Estimating the optimal entry point of the antegrade femoral nailing: Previous and novel morphometric measurements.

OBJECTIVE: This anatomical study aimed to investigate the possible relationships between the proximal femur parameters and verify the optimal entry point in line with the medullary canal. METHODS: Both in single image series and 3D-MPR views, 63 femur bones were evaluated. One-millimeter multidetector computed tomography scans were collected and assessed by OsiriX-Lite version 8 and Horos v3.3.5. Entry point locations, projected and true femoral neck-shaft, anteversion, and newly defined nail entrance angles were measured. RESULTS: The entry points of 16 femurs were placed at the tip of the greater trochanter, and the remaining 47 femurs were in the trochanteric fossa (i.e., piriformis fossa). Thirty-three of the entry points found in the trochanteric fossa were overlapped by the greater trochanter. When the parameters of the right and left sides were compared, it was found that; projected neck angle, nail entrance angle, and the differences between true neck angle and nail entrance angle were found significantly different. The relationship between nail entrance angle and entry point localization was assessed, and the probability of the entry point being at the tip of the greater trochanter is 63 times greater when the NEA is below 90. CONCLUSION: This study has demonstrated that the ideal entry point for straight nails, which is based on the anatomic axis of the femur, is found mainly at the trochanteric fossa, and the greater trochanter overlapped 70.21% of them. LEVEL OF EVIDENCE: Level IV, Diagnostic Study.

Tendon of Flexor Carpi Radialis in carpal tunnel: a radiologic and cadaveric study

Background/aim: Carpal tunnel is an important anatomical passage that carries the flexor tendons into the hand. As there is still no consensus about its contents among the anatomy textbooks, the main purpose of this study was to identify the relations of the flexor carpi radialis tendon in the carpal tunnel. Materials and methods: This retrospective study was completed in April 2018 at authors' university's hospital. Seventy-four female and 44 male patients' wrists without any pathology were examined by using magnetic resonance images. The series of axial sections where the pisiform exist were evaluated by using T1 sequence and the structures in the carpal tunnel were identified. Results: Results of this study showed that the tendon of the flexor carpi radialis was found above the flexor retinaculum within its own septal compartment in all patients. Conclusion: According to the results, tendon of flexor carpi radialis crosses the wrist region superficial to the carpal tunnel. Thus, tendon of flexor carpi radialis doesn't have any effect on the carpal tunnel syndrome. Further cadaveric studies would be useful for identifying the contents of the carpal tunnel and morphological organization of the wrist.

Redefining the morphometry of subclavian vessels for clavicle fracture treatments.

PURPOSE: Clavicle fractures are common injuries in adults and children. Although neurovascular damage is rarely seen, acute subclavian artery pseudoaneurysms and injuries to subclavian vessels were reported for closed fractures of the clavicle. The aim of this study was to identify the morphological details of the subclavian vessels and their relation to the sternoclavicular joint and body of the clavicle. METHODS: 127 patients (66 females and 61 males) were evaluated using reconstructed three-dimensional computed tomographic angiographies. The point at which the subclavian artery crossed posterior to the clavicle was detected as a landmark. The medio-lateral distance between the sternal end of the clavicle, landmark, antero-posterior distance between the clavicle and the subclavian artery, diameter of the artery and vein, angle between the subclavian artery and vein, distance of the subclavian vein to the subclavian artery and the clavicle at the landmark were measured. Measurements were compared according to gender and right and left sides, and age correlation was determined. RESULTS: Morphometric relationship between the subclavian vessels and clavicle presented differences between genders. We measured the antero-posterior distance between the subclavian artery and the clavicle to be less than 1 cm (0.91 cm). CONCLUSION: The subclavian artery travelled longer distances in men than women to reach the point that it crossed the clavicle. Our results demonstrated that the subclavian artery does not pass from the inferior margin of the clavicle, thus, superior plate osteosynthesis does not have any risk to injury against the subclavian vessels during the management of the clavicle fractures.

Lateral Ligament Reconstruction for Ball-and-Socket Ankle Accompanying Lateral Ankle Instability: A Case Report and Literature Review.

The ball-and-socket ankle joint is a rare deformity characterized by the loss of concavity in the trochlear surface of the talus with rounding of the articular surfaces of the distal fibula and tibia. Frequently, tarsal coalitions, fibular hypoplasia, and shortening of the limb accompany this deformity. To date, no data have been reported on surgical treatment of lateral ankle joint instability and peroneal tendon dislocation concomitant with a ball-and-socket ankle joint. In the present study, we report the case of a 43-year-old male patient with right lateral ankle joint instability and peroneal tendon dislocation in a ball-and-socket ankle joint, with accompanying tarsal coalition. This was surgically treated by lateral ankle joint ligament reconstruction and tenodesis.

Evaluation of Tryptophan/Kynurenine Pathway Relevance With Immune System Biomarkers of Low Energy Trauma Hip Fractures in Osteoporotic Patients.

OBJECTIVES: This study aims to evaluate tryptophan degradation and clarify whether altered levels of kynurenine and tryptophan (Kyn/Trp) ratio could be correlated to osteoporotic hip fractures via immune system. PATIENTS AND METHODS: The study included 60 patients with osteoporotic hip fracture (20 males, 40 females, mean age 76.6±6.9 years; range 59 to 95 years). Patients were divided into two as patients with collum femoris fractures (group 1; n=23) and intertrochanteric fractures (group 2; n=37). Fifteen healthy subjects without any fracture were selected as control group (group 3; 3 males, 12 females; mean age 69.7±8.4; range 60 to 86 years). All fractures were simple falls due to low energy trauma. Bone mineral density measurements were performed with Lunar dual energy X-ray absorptiometry. Kyn/Trp levels were measured by high performance liquid chromatography. Interleukin (IL)-6 and IL-1 beta levels were measured with solid-phase sandwich enzyme-linked immunosorbent assay. RESULTS: All bone mineral density values were in agreement for osteoporosis and there was no significant difference between the two groups. Higher Kyn/Trp ratios were observed in groups 1 and 2 compared to group 3. This difference was more significant in group 1 (p=0.0001) than that in group 2 (p=0.048). Also, group 1 had significantly higher Kyn/Trp ratio than group 2 (p=0.011). There were significantly higher IL-6 and lower IL-1 beta levels both in groups 1 and 2 compared to group 3 (p=0.0001). There was no significant difference between group 1 and group 2 in terms of IL-6 and IL-1 beta levels. There was positive correlation with Kyn/Trp ratio (r=0.581, p=0.004) in group 2. Also, significant correlation was detected between IL-6 and IL-1 beta levels in the same group (r=0.665, p=0.036). CONCLUSION: Both increased degradation of tryptophan and ratio of Kyn/Trp indicate the relationship of immune activation with bone healing.

Redefining the proximal ulna anatomy.

PURPOSE: Complex fractures of the olecranon have always been a difficult condition for treatment. Successful reconstruction depends on restoration of the anatomic contributors to stability. The purpose of this study was to define the proximal ulna anatomy in detail with respect to fracture fixation and arthroscopy. METHODS: In 50 normal adult ulnae (26 left, 24 right); posterior olecranon height (POH), olecranon width (OW), trochlear notch width (TW), the distances between the olecranon and the trochlear notch on radial and ulnar sides (RTH, UTH), and proximal ulnar angulations were measured with a ruler and a digital goniometer. RESULTS: The average POH was 24.6 mm, OW was 23.1 mm, TW was 22.3 mm, RTH was 16.2 mm, and UTH was 15.8 mm. The mean value for proximal ulna torsion angle (PUTA) was found 11.1°. The mean varus angulation was 9.3°. The average articular angle was 27.7° and proximal ulnar dorsal angulation (PUDA) was 8°. CONCLUSIONS: The unique bony architecture of the proximal ulna presents particular difficulties for the implants used in fracture fixation and arthroplasty of the elbow. Knowing the detailed anatomy of the variations of proximal ulna will guide the surgeon to obtain a more reliable length of the olecranon and to offer a safe place for Kirschner wire replacement concerning humero-ulnar joint functionality. In this study, PUTA was also defined. The angle determines the rotation of the proximal ulna and it has a great importance for the movements of the joint. The measured angulations will help the surgeon to design the proper prosthesis for the maintenance of the functions of the elbow joint.

A low recurrence rate is possible with a combination of surgery and radiosynovectomy for diffuse pigmented villonodular synovitis of the knee.

BACKGROUND: Diffuse pigmented villonodular synovitis (DPVNS) is an uncommon proliferative disease. After only surgery, recurrence rates are high. This study presents the efficacy of combined surgical and adjuvant radiosynovectomy (RS) in the treatment of DPVNS. MATERIALS AND METHODS: Between September 2006 and September 2012, 15 knee joints of 15 patients (10 female and 5 male) with histopathological DPVNS diagnosis with mean age 27 ± 12 years underwent surgery. At mean 14.4 ± 18 weeks postoperatively, RS was applied using 5 mCi (90)Y citrate colloid. Three-phase bone scintigraphy and contrast-enhanced MRI were used to evaluate residual and recurrent tumorous tissues in the joint. RESULTS: Mean follow-up was 48 ± 22 months. Blood flow and blood pool images showed that 2 patients had marked, 4 had moderate, 6 had mild, and 3 had no uptake. Late static images showed 5 had marked, 10 had moderate (99m)Tc-HDP uptake in the related joint. MRI examination indicated that there was no progression in any of the patients. The disease was determined to be stable in 2, regressed in 9, and totally cured in 4 cases. Bremsstrahlung imaging indicated an even distribution of radionuclide in all the knee joints. There was no evidence of leakage of radioactivity in the total body scans. There was significant improvement in Lysholm knee scores after treatment. CONCLUSION: Adjuvant yttrium-90 radiosynovectomy after surgical excision in the treatment of DPVNS is a reliable and efficient treatment method with successful clinical results. RS treatment can be considered for cases with DPVNS.

A technical complication of radiosynovectomy in the ankle: leakage to distal tibiofibular syndesmosis.

Chronic hemophilic synovitis due to intra-articular bleeding in hemophilia A (a congenital coagulation defect) is a common manifestation. Radiosynovectomy is used for the ablation of chronic hemophilic synovitis. Complications due to radiosynovectomy may be seen, such as leakage of radioactivity to the lymph nodes, liver, and spleen via the lymphatic system. We report herein 2 cases that developed leakage to the distal tibiofibular syndesmosis, lymph nodes, liver, and spleen after radiosynovectomy to the ankles. In order to prevent leakage, low-volume injection is recommended.

Application of rhenium-186 radiosynovectomy in elbow diffuse pigmented villonodular synovitis. - a case report with multiple joint involvement.

After surgical therapy of diffuse pigmented villonodular synovitis (DPVNS), recurrence is seen in almost half of the patients. The effectiveness of radiosynovectomy (RSV) in preventing recurrence and complaints of DPVNS is well known. Elbow involvement in DPVNS is a very rare condition; therefore, RSV in elbow hasn't been experienced widely. The aim of this case report is to show the effectiveness of RSV with rhenium-186 (Re-186) sulfide colloid. We applied Re-186 sulfide colloid to the elbow joint of DPVNS patients six weeks after arthroscopic synovectomy. As a result, the patient did not have any complaints, and our findings are compatible with residue or recurrence on magnetic resonance imaging (MRI) in sixth and twentieth month controls after administration. We concluded that Re-186 is an effective adjuvant therapy for the prevention of recurrence and complaints.

Outcome of ulnohumeral arthroplasty in osteoarthritis of the elbow.

Ulnohumeral arthroplasty is commonly used to treat mild or moderate osteoarthritis (OA) of the elbow. Previous studies have reported good to excellent results, but have not focused on the continuing degenerative process which can alter the outcome. The authors retrospectively evaluated 10 patients with elbow OA who were treated with the Outerbridge-Kashiwagi procedure from 2004 to 2006. The mean increase in the overall Andrews and Carson scores was 91 points (range: 70 to 100) at 3 months followup. The overall gain in range of motion, patient satisfaction rate and VAS and Andrews and Carson scores was found to be significantly diminished at the last follow-up, as compared with early postoperative values. Although ulnohumeral arthroplasty is an accepted procedure for elbow osteoarthritis, the deterioration of the overall gain in pronation/supination and progression of the disease can affect the final scores and patient satisfaction.

Hip fracture risk and different gene polymorphisms in the Turkish population.

BACKGROUND: We aimed to discuss the risk assessments for both patients with hip fractures due to fall-related, low energy traumas and non-fractured control patients by examining bone mineral density and genetic data, two features associated with femoral strength and hip fracture risk. METHODS: Twenty-one osteoporotic patients with proximal femur fractures and non-fractured, osteoporotic, age- and gender-matched controls were included in the study. Bone mineral density measurements were performed with a Lunar DXA. The COL1A1, ESR, VDR, IL-6, and OPG genes were amplified, and labeling of specific gene sequences was performed in a multiplex polymerase chain reaction using the osteo/check PCR kit from the whole blood of all subjects. RESULTS: The bone mineral density (trochanteric and total bone mineral density values) of the fracture group was significantly decreased relative to the control group. We were not able to conduct statistical tests for the polymorphisms of the COL1A1, ESR, and VDR genes because our results were expressed in terms of frequency. Although they were not significant, we did examine differences in the IL-6 and OPG genes polymorphisms between the two groups. We concluded that increasing the number of cases will allow us to evaluate racial differences in femoral hip fracture risk by genotypes.

Hip fracture risk and different gene polymorphisms in the turkish population

BACKGROUND: We aimed to discuss the risk assessments for both patients with hip fractures due to fall-related, low energy traumas and non-fractured control patients by examining bone mineral density and genetic data, two features associated with femoral strength and hip fracture risk. METHODS: Twenty-one osteoporotic patients with proximal femur fractures and non-fractured, osteoporotic, age- and gender-matched controls were included in the study. Bone mineral density measurements were performed with a Lunar DXA. The COL1A1, ESR, VDR, IL-6, and OPG genes were amplified, and labeling of specific gene sequences was performed in a multiplex polymerase chain reaction using the osteo/check PCR kit from the whole blood of all subjects. RESULTS: The bone mineral density (trochanteric and total bone mineral density values) of the fracture group was significantly decreased relative to the control group. We were not able to conduct statistical tests for the polymorphisms of the COL1A1, ESR, and VDR genes because our results were expressed in terms of frequency. Although they were not significant, we did examine differences in the IL-6 and OPG genes polymorphisms between the two groups. We concluded that increasing the number of cases will allow us to evaluate racial differences in femoral hip fracture risk by genotypes.

Multicentric, synchronous giant-cell tumor of bone.

Multicentric giant cell tumor is a rare variant of giant cell tumor. In this case, we report a case of a 15-year-old female patient with synchronous type of multicentric giant cell tumor.