Mehmet Armangil

Objective: This study aimed to evaluate the efficacy and safety of pediatric trigger thumb release performed without tourniquet application. Methods: This retrospective study included 17 trigger thumb releases in 16 patients (11 female, 5 male) performed between October 2021 and December 2023. The mean patient age at surgery was 2.81 ± 0.75 years (range, 2-4). All procedures were conducted at a single center under deep sedation or laryngeal mask airway anesthesia using a transverse volar incision at the metacarpophalangeal joint to release the A1 pulley. Outcomes included postoperative range of motion, complications, reoperation, and parent-reported satisfaction. The mean follow-up was 38.87 ± 13.95 weeks. Results: Full interphalangeal joint range of motion was achieved in 94.12% of cases, with no major complications and no reoperations. Minor postoperative events occurred in 17.65 (3/17) of cases, including a superficial wound infection managed with oral antibiotics and early residual flexion deformity that resolved with physiotherapy within 2 months. Overall satisfaction was high, with most families reporting they were “very satisfied” with the surgical outcome. Conclusion: Tourniquet-free pediatric trigger thumb release appears to be a safe and effective option, achieving high rates of motion recovery and satisfaction without major complications. Cite this article as: Bezirgan U, Bekar H, Savran Dursun M, Temel AS, Yoğun Y, Armangil M. Tourniquet-free pediatric trigger thumb release: single-center experience and clinical outcomes. Acta Orthop Traumatol Turc.,2026; 60(6), 0830, doi: 10.5152/j.aott.2026.25830.

Rotator cuff tears, often caused by degeneration, trauma, or repetitive use, can severely affect shoulder function. Pseudoparalysis, characterized by the inability to elevate the arm despite normal passive range of motion, is a challenge in massive tears. This study aimed to evaluate the association between radiological parameters on X-ray and MRI and pseudoparalysis/pseudoparesis in patients with large to massive rotator cuff tears. A retrospective cohort study was conducted on 58 patients who underwent arthroscopic surgery for large to massive rotator cuff tears between 2018 and 2024. Patients were categorized based on shoulder abduction and flexion: Group 1 (0–45°, pseudoparalysis), Group 2 (45–90°, pseudoparesis), and Group 3 (> 90°, near-normal motion). For abduction, Groups 1, 2, and 3 consisted of 14, 27, and 17 patients, respectively, while the corresponding group sizes for flexion were 13, 26, and 19. Preoperative X-rays and MRI assessed the critical shoulder angle (CSA), acromiohumeral distance (AHD), and muscle integrity. Intraoperative findings detailed tendon tears. Higher Patte stages and a greater number of torn tendons were significantly associated with reduced abduction and flexion ROM (p < 0.001). AHD correlated with greater ROM in abduction and flexion (respectively p = 0.006, p = 0.033), while CSA and tangent sign showed no significant association. Subscapularis involvement correlated with reduced abduction (p = 0.021). Comorbidities like diabetes, hyperlipidemia, and smoking had no significant effect on ROM. The number of torn tendons, Patte stage, and reduced acromiohumeral distance were significantly associated with pseudoparalysis. When physical examination is limited, these imaging findings may be more frequently observed in patients with pseudoparalysis or pseudoparesis; however, they should be interpreted in conjunction with clinical evaluation. Level of Evidence: Level 3

Aims: This study aimed to compare the standard and congruent arc Latarjet techniques in anterior shoulder instability using a multiplanar computed tomography–based modeling approach, with particular focus on coracoid process morphology, glenoid reconstruction capacity, and graft contact surface area. Methods: A total of 200 patients were included for coracoid measurements and 156 patients for glenoid measurements. Coracoid length, width, and thickness were evaluated, and glenoid width was measured on computed tomography images. The potential glenoid bone defect reconstruction capacity and graft to glenoid contact surface area were calculated for both techniques. Sex-based anatomical differences were also analyzed. Results: Coracoid dimensions were significantly larger in males than in females. The congruent arc Latarjet technique allowed reconstruction of a larger proportion of the anterior glenoid bone defect (mean 55%) than the standard Latarjet technique (mean 37%). In contrast, the standard technique provided a larger contact surface area between the transferred coracoid graft and the glenoid (452±126 mm² vs. 292±105 mm², p<0.001). Smaller coracoid dimensions, particularly in female patients, were associated with a smaller graft to glenoid contact area and the need for smaller fixation screws, which may reduce the mechanical stability of graft fixation. Conclusion: While the congruent arc Latarjet technique allows reconstruction of larger glenoid bone defects, the standard technique offers a greater contact surface area that may favor graft healing and fixation stability. Coracoid process morphology, especially in smaller-sized coracoids, should be considered during surgical planning. Preoperative evaluation of coracoid process dimensions may help optimize technique selection and reduce the risk of complications.

Background: This prospective randomized study aimed to compare the clinical effectiveness of ultrasound-guided dry needling and platelet-rich plasma injections in patients with refractory lateral epicondyle tendinopathy.Methods: Fifty patients (25 in each group) diagnosed with refractory lateral epicondyle tendinopathy were randomized to receive either ultrasound-guided dry needling or platelet-rich plasma injection. Patients were evaluated before treatment and at 1, 3, and 6 months after the intervention using the visual analog scale, the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire, the Patient-Rated Tennis Elbow Evaluation, and grip strength measurements. All procedures were performed under continuous ultrasound guidance.Results: Both groups showed significant improvements in pain, function, and grip strength over time. There were no significant differences in grip strength between the groups at any time point. However, patients treated with platelet-rich plasma showed superior outcomes in pain and functional scores, particularly at the 6-month follow-up. No complications were observed in any of the patients.Conclusions: Both ultrasound-guided dry needling and platelet-rich plasma injections are effective options for refractory lateral epicondyle tendinopathy. Platelet-rich plasma may offer greater clinical benefit, particularly in pain reduction and functional improvement. Further research with larger cohorts is required to establish optimal treatment protocols.Level of evidence: I.

Objectives: This study aims to evaluate the functional outcomes of patients undergoing hemiarthroplasty with modular tumor prostheses for proximal humeral tumors. Material and Methods: A total of 28 patients were included in the study, with an average follow-up of 71.11 months. The mean age of participants was 47.8 years, and the cohort included various tumor types, including osteosarcoma and chondrosarcoma. Functional outcomes were assessed using the Modified Musculoskeletal Tumor Society evaluation system, the American Shoulder and Elbow Surgeons score, and the Visual Analog Scale for pain.Results: The postoperative results demonstrated an average Modified Musculoskeletal Tumor Society score of 21.68 and an American Shoulder and Elbow Surgeons score of 52.71, reflecting substantial improvements in both shoulder function and pain management. Notably, the Visual Analog Scale scores decreased significantly, from a preoperative average of 6.57 to a postoperative average of 3.79. This reduction in pain intensity indicates that patients experienced a marked alleviation of discomfort following the surgical intervention.Conclusion: Modular tumor prosthesis represents a reliable and effective treatment option for proximal humerus tumors. Although low infection and recurrence rates were noted, further research with larger sample sizes and longer follow-up is necessary to fully understand the long-term durability of the prosthesis and its potential complications, particularly in younger, more active patients.

Introduction: Neurogenic Thoracic Outlet Syndrome (nTOS) is characterized by compression of neural structures within the interscalene triangle of the thoracic outlet, with anatomical variations frequently implicated in its etiology. In patients with TOS, spinal nerves pass through a narrow anatomical space as they exit the foramen and traverse the thoracic inlet. The tension of the suprapleural bands extending between the C7 transverse process and the first rib, along with changes in neck position and certain anatomical variations, can lead to compression of the lower trunk. The condition of this anatomical space, where compression occurs, is influenced by the relationship between the lower cervical vertebrae and the first rib. This study aims to determine whether these cervicothoracic angles could lead to lower trunk compression as it passes over the suprapleural membrane. It is hypothesized that this radiological variation may present a higher likelihood of causing compression in TOS patients compared to the normal population. Methods: This retrospective study included patients diagnosed with neurogenic TOS who underwent surgery between 2015 and 2023, patients managed with physical therapy without surgery, and a matched control group. The control group consisted of patients presenting to the orthopedic clinic with neck pain but without any pathological findings. Cervical anteroposterior and lateral radiographs were evaluated to measure T1 slope, cervical inclination, the length of the T1 transverse process, and the angle between the T1 transverse process and the T1 vertebral body. We hypothesize that differences in these radiological parameters, often assessed in patients with cervical spondylosis, might contribute to nerve compression at the thoracic outlet. These parameters were compared between groups. Thoracic Outlet Syndrome Index (TOSI) scores and surgical approaches were documented for the operated patients. Results: The study included 52 patients with a mean age of 34.23 ± 11.15 years. Of these, 24 patients were in the TOS group, and 28 were in the control group. Sixteen of the 24 TOS patients underwent surgery, while 8 were managed with physical therapy. Significant differences were observed between the TOS and control groups in cervical inclination and T1 transverse process angle ( p = 0.04, p = 0.004). However, no significant relationship was found between T1 slope, T1 transverse process length, and TOS. Cervical inclination was 43 degrees in the TOS group and 48 degrees in the control group. The T1 transverse process angle was 106.5 degrees in the TOS group and 116.5 degrees in the control group. Among the 16 operated patients, 13 (81.25%) underwent a supraclavicular approach, 2 (12.5%) had a combined supraclavicular and pectoralis minor approach, and 1 (6.25%) underwent a pectoralis minor approach. Supraclavicular surgeries included fibrous band excision and anterior and middle scalenectomy. The preoperative and postoperative TOSI scores for the 16 operated patients were 26.2 and 2.23, respectively, with a statistically significant difference ( p < 0.001). Discussions: Increased tension in the fibrous bands over the Sibson-Truffert fascia, exacerbated by poor neck posture, may contribute to lower trunk compression in TOS. The literature supports treatment through excision of these bands via a supraclavicular approach, yielding clinically satisfactory outcomes. Conclusion: In conclusion, demonstrating cervical inclination and T1 transverse process angle preoperatively as indicators of lower trunk compression may predict favorable outcomes with supraclavicular surgery.

Introduction This study aims to investigate the anatomical variations in the median nerve and its branches, specifically focusing on their distribution to the muscles and the points at which they enter the muscles. In addition, the branching level of the ramus muscularis of the median nerve supplying the thenar muscles was examined to explore potential correlations with carpal tunnel syndrome. Understanding these variations is crucial for minimizing iatrogenic nerve damage during surgical procedures in the carpal tunnel region. Methods Dissections were conducted on 15 forearm and wrist specimens, including 8 right-sided cadavers and 7 left-sided cadavers. The muscle branch entry levels into the thenar region were measured, and the nerve was classified according to Lanz’s classification system during the opening of the flexor retinaculum. Parameters such as the height of the first branch of the median nerve relative to the z-line (interstyloid line), the relationship of the nerve’s muscular branch to the flexor retinaculum, the level of entry of the muscle branch into the muscle (relative to the z-line), muscle length, and the ratio of the entry level of the first branch to muscle length were examined. Results Four types of median nerve branching were observed according to Lanz’s classification. The extraligamentous type was the most common, found in 53% of the specimens. In preligamentous types, the branches emerged on average 13.37 ± 5.69 mm inferiorly, except for those relative to the z-line. The entry level of the muscle branch into the muscle was most frequently located in the upper third of the thenar region. The average length of the thenar region was measured to be 11.40 ± 1.02 mm. The high frequency (53%) of the extraligamentous type in our study aligns with the findings in the general literature. However, the discovery of an additional preligamentous accessory motor branch in 46% of cases is a noteworthy observation, highlighting a higher rate than previously documented. Conclusion These branching patterns suggest the need for careful consideration of accessory branches during surgical procedures in the carpal tunnel region. In particular, during carpal tunnel surgeries, it is recommended to assess the relationship between the motor branch of the median nerve and the flexor retinaculum before releasing it, as variations in branching could have implications for surgical outcomes.