Kadir Bahadır Alemdaroğlu

Introduction Proximal femoral nails commonly used to treat trochanteric hip fractures in the elderly have different distal fixation options such as interlocking screws and claws. The aim of this study was to compare the failure rate and migration of the fixation construct during the follow-up of screw- and claw-fixed nails in elderly patients with trochanteric hip fractures. Materials and Methods A retrospective case–control study was conducted including patients aged 65 years or older and treated with a proximal femoral nail between 2018 and 2023. Patients were grouped according to the type of distal locking: screw- and claw-fixed. Demographic data and follow-up radiographs were obtained from hospital records. Follow-up radiographs were analyzed to assess fracture type, treatment failure through lag screw cut-out, and migration of the nail and the lag screw over time. Two types of migration were evaluated; distal migration of the nail in the medullary canal (nail migration distance; NMD) and migration of the lag screw in the femoral head (lag screw migration ratio; LSM). Results There were 339 patients with a mean follow-up of 7.2 ± 4.2 months (208 in the screw-fixed group and 131 in the claw-fixed group). The groups were similar in terms of age, sex, fracture type, and stability. While 16 (7.7%) cut-outs were observed in the screw-fixed group, there were 1 (0.8%) in the claw-fixed group (p = 0.004). Mean nail migration was 1.3 ± 2.1 mm for screw-fixed nails and 4.8 ± 5.8 mm for claw-fixed nails (p < 0.001). Lag screw migration ratio was significantly higher in screw-fixed nails (4.2% vs 2%, respectively, p < 0.001). Conclusions Claw-fixed nails are significantly more likely to slide in the medullary canal, resulting in a reduced lag screw cut-out compared to screw-fixed nails in elderly patients with trochanteric hip fractures.

Purpose: The aim of this study was to evaluate how the pie‐crusting technique affects clinical and radiological outcomes in patients undergoing arthroscopic partial meniscectomy.Methods: A total of 68 patients with Kellgren–Lawrence (K‐L) grade 2 who underwent arthroscopic partial meniscectomy between 2015 and 2021 were evaluated and divided into two groups as arthroscopic partial meniscectomy (36 patients) and arthroscopic partial meniscectomy with pie‐crusting (32 patients) according to whether the pie‐crusting technique was applied or not. All patients were evaluated at a minimum 2‐year follow‐up in terms of Lysholm score, Tegner activity score, International Knee Documentation Committee (IKDC) score and Visual Analogue Scale (VAS) score. To assess the impact of the pie‐crusting technique, radiological measurements were conducted using radiographs taken before and after pie‐crusting, as well as postoperative radiographs.Results: Lysholm, Tegner, IKDC and VAS scores exhibited statistically significant differences after surgery compared to preoperative evaluations in both groups (p < 0.05). Furthermore, these scores were significantly superior in the arthroscopic partial meniscectomy with pie‐crusting group compared to the arthroscopic partial meniscectomy group at 24 months postoperatively (p < 0.05). While the radiological measurements in the arthroscopic partial meniscectomy with pie‐crusting group showed statistically significant differences before and after pie‐crusting (p < 0.05), no significant difference was observed between before pie‐crusting and 12 and 24 months postoperatively (n.s.).Conclusion: The current study is the first to demonstrate the true effectiveness of the pie‐crusting technique. The application of the pie‐crusting technique when necessary results in a statistically significant improvement in clinical scores without affecting radiological measurements for patients undergoing arthroscopic partial meniscectomy compared to not utilising it.Level of Evidence: Level III.

AIM The aim of this study was to evaluate the outcomes of the patients who underwent OCF fixation and simultaneous MPFL reconstruction after patellar dislocation in children. MATERIAL AND METHOD A total of 12 patients who underwent OCF fixation and simultaneous MPFL reconstruction between 2018 and 2021 were retrospectively evaluated. Demographic information, surgical specifics, and clinical follow-up data were gathered. Postoperative clinical assessments were conducted utilizing Kujala and Lysholm scores. RESULTS The mean age at surgery was 10.4 years (range, 7-15 years). The mean period of follow-up was 36.5 months(range, 24-58). One (8%) patient required a second surgery on the ipsilateral knee. The mean surface area of the fragments was 2.5 cm² (SD: 1.4). Preoperatively, the Kujala score and the Lysholm score were 38.2 (SD: 13.3) and 44.1 (SD: 10.4), respectively. These scores exhibited significant improvement postoperatively, reaching 87.6 (SD: 11) and 88.2 (SD: 10.3) at the latest follow-up. Radiological examinations, including X-ray and MRI, indicated favorable healing of the OCFs. CONCLUSION Osteochondral fracture fixation in children with patellofemoral instability can be effectively managed through fixation combined with simultaneous medial patellofemoral ligament reconstruction. The mid-term results have demonstrated satisfactory outcomes.

Objective: This study aimed to improve the surgical anatomical knowledge of pelvic/acetabular trauma surgeons by providing detailed morphometric data on some of the most vulnerable arteries and nerves due to constant bony landmarks during anterior intra-pelvic approach fixation of acetabular fractures in women. Methods: Ten hemipelvis were dissected from 5 female cadavers. The following measurements relative to the symphysis were performed: (1) the distance of the corona mortis anastomosis and (2) the bisection of the external iliac vein with the pubic ramus. In addition, dis- tance to the pelvic brim at the level of pectineal convexity of the following structures was measured: (3) depth of obturatory neurovascu- lar bundle, (4) superior vesical artery, and (5) vaginal artery. Also, the clock position of the (6) gluteal superior and inferior vessels due to sciatic notch in the supine position. Due to antero-superior corner of sacroiliac joint (7) location of the common iliac artery bifurcation, (8) location of the bifurcation of internal iliac vessels to truncuses, (9) bifurcation of superior gluteal artery and lateral sacral artery, and (10) L5 nerve were measured. The descriptive statistics were given as medians and ranges as this is a descriptive anatomical study without comparisons. Results: The median distance of corona mortis to symphysis pubis was 59.5 mm (range = 58-61). The external iliac vein bisected the pubic arm 68.5 mm (range=65-70) lateral to the symphysis pubis. At the level of pectineal convexity (about the middle of the pelvic brim), obturatory neurovascular bundle, superior vesical artery, and vaginal artery were 15 mm (range=13-16), 24 mm (range=23-25), and 36 mm (range=34-38) inferior to the pelvic brim, respectively. The superior gluteal vessels leave the sciatic notch at 12 o’clock position in supine position. Inferior gluteal vessels leave the sciatic notch at 31⁄2 o’clock position (given for left side). Common iliac artery bifurcation bisects the SI joint 5 mm (4-7) superior to antero-superior corner of the Sacro-iliac (SI) joint. The internal iliac artery gives its posterior trunk 18 mm (range=15-20) straightly anterior to antero-superior corner of the SI joint. Bifurcation of superior gluteal artery and lateral sacral artery was 11 mm (range = 10-12) away from the beginning of the posterior truncus. L5 root’s medial margin was 9 mm (range = 7-10) medial to this landmark, where its lateral margin was on the SI joint (2 mm medial to 2 mm lateral). Conclusion: The majority of the bleeding complications of the major branches of the internal and external iliac arteries and neurologic palsies due to obturatory nerve and L5 nerve root damage within the operative field of the anterior intra-pelvic approach can be avoided or managed by utilizing morphometric data provided from this study. Level of Evidence: N/A. Cite this article as: Özmeriç A, Alemdaroğlu KB, Fırat A, Şahin Ö. Morphometric measurements for potential dangers of anterior intra-pelvic approach in women: A cadaveric study. Acta Orthop Traumatol Turc., 2023;57(4):183-188.