Measurement of the knee joint line in Turkish population.

OBJECTIVE: The aim of the present study was to determine the knee joint line level by its distance to the adductor tubercle and the apex of the fibular head in the Turkish population. METHODS: The study included 117 knees of 108 patients (63 males, 45 females; mean age: 31.3 years, range: 16 to 82 years). Femoral width and the distance from the apex of the fibular head to the joint line as well as the distance from the adductor tubercle to the joint line were measured on anteroposterior radiographs. RESULTS: Mean femoral width was 87.2 mm. The average distance from the adductor tubercle to the joint line was 47.9 mm and from the fibular head to the joint line was 20.5 mm. A linear correlation was found between the distance from the adductor tubercle to the joint line and femoral width, with a ratio of 0.55. There was no significant correlation between the distance from the fibular head to the joint line and femoral width. CONCLUSION: There was a linear correlation between the femoral width and the adductor tubercle-joint line distance irrespective of any factors such as age, gender and height. Therefore, the adductor tubercle can be used as a reliable landmark to determine the joint line level for easy evaluation and measurement during surgery.

Endothelial nitric oxide synthase immunreactivity and the ultrastructure of endothelial cells of umbilical artery in normal and preeclamptic pregnancies.

Our objective was to investigate the endothelial nitric oxide synthase (eNOS) immuno-reactivity and the ultrastructure of endothelial cells of a human umbilical artery in both normal and preeclamptic pregnancies. The umbilical cords from normal and preeclamptic pregnancies were collected immediately after vaginal and abdominal deliveries. Umbilical arteries were isolated and fixed in 10% neutral formaline solution, embedded in paraffin, and then stained with hematoxylin and eosin (H&E) for the histologic investigation, and eNOS activation were examined in samples by streptavidine-biotine immunohistochemical methods. The arterial sections were also fixed in phosphate-buffered 2.5% glutaraldehyde solution (pH 7.2) for 3 h and post-fixed with 1% osmium tetroxide at 4°C for 2 h for the investigation of the ultrastructural examination. In the umbilical artery of preeclamptic pregnancies, endothelial cells were oval, triangular, or polygonal, and were disorganized. Some endothelial cells were separated by enlarged intercellular spaces. A dilated endoplasmic reticulum, swollen mitochondria, and vanished mitochondrial cristae were observed. The nuclei of some endothelial cells displayed deep invaginations and irregular outlines. Most endothelial cells had a high number of cytoplasmic vacuoles. In preeclampsia, eNOS immunoreactivity increased considerably in endothelial cells when compared to normal pregnancies. We believe that preeclampsia plays an important role in the pathogenesis of endothelial cell dysfunction and activation in the umbilical artery. However, the disturbance mechanism of endothelial cells is not known, and further studies are necessary to clarify the exact mechanism.

Symphysis pubis distance in adults: a retrospective computed tomography study.

BACKGROUND: In this retrospective study, symphysis pubis (SP) distance was measured by transverse computed tomography scans. The relation between the SP distance and age, gender, number of birth and body-mass index was studied. METHODS: Symphysis pubis joint distances were evaluated for the patients who had undergone abdominal or pelvic computed tomography examination for other medical reasons between the dates of March and May 2007. Anterior, middle, and posterior SP joint distances were measured at transverse planes. Normal joint width in women and men was determined. The relation between obtained values, and age, gender, number of birth, as well as body-mass index was studied. RESULTS: Symphysis pubis narrows at anterior concurrently with ageing (r = -0.150; P < 0.001) [corrected] Narrowing, though less, is also observed at posterior (r = -1.50 P = 0.000); however, middle part does not change (r = 0.030; P = 0.489). Number of birth and body-mass index values do not affect SP width. The widths measured at anterior and middle of the SP were significantly higher in women (P = 0.010 and P = 0.002). CONCLUSIONS: Osteoarthritic changes develop in SP with ageing. However, osteoarthritis in SP, was found to be clinically and radiologically different from that in other symphyseal joints, as SP hardly ever moves, and vertically processing interpubic disc combines pelvis girdle with counterforces, and is supported by very strong ligaments and muscles. Anterior and middle part of the SP joint is wider in women, because fibrocartilaginous disc is too thick to provide the mobility.

The synovial plicae in the knee joint.

OBJECTIVE: To investigate and evaluate the prevalence of 4 kinds of synovial plicae named according to patella, which are inferior, medial, lateral and superior. METHODS: We evaluated plicae in 318 knee arthroscopies through video records, obtained from January 1994 to December 2002 in the Arthroscopy Unit, Department of Orthopedic Surgery, Faculty of Medicine, Trakya University, Edirne, Turkey. In addition, we also investigated plicae in 7 bilateral knee cadavers. RESULTS: In the arthroscopic evaluation, the prevalence of infrapatellar synovial plica was 194 (61%), mediopatellar plica was 302 (95%), lateral patellar plica was 66 (20.7%) and suprapatellar plica was 184 (57.8%). We found that there were 8 (57%) infrapatellar synovial plicae, 13 (92%) mediopatellar plicae, 7 (50%) lateral patellar plicae and 6 (42%) suprapatellar plicae in 14 cadaveric knees. CONCLUSION: We observed a high prevalence of lateral plicae and mediopatellar plicae on the cadavers and the people with arthroscopic diagnosis, and believe our results can contribute to knee anatomy and surgery.

Measurement of active abduction of metacarpophalangeal joints via electronic digital incinometric technique.

To define the usefulness of electronic digital inclinometric (EDI) method to measure active abduction of metacarpophalangeal joints and to determine the mean scores. A modified electronic digital inclinometric method which was specifically designed to measure range of joint movements was administered to metacarpophalangeal joints of 20 male and 21 female university students. Active abduction of each metacarpophalangeal joint of both dominant and non-dominant hands were measured and recorded separately. Results were presented as mean +/- standart deviation and statistical analysis of data was performed. First data obtained for Turkish people were as follows: 4.12 degrees for thumb, 41.9 degrees for index finger, 80.98 degrees for median finger (approximately twice of others as it was the sum of radial and ulnar abductions), 41.57 degrees for ring finger and 48.53 degrees for little finger. Electronic digital inclinometer was found to be safe, practical and useful in the measurement of active movement ranges of metacarpophalangeal joints.

The extensor indicis et medii communis.

The aim of this study was to examine the existence of the extensor indicis et medii communis in detail. Thirty-one randomly selected adult cadavers (62 upper extremities) were examined for this project (22 males and 9 females between the ages 38 and 87). The muscle was observed in 3 of 62 hands, an incidence of 4.8%. One was in the right and the other two were in the left hands. Mean length and width of the muscle belly were 4.5 +/- 0.8 and 0.8 +/- 0.3 mm, respectively. Although the muscle did not have a junctura tendinum attachment between its two tendons, in one hand, the tendon to the index finger gave a thin slip to the tendon of the extensor digitorum communis for the same finger. Knowledge of variant muscle may be important when one is assessing the traumatized or diseased hand.

Anatomical dimensions of anterior bundle of ulnar collateral ligament and its role in elbow stability.

OBJECTIVE: To study the anatomical dimensions of the anterior bundle of ulnar collateral ligament and its role in elbow instability. METHODS: We studied 20 elbows of 10 cadavers. Anterior bundle of ulnar collateral ligament was dissected in all elbows and its anatomical length and width were measured. After measuring it, we assessed the role of the anterior bundle of ulnar collateral ligament in the medial elbow joint stability, with the capsule, the radial head and anterior bundle of ulnar collateral ligament being cut. RESULTS: The mean right length of the anterior bundle of ulnar collateral ligament was 21.10 +/- 6.29 mm and the mean left length was 21.70 +/- 5.31 mm. The mean right width of the anterior bundle of ulnar collateral ligament was 12.70 +/- 2.79 mm and the mean left width was 13.90 +/- 2.37 mm. Anterior bundle of ulnar collateral ligament was found to be the main stabilizer of the valgus stress. The anterior capsule and the radial head also make contributions to this stability. However, when anterior bundle of ulnar collateral ligament is cut, the radial head and the anterior capsule fails to maintain the stability against valgus stress. CONCLUSIONS: The anatomical dimensions of the anterior bundle of ulnar collateral ligament are important for a surgeon when graft is used in reconstructing this ligament. Our study is an initiator of this topic and we believe that with larger series, more reliable anatomical measurements can be obtained. We also showed that the anterior bundle of ulnar collateral ligament is the main medial stabilizer of the elbow joint.