The aim of this study was to compare the efficacy, advantages, and complications of percutaneous achillotomy in the treatment of clubfoot with the Ponseti method when performed to two different groups under general anesthesia or polyclinic conditions with local anesthesia. A retrospective evaluation was made of 96 patients treated for clubfoot in our clinic between January 2013 and June 2016. Fifty-seven patients were separated into two groups according to whether the achillotomy was performed in polyclinic conditions with local anesthesia or under general anesthesia following serial plaster casting with the Ponseti method. The characteristics of age distribution, mean week of tenotomy, side, and sex were similar in both groups. No statistically significant difference was determined between the two groups in respect to complication and recurrence. The durations of hospitalization-observation, separation from the mother, and fasting were found to be statistically significantly shorter in local anesthesia group. Although the performance of percutaneous achillotomy with local or general anesthesia has different advantages, it can be considered that especially in centers with high patient circulation, achillotomy with local anesthesia can be more preferable to general anesthesia because it is practical and quick, does not require a long period of fasting or hospitalization, and has a similar complication rate to general anesthesia procedures.

BACKGROUND: To investigate the efficacy of new foams with boric acid particles combined with a negative pressure wound treatment (NPWT) system in open fractures with tissue defects secondary to trauma. METHODS: Forty-nine patients with open fractures secondary to trauma with soft tissue defects who were admitted between 2016 and 2018 were included in the study. Patients were examined in two groups. In Group 1, boric acid-impregnated foams combined with the NPWT system were used in 27 patients, and in Group 2, silver nitrate-impregnated foams combined with NPWT systems were used in 22 patients. In addition to evaluating the broad-spectrum antibacterial feature of silver nitrate, the antimicrobial, angiogenetic, and epithelializing effects of boric acid were investigated macroscopically and histopathologically. RESULTS: A reduction in wound size and granulation was observed in each group. Macroscopically, the reduction in wound size, epithelialization and granulation were pronounced in Group 1 and in Group 2. Microscopically, the number of fibroblasts, collagen synthesis, and angiogenesis were significantly increased in Group 1 compared with Group 2. CONCLUSION: In this clinical trial, both the broad spectrum antimicrobial feature of boric acid and its positive effect on the cells responsible for wound healing were found to be an alternative compared with silver nitrate. The use of new foams with boric acid particles combined with the NPWT system may be a good alternative method in the treatment of open wounds due to trauma.

The aim of this study was to present and discuss our clinical experience of patients presenting with a mass in the upper extremity, in respect of demographic characteristics, localisation of the mass, clinical and pathological characteristics. A retrospective evaluation was made of 114 cases (60 females, 54 males) who presented at our clinic with complaints of localised pain and swelling in the upper extremity between 1 June 2016 and 31 December 2018. The cases were separated into 3 groups; Group 1 with a mass determined in the carpal region, Group 2 with localisation between the wrist and the metacarpophalangeal joint, and Group 3, in the distal of the metacarpophalangeal joint. The mass was of soft tissue origin in 90 cases, and of bone origin in 24 cases. The distribution of cases was 6 in Group 1, 20 cases in Group 2, and 88 in Group 3. The tumour was benign in 105 (92%) cases and a primary malignancy in 9 (7.8%) cases. Recurrence occurred in 4 cases, of which 2 were enchondroma, 1 was a giant cell tendon sheath tumour, and 1 was hemangioma The majority of painful masses seen in the hand are benign and very few are malignant. In the approach to hand tumours, clinical evaluation guided by demographic data, and the evaluation of diagnostic and treatment options according to the radiological appearance and anatomic localisation will determine the ideal approach providing a full cure.

Tr en Amaç: Distal tibia kırığı nedeniyle minimal invaziv yöntem ve biyolojik fiksasyon prensipleri ile plak kullanarak osteosentez uyguladığımız olgularda klinik, radyolojik sonuç ve komplikasyonların değerlendirilmesi. Yöntem: Bu çalışmada distal tibia kırığı nedeniyle minimal invaziv yöntem ve biyolojik fiksasyon prensipleri ile ameliyat olan 58 hasta (35 erkek, 23 kadın, ortalama yaş 32) ortalama 28 aylık takibleri sonucunda değerlendirildi. Hastaların kırıkları AO/OTA (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association) sınıflamasına göre değerlendirildi. Buna göre 16 hastada A1 (%27.6), 13 hastada A2 (%22.4), 14 hastada B1 (%24.1), 11 hastada B2 (%19), 4 hastada ise C1 (%6.9) tipi kırık mevcuttu. Tüm hastalarda kırıkların kaynama sonuçları, aktiviteye dönüşleri, ayak bileği hareket açıklıkları, enfeksiyon ve komplikasyonlar Johner ve Wruhs kriterlerine göre değerlendirildi. Bulgular: Hastalarda kırıkların ortalama kaynama süresi 13 hafta (11-24 arası) idi. Tüm olgularımızda kaynama elde edilirken bir hastada gecikmiş kaynama görüldü. Hiçbir olgumuzda enfeksiyon ve yara yeri problemi görülmedi. İki olguda kaynama sonrasında 5 derece varus deformitesi tespit edildi. Dört olgumuzda diğer ayağa kıyasla 5 derece, 4 olguda ise 10 derece dorsifleksiyon kaybı görüldü. Sonuç olarak Johner ve Wruhs değerlendirme kriterlerine göre 48 hasta mükemmel (%82.75), 10 hasta (%17.25) iyi olarak değerlendirildi. Sonuç: Yumuşak doku azlığı, zayıf vaskülarizasyon gibi nedenlerden dolayı komplikasyonla karşılaşma oranının yüksek olduğu distal tibia kırıklarında, minimal invaziv yöntem ve biyolojik plaklama prensipleri ile başarılı sonuçlar alınabilmektedir. Purpose: The aim of this study was to evaluate clinical, radiological and complication results in cases of osteosynthesis using plate by minimally invasive methods and biologic fixation principles due to distal tibia fracture. Materials and Methods: In this study, 58 patients (35 males, 23 females, mean age 32 ) who underwent surgery by minimally invasive method and biologic fixation principles due to distal tibial fracture were included. Patients were followed for an average of 28 months . Fractures were classified according to AO/OTA (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association) classification. 16 patients were classified as A1 (27.6%), 13 patients classified as A2 (22.4%), 14 patients classified as B1 (24.1%), 11 patients classified as B2 (19%) and 4 patients were classified as C1 (%6.9) according to AO classification. All patients fractures, union results, return to activity, ankle range of motion, infection and complication were evaluated according to the criteria of Johner and Wruhs. Results: Mean union time of fractures was 13 weeks (11-24). In all our cases, union was achieved. Delayed union was observed in only one patient. There was no infection or wound problem in any of our cases. In four cases, dorsiflexion loss was seen at 5 degrees compared to the other foot and 10 degrees at 4 other cases. 48 patients were evaluated excellent (82.75%) and 10 patients (17.25%) were evaluated good according to Johner and Wruhs evaluation criteria. Conclusions Successful clinical and radiologic results can be obtained by using the minimally invasive methods and biological fixation principles in distal tibia fractures which has high complication rates due to soft tissue weakness and weak vascularization.