Soft spot: the important zone at the standard posterior portal of shoulder arthroscopy

Background/aim: The localization of the standard posterior portal of shoulder arthroscopy and landmarks mentioned in the literature are unclear. The purpose of this prospective cadaveric study was to determine the localization of the standard posterior portal and its distance to the neural structures. Materials and methods: One fresh frozen and 10 formalin-fixed adult cadaveric shoulders were dissected. In the beach chair position, a 5-mm trocar was placed anteroposteriorly from the superior edge of the subscapularis muscle, superior to the tip of the coracoid process and tangent to the glenoid. The relevant distances of the posterior exit point were measured. Results: In all specimens, the exit point was a triangular fibrous area, between the posterior and lateral parts of the deltoid. Medial and inferior distances of the trocar to the posterolateral tip of the acromion were 1.88 ± 0.53 cm and 1.35 ± 0.34 cm and distances to the axillary and suprascapular nerves were 4.54 ± 1.08 cm and 2.54 ± 0.85 cm, respectively. Conclusion: The most important finding of this study was the superficial localization of the soft spot between the posterior and lateral parts of deltoid.

Successful use of recombinant factor VIIa in a child with Schoenlein-Henoch purpura presenting with compartment syndrome and severe factor XIII deficiency.

In this article, we present a 7-year-old boy with Schoenlein-Henoch purpura (HSP) presented with compartment syndrome and factor XIII deficiency and treated with recombinant factor VIIa and fasciotomy. Treatment decisions for patients with HSP presenting with compartment syndrome should be made on a case-by-case basis. Factor XIII deficiency should be in mind in these patients. The use of recombinant factor VIIa might be effective and well tolerated for treating hemorrhage in patients with HSP and compartment syndrome. Surgical treatment should be preferred in patients with compartment syndrome. However, in patients who have a coagulation defect, the first priority is to correct the clotting deficiency. The use of recombinant factor VIIa is a treatment option for children who develop compartment syndrome due to a coagulation defect.

[Biomechanical comparison of two different wire stretching methods in the treatment of tibial plateau fractures with the Ilizarov echnique and the related clinical results]. / Tibia plato kiriklarinin Ilizarov teknigi ile tedavisinde iki degisik tel germe yönteminin biyomekanik karsilastirmasi ve klinik sonuçlari.

OBJECTIVES: In this study, the divergent wire stretching method used to fix the fractured pieces in the Ilizarov technique is biomechanically compared with the olive wire fixation method. PATIENTS AND METHODS: Between 1999 and 2005, 36 tibial plateau fractures of 34 patients (27 males, 7 females; mean age 48.4; range 26 to 81 years) were treated with the Ilizarov technique. Divergent wire stretching technique was used in all cases. Patients were mobilized regardless of fracture type and with full load bearing in the shortest possible time after the operation. In the second stage of this study, in order to achieve interfragmentary compression, the reciprocal olive wire method was compared with the divergent wire stretching method developed by us on tibia models at the biomechanic laboratory. RESULTS: All cases were mobilized with full weight bearing at the early postoperative period. The fusion period was 14 weeks and fixators were removed at an average of 19 weeks. No deep infection was observed in any of the cases. No other surgical intervention was required for nonunion or reduction failure. More than 2 mm separation was detected in 12 cases during 24 weeks of observation. But this has not been considered to be clinically significant. In 29 cases, the knee range of motion was 0-135 degrees. In the biomechanical phase of the study, no distinct difference was observed between the classic olive wire stretching method and the divergent wire stretching method regarding the preservation of the interfragmentary compression under weight. The divergent wire stretching method was significantly superior in achieving an homogeneous interfragmentary compression. CONCLUSION: The divergent wire stretching technique applied parallel to the Ilizarov fixation technique is an effective method for the early and unrestricted mobilization of the patients and the preservation of the range-of-motion of the joint.

Differential diagnosis in a professional basketball player with foot pain: is it an avulsion fracture or an os supranaviculare?

The os supranaviculare is an accessory bone located on the dorsal aspect of the talonavicular joint close to the midpoint. This rare incidental skeletal variant has an estimated prevalence of 1%. It may rarely become symptomatic and should not be confused with cortical avulsion fractures of navicular or talar head. We present the case of a 25-year-old professional basketball player with pain on the dorsum of his right foot after twisting his ankle during a regular season match. Magnetic resonance imaging findings of the player's foot represented a flake of bone on the superior part of the talar head. The differential diagnosis and clinical outcome of this unusual case are briefly discussed.