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    Acromion-axillary nerve distance and its relation to the arm length in the prediction of the axillary nerve position: A clinical study
    (PubMed, 2022) Yıldırım, Cem; Demirel, Mehmet; Bayram, Erhan; Ekinci, Mehmet; Yılmaz, Murat
    Background: Because of the broad anatomic variation in the course of the axillary nerve, several cadaveric studies have investigated the acromion-axillary nerve distance and its association with the humeral length to predict the axillary nerve location. This study aimed to analyze the acromion-axillary nerve distance (AAND) and its relation to the arm length (AL) in patients who underwent internal plate fxation for proximal humerus fractures. Methods: The present prospective study involved 37 patients (15 female, 22 male; the mean age=51 years, age range 19–76) with displaced proximal humerus fractures treated by open reduction and internal fxation. After anatomic reduction and fxation were achieved, the following parameters were measured in each patient before wound closure without making an extra incision or dissection: (1) the distance from the anterolateral edge of the acromion to the course of the axillary nerve was recorded as the acromion-axillary nerve distance and (2) the distance from the anterolateral edge of the acromion to the lateral epicondyle of the humerus was recorded as arm length. The ratio of AAND to AL was then calculated and recorded as the axillary nerve index (ANI). Results: The mean AAND was 6±0.36 cm (range 5.5–6.6), and the mean arm length was 32.91±2.9 cm (range 24–38). The mean axillary nerve ratio was 0.18±0.02 (range 0.16 to 0.23). There was a signifcant moderate positive correlation between AL and AAND (p=0.006; r=0.447). The axillary nerve location was predictable in only 18% of the patients. Conclusion: During the anterolateral deltoid-splitting approach to the shoulder joint, 5.5 cm from the anterolateral edge of the acromion could be considered a safe zone to prevent possible axillary nerve injury. Keywords: Axillary nerve, Trans-deltoid approach, Deltoid-splitting approach, Iatrogenic nerve injury, Safe zone
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    Effect of tranexamic acid on fracture Heling in Rats [Efeito do acido tranexamico na cura de fratura em ratos]
    (Sociedade Brasileira de Ortopedia e Traumatologia, 2022) Bayram, Erhan; Yünlü, Mehmet; Gülabi, Deniz; Bozdağ, Ergün; Yılmaz, Murat; Atlıhan, Doğan
    Introduction: In this study we investigated the effect of tranexamic acid (TXA) on fracture healing in an established animal model, when used to stop bleeding in orthopedic trauma surgery. Materials and Methods: This study was a randomized, controlled, laboratory study. Eighteen Sprague-Dawley rats were randomly assigned to three groups, either receiving TXA intravenously (Group 1), TXA topically (Group 2), or isotonic TXA intravenously and TXA topically in the same amounts for the control group (Group 3). First, a Kirschner wire was inserted retrogradely into the femoral intramedullary canal. Then the femurs were fractured at the midshaft region with blunt guillotine. After 4 weeks, the rats were sacrified and the femurs harvested. Cortical bone volume, callus volume, and bone mineral density were calculated using computer tomography scans. Torsion tests were performed. Groups were compared by maximum torque to failure and callus stiffness. Results: There were no statistical differences in torque to failure and stiffness between the 3 groups. There were no differences in mean total bone volume, callus volume, percent bone volume, or callus density between the groups. Conclusions: A single dose of topical or intravenous TXA has no negative effect on fracture healing when used in traumatic femur fracture surgery in an animal model. Evidence level II; Randomized controlled experimental study. © 2022. All Rights Reserved.
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    Internal tibial torsion is associated with medial meniscus posterior horn tears
    (Springer Science and Business Media Deutschland GmbH, 2022) Bayram, Erhan; Şener, Nurullah; Korkmaz, Musa; Yıldırım, Cem; Aydın, Mahmud; Yurdaışık, Işıl; Çetinus, Mahmut Ercan
    Purpose: Risk factors for meniscal tears play a decisive role in deciding on treatment and rehabilitation. The purpose of this study was to investigate the effect of tibial rotation on medial meniscus posterior horn tears (MMPHTs). Methods: This study is a retrospective case–control study. Fifty patients with meniscal tears and 57 knees with intact meniscus were compared. Tibial rotation, femoral version, tibial slope and knee varus were measured in each participant. Knee osteoarthritis was classified according to the Kellgren–Lawrence classification. Demographic characteristics were noted. Results: There were significant differences in the mean tibial torsion angles and mean mechanical axes between the groups. The mean tibial rotation and mean mechanical axis were 26.3° ± 6.7 and 3.7° ± 2.7 in the MMPHT group and 30.3° ± 8.4 and 2.05° ± 2.7 in the control group, respectively (p = 0.008, p = 0.002). Conclusion: The current retrospective study has shown that tibial rotation is markedly reduced in patients with MMPHTs. Although the actual mechanism is not clear, the internal torsion of the tibia causes a decrease in the foot progression angle and increases the knee adduction moment, which in turn increases the medial tibial contact pressure. Internal torsion of the tibia, such as knee varus, may play a role in the aetiology of MMPHTs by this way. Whilst there was a significant difference in the mean varus and tibial torsion between the groups, there was no significant difference in the mean femoral version or tibial slope. Level of evidence: III.