Amaç: Bu çalışma, acil şartlarında değerlendirilen femur boyun kırığı hastalarında femur başı histopatolojik inceleme gerekliliğini ve erken dönemde yapılan ameliyatların klinik sonuçlarını araştırmayı amaçladı. Gereç ve Yöntemler: Etik kurul onayı sonrası 01.01.2019–31.12.2023 arasında tek merkezde 1450 femur boyun kırığı olgusu retrospektif incelendi. Radyografide patolojik şüphe saptanan olgular BT/MR ile değerlendirildi ve yaklaşık 20 uzman hekimin katılımıyla şüpheli bulunan 293 hastadan, bilinen kanser öyküsü olan 52’si ve patolojik örnek gönderilmeyen 9’u dışlandı; 65 yaş üstü, düşük enerjili travmalı 232 hasta analize alındı. Cerrahi, patoloji sonucu beklenmeden uygun artroplasti ile gerçekleştirildi; femur baş-boyun örnekleri rutin histopatolojiye gönderildi ve gerektiğinde immünohistokimya ile moleküler testler uygulandı. Bulgular: Ortalama yaşı 82,11 (64–99) olan 232 hastanın 11’inde (%4,7) patolojik kırık saptandı; bu olguların tamamında geriye dönük sorgulamada kırık öncesi kalça ağrısı, kilo kaybı ve halsizlik vardı. On hastaya hemiartroplasti uygulandı; bir olguda metastaz progresyonuna bağlı 6. ayda implant yetmezliği gelişerek tümör rezeksiyon protezi ile revizyon yapıldı, dış merkezde total kalça protezi uygulanan bir olguda ise asetabular gevşeme ve litik alanlar nedeniyle sementli asetabular ring ile revizyon sonrası prostat kanseri metastazı tanısı kondu. İzlemde 49 hasta (%21,1) eksitus oldu ve patolojik kırık saptanan 11 hastadan 1’i bu gruptaydı. Sonuç: Kırık öncesi kasık/kalça ağrısı, hızlı kilo kaybı, halsizlik ve ailevi/kişisel kanser öyküsü gibi klinik ipuçları ile radyolojik şüpheli bulguların birlikte olduğu hastalarda seçici histopatolojik inceleme hastalık yönetimi açısından değer taşırken, histopatolojik inceleme düşük tanısal getiriyle gereksiz maliyet artışına yol açabilir.

High-pressure injection injuries to the upper extremities are uncommon yet serious, particularly when they involve substances such as concrete. These injuries, frequently occurring in industrial environments, can lead to substantial tissue damage and functional impairment. A 24-year-old male patient who incurred a high-pressure concrete injection injury to his left hand and forearm while employed at a construction site was admitted. The injury, originally seeming minor, involved concrete penetration into the thenar region and extended through the forearm, resulting in significant damage to muscles, tendons, and nerves. The immediate medical care comprised immersion of the injured arm in warm water, administration of intravenous antibiotics, and tetanus prophylaxis, succeeded by rapid debridement in the operating room. Through a series of surgeries, comprising sequential debridements and reconstructive interventions, hand function of the patient was acceptable regarding the occupational return. Radiographic imaging was essential in evaluating the severity of injury and informing surgical choices. Preoperative radiological clarification of the extension of the upper extremity to the anatomical regions with high pressure is of utmost importance in determining the location and size of the surgical incision to remove the vital initial debridement and cement from the anatomical regions as much as possible. This case highlights the significance of prompt identification, assertive treatment, and sequential surgical procedures in high-pressure injection injuries. The necessity for proactive workplace safety protocols and heightened awareness of the potential severity of these injuries is underscored. We believe that this case report enhances the comprehension of the difficulties and problems associated with treating high-pressure concrete injection injuries to the upper extremities.

Bone metastasis from papillary thyroid carcinoma (PTC) is uncommon, and periacetabular involvement is particularly rare. Metastatic lesions located in the pelvis may cause pain, functional impairment, and mechanical instability. This case report presents the surgical management of a periacetabular bone metastasis arising from the follicular variant of papillary thyroid carcinoma. A 60-year-old man presented with progressive left hip pain. He had undergone total thyroidectomy for papillary thyroid carcinoma two months earlier. Radiological evaluation demonstrated a large expansile lytic lesion in the anterior acetabular region extending to the superior pubic ramus. Following multidisciplinary evaluation, the lesion was completely excised through an anterior Stoppa approach. The resulting bone defect was reconstructed using a free tricortical iliac autograft together with plate-and-screw fixation. Histopathological examination confirmed bone metastasis of the follicular variant of papillary thyroid carcinoma. At the one year follow-up, graft union had been achieved, and the patient was able to walk without assistance with satisfactory hip function. Periacetabular metastasis of follicular variant papillary thyroid carcinoma is rare and may significantly compromise functional status. In selected patients, surgical excision and reconstruction may provide effective local tumor control, pain relief, and restoration of pelvic stability.

Objective: There is still no optimal suture material or configuration for flexor tendon repair. Barbed sutures provide an alternative for flexor tendon repair with unidirectional clefts that effectively resist sliding. Increasing the suture purchase results in an expected increase in the tensile force. This study investigated the relationship between suture purchase length and repair strength in flexor tendon. This addresses the question of whether it is possible to achieve sufficient tensile strength compared to a 2-strand polypropylene suture by simply increasing the barbed suture course inside the tendon. Methods: The study involved 24 sheep flexor digitorum tendons, which were divided into 4 subgroups, each comprising 6 tendons. Group P1 utilized polypropylene sutures 1 cm from the incision, while group P2 used it 2 cm away. Group B1 utilized a barbed suture positioned 1 cm from the incision, while group B2 employed a barbed suture 2 cm from the incision. The outcome measures included testing for 2-mm Gap Resistance (2mm-GR) and maximum tensile strength (MTS) using an Instron® 3345K7023 tensile testing device (Norwood, MA, USA). Results: A 2 cm suture purchase length increased by the mean 2mm-GR by 6.9 N for polypropylene and 12.6 N for barbed sutures. Group B2 showed the highest 2mm-GR (20.7 N). Groups P2 and B2 had significantly higher 2mm-GR than groups P1 and B1 (P < .05). The MTS did not differ significantly between the groups (P = .743). Suture breakage occurred in 92% of cases, with knot failure observed in 8%. Conclusion: Extending the purchase length of the barbed suture within the tendon significantly enhances the MTS and 2mm-GR. With further refinement, barbed sutures have the potential to become a favorable option for tendon repair, possibly facilitating early and effec tive postoperative rehabilitation. Cite this article as: Cırdı YU, Günay AE, Ekici M, Şekerci ÖT, Ozturk Rİ, Gürsoy S. Increases in suture purchase of same magnitude lead to a higher gap resistance force for barbed sutures used in flexor tendon repair. Acta Orthop Traumatol Turc., 2025;59(6):434-438.