Search

Background: Syndesmosis is an important soft-tissue component supporting ankle stability. It is commonly injured along with ankle fractures. Accurate reduction and fixation of syndesmosis is essential to obtain better functional results. Therefore, we aimed to find a practical method using the mortise view of the ankle to determine the optimal syndesmosis fixation angle intraoperatively. Methods: We randomly selected 200 adults (100 women and 100 men) aged 18 to 60 years. Three-dimensional anatomical models of the tibia and fibula were created. We created a best-fit plane on the articular surface of the medial malleolus and a 90° vertical plane to the medial malleolus plane. We determined two splines on the cortical borders of the tibia and fibula distant from the most superior point of the ankle joint in horizontal view. We created two spheres that fit to the predefined splines. The optimal syndesmosis fixation angle was determined measuring the angle between the line connecting the center points of the spheres and the 90° vertical plane to the medial malleolus plane. Results: We observed no statistically significant difference in optimal syndesmosis fixation angles between sex groups. The participant mean ± SD age was 47.1 ± 10.5 years. The optimal syndesmosis fixation angle in the mortise view was found to be 21° ± 4.3°. Conclusions: We determined the optimal syndesmosis fixation angle to be 21° ± 4.3° using the mortise view of the ankle. The surgeon could evaluate the whole articular surface of the ankle joint with the medial and lateral syndesmotic spaces in mortise view accurately, and at the same position syndesmosis fixation could be performed at a mean ± SD angle of 21° ± 4.3°.

Intertrochanteric femur fractures (ITFF) are frequently fixed with proximal femoral nailing (PFN), and a common cause of fixation failure is cut-out of the lag screws. In the literature, many factors have been defined to determine the failure risk, including the tip–apex distance (TAD), calcar-referenced tip–apex distance (CalTAD), the Cleveland zone and Parker's ratio. In this study, a novel technique is described which favors infero-posterior placement of the lag screw and predicts failure risk for PFN. The purpose of this study was to evaluate the tip–neck distance ratio as a factor for the prediction of cut-out after PFN of ITFF. A retrospective evaluation was made of the data of 125 patients applied with PFN for ITFF between October 2016 and September 2019. The occurrence of mechanical complications was analyzed in relation to age, gender, fracture side, American Society of Anaesthesiologists classification, fracture classification, reduction quality, bone quality, Cleveland zone, Parker’s ratio, TAD, CalTAD and the TNDR. A total of 125 patients, including 16 with mechanical complications, were suitable for full analysis. In the univariate analysis, reduction quality (p = 0.003), the TAD (p = 0.048) and the TNDR (p = 0.030) were statistically associated with mechanical complications (p

The posterior tibial slope (PTS) is an important factor in patients undergoing unicondylar knee arthroplasty. It is an area subjected to high shear and compressive forces. Our objective is to investigate the changes taking place on the tibial slope of cementless unicondylar knee arthroplasties and define its relationship with functional scores.Patients undergoing a cementless unicondylar knee arthroplasty between January 2011 and July 2019 were selected. Exclusion criteria were lack of at least 1 year of follow up, loss to follow-up for any reason, and revision of a metallic component. Overall, 161 cases were included. Patients were analyzed using standard radiographs for changes in PTS, coronal positioning of the implant, and overhanging. Function was analyzed using Oxford Knee Score, Tegner Activity Scale, and Knee Society Score. Changes of the PTS were analyzed for statistical significance and for correlations with all the other variables.All postoperative functional scores showed significant improvement (P.05). Compared to the early postoperative values, increases of ≤5° were detected in 79% of all patients. The greater amount of slope change occurred during the first 6 months postoperatively. Statistical analysis revealed no significant relationship with functional scores of the knee, age, body mass index, overhanging, and coronal alignment of the tibial component.This study showed that, with time, minimal changes take place in the PTS of cementless unicondylar knee arthroplasty. The change mostly takes place during the first 6 months. These changes do not affect functional scores.

Background: Tibial slope measurements performed using only the proximal part of tibia ignore the native tibial anatomical axis. Our first aim is to measure the native medial, lateral and total tibial slope angles of gender groups using the whole tibial anatomical axis on computerized tomography-based three-dimensional anatomical models. The second aim is to determine the correlation between proximal and whole tibial anatomical axis for measurement of medial, lateral, and total tibial slope angles. Methods: We randomly selected 100 females and 100 males between 18-60 years of age. Three-dimensional anatomical models of right and left tibia were created. The gender-specific differences of medial, lateral, and total tibial slope angles according to proximal and whole tibial anatomical axis were measured. Correlation coefficients (r) of medial, lateral, and total tibial slope angles measured with proximal and whole tibial anatomical axis were calculated. Results: The mean age was 47.1 years. A statistically significant difference was observed between female (7.1 ± 3) and male (8.2 ± 2.5) groups in terms of mean lateral tibial slope angles according to the whole tibial anatomical axis (p=0.008). A strong correlation between proximal and whole tibial anatomical axis for all tibial slope angle measurements was detected. Conclusion: The method we determined for 3D measurement of medial, lateral and total tibial slope angles using proximal tibial anatomical axis has a strong correlation with slope angles measured in accordance with the whole tibial anatomical axis. Our 3D tibial slope angle measurement method on the proximal tibia has high reliability and could be used in the daily practice.

Dunya genelinde en onde gelen olum ve sakatlik sebepleri arasinda yer almasi sebebiyle halk sagligini tehdit eden travma ile Ortopedi ve Travmatoloji ailesi olarak on saflarda mucadele etmekteyiz. Bu alanda bugun ki mesleki uygulamalarimiz ve yaklasimlarimiza ulasmamizda bizlere oncu olan buyuklerimizin tecrubelerine duydugumuz minnet sonsuzdur. Tum bu bilgi birikimine bir nebze katkida bulunmus olmak en buyuk hedefimizdir.Ortopedi ve Travmatoloji uzmanlik egitiminde yol gosterici olmasini istedigimiz bu eser; bilgilerimizin ve deneyimlerimizin guncel literatur isiginda bir derlemesidir.“Ortopedik Travma Asistan El Kitabi’nin hazirlanmasinda emegi gecen konularini buyuk bir ozenle hazirlayan tum yazarlara, katkilari icin tum editor yardimcilarina, yayin evi calisanlarina ve aileme bu eserin hazirlanmasi sirasinda bana olan destekleri icin tesekkur ederim. Tum asistan arkadaslar icin klinikte bir basucu kaynagi olacak bu kitabi, tekrari kolay, yalin, guncel ve pratik bir calisma kaynagi olarak sunmaktan onur ve mutluluk duymaktayim.

Difficulties in graft harvesting of the hamstring have been the topic of many studies. These difficulties are related to the aponeurotic or fibrous attachments of the hamstrings with the medial head of the gastrocnemius muscle, soleus muscle, and leg fascia. Freeing the graft from these attachments is important because insufficient release prior to stripper insertion can lead to premature transection or amputation. We describe a reliable intraoperative physical examination sign to help understand the sufficient amount by which a tendon graft needs to be released prior to stripper insertion. The presence of the motionless gastrocnemius (“motionless gastroc”) phenomenon is used in our clinic as a sign that the grafts have been sufficiently freed and that a tendon stripper can be used without fear of transection or graft amputation.