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Objective: This study investigated whether electromyelography (EMG) evaluation is helpful in the late phase after surgical treatment of carpal tunnel syndrome (CTS). Methods: This retrospective study included 35 patients who underwent mini-open decompression therapy between 2008 and 2011 with CTS diagnosis. Patients were assessed electrophysiologically and clinically with Patient Evaluation Measurement (PEM) scoring and handgrip, palmar grip, lateral grip, and fingertip grip strength. Additionally, patients' clinical scores and strength values were compared with electrophysiologic values from preoperative and postoperative 4-year controls. Results: According to the Padua classification, EMG data were classified before and after surgery. One patient had extreme grade, four patients had severe grade, 26 patients had moderate grade, and four had a mild grade before surgery. At the postoperative 4th year EMG follow-up, six patients were classified as minimal and 29 as negative. According to the PEM scale, the mean score before surgery was 58.77±7.89, and in the controls at the 4th year after surgery, the mean score was 13.48±4.01. The strength of the operated hand was significantly weaker than that of the contralateral healthy hand before surgery. However, in the controls at the 4th year after surgery, the strength of the operated hand was significantly increased compared with the preoperative period, and there was no significant difference from the contralateral hand. Conclusion: Electrophysiological assessment (EMG) in the late phase after surgical treatment of CTS has positive parallels with clinical assessment and strength assessment. Therefore, we conclude that EMG helps follow late surgical outcomes. © Copyright 2022 by Medical Journal of Bakırköy published by Galenos Yayınevi

Objectives: This study aims to investigate the correlation between posterior cruciate ligament (PCL) buckling phenomena and the presence or absence of the anterior meniscofemoral ligament (aMFL). Patients and methods: Between January 2012 and January 2019, magnetic resonance imaging of a total of knee joints of 199 patients (163 males, 16 females; mean age: 31.5±5.3 years; range, 18 to 40 years) were reviewed retrospectively. The patients were divided into four groups. The first group included 32 patients with a ruptured anterior cruciate ligament (ACL) and absent aMFL. The second group included 67 patients with a ruptured ACL and apparent aMFL. The third group included 23 patients with an intact ACL and absent aMFL, and the fourth group included 77 patients with an intact ACL and apparent aMFL. The PCL angle was used to measure the buckling degree of the ligament, as calculated as the angle between two lines drawn through the tibial and femoral central portions of the PCL insertions. We assessed the buckling phenomena of the PCL in ACL-ruptured and ACL-intact knees and examined a possible correlation between the PCL buckling angle and the presence or absence of the aMFL of Humphrey. Results: In the ruptured ACL groups (Groups 1 and 2), the mean PCL buckling angle values were 133.88±6.32 and 104.83±7.34 degrees, respectively. A significant difference was detected between both groups (p=0.026). In the intact ACL groups (Groups 3 and 4), the mean PCL buckling angle values were 143.47±5.96 and 116.77±8.38 degrees, respectively. A significant difference was detected between both groups (p=0.039). No statistically significant difference was observed between Groups 1 and 3 (p=0.13) and between Groups 2 and 4 (p=0.088). Conclusion: The PCL buckling sign is not specific for ACL ruptures, and can be seen frequently in normal knee joints which it is strongly associated with the presence of aMFL of Humphrey.

BackgroundHallux valgus, one of the most common deformities of the great toe, may cause pain, dysfunction, and impaired gait pattern. In this retrospective study we report the results of a new type of distal metatarsal osteotomy combined with distal soft-tissue release in patients with mild-to-moderate hallux valgus deformity.MethodsThis new technique was used in the management of 32 feet of 31 patients (eight men and 23 women) with mild-to-moderate hallux valgus. Hallux valgus angle, intermetatarsal angle, and distal metatarsal articular angle were measured on preoperative, early postoperative (6–8 weeks), and late (1 year) postoperative radiographs. American Orthopaedic Foot and Ankle Society hallux metatarsophalangeal score was calculated. Sesamoid position, by considering medial sesamoid position, and metatarsal shortness were also measured.ResultsStatistically significant differences were detected between the preoperative and late postoperative measurements of the hallux valgus angle, distal metatarsal articular angle, intermetatarsal angle, and sesamoid position parameters in patients operated on with this technique. Improvement was 14° for the hallux valgus angle, 4° for the distal metatarsal articular angle, and 4° for the intermetatarsal angle. Sesamoid position was also improved, and the mean American Orthopaedic Foot and Ankle Society score was significantly improved. Metatarsal shortness greater than 2 mm was observed in two patients without resulting in any clinical discomfort.ConclusionsThis new technique was easy, safe, and promising in patients diagnosed as having mild-to-moderate hallux valgus deformity.

Introduction: Percutaneous Vertebroplasty (PVP) is a procedure frequently performed to obtain pain relief and mechanical strengthening of the collapsed vertebral body which may be caused by variant reasons. Aim: To assess frequent complications commonly encountered during vertebroplasty procedure. Materials and Methods: A retrospective study was conducted on 1375 patients followed from January 2005 and June 2012 in Department of Neurosurgery, faculty of medicine, Dokuz Eylül University. Severe vertebral fracture collapse (vertebra plana), vertebral metastasis, quadriplegic patients and bed-ridden patients were excluded from this study, whereas active mobile patients without associated severe co-morbidities were included in the study. Pain, pattern of cement leakage and associated complications had been assessed. Results: Total 601 patients who fullfilled the inclusion criteria {244 (40.5%) males, 357 (59.5%) females}, average age was 63.04±7.4 (range 34 to 90) years, had undergone the PVP procedure. Mean preoperative Visual Analog Scale (VAS) was 8.51±1.5, whereas after one and six months, the mean postoperative VAS were 1.94±1.0 and 2.53±2.2, respectively. Central spinal canal leakage has been observed in four cases. Three patients had developed transient monoparesis and radiculopathy symptoms. Whereas, the fourth patient developed paraplegia. Cement leakage had been tolerated well by one patient, where symptomatic resolution occurred within one month. However, decompressive foraminotomy had been performed for two patients on the 24th and 38thdays postoperatively due to intractable radicular pain. Immediate total laminectomy and decompression surgery had been performed for removal of the cement leakage to the spinal canal for the patient who developed total paraplegia. Asymptomatic leakage had been recognised beneath the posterior longitudinal ligament in 42 patients (6.9%), beneath the anterior longitudinal ligament in 18 patients (2.9%) and into disc space in 31 patients (5.1%). Venous leakage occurred in four patients (0.6%) and was asymptomatic in all of them. Conclusion: Vertebroplasty should be performed in a fully equipped operation theater in order to be able to revert quickly to open surgery in case of cement leakage into the spinal canal.

Background The short stability window of several hours from blood collection to measuring basophil activation has limited the use of flow cytometry-based basophil activation assays in clinical settings. We examine if it is possible to extend this window to 1 day allowing for shipment of samples between laboratories. Several options exist for reporting the results including reporting all the measured values directly, calculating ratios and reporting a single value covering all measured results. Each of these options have different stability and value to the physician. Methods Whole blood samples from peanut allergic patients were stimulated with four different peanut concentrations at Day 0, Day 1, and Day 2. Samples were stored under temperature-controlled conditions. Flow cytometry was used to analyze the samples. The basophil activation and degranulation were measured as percentage of positive CD63 basophils and CD203c MFI fold change. Shipped samples were transported under ambient conditions. Results The results show that CD63 is a stable marker at Day 1. The CD203c ratio decreases significantly at Day 1. Calculating the CD63/IgE ratio proves to be more stable than CD63 alone. The most stable readouts are the semi-quantitative results and the trajectory of the dose response curve. Finally, we confirmed that the stability can be extended to samples shipped overnight to the laboratory. Conclusions It is possible to extend the stability of the basophil activation assay to 1 day for samples stored at 18-25°C as well as samples shipped under ambient conditions as long as the temperature is within the 2-37°C range.

Purpose: Aim of our study was to compare the effects of partial meniscectomy and meniscus repair on knee proprioception and function. Methods: The study included 46 patients with clinical and radiological diagnosis of meniscal tear and accompanying anterior cruciate ligament (ACL) rupture. The patients were evaluated under two groups: group 1: partial meniscectomy and ACL reconstruction, and group 2: meniscal repair and ACL reconstruction. Proprioceptive and functional evaluation of all patients was performed prior to surgery and on postoperative 12th month. Results: Group 1 consists of 18 male and 1 female patients with an average age of 28.78 ± 3.50. Group 2 consists of 23 male and 4 female patients with an average age of 27.14 ± 3.65. Preoperative evaluation revealed significant differences in knee joint position sense values on wide range of knee motion (15°, 30°, 45°, 60°, and 75°) in both groups. The statistically significant difference was observed in only the range of knee motion of 60° in patients underwent meniscal repair (group 2), whereas in the range of knee motion of 45°, 60°, and 75° in patients underwent partial meniscectomy (group 1) at 12th-month control. According to Lysholm knee scoring system, significantly better results were achieved with meniscal repair compared to the partial meniscectomy at 12th-month control. Conclusion: In case of ACL rupture accompanied by meniscal tear, the meniscal repair should be sutured, if possible, in order to obtain better results in terms of knee function and proprioception.

BACKGROUND There is no clear information on the efficacy of corticosteroids, and splints in the treatment of patients with diabetes mellitus (DM). The aim of this study was to compare the outcomes of isolated corticosteroid injection therapy with splint treatment with corticosteroid injection in patients with and without DM. METHODS 84 diabetics, and 84 healthy patients with a diagnosis of de Quervain's tenosynovitis were included in our study. The patients were randomly distributed into four subgroups with and without DM. Groups 1 and group 2 consisted of diabetic patients, while group 3 and group 4 consisted of healthy patients. Corticosteroid injections were administered to groups 1 and 3, and corticosteroid injection and splint treatment were administered to groups 2 and 4. RESULTS There was no significant difference in terms of age, gender, dominant/non-dominant hand, pre-treatment Quick Disabilities of the Arm, Shoulder and Hand score and visual analog scale scores score between the four groups. Quick Disabilities of the Arm, Shoulder and Hand and visual analog scale scores in the four groups were found to be significantly better than pre-treatment at the 12th month. Finkelstein test results were positive in 37.5% of the patients in the first group, 35% of the patients in the second group, 20% of the patients in the third group and 9.5% of the patients in the fourth group. Groups 1 and 2 and, groups 3 and 4 were compared to evaluate the effect of the splint. While forearm-based thumb splint affected the results positively in healthy individuals, it was determined that it had no effect on the results in diabetic patients. CONCLUSION Although corticosteroid treatment is effective in the treatment of de Quervain's tenosynovitis in healthy and diabetic individuals, the results are worse in diabetic patients than in healthy patients. In addition, the use of splint with corticosteroid injection in healthy individuals positively affects the results, while it does not affect the results in diabetic patients.

Background The aim was to evaluate the results of two different methods in surgical treatment for patients with late-stage avascular necrosis of the metatarsal head. Methods Between 2007 and 2012, fourteen consecutive patients (13 females, 1 male; mean age 29 yrs; range, 12–58 yrs) with metatarsal head infarction were enrolled for this study. The main presenting symptom was pain on walking or daily activities. According to the Smillie classification all of lesions were classified as in stage IV–V. Six patients had cheilectomy and microfracture procedure in Group A, 8 patients had received cheilectomy and dorsal crescentic osteotomy in Group B. Clinical outcomes were evaluated according to American Orthopaedic Foot and Ankle Society (AOFAS) lesser toe metatarsophalangeal-interphalangeal scale and range of motion (ROM) of metatarsophalangeal (MTP) joint. Metatarsal shortening and osteotomy-site healing were evaluated with AP and oblique view X-rays. Results The mean follow-up period was 22 months (range, 12–53). The clinical outcomes were excellent in 11(78%) patients and in the 3(22%) patients the results were good. The AOFAS scores increased from a mean of 66.3 points (range, 55–75) preoperatively to 92 points (range, 84–100) at last follow-up in Group A. The mean AOFAS score increased 55.8 points (range, 45–64) to 90.6 points (range, 84–95) in Group B. In the patients that osteotomy have been applied there were no limitation of movement or fixed deformity of the toe. Discussion These results suggest that both surgical techniques may provide significant improvement in pain and ROM of the MTP joint.

Objectives: The aim of this prospective study is to evaluate the impact of the simulation training programin learning duration of arthroscopic motor skills. Furthermore, we investigated the difference betweenjunior and experienced residents in the improvement of arthroscopic motor skills duration.Methods: We established 2 study groups according to participants' year of experience in orthopedicresidency with junior group residents with three years or less than three years experience as group 1 andexperienced group with over 3 years of experience as group 2. We calculated duration change of motorskill test results for each participant before and after the course. The tools used were; auto scoring mirrortracer(ASMT), 0'Conner the tweezer dexterity test(OCTDT), etch-a-sketch with overlay(ESOT), purdue thepegboard test(PPT), two-arm coordination test(TACT) and grooved pegboard test(GPT) which were allproduced by LafayetteŞrm. These instruments were used to practice and measure the basic motor skills.Results: All postecourse test durations for participants decreased signiŞcantly when compared to precourse. We calculated percentage change of motor skill test results for each participant before and after the course. All motor skill test percentage changes were similar between two groups. In comparisonof participants according to their experiences, results revealed that there was no difference in test resultsof experienced and junior surgeons. Both groups had provided equal improvement in terms of motorskills.Conlusion: As our results revealed, residents will be able to act with a strong motivation to learn applications through basic arthroscopic information gained in early period of orthopedic training and willmake more successful applications of real patients.© 2017 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V. Thisis an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-ncnd/4.0/). https://dx.doi.org/10.1016/j.aott.2017.01.004

Cerebral Palsy (CP) is the most common of the childhood neuromuscular diseases and generally leads to permanent disability. Voluntary motor control impairment is the basic clinical manifestation. While the superficial sensation is generally normal, the cortical perception, joint position sense (proprioception) and the sensation of movement (kinesthetic perception) are impaired. The peripheral reflections (contractures, bone deformities) of the cerebral lesion are progressive. Cerebral injury resulting in cerebral palsy may develop in prenatal, perinatal or postnatal periods. However prenatal factors are mostly involved. The most significant risk factors include prematurity and low birth weight. Classification is made based on the tonus changes, the type of movement disorder and the number of extremities affected, rather than the cerebral lesion. Clinical and anatomic classification is used commonly. CP treatment aims to assist in increasing the physical, cognitive and communication capacity, achieving and maintaining mental balance for the individual and the family. It is multidisciplinary. (JAREM 2012; 2: 38-42)