Aim: In this study, we aimed to evaluate the results of reconstruction with hemi-hamat osteoarticular autograft in patients with unstable PIP fracture dislocation.\nMethods: Reconstruction process applied on the 11 patients autografted with the hemi-hamate osteoarticular bone graft those have unstable pip fracture dislocation and cannot be repaired with the primary surgical techniques. Base of the fractured phalanx prepared. The graft was taken from the dorsal and osteoarticular surface of the hamate, inserted and fixed with the mini screws. Preoperative radiological imaging studies revealed that the middle phalanx volar lip involvement corresponded 50% (interval;40%-60%). Mean surgical delay was 4.9 weeks (interval;3-8 w). PIP range of motion, contracture, stability and VAS were evaluated at a mean follow-up of 30 months. Graft position, collapse and degeneration was evaluated with the radiological techniques. \nResults: Average range of motion angle was 86° (interval;80°-100°). Flexion contracture was 10° (interval;0°-20°). In the follow ups with 30 months period postoperatively, total union of the graft was achieved on the radiological confirmation studies. Three out of eleven patients volar sided collapse was seen. But even although in those patients no unstability was occured. Mean VAS of the postoperative follows was 0.27 (interval;0-1). At a mean follow-up of 30 months; the patients were subjectively satisfied and returned to work.\nConclusion: This study showed us articular surface of middle phalanx can be reconstructed with a proper surgical technique. Even if there is a mild extension loss can be seen, functional range of motion was protected. The possible collapse of the graft detected in the follow-ups. To avoid the risk of unstability of the graft volar plate must be repaired. So we minimalize the occurrence risk of complications and excellent functional results are obtained.\n [Hand Microsurg 2019; 8(3.000): 160-166]

Objective: The purpose of this study is twofold; first we aimed to provide age and gender specific normative hand grip strength (HGS) data in Anatolian adult population and secondly we aimed to determine the effects of gender and hand dominance on HGS. Patients and Methods: The study included 1359 adult healthy subjects, aged 18-90 years. A calibrated hydraulic hand dynamometer was used for the HGS measurements in accordance with current standardized instructions. The HGSs on sides, age, gender, and dexterity were recorded and statistically analyzed. Results: The subjects were 712 males and 647 females with a mean age of 41.8±15.9 years and 46.9±16.1 years, respectively. Left hand dominance was determined in 67 subjects. Male subjects were stronger than female subjects in each age stratified group (p: 0.001). HGS showed a significant decline as the age of the subjects increased (r=-0.463, p=0.0001 dominant hand, r=-0.472, p=0.0001 non-dominant hand). The dominant hand was stronger than the non-dominant hand (p=0.0001). The mean difference between the dominant and non-dominant hand was 8.5% (SD: 13.1, median 7.6%). The mean strength ratio between the dominant and non-dominant hand was 1.07±0.12 for males and 1.09±0.13 for females. Conclusions: This study is the largest study to present normative values of HGS in an Anatolian population. These findings can be used as a reference for future studies in an Anatolian population. HGS was seen to be higher in males and to decrease proportionally with age. The dominant hand is on average 8% stronger than the non-dominant hand in both genders and all age groups.

Objectives: Recently, many surgeons started to prefer wide awake local anesthesia no tourniquet (WALANT) approach to provide an almost bloodless field for the vast majority of hand surgery procedures. We aimed to present our two-year experience with WALANT technique.\nMethods: A wide variety of 682 hand surgery operations in 626 patients were performed with WALANT technique. For infiltrative local anesthesia, the mixture of 1% lidocaine, 1:100.000 epinephrine and 8.4% bicarbonate was prepared. The need for intraoperative sedation and intraoperative patient cooperation were evaluated. Patients' fingers were observed in case of postoperative circulatory compromise. A simple cost-effectivity analysis for the anesthesia types was performed.\nResults: Mean age of the patients was 43.7. None of the patients needed intraoperative sedation, and patients obeyed to orders of surgeon throughout the procedure. The postoperative circulatory compromise was observed in two fingers; one finger resolved spontaneously and the other rescued with phentolamine. WALANT technique was more cost-effective than Bier block or general anesthesia.\nConclusion: The WALANT technique seems like a great innovation to perform a wide variety of hand surgery cases. Increased patient comfort without a tourniquet, cost-effectivity, no preoperative tests, no risks of general anesthesia, no need to stay in the hospital overnight, and intraoperative active motion assessment facility are important advantages. [Hand Microsurg 2018; 7(3.000): 125-134]

Objective: To present six cases treated with kite flap for thumb reconstruction and to discuss important aspects of the first dorsal metacarpal artery (FDMA) flap technique along with the pertinent literature.\nMethod: We evaluated the age, etiology, operation time, and postoperative flap necrosis of six patients who had undergone thumb reconstruction with FDMA flap between 2014 and 2017. All patients signed a written informed consent form. A) Relevant anatomy: The FDMA is a branch of the radial artery. It supplies the dorsal aspect of the index finger up to the proximal interphalangeal (PIP) joint. The artery is located in the groove between radial of the body of the second metacarpal bone and the ulnar head of the first interosseous muscle. B) Flap design and surgical technique: The proximal and distal borders of the flap were constituted from the metacarpophalangeal (MCP) and PIP joints, respectively. Flap elevation was performed from the distal to proximal direction and from the ulnar to radial side.\nResults: The average patient age was 46.8 years. Five patients underwent surgery due to trauma and one patient underwent surgery due to a painful scar on the tip of the thumb. For the five trauma patients, thea verage operation time was 1.4 days. The patient with the painful scar had sustained the trauma 15 years ago. Flap necrosis was not observed. The average postoperative follow-up duration was 1.6 years.\nConclusion: The FDMA flap is a safe and practical solution for thumb reconstruction provided that the anatomy of the FDMA is well known and proper technique is used. [Hand Microsurg 2018; 7(3.000): 143-148]

Aim: During diagnostic and therapeutic cerebral angiographic studies, the prediction of the dominant vertebral artery side is highly important. The reason for right and left vertebral artery diameter asymmetry is not clear. We believe there may be a correlation between hand preference and vertebral artery flow volume dominance and subclavian artery diameter. Material and Methods: A total of 112 patients were included in this study. We examined 14 left-handed and 98 right-handed individuals. Ultrasonographic measurements of the vertebral arteries were performed with 7,5 Mhz linear probing between the fifth and sixth cervical vertebrae at each side. Vertebral artery diameter and volume flow and subclavian artery diameters were measured and average values recorded. Normality analysis was conducted by one-sample Kolmogorov-Smirnov testing. The paired-sample t-test was applied to compare the left and right side measures. Results: There were no significant differences in the diameter or volume flow of the right and left vertebral arteries (VA) between right- and left-handed individuals (p>0.05). Beside this, no significant difference was found in the diameter of either the subclavian artery between right- and left-handed individuals (p

Objectives: The aim of this study was to compare the efficacy of simple trapeziectomy (ST) with trapeziectomy and flexor carpi radialis tendon interposition (T+LRTI) for grade III and IV CMC osteoarthritis in terms of clinical and radiological findings. Methods: Of the selected 13 patients, ST alone was applied to 7 (Group 1) and T+LRTI was applied to 6 (Group 2) by a single surgeon. Quick DASH and VAS scoring were used in the clinical evaluation; the grip, palmar pinch, key pinch and tip pinch were measured with a pinchmeter; the trapezial space ratio (TSR) was measured on the standard AP hand radiographs taken at the final follow-up. Clinical and radiological results of both groups were compared. Results: The mean follow-up period was 12 months in Group 1 and 17 months in Group 2. The postoperative final follow-up examination mean VAS values of Group 1 and 2 were 2 and 2.5, respectively; the Quick DASH scores were 23.2 and 27.4, respectively. Mean grip strength of Group 1 and 2 was measured as 13.2 and 12; palmar pinch strength as 3.9 and 4.6; key pinch strength as 5.6 and 4.3; and tip pinch strength as 8 and 5, respectively. The trapezial space ratio was measured with the final follow-up radiographs as mean 0.22 in Group 1 and 0.18 in Group 2. Conclusion: ST and T+LRTI have similar results and we believe that T+LRTI has no clinical or radiological benefits over ST in short-term follow-up.

Objectives: Adhesions around the flexor tendons block tendon gliding. The most common problem in secondary surgery is inadequate and ineffective tenolysis. Local anesthesia facilitates patient comfort and early active mobilization, which is very important after tenolysis surgery and even surgery without tourniquet. This study presents a tenolysis series managed with local anesthesia. Methods: We performed 22 tenolysis surgeries for zone 1 and zone 2 tendon adhesions under local infiltration anesthesia. If active flexion was achieved due to unblocked motor function, we removed the screen between the surgery area and patient to allow the patient to view their own movement. Results: There was 1 relapse. However, the results of the remaining patients were good or excellent. Discussion: This anesthesia technique enables comfortable surgery without tourniquet, unblocked motor function, and less postoperative pain. Preserving motor function is crucial for evaluating the adequacy of tenolysis intraoperatively. We recommend local infiltration anesthesia for suitable patients undergoing tenolysis.

Distal radioulnar joint (DRUJ) dislocation without fracture is uncommon. Herein, we present three cases that were treated surgically and followed for a mean of 24 months. Symptoms of DRUJ dislocation without fracture may vary, so clinical suspicion for this injury should increase whenever there is a history of wrist trauma and evidence of restricted or painful forearm supination or pronation. Radiographic evaluation may be more accurate than physical examination for diagnosis. Surgical therapy with arthroscopy-assisted closed reduction and percutaneous Kirschner wire placement yields favorable clinical and functional results.

Synovial chondromatosis is the process of progressive metaplasia associated with formation of cartilage in synovial membranes of joints, tendon sheaths or bursae. It is a rare, chronic, benign disease with unknown etiology which involves single joint. It is generally seen in large joints like knee, hip and, ankle. Wrist involvement is very rare. More common diagnoses with calcified foci and effusion in a joint like rheumatoid arthritis, osteoarthritis, synovial osteochondromatosis, chondrocalcinosis, calcifications that occur after septic arthritis and synovial chondrosarcoma may interfere with this condition. And high recurrence rate makes the treatment challenging for orthopaedic surgeon. Treatment consists of surgically removing loose bodies and partial or total synovectomy. Here, we present a 31 years old male patient referred to our clinic with painfull recurrent wrist mass. And patient was reoperated for synovial chondromatosis of wrist 17 months after the first operation. We represented the preoperative findings and histopathologic confirmation of synovial chondromatosis. We didn’t encounter any recurrence in the follow up period nearly 5 years after tumor removal and synovectomy. We will also discuss differential diagnosis and treatment according to updated literature.