Objective: The aim of this study was to evaluate changes in lesser trochanter shapes in relation to femoral rotations and to develop a reference value for the determination of clinically relevant malrotation of the femur. Methods: Patients who underwent computed tomography angiography between January 2009 and July 2018 were identified based on a review of their institutional medical records. Thereafter, three-dimensional (3D) images of the whole femur for a total of 860 patients were obtained from their tomographic sections. The distance between the lateral outer cortex of the femur and the most medial point of the lesser trochanter with the femur in neutral rotation was measured and set as the reference value. Then, the same distance was measured at 5°, 10°, 15°, and 20° of femoral internal rotation and at 5°, 10°, 15°, 20°, and 25° of femoral external rotation. To avoid magnification errors, the reference values were divided by each measured value at these different rotation angles and then multiplied by 100. Results: The mean distances between the lateral cortex and the most medial point of the lesser trochanter at 5°, 10°, 15°, and 20° of femoral internal rotation were 97%, 93%, 90%, and 88%, respectively, of those measured with the femur in neutral rotation. The same distances at 5°, 10°, 15°, 20°, and 25° of femoral external rotation were 102%, 104%, 106%, 107%, and 108%, respectively, of those measured with the femur in neutral rotation. There was no statistically significant difference between the measured distances in males and females (p>0.05). However, significant differences were observed among each measured distance at different angles of femoral rotation (p<0.01). Conclusion: The surgeon should be aware of the possible femoral malrotation if the distance between the lateral cortex of the femur and the most medial point of the lesser trochanter on the operated side is more than 106% or less than 90% of that measured with the femur in neutral rotation on the healthy side. Level of Evidence: Level IV, Diagnostic study Cite this article as: Turgut A, Koca A, Uzakgider M, Hancıoğlu S, Erkuş S, Kalenderer Ö. Quantitative assessment of changes in lesser trochanter shapes in relation to femoral rotations. Acta Orthop Traumatol Turc 2020; 54(2): 149-54.

Stable fixation of displaced simple transverse olecranon fractures is required to maintain reduction under triceps traction and enable early elbow motion. Although Weber tension band fixation is widely used, the biomechanical influence of tension band material (cable vs cerclage wire) across different pin/anchorage designs remains unclear. This study compared resistance to fracture-line separation among six Weber-based constructs in a standardized synthetic ulna model. Sixty commercially available synthetic ulnae were osteotomized to create a transverse olecranon fracture model (Mayo type IIA) and randomly assigned to six groups (n = 10/group): bicortical pins, eyelet pins, and AA crimp constructs, each combined with either cable or cerclage wire in a figure-of-eight configuration. Specimens underwent monotonic tensile loading simulating triceps traction. Forces corresponding to 2 mm and 3 mm fracture-line separation were recorded. Between-group comparisons were performed within cable and cerclage subgroups, and cable-versus-cerclage comparisons were conducted within matched constructs (α = 0.05). At 2-mm separation, mean forces (N) were 316.1 ± 98.1 (bicortical cable), 277.0 ± 101.7 (eyelet cable), and 249.1 ± 104.2 (AA crimp cable), versus 273.1 ± 34.4 (bicortical cerclage), 283.6 ± 38.4 (eyelet cerclage), and 282.2 ± 36.9 (AA crimp cerclage). At 3-mm separation, mean forces were 340.5 ± 129.6, 336.5 ± 111.0, and 319.4 ± 78.8 for the cable constructs, and 332.9 ± 48.3, 354.7 ± 42.4, and 349.0 ± 37.2 for the cerclage constructs (bicortical, eyelet, and AA crimp, respectively). No significant differences were observed among pin/anchorage designs within the cable or cerclage subgroups at either threshold (all p > 0.05). Similarly, cable versus cerclage comparisons within matched constructs showed no significant differences at 2 mm or 3 mm (all p > 0.05). Under the specific conditions of this synthetic ulna model and monotonic tensile loading protocol, no statistically significant differences were detected between cable- and cerclage wire-based Weber tension-band constructs at either the 2-mm or 3-mm separation threshold. Bicortical, eyelet, and AA-crimp-based configurations also showed no significant differences in early gapping resistance. These findings should be interpreted as controlled monotonic early-separation data and not as evidence of clinical equivalence or fatigue durability.

Minimally displaced intra-articular calcaneal fractures are commonly managed with cast immobilization, but prolonged immobilization may delay recovery and contribute to hindfoot stiffness. This study compared mid-term clinical and radiographic outcomes of two institutional protocols for minimally displaced Sanders type II-III calcaneal fractures: closed reduction and percutaneous screw fixation with earlier range-of-motion exercises versus cast immobilization. This two-center retrospective cohort study included 87 patients treated between January 2018 and February 2024 with a minimum 24-month follow-up. Fifty-three patients underwent closed reduction and percutaneous fixation using two 5-mm headless cannulated screws, with range-of-motion exercises beginning at 2 weeks. Thirty-four patients were treated nonoperatively with short-leg cast immobilization for 6 weeks. The primary outcome was the Foot and Ankle Ability Measure (FAAM), including Activities of Daily Living and Sports subscales. Secondary outcomes included the AOFAS Ankle-Hindfoot score, visual analog scale pain score, and serial radiographic measurements. Pre-treatment demographic, fracture, follow-up, and radiographic characteristics were comparable between groups. At final follow-up, the fixation and earlier rehabilitation protocol was associated with higher FAAM Activities of Daily Living, FAAM Sports, and AOFAS scores. VAS pain was lower in unadjusted analysis but was not significant after adjustment. Final Böhler and Gissane angles were higher in the fixation group. The fixation group also showed greater calcaneal height increase and calcaneal length decrease from pre-treatment to final follow-up. All fractures united. No wound-healing complications or surgical-site infections occurred after fixation; posterior implant-entry-site irritation occurred in three patients and required implant removal after union. In selected minimally displaced Sanders type II-III calcaneal fractures, the institutional protocol including closed reduction, percutaneous screw fixation, and earlier rehabilitation was associated with better mid-term functional outcomes and more favorable radiographic parameters than cast immobilization. Prospective comparative studies are needed to evaluate fixation, cast immobilization, and functional nonoperative rehabilitation strategies.

Background: The aim of this study was to investigate the relationship between surgical timing and treatment outcomes in calcaneal fractures treated with the sinus tarsi approach. Methods: Eighty-eight patients with displaced intra-articular calcaneal fractures who were operated on between March 2015 and March 2022 were included in the study. The patients were divided into two groups: those operated on within 3 days post-injury (G_early, n: 32) and those operated on past 3 days post-injury (G_late, n: 56) with respect to admission year. The groups were compared in terms of Bohler angle (BA), Gissane angle (GA), calcaneal length (CL), calcaneal height (CH), complications, and American Orthopedic Foot and Ankle Society (AOFAS) score. In addition, we made comparisons based on fracture type. Patients with Sanders type 2 and type 3 fractures were included in Group S_2–3 (n: 58; median age: 45.2), and those with Sanders type 4 fractures were included in Group S₄ (n: 30; median age: 46.5). Results: The median follow-up period of our patients was 62.5 (min: 24; max: 100) months. No statistically significant differences were observed between the groups in terms of comorbidities, age, gender, mechanism of injury, Sanders fracture type classification, and operative and follow-up times. There were no statistically significant differences between the groups regarding postoperative AOFAS scores. The main complication was screw head irritation on the posterior foot while wearing shoes in both the early and delayed fixation groups. There were no statistically significant differences between the groups regarding soft tissue complications and postoperative radiological parameters. Conclusions: The sinus tarsi approach is safe for the early fixation of intra-articular calcaneal fractures and can even be safely applied for intra-articular Sanders type 4 fractures.