Objective: The aim of this study was to evaluate whether intertrochanteric femur fractures can be reduced and nailed properly in the lateral decubitus position using Proximal Femoral Nail Antirotation (PFNA) as a fixation device without the use of a traction table. Methods: The study included 207 patients (81 male and 126 female; mean age: 75 years, range: 22 to 95 years). According to the Evans classification, there were 7 Type 1, 40 Type 2, 33 Type 3, 38 Type 4, 61 Type 5 and 28 reverse oblique fractures. Radiographs were used to measure the tip-apex distance (TAD), the quadrant of the helical blade according to Cleveland and Bosworth, Ikuta’s reduction subgroup, collodiaphyseal angle and reduction gaps postoperatively. Results: Mean follow-up time was 20.4 (range: 6 to 38) months. According to Ikuta’s classification, 176 (85%) reduced fractures were of subtype N, 15 (7.2%) subtype P and 16 (7.7%) subtype A. Good or acceptable reduction according to the Herman criteria was obtained in 99% of fractures. Mean TAD was 29.2 millimeters. Mean operation time was 57.2 minutes. Optimal blade position (center-center or inferior-center) was achieved in 53.5% of patients and was in the superior-posterior quadrants in only 2.4% of patients. Cut-out complication occurred in 9 patients (4.3%). Conclusion: While the nailing of intertrochanteric fractures in a lateral decubitus position does not provide ideal quadrant placement and TAD, results are encouraging probably due to the excellent stability that is provided by PFNA. Özet Amaç: Bu çalışmanın amacı, intertrokanterik femur kırıklarının Proksimal Femoral Çivi Antirotasyon (PFNA) kullanılarak, traksiyon masasız, lateral dekübit pozisyonda uygun bir şekilde redükte edilip tespit edilip edilemediğinin değerlendirilmesi idi. Çalışma planı: Çalışmaya 81’i erkek, 126’sı kadın olmak üzere 207 hasta (ortalama yaş: 75, dağılım: 22-95) dahil edildi. Evans sınıflamasına göre; 7 Tip 1, 40 Tip 2, 33 Tip 3, 38 Tip 4, 61 Tip 5 ve 28 ters oblik kırık mevcuttu. Ameliyat sonrası röntgenlerde; implant ucu-apeks mesafesi, helikal bıçağın Cleveland ve Bosworth kadranı, Ikuta redüksiyon alt grubu, kollodiyafizer açı ve redüksiyon aralıkları ölçüldü. Bulgular: Ortalama takip süresi 20.4 (dağılım: 6-38) ay olan hastalarda Ikuta sınıflamasına göre 176 kırık (%85) normal alt tip, 15 kırık (%7.2) posterior alt tip ve 16 kırık (%7.7) anterior alt tip olarak redükte edilmişti. Herman kriterlerine göre hastaların %99’unda iyi veya kabul edilebilir redüksiyon sağlandığı görüldü. Ortalama implant ucu-apeks mesafesi 29.2 mm, ortalama ameliyat süresi 57.2 dakika olarak ölçüldü. Uygun kadran (merkez-merkez, alt-merkez) yerleşimi hastaların %53.5’inde sağlanmışken, üst-arka kadran yerleşimi hastaların sadece %2.4’ünde görüldü. Dokuz hastada (%4.3) sıyrılma komplikasyonu gerçekleşti. Çıkarımlar: İntertrokanterik kırıkların lateral dekübit pozisyonda çivilenmesi uygun kadran yerleşiminin sağlanması ve implant ucu-apeks mesafesinde ideal değerlerin elde edilmesinde başarılı olmasa da, muhtemelen PFNA tarafından sağlanan mükemmel stabilite sayesinde sonuçlar cesaret vericidir.

The diagnosis of anterior cruciate ligament tear can be made by physical examination and magnetic resonance imaging (MRI) in the supine position. In cases where the tear is partially evaluated on MRI, the choice of treatment may vary. The purpose of the study was to investigate the efficiency of MRI at maximum knee flexion in the prone position and to compare the images with findings of the ACL detected during surgery. Sixty-one patients with partial ACL tears with meniscal and cartilage lesions requiring arthroscopic knee surgery were included in the study between 2017 and 2019. MRI of these patients was prescribed at maximum knee flexion in the prone position. Then, an arthroscopic operation was performed on 61 patients and the findings (intact, partial or total tear of ACL) were recorded. The ACL was evaluated as being intact and partial or total tear. The statistical significance of the efficacy of MRI in the supine position with the knee at maximum flexion in the prone position was compared. It was found that, of 61 patients with suspected partial ACL tears, 25 patients had intact ACLs, 22 patients had partial tears and 14 patients had total ACL tears, through the interpretation of MRIs of the prone position by the radiologist. In the arthroscopic surgery of 61 patients, 20 patients had intact ACLs, 27 patients had a partial tear and 14 patients had a total tear. The MRI results with maximum knee flexion in the prone position were more compatible with the findings of the arthroscopic surgery. It could be considered that MRI with maximum knee flexion in the prone position may also be guiding in the diagnosis and treatment of patients with partial anterior cruciate ligament rupture.

Background: Studies have shown that the anterolateral ligament contributes to knee stability. This study aims to compare the results of postoperative physical examinations, knee joint stability tests, and functional assessment tests of patients with intact anterolateral (AL) ligaments and patients with ruptured anterolateral (AL) ligaments. Material and Method This study consisted of 101 patients, with at least a 12-month follow-up period, who underwent an anterior cruciate ligament reconstruction between 2010 and 2016, and whose AL ligaments were evaluated by the radiologist with the preoperative and postoperative magnetic resonance images (MRI). Of these patients, 41 had intact AL ligament (Group 1) in MRI and other 60 had ruptured AL ligament (Group 2). Groups were compared according to postoperative physical examinations, knee joint stability tests, and functional assessment tests. Results: The average Lysholm score of Group 1 was 94.9 (range: 81–100), and the score of Group 2 was 87.2 (range: 74–100). The modified Cincinnati score of Group 1 was 28.7 (24–30), while the score of Group 2 was 25.6 (21-30). The average IKDC subjective knee evaluation score of Group 1 was 91.9 (range: 83–100), and the score of Group 2 was 86.6 (range: 75–100). The average thigh atrophy value was 1.5 centimeters (cm) in Group 1 and 2.4 cm in Group 2. Thirty-three patients in Group 1 were able to jump over 85% of the distance in single-legged hop test compared to the intact side, while 16 patients in Group 2 were able to jump over this distance successfully. As a result of the analysis, it was determined that the Lysholm activity scoring results, the Modified Cincinnati scoring results, IKDC subjective knee evaluation results, two-cycle IKDC activity scale results, comparison of thigh diameters and one leg hop tests of two groups showed a statistically significant difference, and the results of the patients with intact AL ligaments who underwent an ACL reconstruction were found to be better (p<0.05). No significant difference was found in other examinations and tests. Conclusion: Since the rupture of the AL ligament has negative effects on functional outcomes, we think that the reconstruction of the AL ligament in the same session with the ACL reconstruction or later will have a positive effect on functional outcomes.

Objective: To evaluate the demographic characteristics of paediatric pelvic fractures. Materials and Methods: Retrospective analysis of 26 patients who were hospitalized with the diagnosis of paediatric pelvic fracture between 2000 and 2010 was performed. Age, gender, hospitalization time, mechanism of injury, fracture type, associated injuries, haemoglobin level drop in the first 24 hours, management and blood transfusion requirement, injuries time (month) information were gathered from hospital records. Results: There were 16 male and 10 female patients. Average age was 10.5 (2-16). Average hospitalization time was 3.5 days (1-17). Average haemoglobin level drop in the first 24 hours was 1.51 (0.3-3.6) gr/dL. Mechanisms of the injuries were as following; 14 patients were struck by a car, 10 patients fell from height and 2 patients involved in a vehicle traffic accident. According to the classification of Torode and Zeig; there was 1 type 2, 22 type 3 and 3 type 4 injuries. Injuries’ occurrence season were; 12 in spring, 7 in summer and 7 in autumn. All of the patients had been managed conservatively. Conclusion: These injuries are rarely seen in children. Their management can be mostly conservative and even with a simple and stable pelvic injury marked bleeding can occur.