Are pelvic anatomical structures in danger during arthroscopic acetabular labral repair? Definition of safe bone depth.

PURPOSE: The purpose of this study was to evaluate safe depth for suture anchor insertion during acetabular labral repair and to determine the neighbouring structures at risk during drilling and anchor insertion. METHODS: Ten human cadaveric hips (six males and four females) were obtained. Acetabular labral surface was prepared and marked for right hips as 12, 1 and 3 o'clock positions, for left hips 12, 11 and 9 o'clock positions. Those were defined as anterior, anterior-superior and superior zones, respectively. These labral positions were drilled at defined zones. After measurements, depth of the bone at 10° and 20° drill angles on zones was compared statistically. RESULTS: Acetabular bone widths at investigated labral insertion points did not statistically differ. A total of 14 injuries in 60 penetrations occurred (23.3 %) with free drill penetrations, and no injuries occurred with stopped drill penetrations. The bone depth was gradually decreasing from 10° to 20° drill angles and from anterior to superior inserting zones without significant importance. The risk of perforation to the pelvic cavity started with 20 mm drill depth, and the mean depth for all insertions was calculated as 31.7 mm (SD 2.6). CONCLUSIONS: It is anatomically possible that some pelvic structures sustain iatrogenic injury during acetabular drilling for anchor placement. Being aware of mean pelvic vault is important in which drilling after excessive pincer rim trimming could easily decrease the depth of acetabular bone without a standard. Careful drilling by using stopped drill bit is crucial to prevent iatrogenic injury.

Irreducible open posterolateral knee dislocation due to medial meniscus interposition.

Posterolateral knee dislocations are generally irreducible due to the interposition of the medial capsule and retinaculum. These injuries have a 'dimple sign' which shows the invagination of the tissues in the medial joint line. We present an unusual case of an open posterolateral traumatic knee dislocation (KD-4 [ACL/PCL/MCL/LCL-PLC torn] open knee dislocation) without a 'dimple sign'. Closed reduction attempts were unsuccessful. In surgery, it was found that the medial meniscus was detached from the meniscocapsular junction and entrapped in the joint. The medial meniscus was extracted from the joint, and the joint was reduced. The medial meniscus was sutured to the meniscocapsular junction with anchors. This is the first study reporting medial meniscus interposition in an open posterolateral knee dislocation. Moreover, the presented case is peculiar because although it was a posterolateral knee dislocation, the posterolateral ligament complex was also torn.

[Childhood injuries, their etiologies, and preventive measures]. / Cocuk yaralanmalari, nedenleri ve önlemler.

OBJECTIVES: The purpose of this study was to evaluate social, economical, and cultural factors of childhood injuries and to assess preventive measures. METHODS: The study included 120 children (75 boys, 45 girls; mean age 8.3 years; range 0 to 14 years) who presented to the emergency department due to trauma from September to December 2007. Information was gathered from the patients or parents on the following: age, number of siblings; time, etiology, place, and type of trauma; type and time of transportation, educational and sociocultural level of the parents, and whether the patient had a similar injury before. RESULTS: About one-tenth (10.8%) of the patients were admitted and treated. Twenty patients (16.7%) had at least one similar injury previously. Most of the events were household injuries (n=42, 35%). The highest number of injuries occurred at the ages of 7, 8, and 10 years, and the number of injuries remained high from 12 to 14 years of age. The most frequent site of injury was the elbow during the first six years of age, the wrist and the hand at ages 7 to 11 years, and the wrist from 12 to 14 years of age. The great majority of the mothers were housewives (86.7%). Occupation and educational status of the mother, and the number of siblings were not related with recurrent childhood injuries (p>0.05). CONCLUSION: This study provided helpful information on the characteristics of childhood trauma. Programs targeting to increase the awareness on pertinent risk behaviors and to promote educational efforts concerning the risks and preventive measures will be of great help in preventing childhood injuries, in particular at the beginning of school life (age 7) and adolescence (age 12), at which time child injuries show culmination.