Ozgur Cetik

Is there a safe area for the axillary nerve in the deltoid muscle? A cadaveric study.

BACKGROUND Several authors have defined a variety of so-called safe zones for deltoid-splitting incisions. The first aim of the present study was to investigate the distance of the axillary nerve from the acromion and its relation to arm length. The second aim was to identify a safe area for the axillary nerve during surgical dissection of the deltoid muscle. METHODS Twenty-four shoulders of embalmed adult cadavers were included in the study. The distance from the anterior edge of the acromion to the course of the axillary nerve was measured and was recorded as the anterior distance. The same measurement from the posterior edge of the acromion to the course of the axillary nerve was made and was recorded as the posterior distance for each limb. Correlation analysis was performed between the arm length and the anterior distance and the posterior distance for each limb. The ratios between arm length and the anterior and posterior distances were calculated for each case and were recorded as an anterior index and a posterior index. RESULTS The average arm length was 30.40 cm. The average anterior distance was 6.08 cm, and the average posterior distance was 4.87 cm. There was a significant correlation between arm length and both anterior distance (r = 0.79, p < 0.001) and posterior distance (r = 0.61, p = 0.001). The axillary nerve was not found to lie at a constant distance from the acromion at every point along its course. The average anterior index was 0.20, and the average posterior index was 0.16. CONCLUSIONS The present study describes a safe area above the axillary nerve that is quadrangular in shape, with the length of the lateral edges being dependent on the individuals arm length. Using this safe area should provide a safe exposure for the axillary nerve during shoulder operations.

Biomechanical comparison of plate-screw and screw fixation in medial tibial plateau fractures (Schatzker 4). A model study

INTRODUCTION The objective of this biomechanical study was to compare the respective efficiency of plate-screw fixation and screw fixation in an experimental model of a Schatzker type 4 fracture. HYPOTHESIS screw fixation and plate fixation have a similar load to failure. MATERIALS AND METHODS This study compares the stability of Schatzker type 4 medial tibial plateau fractures fixed with either 36.5mm cancellous bone screw with a 16 mm threaded segment or with six-holed buttress T-plate-screw system. A Schatzker type 4 fracture was modeled on an artificial bone model. In a first group of 10 fracture models, following the anatomical reduction, fractures were stabilized with screws with washers. In the second group, of 10 fracture models, fractures were stabilized with T-plate. After fixation ascending axial compression was applied on bone models (Instron machine). RESULTS Load bearing capacity was 1397.6+/-194.4N in the Group 1 and 2153.2+/-204.4N in the Group 2. The difference between the two groups was statistically significant (p<0.001). DISCUSSION According to this result, experimental load bearing of bone models indicate that plate-screw fixation system has a significantly higher stabilization capacity than fixation with three screws alone. Our hypothesis was not confirmed. In order to maintain anatomical repositioning, plate-screw system is a more stable fixation method than the screw in medial tibial plateau fractures Schatzker 4 LEVEL OF EVIDENCE: 1.

Simultaneous bucket handle tear of both medial and lateral menisci of a knee with chronic anterior cruciate ligament deficiency.

Bucket handle meniscus tears constitute about 10% of all meniscal tears. Bucket handle tears of medial meniscus is three times more than lateral meniscus. Most of these tears are associated with anterior cruciate ligament (ACL) deficiency. Lateral meniscus lesions are more common with acute ACL deficiency, where medial meniscus lesions are more associated with chronic ACL deficiency. We identified bucket handle tears of each meniscus of a 30-year-old male patient while performing diagnostic arthroscopy during ACL reconstruction procedure. We present an ACL deficient knee with bucket handle tears of medial and lateral meniscus of the same knee and discuss the treatment.

Quadrilateral Space Syndrome Caused by a Humeral Osteochondroma: A Case Report and Review of Literature

Quadrilateral space syndrome (QSS) is a rare condition in which the posterior humeral circumflex artery and the axillary nerve are entrapped within the quadrilateral space. The main causes of the entrapment are abnormal fibrous bands and hypertrophy of the muscular boundaries. Many other space-occupying causes such as a glenoidal labral cyst or fracture hematoma have been reported in the literature. However, we could not find a report on classical QSS caused by an osteochondroma. The aim of this case report is to attract attention to an unusual etiology of shoulder pain, and to emphasize the importance of physical examination and x-ray imaging before performing more complex attempts for differential diagnosing.

Common complications of segmental bone transport with Ilizarov technique in defective tibia pseudoarthrosis: a review

In tibial pseudoarthrosis, segmental bone transport with Ilizarov external fixator is being widely applicated all around the world, with encouraging successful outcomes. As the treatment with this technique requires a long period of time, the surgeon may face many problems which may negatively affect the final outcome. Pin tract infection, early or delayed consolidation, axial deviation and translation at the target area, skin inversion, rupture of the bone by the wires and joint contractures or stiffness form the main and common clinical problems. The rate of failure and complications with Ilizarov method used for diaphysial bone defects are so rare when precise technical details are carried out. With other treatment modalities, it is usually too difficult to obtain union synchronously with infection eradication. Thus, the Ilizarov technique presents successful outcomes against some complications mentioned above. Segmental bone transport is a surgical technique in which some of the problems can never be prevented. However, close patient follow up and always keeping the problems in mind make early diagnosis possible. With the early recognition of problems, successful treatment and increased overall outcome can be expected.RésuméDans le traitement des pseudarthroses du tibia, le transfert osseux grâce au fixateur externe d’Ilizarov est largement utilisé dans le monde entier avec des succès encourageants. A cause de la longueur du traitement, le chirurgien doit faire face à de nombreux problèmes qui risquent d’affecter le résultat final. L’infection des broches, la consolidation trop précoce ou au contraire retardée, la déviation axiale ou la translation dans la zone cible, l’invagination cutanée, la fracture osseuse par la rétraction articulaire ou la raideur sont les problèmes les plus courants et les plus importants. Le taux de complications pour la méthode d’Ilizarov appliquée aux défects diaphysaires est en fait rare lorsque la technique est utilisée de façon précise dans ses moindres détails. Avec d’autres méthodes il est souvent difficile d’obtenir la consolidation osseuse de façon synchrone avec l’éradication de l’infection. La technique d’Ilizarov permet des succès malgré les complications citées plus haut. Le transfert osseux segmentaire est une technique chirurgicale dans laquelle il n’est jamais possible de prévenir toute complication. Mais, le suivi rapproché des patients et le fait d’avoir continuellement ces problèmes à l’esprit, permet le diagnostic précoce de ces complications. Grâce à cette reconnaissance précoce des problèmes, on est en droit d’espérer un résultat favorable malgré tout.

Bilateral osteochondritis dissecans of lateral femoral condyle

A 20-year-old male with bilateral osteochondritis dissecans (OD) of the distal lateral femoral condyle is presented. OD can occur in many joints; however, the medial femoral condyle of the knee is the most common. Bilateral OD of the distal lateral femoral condyle is extremely rare. In our case, the lesion on the right side was traumatic and the lesion on the left side was self-induced. We performed open surgery for both knees. The fragments were stabilized with multiple Herbert screws. This case supports the theory that a defect in the ossification center of the distal lateral femoral condyle plays a role in the etiology of osteochondritis dissecans.

Experience with the surgical treatment of radial polydactyly in adults.

Purpose:The aim of this study is to investigate the functional and cosmetic outcome after surgical reconstruction in adult patients. Methods:Eleven hands of the 10 adult patients with radial polydactyly were treated surgically. Clinical and radiologic examination was performed and cases were classified according to the Wassel system. The outcome was evaluated according to the Modified Wood criteria. Results:Average age of the patients was 20 years (range, 19–23 years) and all patients were male. All of the patients were admitted with the social consequences of the cosmetic problems resulting from the anomaly. Cosmetic and functional results were excellent in 9 cases and good in 2 cases. Conclusion:The findings of this study revealed that radial polydactyly can be surgically reconstructed satisfactorily in adulthood. However, the fact that these patients were mainly admitted as a result of the psychosocial consequences of the cosmetic aspect of the anomaly, we concluded that regardless of age, surgery should not be delayed after diagnosis.

Rotational deformity affects radiographic measurements in distal radius malunion

Malunited distal radius fractures are 3D deformities. The preoperative evaluation of the deformity and surgical planning are usually depended on plain radiographic measurements for corrective osteotomies. In most of the cases, the rotational deformity is disregarded in preoperative planning. We aimed to clarify the effect of rotational deformity on radial inclination and dorsal or volar tilt measurements, which are commonly used as radiologic parameters. This study was performed on standard left radius saw bone models. The malunion models were prepared according to AO distal radius fracture classification system in four main and seventeen subgroups. The differences between the mean radial inclination, volar or dorsal tilt measurements performed on plain radiographies and gold standard values were statistically analyzed. Results showed that rotational deformity causes faulty measurements of radial inclination and dorsal tilt on plain radiographies which may be a contributing factor for unsatisfactory clinical results of corrective osteotomy. We suggest 3D preoperative evaluation of the deformity if possible.

Computerized tomography scout view for determining distal femoral resection angle in intramedullary instrumentation of total knee arthroplasty

This study aims to investigate the results of distal femoral resection by determining the difference between mechanical and anatomical axes of femur using computerized tomography (CT) scout views in pre-operative planning of total knee arthroplasty. CT scout view of the lower extremities was taken before and after the operation in 16 patients undergoing total knee arthroplasty. Distal femoral resection was performed according to the previously determined ideal resection angle (IRA) using intramedullary instrumentation. At post-operative scanogram, femoral component deviation (FCD) was measured. The results were statistically analyzed. The average IRA was 6.95 (5–9) degrees. At post-operative measurements, the average FCD was 0.63 (0–3) degrees. CT scout films improve the accuracy in distal femoral resection and femoral component alignment.

Over-the-top knot placement technique enhances tensile stability of tendon repairs.

Background: Currently a major concern for the surgical treatment of Achilles tendon rupture repairs is the creation of stable enough fixation to allow early range of motion. It was documented that the weakest point in a suture loop is the knot. Thus, we hypothesized that moving the knot away from the repair junction (over-the-top Krackow technique) would increase the strength of the repair. Materials and Methods: Transected bovine tendons were repaired by the traditional Krackow and over-the-top Krackow techniques using four suture materials (Fiberwire Nos. 5 and 2, Ethibond Nos. 5 and 2). Tendons were cyclically tested at incremental loads beginning from 50 N until 5-mm gap formation. Then all tendons were loaded to failure. The number of cycles to 5-mm gapping, ultimate failure loads and knot slip were compared using t-test and Mann-Whitney tests (with Tukey corrections for multiple comparisons). Results: Mean number of cycles to 5-mm gapping did not reveal significant differences (p = 0.113) between repair groups. Mean failure load of tendons repaired by over-the-top Krackow technique were significantly higher (p < 0.0001) for all four paired groups than tendons repaired by traditional Krackow technique. Ethibond No. 5, No. 2, and Fiberwire No. 2 suture repairs with over-the-top configuration did not reveal any knot slip. Conclusion: Over-the-top Krackow technique increases the ultimate failure load of repaired tendons. But 5-mm gapping resistivity was not enhanced either by the technique or the suture material. Clinical Relevance: The knot itself is a stress-riser in the suture loop so we suggest that freeing it from tension by our modificiation may achieve more durable repairs.