Open Release Research Articles

Open versus Endoscopic Release of Carpal Tunnel Syndrome

A total of 90 hands belonging to 80 patients were included in the study. They were mostly female (70) and the rest were male (10). There were 30 endoscopic releases, 60 open releases, and 2 endoscopic converted to open release. There were 15 hands complications in 90 hands. The overall complica­tion rate was 12.2%. Complications noted were pillar pain, open tendonitis presenting as De Quervain disease or trigger finger (1 endoscopic surgeries, 1 open surgeries), infection (1 endo­scopic surgeries, 3 open surgeries), wound adhesion (3 open surger­ies), nerve injury (2 open surgery, 1 endoscopic), complex regional pain syndrome (4 open surgery), and scheduled re­turns to the operating room (OR) for recurrent, ongoing, or wors­ening symptoms (1 endoscopic surgeries, 5 open surgeries). In carpal tunnel syndrome, endoscopic surgery was associated with less postoperative pain than open surgery, but the small size of the benefit and similarity in other outcomes make its cost effectiveness uncertain. There were 12 patients (out of 90) in the surgery group had painful or hypertrophic scar or pillar pain. Wound adhesion and pillar pain was the only statistically significant complica­tion found in the study when comparing open with endoscopic carpal tunnel release. This can potentially be pre­vented in future patients by delaying the removal of sutures and prolong­ing the use of a protective dressing in patients who undergo open release. There was not a statistically signifi­cant increase in overall complications when using the minimally invasive method of release, which is consis­tent with existing literature.

Olecranon Osteotomy-Facilitated Elbow Release (OFER).

The olecranon osteotomy-facilitated elbow release (OFER) is a safe and effective method for releasing severe posttraumatic elbow contractures. The OFER procedure is easier, faster, and relatively less invasive, and appears to offer superior outcomes, compared with more traditional techniques. An olecranon osteotomy provides a trapdoor through which the surgeon will have circumferential access to the joint and will be able to address all intrinsic and extrinsic causes of contracture. Access from the posterior to the anterior compartment is achieved by detaching the origin of the medial collateral ligament (MCL) and hinging the joint from medially to laterally, pivoting around the intact lateral collateral ligament. Once the olecranon and MCL are repaired, the elbow is stable enough for the patient to participate in intensive rehabilitation protocols. The first line of treatment for elbow contracture is physical therapy, focusing on range of motion and using modalities such as static-progressive and dynamic splinting protocols. In some select cases, there is also a role for manipulation under anesthesia. When nonoperative methods fail, elbow contractures may be treated surgically, using either open or arthroscopic techniques. Authors have described open release involving medial, lateral, and anterior approaches. The first outcome report of a posterior approach to treat elbow contractures has recently been published1. An open approach usually utilizes 1 or possibly 2 large incisions and involves invasive dissection through muscle and nerve mobilization. This may result in a postoperative hematoma and usually substantial pain, posing a challenge for rehabilitation. Arthroscopic techniques are less invasive, with potentially fewer complications, but are far more technically challenging. Also, most extrinsic and some intrinsic causes cannot be adequately addressed through the arthroscope. The outcomes of OFER have been found to be superior to those reported after either arthroscopic or more conventional open procedures. In addition, we believe that the OFER procedure is substantially faster and technically easier than either other open or arthroscopic releases, although we are not aware of any studies addressing this topic.

Arthroscopic Pectoralis Minor Release

The scapula has long been recognized as a key component in shoulder motion and a crucial part of the kinetic chain connecting the body's core and upper extremity. The pectoralis minor (PM) has garnered increasing attention as we better understand scapular kinematics and its role in shoulder pain and dysfunction. This is particularly important in patients with scapular dyskinesis and especially in overhead throwing athletes. The most of these patients achieve their recovery goals through nonoperative management, stretching, and strengthening protocols; however, some patients do not respond to nonoperative modalities. Several studies have recently shown improvement in shoulder motion and outcome scores after open surgical release of the PM from its scapular attachment. Arthroscopic release of the PM can be accomplished in the lateral decubitus position with standard shoulder arthroscopic portals.

Ultrasound as a diagnostic tool in the investigation of patients with carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) is reveled to be the most common peripheral nerve entrapment syndrome, estimating for 90% of all compressive. The diagnosis of CTS is based on the use of clinical criteria and imaging technique tests such as ultrasonography (US) and magnetic resonance imaging (MRI). US is a time-saving method in the diagnosis of CTS, which induces less discomfort to the patient and may be a more cost-effective approach to confirm clinical suspicion of this syndrome .The current study was aimed to evaluate the value of US and physical examinations in the diagnosis of CTS. This cross-sectional and cross-sectional prospective case study was conducted to evaluate the usefulness of wrist ultrasonography in diagnosing CTS. Twenty one patients (21 wrists) were invited to participate in the study along with an age- and sex-matched group of participant controls. Physical examination included Phalen, Tinel, Durkan, Tourniquet test. Anteroposterior and mediolateral dimension of carpal tunnel, and the median nerve area at the tunnel were also measured. All the patients underwent the open surgical release of the flexor retinaculum. There was a significant statistical relationship (p=0.05) between anteroposterior diameter of the carpal tunnel and clinical and electro physiologic nerve involvement. Furthermore, some qualitative findings was achieved such as median nerve splitting, hypo echogenicity of the involved nerve, thickening of flexor retinaculum and disappearance of median nerve areas (especially mediolateral direction). In conclusion, ultrasonographic examination of the wrists in the patients with suspected clinical symptoms can improve the diagnostic ability of CTS, especially by improving technology and experience. US can be applied for the median nerve area (MNA) measurement as a first line technique in patients with CTS.

Roles of astrocytic connexin-43, hemichannels, and gap junctions in oxygen-glucose deprivation/reperfusion injury induced neuroinflammation and the possible regulatory mechanisms of salvianolic acid B and carbenoxolone

BackgroundGlia-mediated neuroinflammation is related to brain injury exacerbation after cerebral ischemia/reperfusion (I/R) injury. Astrocytic hemichannels or gap junctions, which were mainly formed by connexin-43, have been implicated in I/R damage. However, the exact roles of astrocytic hemichannels and gap junction in neuroinflammatory responses induced by I/R injury remain unknown.MethodsPrimary cultured astrocytes were subjected to OGD/R injury, an in vitro model of I/R injury. Salvianolic acid B (SalB) or carbenoxolone (CBX) were applied for those astrocytes. Besides, Cx43 mimetic peptides Gap19 or Gap26 were also applied during OGD/R injury; Cx43 protein levels were determined by western blot and cytoimmunofluorescene staining, hemichannel activities by Ethidium bromide uptake and ATP concentration detection, and gap junction intercellular communication (GJIC) permeability by parachute assay. Further, astrocyte-conditioned medium (ACM) was collected and incubated with microglia. Meanwhile, ATP or apyrase were applied to explore the role of ATP during OGD/R injury. Microglial activation, M1/M2 phenotypes, and M1/M2-related cytokines were detected. Also, microglia-conditioned medium (MEM) was collected and incubated with astrocytes to further investigate its influence on astrocytic hemichannel activity and GJIC permeability. Lastly, effects of ACM and MCM on neuronal viability were detected by flow cytometry.ResultsWe found that OGD/R induced abnormally opened hemichannels with increased ATP release and EtBr uptake but reduced GJIC permeability. WB tests showed decreased astrocytic plasma membrane’s Cx43, while showing an increase in cytoplasma. Treating OGD/R-injured microglia with ATP or OGD/R-ACM induced further microglial activation and secondary pro-inflammatory cytokine release, with the M1 phenotype predominating. Conversely, astrocytes incubated with OGD/R-MCM exhibited increased hemichannel opening but reduced GJIC coupling. Both SalB and CBX inhibited abnormal astrocytic hemichannel opening and ATP release and switched the activated microglial phenotype from M1 to M2, thus providing effective neuroprotection. Application of Gap19 or Gap26 showed similar results with CBX. We also found that OGD/R injury caused both plasma membrane p-Cx43(Ser265) and p-Src(Tyr416) significantly upregulated; application of SalB may be inhibiting Src kinase and attenuating Cx43 internalization. Meanwhile, CBX treatment induced obviously downregulation of p-Cx43(Ser368) and p-PKC(Ser729) protein levels in plasma membrane.ConclusionsWe propose a vicious cycle exists between astrocytic hemichannel and microglial activation after OGD/R injury, which would aggravate neuroinflammatory responses and neuronal damage. Astrocytic Cx43, hemichannels, and GJIC play critical roles in OGD/R injury-induced neuroinflammatory responses; treatment differentially targeting astrocytic Cx43, hemichannels, and GJIC may provide novel avenues for therapeutics during cerebral I/R injury.

Minimally invasive distal linear metatarsal osteotomy combined with selective release of lateral soft tissue for severe hallux valgus.

Minimally invasive techniques for hallux valgus have been widely used to treat mild to moderate hallux valgus deformities. The purpose of this study was to evaluate the clinical and radiographic outcomes of distal linear metatarsal osteotomy (DLMO), which is one of the minimally invasive techniques, for severe hallux valgus. 95 patients (141 feet) with severe hallux valgus underwent DLMOs. Lateral soft tissue release (LSTR) was performed at the same time for the cases selected by an original manual test. The satisfaction level, the Japanese Society of Surgery of the Foot (JSSF) hallux scale score, and weight-bearing radiographs of the foot were assessed preoperatively and after more than 24 months. In addition, the clinical and radiographic outcomes were compared among three groups divided by the kind of LSTR: no LSTR; manual correction; and open release through skin incision. Although the first metatarsal bone was significantly shortened, dorsiflexed, and elevated on postoperative radiographs, the rate of satisfaction was 87.2% (123/141), and the mean JSSF hallux scale score improved significantly from 60.4 (44-73) to 90.4 (65-100). The mean hallux valgus and intermetatarsal angles also improved significantly from 45.5° (40.0-60.0°) to 10.3° (-28.0-40.9°) and from 19.9° (14.0-28.7°) to 8.3° (-1.6-18.5°), respectively. Delayed union (18 feet), metatarsalgia (16 feet), recurrence (22 feet), and hallux varus (22 feet) were observed, and they were more obvious in DLMO combined with open release through a skin incision. DLMO combined selectively with LSTR is an effective procedure for correcting severe hallux valgus. However, the indication for open release with DLMO should be considered carefully.

Decreased Rate of Complications in Carpal Tunnel Release with Hand Fellowship Training.

In many procedures, both high case volumes and fellowship training have been shown to improve outcomes. One of the most common procedures performed by hand surgeons, the carpal tunnel release (CTR) is also performed by several other specialties without specialty training in a hand fellowship. This study analyzed the effect that hand fellowship training has on outcomes of CTRs. Using the American Board of Orthopedic Surgeons (ABOS) Part II candidates' case list submissions, a database was created for all open and endoscopic CTRs. Surgeon training, demographics, technique, and complications were recorded. Complications were then categorized and broken down by technique. Results were then analyzed for statistical significance. A total of 29,916 cases were identified. Hand fellowship-trained surgeons performed six times more CTRs at 31 cases per surgeon compared with five for non-hand fellowship-trained surgeons. They also improved outcomes in rates of infection, wound dehiscence, and overall complications. Rates of nerve injury or recurrence showed no statistical difference. This held true for the open release subset. Endoscopically, fellowship-trained surgeons had only improved rates of overall complications. Surgeons undergoing additional hand fellowship training may show improved outcomes in the surgical treatment of carpal tunnel syndrome. However, no effect was seen on nerve injury or recurrence of symptoms.

Surgical Treatment of Objective Patellar Instability: Long-Term Results.

Purpose To evaluate the long-term results of classical “à la carte” surgical treatment of objective patellar instability as proposed by Dejour in 1987. Methods A multicentric retrospective study was conducted evaluating patients that underwent surgical procedure with a 10-year minimum follow-up (mean 12.7; range, 10–15). Surgical procedures were medial transfer of the tibial tubercle transfer according to Elmslie and Trillat et al in 38 cases, plasty of the vastus medialis obliquus according to Insall in 15 cases, open lateral retinacular release in 13 cases, capsuloplasty in 3 cases, and trochleoplasty in 1 case. Different combinations of surgical procedures were adopted according to the pathological features. Subjective outcome was assessed with the visual analog scale (VAS), Kujala score, subjective International Knee Documentation Committee (IKDC) score, Tegner score, and Crosby and Insall scale. Radiographic exams were used to assess the patellar tilt by the Laurin's angle and patellofemoral osteoarthritis (OA) according to the Iwano radiological OA scale. Results Forty patients were evaluated. Subjectively, 60% of patients achieved a result judged good, 34% sufficient, and 6% poor. There were only two cases of recurrence of instability. Mean score results were Kujala score 73.4 ± 9.9 (range, 55–95), VAS 4.5 ± 1.2 (range, 1–6), IKDC 64.8 ± 7.9 (range, 51–88), and Tegner score 4. Only nine patients returned to sports activities). Ten patients developed a grade I patellofemoral OA, 8 patients a grade II, and 22 patients a grade III. Average patellar tilt was 10° ± 3.9°. Conclusion This retrospective study showed that the traditional surgical procedure was successful for the treatment of patellar instability, but it did not prevent symptomatic patellofemoral OA. Level of Evidence Level IV, retrospective case series.

Treatment of elbow joint stiffness by open release combined with distal radius fixation hinged external fixation

To observe the effectiveness of open release combined with distal radius fixation hinged external fixation for the treatment of elbow stiffness. A total of 77 patients with elbow stiffness caused by trauma were enrolled in this study between October 2014 and October 2015. The patients were divided into control group (39 cases) and observation group (38 cases) by random number table method. The patients in the observation group were treated with elbow joint opening and release combined with distal radial fixation hinged external fixation, while the control group was treated with traditional release. There was no significant difference in gender, age, disease causes, original damage diagnosis, the time from injury to operation, preoperative flexion and extension activity of elbow joint, and preoperative Mayo elbow joint function score between 2 groups ( P>0.05). After operation, the function of elbow joint was evaluated by the flexion and extension activity of the elbow joint and the Mayo elbow joint function evaluation standard. The incisions healed by first intention in 2 groups. In observation group, there were 1 case infection of nail tract, 2 cases ulnar nerve symptoms, 1 case elbow ossification, and 1 case moderate pain in the elbow; while in control group, there were 2 cases of infection of nail tract, 2 cases of ulnar nerve symptoms, and 3 cases moderate pain in the elbow. The patients in 2 groups were followed up 6 weeks to 12 months, with an average of 6 months. The flexion and extension activity of elbow joint and Mayo elbow joint function score at last follow-up were significantly improved when compared with preoperative ones ( P<0.05); at last follow-up, the flexion and extension activity of elbow joint and Mayo elbow joint function score in observation group patients were significantly better than those in control group ( P<0.05). According to the Mayo elbow function evaluation standard, the results were excellent in 27 cases, good in 10 cases, and fair in 1 case, with an excellent and good rate of 97.4% in observation group; and the results were excellent in 12 cases, good in 21 cases, fair in 4 cases, and poor in 2 cases, with an excellent and good rate of 84.6% in control group; showing no significant difference between 2 groups ( P=0.108). Open release combined with distal radius fixation hinged external fixation can significantly improve the elbow function of patients with traumatic elbow stiffness, its recovery of elbow function was superior to the traditional release.

Novel Sulfolobus Virus with an Exceptional Capsid Architecture.

A novel archaeal virus, denoted Sulfolobus ellipsoid virus 1 (SEV1), was isolated from an acidic hot spring in Costa Rica. The morphologically unique virion of SEV1 contains a protein capsid with 16 regularly spaced striations and an 11-nm-thick envelope. The capsid exhibits an unusual architecture in which the viral DNA, probably in the form of a nucleoprotein filament, wraps around the longitudinal axis of the virion in a plane to form a multilayered disk-like structure with a central hole, and 16 of these structures are stacked to generate a spool-like capsid. SEV1 harbors a linear double-stranded DNA genome of ∼23 kb, which encodes 38 predicted open reading frames (ORFs). Among the few ORFs with a putative function is a gene encoding a protein-primed DNA polymerase. Sixfold symmetrical virus-associated pyramids (VAPs) appear on the surface of the SEV1-infected cells, which are ruptured to allow the formation of a hexagonal opening and subsequent release of the progeny virus particles. Notably, the SEV1 virions acquire the lipid membrane in the cytoplasm of the host cell. The lipid composition of the viral envelope correlates with that of the cell membrane. These results suggest the use of a unique mechanism by SEV1 in membrane biogenesis.IMPORTANCE Investigation of archaeal viruses has greatly expanded our knowledge of the virosphere and its role in the evolution of life. Here we show that Sulfolobus ellipsoid virus 1 (SEV1), an archaeal virus isolated from a hot spring in Costa Rica, exhibits a novel viral shape and an unusual capsid architecture. The SEV1 DNA wraps multiple times in a plane around the longitudinal axis of the virion to form a disk-like structure, and 16 of these structures are stacked to generate a spool-like capsid. The virus acquires its envelope intracellularly and exits the host cell by creating a hexagonal hole on the host cell surface. These results shed significant light on the diversity of viral morphogenesis.

Management of Symptomatic Plantar Fasciitis

Plantar fasciitis is one of the most common causes of heel pain. Plantar fasciitis occurs from increased stress on the plantar aponeurosis as a result of progressive, repetitive microtears, and degeneration. Plantar fasciitis is largely a clinical diagnosis based on clinical examination; thus using history and physical examination findings. Initial therapy involves addressing of possible modifiable disease factors. Surgical management of plantar fasciitis is considered after an unsuccessful course of nonoperative management, with open or endoscopic release. This article reviews the diagnostic and treatment management for patients with symptomatic plantar fasciitis.

The Fusion Pore Lifetime during SNARE Mediated Fusion of Dense Core Vesicles with t-SNARE Containing Supported Membranes can be Modulated by Asymmetric Lipid Distributions

The two leaflets of the plasma membrane contain different lipid compositions. Phosphatidylethanolamine (PE) is predominantly located in the inner cytosolic leaflet and has been proposed to promote membrane deformation and stabilize fusion pores during exocytotic events. Docking and fusion of neuroendocrine dense core vesicles (DCVs) purified from PC12 cells with supported membranes that contain the neuronal SNARE proteins syntaxin 1a and SNAP-25A can be observed by recording the fluorescence of mRuby-tagged neuropeptide Y in a total internal reflection microscope (TIRFM). Single DCV fusion events can be identified by distinct characteristic time-dependent fluorescence line shapes. These line shapes can be simulated by a mathematical model that includes the opening of a stable fusion pore followed by the collapse of the vesicle into the plane of the supported membrane. We prepared supported t-SNARE membranes with different asymmetric PE distributions between the two leaflets and analyzed the life-time of the fusion pore and the fusion probabilities. With PE in the leaflet facing the DCVs, overall fusion was most efficient and the extended fusion pore lifetime enabled notable detection of content release preceding vesicle collapse. All other PE distributions decreased fusion efficiency, altered pore lifetime and reduced content release. With PE exclusively in the opposite leaflet, resolution of pore opening and content release was lost.

A Comparison of Radiofrequency-Based Microtenotomy and Arthroscopic Release of the Extensor Carpi Radialis Brevis Tendon in Recalcitrant Lateral Epicondylitis: A Prospective Randomized Controlled Study

To compare the clinical effects of radiofrequency (RF)-based microtenotomy and arthroscopic release of the extensor carpi radialis brevis (ECRB) tendon in patients with recalcitrant lateral epicondylitis through a prospective randomized controlled study. A total of 46 patients were randomly assigned to receive arthroscopic release (group A, 24 patients) or RF-based microtenotomy (group B, 22 patients). The visual analog scale (VAS) score for pain, flexion-extension arc, operation time, Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH), Mayo Elbow Performance Score (MEPS), and grip power of groups A and B were compared during the recovery phases for up to 2 postoperative years. Both groups showed statistically significant functional improvement compared with their preoperative grip strength and DASH, VAS, and MEPS scores at 2years after surgery (P < .05). There were no differences in postoperative pain relief or functional restoration between the 2 groups during the recovery phases, however the mean operation time for group B (41.4 ± 5.2minutes) was significantly shorter than that for group A (15.6 ± 3.6minutes, P < .001). In group B, 1 patient underwent revision surgery due to postoperative ECRB rupture, and 1 patient in group A underwent open release for persistent postoperative discomfort. RF-based microtenotomy for treating recalcitrant lateral epicondylitis provided clinical outcomes comparable with those from arthroscopic release of ECRB tendon during the recovery phase. RF-based microtenotomy is considered as one of the surgical procedures for treating recalcitrant lateral epicondylitis, with the advantages of reliable elbow functional restoration and significantly shorter operation time. Level I, prospective randomized trial.

The efficacy of local corticosteroid injection in the treatment of trigger finger

Background and Objectives: Trigger finger is a condition that causes triggering, snapping or locking on flexion of the involved digit. Treatment modalities are conservative (Non-steroidal anti-inflammatory drugs, splints or corticosteroid injections) or operative (percutaneous or open release of A1 pulley- the first annular pulley of the fibro-osseous sheath of the fingers situated at the level of the metacarpophalengeal joint). The aim of this study is to evaluate the efficacy of corticosteroid injection for trigger finger in adults.Material and Methods: Fifty patients with 54 trigger digits were treated by one or two injections of methylprednisolone acetate with 1% lignocaine. Patients were followed-up for a period of 6 months.Results: Symptoms and signs resolved in 79.63% of the injected digits. Local adverse reactions to steroid injection- pain at the injection site and steroid flare were self-limiting. There was no tendon rupture or post-injection infection.Conclusion: The study concludes that steroid injection is an effective first line treatment for trigger finger in most patients.Janaki Medical College Journal of Medical Sciences (2017) Vol. 5(2): 13-18

Maintaining Quality of Candidate Strains of Transgenic Mosquitoes for Studies in Containment Facilities in Disease Endemic Countries.

Transgenic mosquitoes are being developed as novel components of area-wide approaches to vector-borne disease control. Best practice is to develop these in phases, beginning with laboratory studies, before moving to field testing and inclusion in control programs, to ensure safety and prevent costly field testing of unsuitable strains. The process of identifying and developing good candidate strains requires maintenance of transgenic colonies over many generations in containment facilities. By working in disease endemic countries with target vector populations, laboratory strains may be developed and selected for properties that will enhance intended control efficacy in the next phase, while avoiding traits that introduce unnecessary risks. Candidate strains aiming toward field use must consistently achieve established performance criteria, throughout the process of scaling up from small study colonies to production of sufficient numbers for field testing and possible open release. Maintenance of a consistent quality can be demonstrated by a set of insect quality and insectary operating indicators, measured over time at predetermined intervals. These indicators: inform comparability of studies using various candidate strains at different times and locations; provide evidence of conformity relevant to compliance with terms of approval for regulated use; and can be used to validate some assumptions related to risk assessments covering the contained phase and for release into the environment.

Interoperability Specifications and Conformance Testing Services Made Available on the Tukan Platform

In 2018 Polish health IT community faces critical challenges related to the national eHealth agenda. The mission of HL7 Poland is to establish a community around interoperability standards and integration profiles with health IT vendors, medical providers and public authorities. One of the activities that would support this goal is providing tooling for specification publication and implementation validation. HL7 Poland has started a project to create a central hub for specifications and tools. The Tukan is an online platform dedicated to Polish healthcare IT community, where national specifications for interoperability are published together with a set of testing tools supporting their implementation. The platform is based on software components originating from various sources: open source release of IHE Gazelle components, development tooling of Polish National Implementation Guide of HL7 CDA, ART-DECOR platform software components, HAPI FHIR reference implementation for FHIR STU3 standard and Central Authentication Server (CAS) software components. Tukan platform is ready to be used as an environment supporting peer-to-peer testing in connectathon-like events. The pilot phase of Tukan platform has shown that there is a significant interest in testing services, especially when there are official specifications of interoperability standards published. In 2018 the first Polish connectathon will be held by HL7 Poland on Tukan platform in cooperation with national and regional projects.

Functional outcome of open surgical A1 pulley release in diabetic and nondiabetic patients.

Trigger finger, also referred to as stenotic flexor tenosynovitis, is a common condition affecting the digits, with a lifetime incidence of 2.6% among the healthy population and up to 16.5% in diabetic patients. Diabetes mellitus is associated with multiple musculoskeletal conditions including trigger finger. In this study, we aimed to compare the functional outcome of trigger finger release in diabetic and nondiabetic patients to evaluate whether the management of trigger finger in diabetic patients should be the same as that in nondiabetic patients, or whether diabetic patients would benefit from a more tailored management plan to optimize results. A retrospective case-control study was performed at a single center among patients who underwent A1 pulley release from January 2013 to February 2017. Patients were diagnosed with trigger finger grades I to IV according to the Quinnell classification and assessed using the The Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire (Arabic version). Sixty-nine patients, including 21 male (30.4%) and 48 female (69.6%), underwent A1 pulley release surgery. More than half of the participants included in this study were diabetic (n = 40, 58%) and 29 were nondiabetic (42%). The mean postoperative QuickDASH scores were 19.93 among diabetic patients and 17.15 among nondiabetic patients. There was no significant difference in the functional outcome between diabetic and nondiabetic ( p = 0.6) patients. The postoperative functional outcomes are similar in diabetic and nondiabetic patients. Therefore, the management of trigger finger should be the same in both groups.

Trigger Finger: A Prospective Randomised Control Trial Comparing Percutaneous Release versus Open Release

Trigger Finger: A Prospective Randomised Control Trial Comparing Percutaneous Release versus Open Release

Carpal Tunnel Release Experience with Minimal Wrist Incision

Objective: Carpal tunnel syndrome (CTS) is the most common peripheral trap neuropathy resulting from compression of the median nerve in the carpal tunnel of the wrist. Open release of the transverse carpal ligament is now the most commonly used method. New techniques are being developed to avoid complications of standard long curvilinear incision. Methods: Between March 2010 and January 2016, carpal tunnel release was performed by the same surgeon with 110 minimally invasive techniques in 96 patients due to CTS. Complaints and physical examination findings were compatible with CTS and mid- to severe-severity CTS cases supported by EMG were included in the study. Results: Complaints and examination findings were recorded at the post-operative 1st year outpatient clinics of the patients. Of the110 carpal tunnel release, in 50 patients (%45,5) total, in 45 patients (%40.9) significant, in 13 patients (%11,8) slight improvement were recorded, while no improvement was recorded in 2 patients (%1,8). They stated that 88% of the patients were satisfied with the operation and 12% were not satisfied. Visual Analog Scale (VAS) was used to evaluate pain complaints. The mean VAS score was 7,5 pre-operatively and 3,2 at post-operatively 1 year follow-up. Conclusion: In patients with CTS, median nerve decompression with minimal wrist incision is an effective and reliable surgical procedure.

Management of elbow stiffness after postoperative treatment of terrible triad elbow injury: maintaining mobility and stability using a combined protocol.

The purpose of this study was to evaluate the results of our protocol that include the restoration of mobility using open release combined with external fixation and stability using ligament repair, to determine the optimal timing of surgery, and to investigate whether resection and replacement of the radial head are associated with different outcomes. Twenty-six patients with elbow stiffness after operation of terrible triad injury of the elbow were treated with our protocol. We assessed the optimal timing of the operation by comparing outcomes between the early treatment group and the delayed treatment group. The comparison was performed to investigate whether the results differed between resection and replacement of the radial head. Stability of the elbow, range of motion (ROM), Mayo Elbow Performance Score (MEPS), and complications were assessed for each patient. The mean interval from the initial surgery to the index procedure was 13months, and the mean follow-up period was 29months. The MEPS increased from a mean of 65 points to 94 points. Twenty-five of 26 patients achieved stability of the elbow, and all patients achieved functional ROM. There were no significant differences between the two subgroups with respect to ROM and stability of the elbow. Our protocol can restore mobility and stability. Resection and replacement of the radial head are both feasible using this protocol. Lastly, the timing of the surgery was not very rigorous, and the surgical delay may be insignificant. Level IV; Case Series; Treatment Study.