Six groups were formed. In group I, peroneal nerves were transected and its proximal end was attached end-to-side through the epineural window to the adjacent tibial nerve. In group II, contrary to group I, an epineural window was created in the tibial nerve and the same number of sutures were employed. In group III, tibial nerve was transected proximal to the end-to-side repair site, whereas in group IV, distal segment of the nerve was cut, and an end-to-end repair procedure was repeated. In group V, unlike group I, an approximately 1-cm segment was resected and removed distal (from tibial nerve) to the end-to-side repair site. In group VI, an epineural window was created in the tibial nerve and the same number of sutures were used, and also a 1-cm distal nerve segment was resected. The rats were followed for 2 months, and then all of the groups were evaluated histopathologically, and weights of the posterior muscle groups of hind legs were evaluated. Findings and Conclusions: No neuroma formation was observed in the proximal stumps of peroneal nerve segments in end-to-side repair sites in groups I, III, IV, and V, and proximal stumps of the tibial nerve in group V. In group VI, neuroma formation was observed in the proximal end of the tibial nerve. When weights of the posterior muscle groups of hind legs in groups I and II were comparatively assessed, statistically significant difference was not detected. In conclusion, based on histological data obtained for proximal nerve ends and segments distal to the end-to-side repair sites, we think that end to side neurorrhaphy of the proximal end of the damaged nerve to adjacent nerve will prevent the development of neuroma without injuring the intact nerve segment. © American Association for Hand Surgery 2007. Acknowledgements We express our gratitude to Dr. Ahmet Harma for schematic presentation of control and test groups and to Dr. Mücahit Eğri for statistical evaluations. This study received no financial support.

Objectives: The aim of this this study was to assess the clinical outcomes and fixation durability of the AperFix (Cayenne Madical, Scottsdale, Arizona) system and to determine the effect of patient’s age in arthroscopic reconstruction of the anterior cruciate ligament. Methods: Patients with symphtomatic anterior cruciat ligament rupture underwent arthroscopic reconstruction. Patients were evaluated in terms of range of motion values; Lysholm, Cincinati and Tegner activity scales; laxity testing and complications. Tunnel widening was assessed by AP and lateral radiographs. Early postoperative and last follow-up radiographs were compared. Results: Fifty-one patients were evaluated at a 29 months (range: 25-34 months) follow-up. Mean age at the surgery was 26.5 ± 7.2 years. Lysholm, Cincinati and Tegner activity scales were significantly higher from preop scores. (Lysholm scores: preop: 51.4 ± 17.2 postop: 88.6 ± 7.7 (pConclusion: According to our results with 30 years patient comparison we think that patient’s age is less important than activity level for the surgical treatment decision. The AperFix system performed satisfactory clinical and radiological results with low complication rate. But long-term clinical and radiological results are needed to decide the ideal ACL reconcstruction method.

Mehmet Fatih Korkmaz,1 Mehmet Nuri Erdem,2 Zeliha Disli,3 Engin Burak Selcuk,4 Mustafa Karakaplan,1 Abdullah Gogus5 1Department of Orthopedics and Traumatology, Inonu University School of Medicine, Malatya, Turkey; 2Department of Orthopedics and Traumatology, Nisantasi University School of Medicine, Istanbul, Turkey; 3Department of Anesthesiology, Malatya Government Hospital, Malatya, Turkey; 4Department of Family Medicine, Inonu University School of Medicine, Malatya, Turkey; 5Department of Orthopedics and Traumatology, Florence Nightingale Hospital, Istanbul, Turkey Purpose: In this study, we aimed to report the results of a retrospective study carried out at our institute regarding cases of patients who had suffered proximal femoral fractures between January 2002 and February 2007, and who were treated with a proximal femoral nail. Materials and methods: One hundred consecutive cases were included in the study. A case documentation form was used to obtain intraoperative data including age, sex, mechanism of injury, type of fracture according to Association for Osteosynthesis/Association for the Study of Internal Fixation (AO/ASIF) classification and the American Society of Anesthesiologists' (ASA) physical status classification (ASA grade). Clinical and radiographic examinations were performed at the time of admission and at the 6th week; subsequent visits were organized on the 3rd month, 6th month, and 12th month, and in patients with longer follow-up and annually postoperatively. The Harris score of hip function was used, and any change in the position of the implants and the progress of the fracture union, which was determined radiologically, was noted. Results: The mean age of the patients was 77.66 years (range: 37–98 years), and the sex distribution was 32 males and 68 females. Seventy-three fractures were reduced by closed means, whereas 27 needed limited open reduction. The mean follow-up time for the study group was 31.3 months (range: 12–75 months). Postoperative radiographs showed a near-anatomical fracture reduction in 78% of patients. The Harris hip score was negatively correlated with the ASA score and patient age. No cases of implant failure were observed. Three patients died before discharge (one due to pulmonary embolism, two due to cardiac arrest), and five patients died due to unrelated medical conditions within the first 3 months of the follow-up. Conclusion: Our study showed that proximal femoral nail is a reliable fixation with good fracture union, and it is not associated with major complications in any type of trochanteric femoral fracture. Keywords: ASA, femoral fracture, Harris score, proximal femoral nail

Gunshots cause injury on the vascular wall by phsical forces and thermal effect. These injuries are minor intimal damage, complete or partial transaction of the vessel, arteriovenoous fistula and pseudoaneurysm. In this article we report a pseudoaneursym case, at a gunshot wound on right hand planned to repair by reverse radial forearm flap for to cover the defect occured at the ipsilateral dorsum of the right hand, which was suspected on CT angiography but missed out preoperatively and seen in surgery during exploration and reparied. [Med-Science 2013; 2(1.000): 414-22]