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Abstract The meniscofibular ligament is an anatomically defined ligament of the knee in humans. However, there are no data regarding the prognosis following injury to this ligament. Our case was a 42-year-old man who presented at our clinic with pain of the lateral side of his left knee. MRI of his left knee revealed the rupture of the meniscofibular ligament. The mechanism of injury was consistent with anatomical and mechanical studies of the meniscofibular ligament. The patient was treated conservatively for 1 year, but his pain did not resolve completely. A case series of patients with the same injury is required to establish an effective treatment for this rare injury.

Hyperlipidemia is a major risk factor for coronary heart disease. The most commonly used antihyperlipidemic drugs are 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors (statins), of which atorvastatin is one of the most widely used. Little is known about the relationship between tendinopathy and HMG CoA reductase inhibitors (statins) or the effects of atorvastatin use on tendon healing following surgical repair of tendon rupture. We hypothesized that atorvastatin negatively affects this healing process. The Achilles tendons of 16 New Zealand rabbits were ruptured surgically and repaired with sutures. Eight of the rabbits were given oral atorvastatin. The other 8 served as a surgical control group. Six weeks postoperatively, all the rabbits were sacrificed, and the repaired tendons were removed. After standard histological preparation, fibroblastic activity, revascularization, collagenization, collagen construction, and inflammatory-cell infiltration were evaluated. On comparing the atorvastatin and surgical control groups, we observed no difference in fibroblastic activity. Although it did not reach statistical significance in our study, a difference was noted in revascularization, collagenization, and inflammatory cell infiltration; and a statistical difference was observed in collagen construction. Doubt remains about the adverse effect of atorvastatin use during tendon healing. Further investigations in animal and human models are needed on the effects of tendon healing when atorvastatin is administered for a longer time frame prior to the injury. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to establish a feasible conservative treatment algorithm for Legg-Calvè-Perthes Disease (LCPD), clarify its limitations, and evaluate the correlations between radiographical and clinical results., Methods: Patients diagnosed with LCPD and treated conservatively were evaluated retrospectively; 39 hips from 35 patients were included. The treatment protocol consisted of intermittent manual traction, range of motion exercises, activity limitation, bed rest, NSAID (ibuprofen 100mg/5mL), and ASA (100mg/day) during attack periods. The treatment protocol was standardized, and an algorithm was established for all the patients., Results: The mean follow-up was 13.7 (range = 8-22) years. According to the Stulberg classification, 26 (67%) hips were good, 6 (15,3%) were fair, and 7 (17%) were poor. No activity-limiting pain was detected in any patient. The mean Harris score was 90.5 ± 5.3 for Stulberg type 1, 2, and 3 hips, but 84.2 ± 8.8 for Stulberg type 4 and 5 hips. When the patients were evaluated in terms of pain, activity, and func- tion, it was seen that pain and activity were not different, especially in the Stulberg 1, 2, 3, and 4 patients during the mid-term follow-up. The function was the main factor correlating with the Stulberg classification. Twenty-nine (82.8%) families defined the applicability of the treatment protocol as "easy," 4 (10.3%) defined it as "moderate," and 2 (6.2%) defined it as "difficult.", Conclusion: The present study demonstrated that the treatment protocol was successful and easily applicable to LCPD. Although lateral pillar classification was efficient to predict radiographic results, the Stulberg classification was not correlated with the clinical results for every subgroup., Level of Evidence: Level IV, Therapeutic Study.

Medical interventions are becoming more complex day by day. Moreover, compared with the past, more healthcare professionals take part in the same intervention in the field of medicine. The use of technology in medical interventions has also increased. This change in the health sector brings together several legal discussions. In this study, the legal consequences that arise from the treatment processes carried out by the residents and resident educators (registerers / attending physicians), the exchange of information between them, and the usage of some messaging platforms, especially WhatsApp, in this process will be analyzed.

Objective: One of the most common complications following intramedullary nailing of a tibial shaft fracture is anterior knee pain. The etiology of pain remains unclear. Patellar tendon entry point is the most suspected reason for anterior knee pain. This study, sonographically examined the patellar tendons of patients treated via intramedullary nailing., Methods: Thirty-two patients with a tibial shaft fracture requiring intramedullary nailing via a transpatellar approach were included in the study. After all patients were grouped by reference to the presence of anterior knee pain, bilateral patellar tendon ultrasonography was performed., Results: Thirty-two patients were included in the study. Patients were measured postop average in 38.3 months (10th months - 84th months). It was determined that 10 patients of total 32 (31.3%) had anterior knee pain. There were no statistically differences between study groups in the length of patellar tendon. In the painless group; patellar tendon was wider and thicker in the operated side than the non operated side. The mean differences in the thickness between operated side versus non - operated side of the painless group were 5.3 ± 1.8 in the operated side and 3.9 ± 1.4 in the non - operated side (p = 0.007 < 0.05). The corresponding values for width of the patellar tendon was 29.6 ± 3.3 in the operated side and 27.6 ± 3.8 in the non - operated side (p = 0.007 ˂ 0.05). As a result, there were no statistically significant differences between width and thickness of the patellar tendons in the painful group, on the contrary, in the painless group; patellar tendons were wider and thicker in the operated side than those in the non - operated side. Mean values for thickness of the operated and non-operated side were 5.9 ± 2.3 and 4.2 ± 2.0, respectively (p = 0.059 > 0.05). Mean values for width of the operated and non-operated side were 30.2 ± 4.5 and 28.5 ± 4.0, respectively (p = 0.103 > 0,05)., Conclusion: Based on the ultrasonographic investigation of their patellar tendons after intramedullary nailing of a tibial shaft fracture, in the painless patients group; the patellar tendon was wider and thicker in the operated side than the non - operated side, however, in the painful patients there were no statistically significant differences between this parameters. Although the number of patients was not sufficient to conclude precise relation between patellar tendon entry point and anterior knee pain, we determined that thicker and wider tendon might be less related to anterior knee pain., Level of Evidence: Level IV, therapeutic study., (Copyright © 2018 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.)

Objective: The early-period results of our technique for performing a medial biplanar retrotubercle open-wedge proximal tibial osteotomy for the surgical treatment of varus gonarthrosis were evaluated and compared with those reported in the literature., Methods: The clinical and radiological results of a medial biplanar retrotubercle open-wedge proximal tibial osteotomy performed on 23 knees in 22 patients with medial gonarthrosis with varus alignment were analyzed., Results: Twenty patients were female and 2 were male. At the time of surgery, the mean age was 56.22 years (44-66 years), the mean body mass index was 31.95 kg/m 2 (23.4-44.9 kg/m 2 ), and the mean Hospital for Special Surgery (HSS) score was 68.7 (48-83). The mean preoperative femorotibial anatomical axis angle was 186.39° (173-194°), and the mean Insall-Salvati index value was 1.04 (0.94-1.171). The mean length of follow-up was 30.19 months (6-42 months). At the last follow-up examination, the mean HSS score was 86.48 (74-100), the mean femorotibial anatomical axis angle was 175° (168-171°), and the mean Insall-Salvati index value was 1.06 (0.857-1.32). Comparison of the final follow-up values with the preoperative values demonstrated significant improvement in the HSS score and femorotibial anatomical axis angle, but no significant difference in the Insall-Salvati index value., Conclusion: The results of this study indicated that frontal and sagittal plane deformities in patients with varus gonarthrosis can be treated with biplanar retrotubercle open-wedge proximal tibial osteotomy with good clinical results that achieve patellar tendon length stability and avoid patellofemoral problems., Competing Interests: Conflict of Interest: All authors declare that there is no conflict of interest.

Objectives: We aimed to study the effects of repeated sterilization, using different methods, on the carbon fiber rods of external fixator systems., Methods: We used a randomized set of 44 unused, unsterilized, and identical carbon fiber rods (11 × 200 mm), randomly assigned to 2 groups: unsterilized (4 rods) and sterilized (40 rods). The sterilized rods were divided into 2 groups, those sterilized in an autoclave and those sterilized using hydrogen peroxide. These were further divided into 5 subgroups based on the number of sterilization repetition to which the fibers were subjected (25, 50, 75, 100, and 200). A bending test was conducted to measure the maximum bending force, maximum deflection, flexural strength, maximum bending moment and bending rigidity. We also measured the surface roughness of the rods., Results: An increase in the number of sterilization repetition led to a decrease in maximum bending force, maximum bending moment, flexural strength, and bending rigidity, but increased maximum deflection and surface roughness (P < 0.01). The effect of the number of sterilization repetition was more prominent in the hydrogen peroxide group., Conclusions: This study revealed that the sterilization method and number of sterilization repetition influence the strength of the carbon fiber rods. Increasing the number of sterilization repetition degrades the strength and roughness of the rods.

Objective: To evaluate the midterm clinical and radiological outcomes of the medial approach using two intervals for developmental hip dysplasia (DDH)., Methods: The study involved 62 hips of 47 patients (41 girls, 6 boys) treated with medial approach for DDH from 1999 to 2010. The age of the patients at surgery was 18.7 ± 2.25 months. Follow up of the patients was 11.3 ± 3.07 years. The age of the patients at the last follow up was 12.6 ± 1.74 years. According to the Tönnis classification, 13 hips were grade II, 27 hips were grade III and 22 hips were grade IV. Patients were evaluated according to Omeroglu radiological criteria and modified McKay functional criteria. The presence of avascular necrosis (AVN) of the hip was questioned using the KalamchiMacEwen classification., Results: Radiologically, forty eight (77%) hips were evaluated as "excellent", 8 (13%) hips as "good" and 5 (8%) hips as "fair plus" and 1 (%2) hip as "fair minus". Two (3%) patients had type 1 temporary AVN and one (1%) patient had type 4 AVN with coxa magna and overgrowth of the greater trochanter. According to McKay functional criteria, 56 (90%) hips had "excellent" and 6 (10%) had "good" results. Two (3.2%) hips of one patient had to be reoperated with Salter osteotomy and femoral shortening + derotation osteotomy., Conclusion: Medial approach using two separate intervals for tenotomy and capsulotomy does not jeopardize the medial circumflex or the femoral vessels and yields satisfactory midterm results for children 18 months old with dysplasia of the hip., Level of Evidence: Level IV, therapeutic study., (Copyright © 2018 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.)

Background: The present study evaluated the results obtained from the anatomical lateral frame plate treatment of displaced intraarticular calcaneus fractures., Methods: Overall, 14 displaced intraarticular fractures of 13 patients (3 females, 10 males; Mean age, 37.5 years) were included in the present study. Surgery was performed using widened lateral approach and supported by auto grafts following joint line reduction in all patients. They were then fixated by anatomical lateral frame plate. All the joints were stabilized by casting after the operation. All patients were prescribed controlled and full weight bearing at 6-8th and 12th weeks, respectively., Results: Mean follow-up of patients was 28 months. The fractures were classified according to Sanders system. Clinical scoring of the patients was performed according to American Orthopaedic Foot and Ankle Society, Creighton-Nebraska, and Maryland systems. According to these systems, the mean scores of the patients were 83.7, 75.7, and 88.5 respectively., Conclusion: In the present study, we have defined the results of anatomical lateral frame plate treatment in patients with displaced intraarticular calcaneus fractures. We have obtained clinically and radiologically satisfactory results with the anatomical compatibility of plate to the lateral surface of the calcaneus.

Background: It is important to diagnose a scaphoid fracture accurately and start the correct treatment in the shortest time possible. However, the fracture of bone may not be visible on x-ray. In such cases, patients are clinically diagnosed with suspected or occult scaphoid fractures. The aim of this study was to define a scoring system based on physical examination to demonstrate the risk for bone injury in patients with clinically suspected and occult scaphoid fractures with negative radiographs and anatomical snuff box tenderness and to decrease the costs and workforce loss due to unnecessary treatment and magnetic resonance imaging (MRI)., Materials and Methods: Patients were initially evaluated by the attendant orthopedic physician in the emergency service with X-ray of the wrist, and ten wrist physical examination techniques were used. The X-rays of patients were evaluated by three orthopedic surgeons. Finally sixty patients, who were diagnosed as having no fracture by all three orthopedic surgeon, were included in the study. The wrists of these patients were evaluated with MRI., Results: There were 46 male (77%) and 14 female (23%) patients with a mean age of 21.5 years (range 7-61 years). About 3.3% had triquetrum fracture, 15% had bone edema in the scaphoid and radius, 18.3% had distal radius fracture, 31.6% had scaphoid fracture, and 31.8% had no bone injury. A scoring system was also proposed. It can be predicted that in the physical examination of the wrist if the total score is higher than 6.5, the probability of fracture is 2.87 (positive likelihood ratio) fold compared to scores below 6.5., Conclusions: Proposal of this new scoring system was thought to be useful for predicting the risk for bone injury in patients with clinically suspected scaphoid fractures and making decision regarding therapeutic options., Competing Interests: There are no conflicts of interest.

Accurate reduction and maintenance of the stability with correct implant positioning is critical for surgical treatment of tibial plateau fractures. Our technique includes an arthroscopic reduction and fixation of Schatzker type III tibial plateau fractures with a bulls-eye screw placement without fluoroscopy control. With the arthroscopic guidance, an anterior cruciate ligament drill guide is placed and a K-wire sent to the midpoint of the depressed fragment through the guide at a 40° angle to the coronal axis of the tibia. A tunnel is created with the drill over the K-wire. The depressed fragment is further augmented with gentle impacts over the K-wire. After arthroscopic reduction control, an appropriate-sized iliac graft is pushed until it is below the depressed fragment. The targeting device is adjusted at 130° so that it is parallel to the joint line and a K-wire sent through the device so that it would pass just below the graft. The graft is then supported with cannulated screws sent over the K-wire. This technique provides an arthroscopic reduction of the chondral surface and precise placement of the rafting screws without fluoroscopy.

There are several important technical points that need to be observed when using an intramedullary nail to fix diametaphyseal fractures of femur and tibia. We aimed to describe a technique using 3.0-mm K wires, which act like Poller screws, in conjunction with intramedullary nails to obtain alignment of diametaphyseal fractures of the femur and tibia, and present our results. 7 distal femoral, 2 proximal tibial, and 4 distal tibial diametaphyseal fractures who were treated with this technique were identified. There was no case of nonunion at the last follow-up. In all, 12 of the 13 patients had postoperative fracture angulation that was less than 5° degrees in the coronal and sagittal planes. K wires function essentially as a Poller screw for centralization of the nail and help to ensure reduction. Locking the nail in different directions, appropriate reduction can be maintained until the bone heals and there is no need for additional fixation material.

Rhabdomyolysis following pneumotic tourniquet use is an extremely rare complication. In this case report, we aimed to present an unusual tourniquet complication following proximal tibial osteotomy. A 55-year-old female patient was operated on for genu varum in our clinic. Postoperatively, an anuria developed, and liver and kidney function test levels increased. The patient was diagnosed with acute rhabdomyolysis, and an aggressive treatment was begun.

Knowing the relationship between diagnoses is important in knee arthroscopy in terms of defining possible treatment modalities preoperatively. The purpose of our study was to define the diagnoses made intraoperatively through knee arthroscopy and the relationships between them. We evaluated the results of knee arthroscopies performed over a 10-year period. The sites and sizes of chondral lesions, the existence of anterior cruciate ligament (ACL) injury, and the sites of meniscal lesions were noted for a total of 1,774 patients. The relationships between these lesions were evaluated statistically. Chondral lesions and posterior medial meniscal tears were predominant in females, whereas complete ACL tears were predominant in males. ACL tears were commonly accompanied by medial and lateral meniscal bucket-handle tears. In cases with advanced chondral lesions, medial and lateral posterior meniscal and lateral anterior meniscal tears were more common. According to our results, posterior tears of the medial menisci, medial and lateral femoral condyles, lateral tibial plateau type 3 or 4 cartilage lesions, and the rate of diagnostic arthroscopy were higher in females, while middle substance and bucket-handle tears of medial menisci and total rupture of the ACL were more common in males. ACL injuries were seen to coexist with medial or lateral menisci bucket-handle tears, with no relationship between the site or size of the chondral lesions. A relationship between medial and lateral meniscal tears and the site of femoral and tibial chondral surface lesions was detected.

Background: Comminuted fractures can occur due to severe traumas. The treatment of these fractures that may cause serious morbidity and sometimes mortality is N-butyl cyanoacrylate. It has been reported that this adhesive provides sufficient rigid fixation for bone healing. This study aims to examine cyanoacrylate radiologically and histologically to determine whether it provides adequate recovery in segmental fractures. The secondary objective is to evaluate N-butyl cyanoacrylate, an adhesive material that can hold the fragments on the fracture line together following reduction., Methods: Sixteen Sprague-Dawley rats were divided in two groups as control (n = 8) and experimental (n = 8) groups. In the control group, segmental fractures were made and fixated with K-wire. In the experimental group, the same surgical procedure was applied and also fragments were stabilized with N-butyl cyanoacrylate., Results: On the sixth week, we did not see any statistically significant difference in the radiological scoring between groups. However, the pathological scores of the control group were statistically higher than the cyanoacrylate group., Conclusions: We found that cyanoacrylate was rapidly and easily applied in the segmental fractures but did not cause any superior radiological and clinical results compared to the control group. The cyanoacrylate had low viscosity, and it was not capable enough to fill the defects formed between osteotomy surfaces. However, it did not adversely affect fracture healing as seen in biopsies taken as a result of follow-ups.

Purpose: We compared clinical and radiological results of two proximal tibial osteotomy (PTO) techniques: monoplanar medial open-wedge osteotomy and biplanar retrotubercle medial open-wedge osteotomy, stabilised by a wedged plate., Methods: We evaluated 88 knees in 78 patients. Monoplanar medial open-wedge PTO was performed on 56 knees in 50 patients with a mean age of 55 ± 9 years. Biplanar retrotubercle medial open-wedge PTO was performed on 32 knees in 28 patients with a mean age of 57 ± 7 years. Mean follow-up periods were 40.6 ± 7 months for the monoplanar PTO group and 38 ± 5 months for the biplanar retrotubercle PTO group. Clinical outcome was evaluated using the hospital for special surgery scoring system, and radiological outcome was evaluated by the measurements of femorotibial angle (FTA), patellar height and tibial slope changes., Results: In both groups, post-operative HSS scores increased significantly. No significant difference was found between groups in FTA alteration, but the FTA decreased significantly in both groups. Patellar index ratios decreased significantly in the monoplanar PTO group (Insall-Salvati Index by 0.07, Blackburne-Peel Index by 0.07), but not in the biplanar retrotubercle PTO group. Tibial slopes were increased significantly in the monoplanar PTO group, but not in the retrotubercle PTO group., Conclusions: Biplanar retrotubercle medial open-wedge osteotomy and monoplanar medial open-wedge osteotomy are both clinically effective for the treatment for varus gonarthrosis. Retrotubercle osteotomy also prevents patella infera and tibial slope changes radiologically.

The patellar tendon length changes and patella infera occurs in medial open wedge osteotomies. We hypothesized that patellar tendon length in the sagittal plane would not change in a proximal medial tibial biplanar retrotubercle open wedge osteotomy. Proximal medial tibial biplanar retrotubercle open wedge osteotomies were conducted on 23 knees of 22 patients; the mean patient age was 59 ± 7 years (range, 53-69 years). The surgical procedure used had some technical distinctions from those used in literature. The mean follow-up was 37 ± 11 months (range, 19-58 months). Preoperative and postoperative Hospital for Special Surgery Scoring System (HSS) scores, radiological tibial slope, Insall-Salvati, Blackburne-Peel, and Caton indices, femoro-tibial anatomical axis angle, the angle between the femoral condyle and tibial plateau, and the angle between the tibial plateau and tibial axis were measured and compared statistically. Postoperative HSS scores were statistically higher than the preoperative HSS scores. The femoro-tibial axis angle, the angle between the femoral condyle and tibial plateau, and the angle between the tibial plateau and tibial axes decreased significantly. No statistical difference was observed between the preoperative and postoperative Insall-Salvati, Blackburne-Peel, or Caton indices. When we performed proximal medial tibial biplanar retrotubercle open wedge osteotomy, clinical and radiological recovery was observed but patellar height did not change., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Both hyperlipidemia and metabolic syndrome have adverse effect on tendon structure. Atorvastatin is most widely used antihyperlipidemic drug. Statins have adverse effects on the tendon. Many studies have analyzed the relationship between atorvastatin and skeletal muscles. Atorvastatin administered after the surgical repair of a ruptured tendon appears to affect revascularization, collagenization, inflammatory cell infiltration, and collagen construction. Therefore, further investigations on the effects of atorvastatin on tendon healing are needed.

Tibial pilon fractures usually result from high energy trauma and present as a challenge to the orthopedic surgeon. Accurate reduction of the joint with meticulous care for the surrounding soft tissues is mandatory. We present a case report in which an anterior cruciate ligament targeting device is used with a minimally invasive technique under arthroscopic and fluoroscopic guidance for Orthopaedic Trauma Association 43-B2.3 type pilon fracture treatment., (Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

A bilateral total knee prosthesis procedure can be performed simultaneously in patients with bilateral gonarthrosis. The purpose of this study was to evaluate the differences in component alignment between the simultaneous bilateral TKA and unilateral TKA. A total of 20 patients out of 40 underwent simultaneous bilateral TKA, whereas 20 patients had unilateral TKA. The component alignments were compared radiographically. There was no statistically significant difference in the component alignment between the simultaneous bilateral TKA group and the unilateral TKA group. In conclusion, component alignment of the patients with simultaneous bilateral TKA is similar to that of unilateral TKA.

Objectives: The aim of this prospective study was to evaluate the results of anatomical frame plate osteosynthesis in patients with Ada and Miller Type 2 or 4 scapula fractures., Methods: Eleven Ada and Miller Type 2 or 4 scapula fractures in nine patients were treated with anatomical frame plate osteosynthesis. The mean follow-up time was 39.8 (12-77) months. The results were evaluated using the Herscovici score., Results: No complications, such as neurovascular injury, postoperative hematoma, infection, delayed wound healing, implant failure, delayed union, or nonunion occurred. Based on the Herscovici score, the results were excellent., Conclusion: Osteosynthesis with anatomical frame plates appears to be a safe method that allows early range of motion and that provides excellent results in Ada and Miller Type 2 or 4 scapula fractures.

The meniscofibular ligament is an anatomically defined ligament of the knee in humans. However, there are no data regarding the prognosis following injury to this ligament. Our case was a 42-year-old man who presented at our clinic with pain of the lateral side of his left knee. MRI of his left knee revealed the rupture of the meniscofibular ligament. The mechanism of injury was consistent with anatomical and mechanical studies of the meniscofibular ligament. The patient was treated conservatively for 1 year, but his pain did not resolve completely. A case series of patients with the same injury is required to establish an effective treatment for this rare injury.

Objectives: Different techniques and choices exist for revision of pedicle screws, two of which are pedicle screw combined with cement augmentation and expansive pedicle screw fixation. This biomechanical study was designed to compare the pullout strengths of two different revision techniques., Methods: Fourteen lumbar vertebrae obtained from four calves (mean age 15 months) were divided into two groups equal in number. Monoaxial 6.0-mm pedicle screws were inserted into the right pedicles, and axial pullout testing was performed at a rate of 10 mm/min and failure strengths were recorded. Revision was performed with the same-sized pedicle screws reinforced with polymethylmethacrylate in group 1, and with 7.0-mm expansive pedicle screws in group 2, and pullout testing was repeated to record maximum revision pullout strengths., Results: The mean pullout strengths recorded before and after revision were significantly different in both groups, being 2,162.9+/-718.5 N and 2,794.3+/-979.2 N in group 1 (p=0.041) and 2,605.0+/-487.6 N and 3,327.1+/-640.8 N in group 2 (p=0.012), respectively. However, the mean pullout strengths recorded before and after revision did not differ significantly between the two groups (p>0.05)., Conclusion: Our results showed that expansive pedicle screws 1 mm larger in diameter provide similar pullout strengths to those of same-sized, polymethylmethacrylate-reinforced screws in revision of pedicle screw fixation, suggesting that they can be preferred with the additional advantages of ease of application and avoiding risks for pedicle fracture and cement leakage.

Background: Resveratrol, a polyphenol found in grape and red wine, was previously shown to have free radical scavenging and antioxidant properties in various tissues. In this study, the effects of resveratrol were investigated in muscle tissue concerning the ischemia reperfusion (I/R) injury of rat hindlimb., Methods: Arterial circulation of right hindlimbs of 24 Sprague-Dawley rats was ceased by a tourniquet applied for four hours (h). The tourniquet was released at the end of 4th hours and rats were divided into four groups of six rats. Then, extremity was reperfused for 4h in group I and for 8h in group II. Resveratrol in 0.5% ethyl alcohol was administered with a dose of 10 mg/kg in the treatment groups (group I and group II) intraperitoneally. Only 0.5% ethyl alcohol were administered in the control groups (group III and group IV) intraperitoneally. Gastrocnemius muscle was used for histological assessments and the anterior tibial muscle was used for measurement of malondialdehyde (MDA) levels., Results: MN infiltration, edema, changes in diameters of muscle fibers and segmental necrosis were less prominent in rats treated with resveratrol compared with control groups (p<0.05). The MDA levels was significantly lower in treatment groups (p<0.05)., Conclusion: The results suggest that resveratrol may protect the skeletal muscles against I/R injury with its potent antioxidant properties.

In this biomechanical study, 25 in vitro calf tibial models were used in order to compare the stability of the plates under axial compression loading. A 10-mm medial opening gap was stabilized in each of the five calf tibial models either with four or two-holed rectangular shaped plates with wedges, with four-holed reversed L-shaped plates with wedges, with the combination of these two types of plates, or with six-holed anatomical T-plates. The compression behavior of the model was tested by using a universal mechanical testing system. The specimens fixed with the combination of plates with the four-holed reversed L-shaped and with two-holed rectangular shaped; or with six-holed anatomical T-plates, showed significantly better stability than those of others. Four different kinds of failure (slippage of wedge, lateral cortex fracture, damage and/or loosening of screws, and bending of plates) were observed on the models. When the average value of force loading on the plates that were designed by the first author was considered, the plates were stable and the average force values at these points were higher than the loading force on a knee during the normal paced walking or running conditions.

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.

We evaluated in this study indications, surgical technique, and results of wedge plates for fixation in proximal tibia medial opening wedge osteotomy. Fifty-eight knees in 56 consecutive patients (9 men, 47 women; mean age 52 years; ranging between 36 and 66 years) with medial compartment osteoarthrosis were treated with proximal tibia medial open-wedge osteotomy. For fixation, plates which were designed by the first author and which support the osteotomy surface with wedge-shaped projections were used. The plates were either rectangular in shape with two or four holes or had an inverse "L" shape with four holes, and had bearing metal wedges of varying heights from 5 to 15 mm. Tricortical (n=8) and bicortical (n=43) iliac bone autografts and allografts (n=7) were used. The average follow-up time was 21 months (ranging between 6 and 44 months). The mean preoperative tibiofemoral angle was 4.6 degrees varus (0 degrees -11 degrees ) while it was 5.6 degrees valgus (2 degrees -11 degrees ) postoperatively. The mean preoperative HSS score was 58 (range 51-75) and it was found 89 (range 79-96) postoperatively. As complications, lateral tibial plateau fracture in 5 knees (8.6%) and lateral cortex fracture in 15 knees (25.8%) were encountered during surgery. Deep vein thrombosis in two cases (3.4%) and nonfatal pulmonary embolism in one case (1.7%), delayed wound healing in two knees (3.4%), and delayed union as well as breakdown of a distal screw in one knee (1.7%) were encountered postoperatively. In conclusion, using wedge plates for fixation of proximal tibia medial opening wedge osteotomy in the treatment of medial osteoarthritis with unicompartmental involvement of the knee, provides adequate stabilization to allow early movement for functional rehabilitation and keeps the obtained correction level.

Lateral tibial plateau fractures or lateral cortex fractures may occur when performing medial opening wedge osteotomy. Some special tools have been described to prevent lateral tibial plateau or lateral cortex fracture during the medial separation of the osteotomy planes in medial opening wedge osteotomy. The author has developed a distractor with angle-scale to prevent such complications. Between December 2001 and April 2004, 40 opening wedge osteotomies stabilised with the plate with wedge were performed on 38 patients. The distraction of initial osteotomies in 25 knees was done with different techniques and there were three lateral tibial plateau fractures and nine lateral cortex fractures. The remaining, recently operated, 15 knees were treated with the aid of the above described angle-scale distractor to prevent lateral tibial plateau and lateral cortex fractures. There was no lateral tibial plateau fractures during the surgery when we used this instrument for the distraction of the osteotomy sites. A subsequent prospective study evaluated this new device.

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.