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Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_13 | Pages 91 - 91
1 Nov 2021
Aljasim O Yener C Demirkoparan M Bilge O Küçük L Gunay H
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Introduction and Objective

Zone 2 flexor tendon injuries are still one of the challenges for hand surgeons. It is not always possible to achieve perfect results in hand functions after these injuries. There is no consensus in the literature regarding the treatment of zone 2 flexor tendon injuries, tendon repair and surgical technique to be applied to the A2 pulley. The narrow fibro-osseous canal structure in zone 2 can cause adhesions and loss of motion due to the increase in tendon volume due to surgical repair. Different surgical techniques have been defined to prevent this situation. In our study, in the treatment of zone 2 flexor tendon injuries; Among the surgical techniques to be performed in addition to FDP tendon repair; We aimed to compare the biomechanical results of single FDS slip repair, A2 pulley release and two different pulley plasty methods (Kapandji and V-Y pulley plasty).

Materials and Methods

In our study, 12 human upper extremity cadavers preserved with modified Larssen solution (MLS) and amputated at the mid ½ level of the arm were used. A total of 36 fingers (second, third and the fourth fingers were used for each cadaver) were divided into four groups and 9 fingers were used for each group. With the finger fully flexed, the FDS and FDP tendons were cut right in the middle of the A2 pulley and repaired with the cruciate four-strand technique. The surgical techniques described above were applied to the groups. Photographs of fingers with different loads (50 – 700 gr) were taken before and after the application. Proximal interphalangeal (PIP) joint angle, PIP joint maximum flexion angle and bowstring distance were measured. The gliding coefficient was calculated by applying the PIP joint angle to the single-phase exponential association equation.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_13 | Pages 70 - 70
1 Nov 2021
Yener C Aljasim O Demirkoparan M Bilge O Binboğa E Argın M Küçük L Özkayın N
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Introduction and Objective

Scapholunate instability is the most common cause of carpal instability. When this instability is left untreated, the mechanical relationship between the carpal bones is permanently disrupted, resulting in progressive degenerative changes in the radiocarpal and midcarpal joints. Different tenodesis methods are used in the treatment of acute or early chronic reducible scapholunate instability, where arthritis has not developed yet and the scapholunate ligament cannot be repaired. Although it has been reported that pain is reduced in the early follow up in clinical studies with these methods, radiological results differ between studies. The deterioration of these radiological parameters is associated with wrist osteoarthritis as previously stated. Therefore, more studies are needed to determine the tenodesis method that will improve the wrist biomechanics better and will last longer. In our study, two new tenodesis methods, spiral antipronation tenodesis, and anatomic front and back reconstruction (ANAFAB) were radiologically compared with triple ligament tenodesis (TLT), in the cadaver wrists.

Materials and Methods

The study was carried out on a total of 16 fresh frozen cadaver wrists. Samples were randomly allocated to the groups treated with 3 different scapholunate instability treatment methods. These are TLT (n: 6), spiral antipronation tenodesis (n: 5) and ANAFAB tenodesis (n: 5) groups. In all samples SLIL, DCSS, STT, DIC, RSC and LRL ligaments were cut in the same way to create scapholunate instability. Wrist CT scans were taken on the samples in 4 different states, in intact, after the ligaments were cut, after the reconstruction and after the movement cycle. In all of these 4 states, wrist CTs were taken in 6 different wrist positions. For every state and every position through tomography images; Scapholunate (SL) distance, Scapholunate (SL) angle, Radioscaphoid (RS) angle, Radiolunate (RL) angle, Capitolunate (CL) angle, Dorsal scaphoid translation (Dt) measurements were made.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_I | Pages 142 - 143
1 Mar 2009
BiLGE O Doral M Atay A Uzumcugil A Tetik O Leblebicioglu G
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Introduction: Osteochondral lesions of talus are rarely seen. The aim of our study is to report the early functional results of the treatment of the talus osteochondral lesions with Arthroscopic microfracture technique and of the intraarticular hyaluronan injection postoperatively.

Material and Methods: 15 patients (8 men, 7 women) are included in this is a prospective, randomized clinical study between the years January 2003 and February 2006. The mean age is 39 +/−11 SD. The patients had chronic ankle pain. 7 patient had right, 8 patient had left ankle pain. Their MRI revealed osteochondral lesion on the medial and central part of the talus. All the patients are treated with arthroscopic debridement and microfracture. The patients are mobilized non-weight bearing on postoperative first day and full-weight bearing on postoperative third week. As a second part of the study, 6 patients randomized by envelope are selected to apply intraarticular Hyaluronan (Adant) injection. The injection is performed half dose by starting from postoperative third week, weekly, for 3 weeks. The foot and ankle function index is used for the functional evaluation and the pain category of the Freiburg index is used for the pain evaluation of the patients. The surveys are filled by all the patients preoperatively and ninth week postoperatively. The follow-up period is 6 months.

Findings: 10 patients have previous history of ankle trauma. For the biostatistics evaluation of the data, paired t-test is used. The increase in the Freiburg pain index is observed in the evaluation preoperative and postoperative data (p< 0.05). The effect of intraarticular Hyaluronan injection is found insignificant statistically (p> 0.05). The Foot and Ankle Index scores revealed a significant clinical improvement only in the categories; walking 4 blocks and walking fast (p< 0.05). In the injection group, the only significant improvement is observed in the category of walking 4 blocks (p< 0.05).

Results and Discussion: There are different developing modalities in the treatment of talus osteochondral lesions. As a result of our study, arthroscopic debridement and microfracture is found to decrease the pain and to increase the functional performance. The effect of intraarticular Hyaluronan injection is found to be insignificant compared with the non-injection group. Our patient number is small and follow-up period is short. Multi-centered, prospective and randomized studies are needed for further evaluations.