Ali Özdemir

Background: Wide-Awake Local Anesthesia No Tourniquet (WALANT) is gaining popularity as an alternative to traditional anesthesia methods in upper extremity surgical procedures. WALANT, which eliminates the need for a tourniquet, also has advantages such as reduced cost, increased patient satisfaction, and intraoperative functional evaluation. This study aims to evaluate the surgical outcomes, intraoperative pain, and patient satisfaction in a diverse range of upper extremity procedures performed using WALANT. Methods: A retrospective review was conducted on 218 patients who underwent upper extremity surgery using the WALANT technique. Surgical procedures included trigger finger release (n=75), carpal tunnel release (n=65), tendon transfer (n=8), finger fracture fixation (n=34), metacarpal ORIF (n=7), scaphoid fracture fixation (n=2), and flexor tendon repair (n=27). The primary outcomes assessed were surgical time, intraoperative pain (Visual Analog Scale, VAS 0-10), postoperative complications, and patient satisfaction (5-point Likert scale). Results: The mean intraoperative pain score was 1.6 ± 0.9, with minimal discomfort reported across all procedures. The average surgical time varied depending on the procedure, with carpal tunnel release being the shortest (17.4 ± 4.2 minutes) and tendon transfers the longest (52.6 ± 8.9 minutes). The overall postoperative complication rate was 5.0%, with transient stiffness (3.2%) and delayed wound healing (1.8%) being the most common. Infection occurred in 0.9% of cases, all managed successfully with oral antibiotics. No patients required conversion to general anesthesia. Patient satisfaction was high, with a mean Likert score of 4.7 ± 0.6, reflecting strong acceptance of the WALANT technique. Conclusion: WALANT is a safe and effective alternative to conventional anesthesia for upper extremity surgeries, providing adequate intraoperative analgesia, reducing complications, and achieving high patient satisfaction. Its ability to facilitate intraoperative functional assessment is particularly advantageous in tendon and fracture surgeries. Given its benefits, WALANT should be considered a preferred technique for a wide range of upper limb procedures.

Purpose: Scapholunate interosseous ligament (SLIL) injury is the most common cause of carpal instability and may lead to scapholunate advanced collapse if untreated. While several anatomical wrist variations have been implicated in other wrist pathologies, limited studies have explored their role in SLIL injuries. This study aimed to compare specific anatomical parameters on wrist radiographs between patients with arthroscopically confirmed SLIL injuries and healthy individuals to identify potential anatomical predispositions. Methods: This study analyzed bilateral wrist radiographs of 87 patients who underwent arthroscopic dorsal capsulodesis for SLIL injuries between 2010 and 2023. A control group of 87 asymptomatic individuals with normal wrist radiographs was also included. Standardized anteroposterior and lateral wrist X-rays were collaboratively evaluated by three orthopedic surgeons. Parameters measured included radial inclination (RI), lunate fossa inclination (LFI), ulnar variance (UV), lunate tilting angle (LTA), lunate uncovering index (LUCI), carpal height ratio (CHR), palmar tilting angle (PTA), and lunate morphology. Group comparisons were performed, and a multiple logistic regression analysis was conducted using variables found to be significant in univariate analysis to identify independent anatomical predictors of SLIL injury. Results: There were no significant differences between the SLIL-injured patient group and the control group in terms of gender, age, and side (p > 0.05). RI (p < 0.001) and LFI (p = 0.016) were significantly lower, while LTA (p < 0.001) was significantly higher in the SLIL-injured patient group. Multiple logistic regression analysis revealed that lower RI (OR: 0.853, 95% CI: 0.769–0.946; p = 0.003) and higher LTA (OR: 1.126, 95% CI: 1.052–1.204; p = 0.001) were independently associated with SLIL injury. LFI did not remain significant in the final model. No significant differences were observed in UV, LUCI, PTA, CHR, or lunate type between groups. Conclusion: Low RI and increased LTA may represent anatomical risk factors for SLIL injury. Other parameters were not associated with an increased risk of injury. This study was not designed to establish a radiological diagnosis of SLIL injury; rather, it demonstrates that SLIL injuries may be influenced by individual anatomical variations. Further large scale studies are needed to validate these findings and to better understand the anatomical contributions to SLIL injury susceptibility.

Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.

Bennett fractures are intra-articular fractures of the first metacarpal, typically resulting from axial loading. The optimal surgical method for fixation remains a topic of ongoing debate. This study aims to evaluate and compare the biomechanical properties of different fixation techniques. Four fixation models were analyzed: the Lag Screw (LS) model, the Plate-screw (PS) model, and two K-wire models (Kw1 and Kw2). The biomechanical stability of each model was assessed by measuring the total displacement at the fracture line and the maximum von Mises stresses (MvMs) on the fixation materials. Measurements revealed that the LS model exhibited the highest total displacement of 2,184 mm, while the PS model showed the least displacement at 0,069 mm. Among the K-wire models, Kw1 had a total displacement of 0,408 mm, while Kw2 displayed 0,146 mm. Notably, the MvMs values at the fracture line were highest in the LS model (623,95 MPa for the large fragment surface) and lowest in the Kw2 model (16,237 MPa). The PS model demonstrated the lowest stresses on the fixation materials, highlighting its biomechanical advantage. Furthermore, the assessment of joint-level displacement indicated that the Kw1 model had the greatest displacement (0,156 mm), while the PS model maintained remarkable stability, recording a stable 0 mm displacement. The PS model demonstrated superior biomechanical stability, making it the most suitable fixation method among those studied. While the Kw2 model showed promising results with low total displacement values, further studies are necessary to establish its clinical efficacy.

Background: Scaphoid nonunion remains a challenging injury with no clear consensus on treatment. Surgical options, such as bone grafting procedures, are available for the treatment of scaphoid nonunions. While open grafting provides direct visualization, it is theoretically believed to lead to several problems due to the complex ligamentous structure responsible for wrist stability and challenges in the vascular supply of the scaphoid. On the other hand, despite its technical challenges, arthroscopic grafting is thought to avoid complications by preserving surrounding tissues. Questions/purposes: (1) Do patients undergoing bone grafting via arthroscopy for scaphoid nonunion report better function than patients undergoing an open procedure? (2) Do patients undergoing bone grafting via arthroscopy for scaphoid nonunion demonstrate better objective outcomes, such as ROM, extremity strength, and bony union? Methods: Between January 2012 and January 2022, we operated on 141 patients with scaphoid nonunion. The following patients were excluded from this study: 33 patients with scaphoid nonunion advanced collapse and arthritis, 18 patients with proximal pole fractures, 5 patients with previous surgeries, 16 patients with avascular necrosis, and 8 patients with the radius used as a graft source. In total, 28 patients underwent open grafting, and 33 patients underwent arthroscopic grafting; for both groups, the iliac crest was used as the graft source. Two patients with nonunion were observed in each treatment group, and they were excluded from the study. Results from the remaining 26 patients treated with open grafting and 31 patients treated with arthroscopic grafting (totaling 57 patients) were analyzed. The decision to treat patients with open or arthroscopic methods was not based on a particular reason. In our clinic, we initially preferred open grafting for treating nonunion of the scaphoid. Subsequently, we began to prefer arthroscopic methods for the treatment of these injuries. Twenty patients in the arthroscopic group had additional ligamentous injuries, which were simultaneously treated arthroscopically. All patients in both groups had at least 1 year of follow-up, but 48% of patients treated arthroscopically and 42% of those treated with open approaches were lost before 2 years of follow-up. The remaining patients had follow-up periods longer than 24 months. Our primary analysis was performed at 1 year, and we did a secondary analysis at 2 years. We compared the Patient-Rated Wrist Evaluation (PRWE), QuickDASH, and VAS scores of the patients. We also compared ROM and grip and pinch strength in patients’ contralateral wrists. We used predefined, evidence-based thresholds for the minimum clinically important differences for these outcome measures. Results: According to the 1-year functional analysis, we found no clinically important difference between the open surgery group and the arthroscopic surgery group in terms of PRWE score (median [IQR] 19 [25] versus 8 [9], difference of medians 11; p = 0.001), QuickDASH (median 14 [23] versus 7 [11], difference of medians 7; p = 0.004), and VAS scores (median 2 [2] versus 1 [1], difference of medians 1; p = 0.02). At 1 year, there were no differences in objective measurements, including grip strength (median 81 [16] versus 85 [14], difference of medians 4; p = 0.60), pinch strength (median 82 [18] versus 81 [15], difference of medians 1; p = 0.85), and ROM (flexion-extension median 83 [22] versus 85 [13], difference of medians 2; p = 0.74; radial deviation-ulnar deviation median 80 [36] versus 85 [14], difference of medians 5; p = 0.61). In the 2-year analysis, no clinically important difference was observed in terms of PRWE score, and no differences were found in terms of QuickDASH, VAS, strength tests, and ROM between the open and arthroscopic groups. No difference was observed in the union rates between the open group and the arthroscopic group (93% [26 of 28] versus 94% [31 of 33], OR 1.19 [95% CI 0.16 to 9.06]; p = 0.86). Conclusion: In comparing open surgical procedures with arthroscopic techniques for the treatment of scaphoid nonunions, the present study revealed no differences in functional outcomes and objective measures such as ROM and strength tests at both the 1-year and 2-year follow-up visits. Although technically more challenging, arthroscopy provides a potential advantage, such as addressing concomitant ligament injuries simultaneously. However, patients did not perceive a difference between the two surgical methods. In future studies, investigating long-term outcomes in a larger population will contribute to better elucidating this issue. Level of Evidence: Level III, therapeutic study.

Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.

Periosteal or osteoperiosteal medial femoral condyle (MFC) flaps may be good options for atrophic nonunion. The aim of this study was to evaluate the effectiveness and safety of pedicled MFC flap in the treatment of recalcitrant femur nonunion without bone defect. Thirteen patients (11 male and 2 female), who suffered recalcitrant femur nonunion and were treated with pedicled osteoperiosteal MFC flap between January 2014 and April 2018, were included in this study. Patient files were reviewed retrospectively. Atrophic or recalcitrant 2/3 distal femoral nonunion were the indications for this clinical procedure. Demographics and operative data, flap size, visual analog scale (VAS) score, time to union, and complications were evaluated. A total of 13 patients underwent femur nonunion treatment with MFC flap after an average of 3.4 previous surgical procedures. The median age was 34 (Q1: 32.5, Q3:43) years old. The mean flap size was 4.3 × 6.4 cm, all nonunions healed in a median 5 months (Q1: 4.5, Q3: 6). There were an intraoperative knee medial collateral ligament injury in a patient, hematoma in a patient, and seroma in two patients. The median length of the follow-up was 40 months (Q1: 30, Q3: 47). There wasn’t any additional complication in long-term follow-up. Functional outcomes were satisfactory. The median preoperative VAS score was 7 (Q1: 6, Q3: 9.5), decreasing to 1 (Q1: 0, Q3: 1) at the 6-month follow-up, and further reducing to 0 (Q1: 0, Q3: 1) at the 24-month follow-up. The nonunion period ranged from 6 to 18 months. The pedicled MFC flap is a good option for recalcitrant femur nonunion where larger vascularized flaps are not warranted. It is easy to harvest, does not require microvascular anastomosis, is effective, and offers minimal donor site morbidity.