Han SK, et al. Clin Orthop Surg. 2017 Jun;9(2):136-144. https://doi.org/10.4055/cios.2017.9.2.136

We evaluated the clinical manifestation and surgical results following operative treatment of cubital tunnel syndrome (CuTS) caused by anconeus epitrochlearis (AE) muscle. Among 142 patients who underwent surgery for CuTS from November 2007 to October 2015, 12 were assigned to the AE group based on discovery of AE muscle; 130 patients were assigned to the other group. We analyzed retrospectively; age, sex, dominant hand, symptom duration, and weakness in hand. Severity of the disease was evaluated using the Dellon classification and postoperative symptom were evaluated using disability of arm shoulder and hand (DASH) and visual analogue scale (VAS) scores. Surgery consisted of subfascial anterior transposition following excision of AE muscle. AE muscle was present in 8.5% of all patients, and was more common in patients who were younger and with involvement of their dominant hand; the duration of symptom was shorter in patients with AE muscle. All patients showed postoperative improvement in symptoms according to DASH and VAS scores. The possibility of CuTS caused by AE muscle should be considered when younger patients have rapidly aggravated and activity-related cubital tunnel symptoms with a palpable mass in the cubital tunnel area. Excision of AE muscle and anterior ulnar nerve transposition may be considered effective surgical treatment.

Objective: Our aim was to compare the clinical results of two different methods for treatment of subtrochanteric nonunion: an additional fixation to the previous hardware, and exchange of previous hardware.\r\nMethods: We retrospectively analyzed 19 cases of subtrochanteric nonunion, and compared clinical results from 10 cases (Group 1) with exchange of the previous hardware, and 9 cases (Group 2) with retained previous hardware and an additional fixation. Autogenous bone grafting were performed for all cases. The mean age of the patients was 49.1 years in Group 1, and 48.2 years in Group 2. The mean follow-up period was 19.3 months. \r\nResults: The union rate was 100% in Group 1, and 77.8% in Group 2 (p<0.05). The average time of union was 7.6 months in Group 1, and 6.9 months in Group 2. The mean preoperative leg length discrepancy (LLD) was 8.3 mm in Group 1, 10.0 mm in Group 2; and the mean final LLD was 13.9 mm in Group 1, and 11.2 mm in Group 2. The mean length of hospital stay was 23.8±3.3 days in Group 1, and 18.2±2.7 days in Group 2; the mean amount of blood transfusion was 960 ml in Group 1, and 647 ml in Group 2; and the mean operative time was 3.7±0.8 hrs in Group 1, and 2.7±0.6 hrs in Group 2 (p<0.05).\r\nConclusion: The union rate in patients with exchange of the previous hardware was better than in those with retained hardware in the treatment of subtrochanteric nonunion by complete removal of the interposed fibrous tissue and meticulous bone grafting leading to a biological environment to achieve bony union. Özet Amaç: Çalışmamızın amacı kaynamayan subtrokanterik kırık tedavisinde daha önce yerleştirilen fiksatörün ek bir tespit ile yerinde bırakılması ve daha önceki fiksatörün değiştirilmesinden oluşan iki ayrı yöntemle elde edilen klinik sonuçları karşılaştırmaktı.\r\nÇalışma planı: Çalışmamızda kaynamayan 19 subtrokanterik kırık geriye dönük olarak analiz edilerek, daha önceki fiksatörün değiştirildiği 10 olgu (Grup 1) ile daha önceki fiksatörün ek bir tespit ile yerinde bırakıldığı 9 olgunun (Grup 2) klinik sonuçları karşılaştırıldı. Olguların hepsinde otojen kemik grefti kullanıldı. Hastaların yaş ortalaması Grup 1’de 49.1, Grup 2’de ise 48.2 idi. Ortalama takip süresi 19.3 aydı. \r\nBulgular: Kaynama oranının Grup 1’de %100, Grup 2’de ise %77.8 olduğu saptandı (p<0.05). Ortalama kaynama süresi Grup 1’de 7.6 ay iken, Grup 2’de 6.9 aydı. Ameliyat öncesi ortalama bacak uzunluğu farkı Grup 1’de 8.3 mm, Grup 2’de ise 10.0 mm bulundu; ortalama nihai bacak uzunluğu farkı ise Grup 1’de 13.9 mm iken, Grup 2’de 11.2 mm idi. Hastanede ortalama yatış süresinin Grup 1’de 23.8±3.3 gün, Grup 2’de ise 18.2±2.7 gün olduğu saptandı. Ortalama kan transfüzyonu miktarı Grup 1’de 960 ml iken, Grup 2’de 647 ml idi. Ortalama ameliyat süresinin ise Grup 1’de 3.7±0.8 saat, Grup 2’de ise 2.7±0.6 saat olduğu bulundu (p<0.05).\r\nÇıkarımlar: Kaynamayan subtrokanterik femur kırığı tedavisinde önceki fiksatörü değiştirilen hastalardaki kaynama oranı, aradaki fibröz dokunun tam olarak alınması ve dikkatli yapılan kemik greftinin kemik kaynamasını sağlayacak biyolojik ortam sağlaması sayesinde daha önce yerleştirilen fiksatörü yerinde bırakılan hastalardakilerden daha iyiydi.