Okyar Altaş

Hand Injuries Caused by Glass Punching in Children and Adolescents: Clinical Characteristics and Injured Structures - Journal of Behcet Uz Children's Hospital

Objective: This retrospective case series study aimed to report the long-term results of six patients treated with the diagnosis of neonatal compartment syndrome (NCS). Although NCS is very rare, it is a clinical entity with high morbidity, which may result in limb loss with delay in diagnosis and treatment. There may be many “etiological factors” however, it may also occur due to idiopathic causes.Material and Methods: We evaluated the possible risk factors, treatment approaches, and long-term outcomes of six patients diagnosed with neonatal compartment syndrome and were referred to our clinic by the neonatal service between 2006 and 2018.Results: The average follow-up period for patients was 47.6 months (37-62 months). Necrotic changes in the volar muscles were observed especially in patients diagnosed late (after day 7), and additional surgeries were required. Complete recovery was observed in one patient who was diagnosed and treated surgically on the first postnatal day, but residual ischaemic contractures remained in the others, and reconstructive procedures were required. These patients underwent prolonged hand physiotherapy, and partial improvement in hand function was observed.Conclusions: Although NCS is a rare condition, it is a disorder that leads to poor prognosis and permanent disability in the absence of immediate diagnosis and urgent surgical treatment. Since there is no definitive test to reveal compartment syndrome and diagnosis is made by clinical observation, timing of treatment is of great importance to prevent complications. Early diagnosis and treatment are essential for favourable outcomes.

Introduction: This study retrospectively assessed the long-term outcomes of surgical treatment for House type 1 thumb-in-palm deformities in 25 patients with spastic hemiplegic cerebral palsy. Methods: The study included 25 patients (mean age: 12.8 years) who met the inclusion criteria. The surgical technique involved the release of spastic thumb adductors, enhancement of thumb abduction and extension and stabilization of the first metacarpophalangeal joint. Patients wore a below-elbow palmar splint with the first phalanx in abduction for 6 weeks, followed by static splinting between weeks 6 and 8, dynamic splinting and rehabilitation between weeks 8 and 16 and night splinting until month 6. The Manual Ability Classification System (MACS) scores and fine and gross grasping abilities were measured and compared with those on the contralateral side. Results: The mean follow-up period was 8.8 years. The MACS score decreased from 2.72 preoperatively to 1.56 in the long term. Marked improvements in grasping ability were observed: key-pinch improved by 19%, tip-to-pinch by 19.2%, triple-pinch by 19.5% and gross grasping by 37%. Conclusion: This study suggests that surgical treatment can improve long-term functional outcomes of thumb-in-palm deformities in patients with cerebral palsy. Level of evidence: III, Therapeutic.

El bileği, ön kol kemiklerini ele bağlayan oldukça hareketli bir bileşik eklemdir. El bileğinin karmaşık mekanizmalarını açıklamak için farklı teoriler önerilmiştir, ancak el bileği kinematiğinin \“evrensel\” bir teorisi üzerinde fikir birliği yoktur. El bileği, proksimal karpal sıranın oldukça hareketli kemikleri etrafında eli ön kola bağlayan iki eklemli bir sistem olarak düşünülebilir. El bileği hareketi, ele harici bir kuvvet uygulandığında pasif olarak veya ön kol kasları kasıldığında aktif olarak gerçekleşebilir. Proksimal karpal sıranın üç kemiği, daha az sıkı bağlı olmaları nedeniyle distal karpal sıradaki kemiklere göre birbirlerine daha yakındır. El bileğinin radialden ulnara rotasyonu sırasında proksimal ve distal karpal sıralar farklı düzlemlerde hareket eder. Kaslar el bileğinin stabilizasyonunda önemli bir rol oynar. İki yaralanma mekanizması karpal disfonksiyona neden olabilir: doğrudan ve dolaylı. Tipik bir doğrudan karpal instabilite mekanizması, transvers karpal arkın ezilmesiyle ortaya çıkar. Dorsal perilunat dislokasyonların çoğu indirekt yaralanma mekanizmasının sonucudur. İlerleyici karpal instabilitenin dört aşaması tanımlanmıştır: SL ayrışması/scaphoid kırığı, LC çıkığı, LT ayrışması/triquetrum kırığı ve lunat çıkığı. El bileğinin biyomekaniğini anlamak, karpal patolojiyi tam olarak anlamak ve başarılı bir şekilde tedavi etmek için çok önemlidir. The wrist is a highly mobile composite joint that connects the forearm bones to the hand. Different theories have been proposed to explain the complex mechanisms of the wrist, but there is no consensus on a "universal" theory of wrist kinematics. The wrist can be thought of as a two-joint system that connects the hand to the forearm around the highly mobile bones of the proximal carpal row. Wrist movement can occur passively when an external force is applied to the hand or actively when the forearm muscles contract. The three bones of the proximal carpal row are closer to each other than the bones in the distal carpal row due to being less tightly bound. During rotation of the wrist from radial to ulnar, the proximal and distal carpal rows move in different planes. Muscles play an important role in stabilizing the wrist. Two injury mechanisms can cause carpal dysfunction: direct and indirect. A typical direct mechanism of carpal instability occurs with crushing of the transverse carpal arch. Most dorsal perilunate dislocations are the result of an indirect injury mechanism. Four stages of progressive carpal instability have been described: SL dissociation/scaphoid fracture, LC dislocation, LT disruption/triquetrum fracture, and lunate dislocation. Understanding the biomechanics of the wrist is crucial for fully understanding and successfully treating carpal pathology.

Yük Dağılımı, Stabilite ve Mobilite İlişkisi Göker YURDAKUL Diz Eklemi Biyomekaniği ve Kıkırdak Üzerindeki Yük Dağılımı Bedrettin AKAR Kalça Eklemi Biyomekaniği ve Total Kalça Protezi Optimizasyonu Çağdaş PAMUK Resul MUSAOĞLU Omuz Eklemi Hareket Mekaniği ve İnstabilite Yönetimi Mehmet Okan ATAHAN Ayak Bileği Biyomekaniği ve Sporcularda Yüklenme Modelleri Mehmet Akif YILMAZ Spinal Biyomekanik ve Bel Fıtığı Üzerindeki Yüklenme Etkileri Mustafa KARAL Bedirhan ALBAYRAK Sina COŞKUN Menisküs Biyomekaniği ve Doku Mühendisliği ile Onarım Yaklaşımları Mesut KARIKSIZ Yaşlanmanın Eklem Biyomekaniği Üzerine Etkileri Bedirhan ALBAYRAK Furkan ERDOĞAN Minimal İnvaziv Cerrahilerin Eklem Biyomekaniğine Etkileri İsmail GÜZEL Obezitenin Diz ve Ayakbileği Biyomekaniğine Etkisi İdris PERKTAŞ El Bileği Biyomekaniği ve Karpal Bağ Yaralanmalarının Patomekaniği Okyar ALTAŞ Dirsek Biyomekaniği: Statik ve Dinamik Stabilizatörler Alperen KORUCU Akromiyoklaviküler Eklem Biyomekaniği ve İnstabilitesi Sebati Başer CANBAZ Sakroiliak Eklem ve Biyomekaniği: Anatomik, Klinik ve Tedavi Açısından Değerlendirme Okan YİĞİT

Aim: This study aims to determine whether additional K-wires to volar plating impact the radiologic and functional outcomes of comminuted distal radius fractures (DRFs). Methods: Forty-two patients treated with either a volar locking plate or a K-wire augmented volar locking plate for intra-articular comminuted distal radius fractures (AO type C) between February 2008 and December 2014 at Haseki Hospital were retrospectively analyzed. Wrist range of motion and hand grip strength were recorded. Patients were evaluated using the Gartland-Werley scale, QuickDASH scale, and Mayo wrist score. Radiological assessments were based on wrist radiographs taken during the last follow-up. Results: No statistically significant difference was observed between the two groups in terms of the range of motion of the affected wrist joint (all p values >0.05). Similarly, there were no statistically significant differences in the Mayo wrist score, Gartland-Werley score, QuickDASH scale, or Stewart score between the two groups (p=0.17, p=0.36, p=0.38, and p=0.35, respectively). At final follow-ups, radial length loss and radial tilt loss did not significantly differ in either group compared to the healthy side (p=0.98 and p=0.96, respectively). Conclusion: Given the potential complications associated with bridge external fixators and K-wires in treating comminuted distal radius fractures, volar locking plates can be safely used alone for managing these fractures.

Background/Objectives: After the earthquakes in Turkey, many citizens were injured, and a long ongoing process requiring physiological and psychological treatments began. The aim of this study was to observe the pain and psychological changes in earthquake victims in light of the QoR-15 score. Methods: After approval by the local ethics committee (Decision No. 2023-194), earthquake victims with catheters in trauma and reconstructive surgery were retrospectively evaluated. Demographic and catheterization data were collected. Baseline, 24 h, 72 h QoR-15 (Quality of Recovery-15), and VAS (Visual Analog Scala) scores were compared for changes over time. Results: A total of 40 catheters were placed in 29 patients (after the exclusion of children, 36 catheters were evaluated in 26 (15 w/11 m) patients). The mean age of the patients was 35.57 ± 13.69 years, and the duration of catheterization was 8 (4.25–12.75) days. An infusion of 0.1% bupivacaine 0.5–1 mg/kg/24 h was started routinely. The QoR-15 scores of the patients at baseline, 24 h, and 72 h were 80.45 ± 17.76, 95.27 ± 15.16, and 101.06 ± 15.52, respectively (p < 0.001). The VAS scores of the patients at baseline, 24 h, and 72 h were 4.61 ± 1.41, 1.79 ± 1.36, and 0.76 ± 0.86, respectively (p < 0.001). Conclusions: In this study, a significant improvement in QoR-15 and VAS scores was achieved as a result of catheter insertion in earthquake victims. Considering that post-traumatic injuries require repeated surgeries and that pain aggravates the existing psychological state, it can be said that catheterization is beneficial.

Background and Objectives: The objective of this study is to examine the correlation between the active range of motion (ROM) of the affected upper extremity and functional capacity in children with Obstetric Brachial Plexus Palsy (OBPP) who have undergone the modified Hoffer tendon transfer technique. Materials and Methods: The study cohort comprised 52 children with OBPP, aged 4–14 years, who had undergone a shoulder tendon transfer. The ROM was quantified using a goniometer, while functionality was evaluated through the administration of the Brachial Plexus Outcome Measure (BPOM). Results: The study identified significant correlations between the shoulder ROM and the Brachial Plexus Outcome Measure (BPOM). Specifically, shoulder flexion (p = 0.017; r = 0.351) was positively associated with shoulder functionality, while shoulder internal rotation (p = 0.001; r = 0.481) was linked to appearance scores. A significant negative relationship was observed between elbow extension (p < 0.001; r = −0.512) and elbow and forearm activities. Conclusions: The study highlights the necessity of assessing both joint range of motion and body perception for effective treatment and follow-up, to improve the functionality and quality of life for children with OBPP.

Background/Objectives: After the earthquakes in Turkey, many citizens were injured, and a long process requiring physiological and psychological treatments started in the ongoing process. The aim of this study was to observe the pain and psychological changes in earthquake victims in light of the QoR-15 score. Methods: After approval by the local ethics committee (Decision No. 2023-194), earthquake victims with catheters in trauma and reconstructive surgery were retrospectively evaluated. Demographic and catheterization data were collected. Baseline, 24-hour, and 72-hour QoR-15 (Quality of Recovery-15) and VAS (Visual Analog Scala) scores were compared for changes over time. Results: A total of 40 catheters were placed in 29 patients (after the exclusion of children, 36 catheters were evaluated in 26 (15 w/11 m) patients). The mean age of the patients was 35.57 ± 13.69 years, and the duration of catheterization was 8 (4.25–12.75) days. Infusion of 0.1% bupivacaine 0.5–1 mg/kg/24 h was started routinely. The QoR-15 scores of the patients at baseline, 24-hour, and 72-hour were 80.45 ± 17.76, 95.27 ± 15.16, and 101.06 ± 15.52, respectively (pConclusions: In this study, a significant improvement in QoR-15 and VAS scores was achieved as a result of catheter insertion in earthquake victims. Considering that post-traumatic injuries require repeated surgeries and that pain aggravates the existing psychological state, it can be said that catheterization is beneficial.