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Objectives: We investigated the effect of human placental suspension (HPS) on rat sciatic nerve regeneration., Methods: Eight adult female Sprague-Dawley rats weighing between 250 and 300 g were randomly divided into control and study groups equal in number. Both sciatic nerves were explored under anesthesia, transsected and then immediately repaired. At the end of the operation, and on the second and fifth days, HPS and saline were administered to the operation zone in the test and control groups, respectively. For functional examination, electromyographic activity was measured in posterior extremities of all rats preoperatively and at the end of eight weeks. The rats were then sacrificed to obtain transections from the repaired area and its distal region for histologic examination and the number of myelin-sheathed axons was estimated in both regions., Results: Electromyographic study showed delayed latency and decreased amplitude following operation in both groups, being less severe in the study group without reaching a significant difference from the control group (p>0.05). The most notable histopathologic finding was increased endoneural collagen in the control group and regenerative axonal growth in the HPS group. The number of axons was greater in the distal region in both groups. In both regions, the number of myelin-sheathed axons was greater in the HPS group, but this difference was significant only for the number of axons in the repair zone (p=0.001)., Conclusion: Our data suggest that HPS may exert a favorable effect on peripheral nerve regeneration.

Impaction fractures of the femoral head occurring after anterior or posterior hip dislocations are well described. However, locked posterior hip dislocation resulting in sinking of the posterior acetabular rim into the femoral head has hitherto been undescribed. A 26-year-old male patient presented with complaints of severe pain in the left thigh and marked limitation in the movements of the left hip two weeks after an in-car crash. He could only walk with crutches. Shortly after the accident, he was examined at another center with physical examination and plain radiographies and was given bed rest and medications for pain relief. Computed tomography demonstrated the locked posterior hip by the impact of the posterior acetabular rim against the femoral head. At surgery, the posterior acetabular rim was embedded in the anteromedial surface of the femoral head resulting in an osteochondral impaction fracture with a penetration depth of 12 mm. Due to wide destruction to the cartilage surface, an uncemented bipolar hemiarthroplasty was performed. After 28 months of follow-up, he had no complaints and hip movements were painless with full range of motion.

Objectives: We evaluated the dimensions and anatomic localization of the proximal tibiofibular joint (PTFJ) in human cadaver and amputated knees. In addition, we assessed the relation between the osteotomy line and the PTFJ and its vulnerability to injury on radiographs of patients after proximal tibial medial open wedge osteotomy (PT-MOWO)., Methods: In the first phase, dimensions of the tibial part of the PTFJ lying between the lateral tibial condyle and the fibular head were measured by digital calipers in six human cadaver and six fresh amputed tibiae (4 females, 8 males; mean age 57 years) to evaluate the relation between the tibial surface of the PTFJ and the posterior part of the lateral tibial plateau. In the second phase, anteroposterior, lateral, and medial oblique radiographs were assessed with respect to the relation of the osteotomies with the PTFJ following PT-MOWO in 46 knees of 44 consecutive patients (38 females, 6 males; mean age 51 years)., Results: On cadaver and fresh amputation materials, the mean long and short axis dimensions of the ellipsoidal articular surface of the PTFJ in the posterolateral aspect of the tibial plateau measured 18.8 mm (range 13 mm to 20 mm) and 14.9 mm (13 mm-17 mm), respectively. The upper articular border lied at a mean of 6.3 mm (2 mm to 11 mm) distal to the posterior border of the articular surface of the lateral tibial plateau. Medial oblique radiographs showed that the osteotomy line extended to the PTFJ in cases in which it was proximally located, particularly in three cases (6.5%) where lateral cortex continuity was interrupted., Conclusion: The osteotomy line may encroach upon the PTFJ unless preoperative oblique radiographs are evaluated and a parallel course to the tibial slope of the lateral tibial plateau is followed. In addition, insufficient evaluation of PT-MOWO candidates may result in damage to the lateral cortex, which increases the risk for injury to the PTFJ.

Objectives: We investigated the possible effects of three pedicular screws on axial pull-out strength in pedicular revision surgery., Methods: Two study groups were formed from calf lumbar vertebrae. Initially, Alici pedicular screws with an outer diameter of 6.5 mm were applied (with or without tapping) to all the pedicles. All the pedicles were subjected to axial pull-out testing to induce pedicular insufficiency. Then, Alici pedicular screws with an outer diameter of 7 mm were applied to the left pedicles. The right pedicles in the two study groups were assigned to receive two different types of pedicular screws with an expandable (enlargeable) end, respectively. Axial pull-out testing was repeated in both groups and the results were compared with the initial pull-out strength values., Results: In the first group, 65% and 64% of the initial pull-out strengths were obtained with 7-mm Alici pedicular screws and with expandable pedicular screws, for the left and right pedicles, respectively. The corresponding pull-out strengths in the other study group were 70% and 68.5% of the initial values, respectively. Tapping of the screw hole entrance resulted in a mean decrease of 13% in the pull-out strength compared to screw applications without tapping., Conclusion: Pedicular screw revisions using a 0.5 mm greater screw in diameter did not provide adequate screw-bone inter-face strength and pedicle filling. Similarly, expandable pedicular screws did not contribute to screw stability.

Objectives: The indications, surgical technique, and the results of fixation using plates with metal wedges were assessed in proximal tibia medial opening wedge osteotomy., Methods: Forty knees in 38 consecutive patients (5 men, 33 women; mean age 51 years; range 36 to 65 years) with medial compartment osteoarthritis of the knee were treated with proximal tibia medial opening wedge osteotomy using plates with wedges. Following arthroscopic debridement, medial proximal tibial osteotomy was performed laterally and proximally on an oblique line and 3-4 cm distal to the medial joint space. Disruption of the lateral cortex was avoided. Fixation of the osteotomy was performed using plates with wedges. The plates which were designed by the author were either rectangular in shape with two or four holes or had an inverse "L" shape with four holes, bearing metal wedges at varying heights from 5 to 15 mm. The plates were fixed with screws. Tricortical (n=8) or bicortical (n=25) iliac bone autografts and allografts (n=7) were used. Clinical and functional evaluations were made using the HSS scoring system. The mean follow-up was 17 months (range 9 to 36 months)., Results: The mean preoperative and postoperative tibiofemoral angles were 4.3 degrees varus (0 degrees -10 degrees ) and 5.8 degrees valgus (3 degrees -11 degrees ), respectively. The mean HSS score increased from 59 (range 52 to 75) preoperatively to 90 (range 79 to 96) on final evaluations. During surgery, lateral tibial plateau fissures and lateral cortex fractures occurred in three (7.5%) and 11 (27.5%) knees, respectively. Delayed healing and delayed union and breakdown of a distal screw were encountered in one patient (2.5%)., Conclusion: Fixation of proximal tibia medial opening wedge osteotomy using plates with wedges provides adequate stabilization to maintain the desired correction and to allow early functional rehabilitation in the treatment of medial osteoarthritis of the knee.

Objectives: We evaluated the results of medical and surgical treatment for venomous snakebites and reviewed current principles of first aid and therapy for affected patients., Methods: Fourteen venomous snakebite victims (8 males, 6 females; mean age 22 years; range 7 to 75 years) were enrolled in the study. Six patients received medical treatment alone, while eight patients required both medical and surgical treatments. Injury was in the upper and lower extremities in nine and five patients, respectively. Fasciotomy was performed in seven patients due to ensuing compartment syndrome, which was manifest with extreme swelling in the affected extremity and severe pain on passive stretching of the muscles at the site of the lesion. Fasciotomy site was primarily closed in three patients, whereas four patients required debridement and skin grafting. One patient, who developed necrosis due to an excessively tight tourniquet at the time of first aid, underwent amputation of the third finger at the level of the middle phalanx. The mean follow-up was 11.5 months (range 3 to 30 months)., Results: Following fasciotomy, a long incision line remained in all the patients and a marked scar tissue due to skin grafting, which were associated with flexion contracture deformities in two elbows (35 and 105 degrees). Hemopericardium detected in one patient was dealt with by medical treatment. The mean length of hospital stay was 11.3 days for medically treated patients, and 18.2 days following surgical treatment. No incidence of late serum disease or mortality was encountered., Conclusion: Management of snakebite victims include an appropriate first aid and treatment at the hospital; identification of compartment syndrome through clinical means and measurements should lead to an indication for fasciotomy.

Objectives: To evaluate the findings and results in patients who were treated surgically for scapular fractures., Methods: Six patients (4 females, 2 males; mean age 40 years; range 25 to 59 years) with scapular fractures were treated by open reduction and internal fixation. All the fractures were caused by traffic accidents and all the patients had associated injuries. Four patients had scapular neck fractures, three of whom had accompanying ipsilateral clavicular fractures. In two patients, the fractures involved the glenoid fossa. The mean follow-up period was 27 months (range 18 to 38 months). Functional evaluations were made according to the scoring system described by Herscovici et al., Results: The results were excellent in six patients, good in one, and fair in one patient. Four patients had no pain. Three patients returned to preinjury jobs. Two patients who were housewives were able do their housework. The range of movement was greater than 120 degrees in both abduction and flexion, and the muscle strength was 5 in four patients. No postoperative complications were encountered., Conclusion: Open reduction and stabilization followed by early rehabilitation may be successful in preventing stiffness, pain, and disability in scapular neck fractures accompanied by ipsilateral clavicle fractures, or fractures involving the glenoid fossa and leading to significant displacement.

Four patients with three diverse localizations of synovial chondromatosis are presented. Three were men and one was a woman (mean age 32 years; range 21 to 55 years). The site of involvement was the shoulder joint in two patients, and the ankle and hip joints in the remaining two. Pain and restricted joint movement were common complaints. Other clinical complaints included locking, crepitus, loss of muscle strength, instability, and feeling of a mass lesion. Plain roentgenograms showed multiple radiopaque nodules/loose bodies, with the female patient additionally having osteoporosis and bone erosion. The patients underwent arthrotomy followed by synovectomy and the loose bodies were removed. Diagnoses were confirmed by histologic examination. All the patients became asymptomatic following surgical treatment and no evidence of recurrent disease was detected.

Objectives: Morphologic measurements of the lateral sacral mass (LSM) and adjacent bone structures were made on dried sacrum specimens, together with radiologic evaluations on computed tomography (CT) scans in order to assess the appropriateness of this area in iliosacral screw applications., Methods: On thirty dried human sacral bone specimens, morphologic measurements of the LSM were made by a compass sensitive to millimeters. Computed tomographic views of S1 and S2 pedicle-bodies and intervertebral foramina were obtained to make radiologic measurements by a millimeter-sensitive ruler to examine the relationship between LSM and the neural canal and intervertebral foramina., Results: The average widths of the LSM on the posterior and anterior surfaces of the sacrum were as follows. Posterior aspect: 24.1 mm on S1, 18.4 mm on S2 levels on the right; 24.5 mm on S1 and 18.8 mm on S2 levels on the left. Anterior aspect: 28.9 mm on S1, 22.6 mm on S2 levels on the right; 29.1 mm on S1 and 23 mm on S2 levels on the left. The average (oblique) heights of LSM on the postero-lateral surface were 39 mm on S1, 28.6 mm on S2 levels on the right; 37.4 mm on S1, 27.6 mm on S2 levels on the left. The average depth of the sacral ala was 50.6 mm on the right, 50.7 mm on the left. The average posterior alar height was 26 mm on both sides. On CT scans, the average widths of pedicle+sacral ala were measured as 37.6 mm (right) and 36.3 mm (left) at the S1 pedicle-body level. The average widths of LSM were 22 mm (right) and 22.3 mm (left) at the S1 intervertebral foramina level. The average widths of pedicle+LSM were 27.8 mm (right) and 26.4 mm (left) at the S2 pedicle-body level. The average widths of LSM at the S2 intervertebral foramina level were 15.9 mm (right) and 16.3 mm (left)., Conclusion: Our results suggest that iliosacral screw fixation may be more safely performed, especially at the S1 pedicle-body level and lateral to the sacral neural canal and intervertebral foramina. Injury to the neural tissues and surrounding structures is more unlikely if preoperative measurements of LSM are made on CT scans.

Objectives: Most of the gunshot injuries are caused by low-velocity bullets and shotgun pellets, resulting in mild soft tissue damage. They are sometimes associated with vascular involvement and fractures depending on the angle of entry. Bullets and especially pellets usually lodge in soft tissues. For those that are not easily detected, surgical exploration is not recommended unless they are of vital localizations. However, the removal of wadding, which may incite a local inflammatory response and harbor bacterial contaminants, is strongly recommended., Methods: Of forty-one patients with shotgun injuries, eight patients were found to bear waddings that required removal., Results: Waddings made of cork and plastic were removed from one and seven patients, respectively. In addition to patients' histories and wound-related features, radiolucent plastic waddings were predicted by the presence of a cluster of pellets on radiographs. Fractures were encountered in the injured extremity in six patients. No infections developed related to the primary wound., Conclusion: Although it is often difficult to locate a lodged wadding in the body, its removal is necessary because it can incite a local inflammatory response and harbor bacterial contaminants.

A thirty-nine-year-old female patient was brought to the emergency room following an automobile accident. Radiographic examination revealed a subcapital fracture of the left femur associated with anterior femoral head dislocation, and a contralateral comminuted femoral shaft fracture. Computed tomography showed that the acetabulum was empty, with the femoral head dislocated anteriorly close to the obturator foramen. Uncemented total hip arthroplasty and locked intramedullary nailing were performed on the left and right sides, respectively. Sixty-two months after surgery, she had no difficulty in performing daily activities.

Objectives: Morphological measurements were performed, of the articular surfaces and adjacent bone structures of the sacroiliac joint on dry bone specimens to determine the projection of the sacroiliac joint on the outer table of the posterior ilium. In addition, the effect of plate fixation using transiliosacral screws and a pedicular screw on S1 attached via a compression rod was evaluated on pelvic models to be applied in sacroiliac joint injuries., Methods: Quantitative caliper measurements of dry bone specimens including 20 os coxae and 10 sacrum were made on the articular surfaces of the sacrum and the posterior ilium, thickness of the posterior iliac bone at different levels, and the distance from the outer walls of S1 and S2 foramina to the sacral facies articularis. After the construction of a plate matching the projection of the lateral sacral mass on the outer table of the posterior ilium, four transiliosacral screws were applied lateral to the sacral foramina on pelvic models. A pedicular screw sent to S1 was attached to the plate with a threaded compression rod., Results: The mean values for the articular surface of (i) the posterior ilium were 53.3 mm (base length), 38.5 mm (height), and 56.2 mm (the distance from the anterior margin of the articular surface to the spina iliaca posterior superior); and (ii) the sacrum, 57.2 mm (base length), and 34.6 mm (height). The mean thickness of the posterior ilium was 19.2 mm, and the mean distance from the lateral walls of the sacral foramina at S1 and S2 levels to the articular surface was 21.7 mm. For the deduced projection, the perpendicular line from the middle of the base was found to be the safe zone for screw applications., Conclusion: Through a plate applied matching the projection area, multiple screws may be sent lateral to S1 and S2 foraminal levels without damage to the sacral neural and surrounding vital structures. A stable fixation can be achieved by combining the plate/screw system with a S1 pedicular screw.