As much interest has been focused on afferent innervation of knee than that of patella, there are few articles about patellar innervation. But in clinical practice anterior knee pain due to patellar disorders is a quite frequent problem. Our aim was to review the innervation pattern of patella and to give the topographic anatomy of the nerves. We dissected 30 knees of 15 formaldehyde-fixed cadavers. Two nerves from vastus medialis and lateralis were found to reach patellar edge. Apart from these, we were unable to find any other neural structures around patellae. Mean distances between the tuberosity of the tibia and medial and lateral nerve entry points were 90.1(range 74-102) and 96.3 mm (range 76-109), respectively. The angles between lines which join the entry points of nerves and vertical line to the center point of patella were measured in frontal plane. It was approximately 60 degrees medially and 40 degrees laterally. To confirm that these nerves are patellar pain afferents, we performed a local anesthesia test in 32 knees of 20 patients with patellofemoral pain. Clinically, there was a significant difference between the visual analogue scale (VAS) scores before and after local anesthetic injections (p<0.01). Previous studies have emphasized especially the medial innervation. We found that both superomedial and superolateral nerves were important for patellar innervation. We described precisely the entry points of these nerves to patella for selective denervation.

distraction rate, the less the healing index and consolidation time. Conclusion. Age has the most effect on healing index and consolidation time. Metacarpal lengthening using callus distraction is recommended. Adolescence is the most appropriate time to perform distraction lengthening of a congenitally short metacarpal. This will avoid additional lengthening of normal metacarpals prior to epiphyseal closure.

For determination of femoral component rotation in surgery setting, different results between cTEA and PCA+3° ER techniques possibly may due to disadvantages of techniques and anatomic variation of distal femur. Thus, using both techniques to check each other's results seems unsafe.

No abstract

Endoscopy-assisted percutaneous repair of Achilles tendon ruptures were investigated in a cadaveric and clinical study. Sixteen above-knee fresh amputation specimens in which different types of Achilles tendon ruptures were created were repaired percutaneously with the visualization of the tendon ends by endoscopy. Neither malalignment nor damage to the neurovascular structures was observed. Eleven patients were treated in this way. No reruptures, wound problems, or neurovascular injury were observed. All patients returned to daily activities 10-11 weeks after the repair. This technique seems to overcome certain problems of conservative, surgical, or percutaneous repair of the Achilles tendon ruptures.

S Su um mm ma ar ry y O Ob bj je ec ct ti iv ve e: : The quadriceps muscle group plays an important role in patellar stabilization. This study was designed to investigate the effect of a quadriceps exercise program along with a patellar brace in reducing pain and increasing function in patello-femoral pain syndrome (PFPS) patients. M Ma at te er ri ia al ls s a an nd d M Me et th ho od ds s: : A total of 86 patients with PFPS were included in this study. Patients were randomized into two groups: Group 1 (n=45) received a home based exercise program only; group 2 (n=41) received the same home based exercise program along with a patellar brace. The duration of the intervention was six weeks. At the end of the therapy patients were evaluated for pain and functional capacity. Pain was assessed using the visual analogue scale (VAS) and the Western Ontario McMaster Osteoarthritis Index (WOMAC) Pain Scale. Functional capacity was evaluated by using the WOMAC Functional Capacity Index and the Fulkerson-Shea Patellofemoral Evaluation Score (FSPES). R Re es su ul lt ts s: : After the program, there were statistically significant decreases in the VAS and WOMAC pain scale for both group 1 and 2 (p<0.001). Also, statistically significant increases were observed in the WOMAC functional capacity index and the FSPES for both groups (p<0.001). There were no statistical differences among parameters between two groups (p>0.05). C Co on nc cl lu us si io on n: : Addition of patellofemoral brace to the home exercise program didn't provide statistically significant differences in decreasing pain and increasing the functional capacity in patients with PFPS. Turk J Phys Med Rehab 2010;56:100-4. K Ke ey y W Wo or rd ds s: : Patellofemoral pain, exercise, patellar brace, functional capacity Ö Öz ze et t A Am ma aç ç: : Patellan›n stabilizasyonunda kuadriseps kas grubu önemli rol oynar. Bu çal›flmada patellofemoral a¤r› sendromu (PFAS) olan hastalarda ev egzersiz program› ile ev egzersiz program›na patellar breys eklemenin a¤r› ve fonksiyonel kapasite üzerine etkisini araflt›rmak amaçland›. G Ge er re eç ç v ve e Y Yö ön nt te em m: : Çal›flmaya PFAS olan 86 hasta dahil edildi. Hastalar iki gruba randomize edildi. Grup 1 (n=45) hastalara yaln›z ev egzersiz program›, grup 2 (n=41) hastalara ev egzersiz program›na ilave patellar breys verildi. Hastalar alt› hafta boyunca tedaviye al›nd›. Tedavi sonunda a¤r› ve fonksiyonel kapasite düzeyleri de¤erlendirildi. A¤r›; görsel anolog skala (GAS) ve Western Ontario McMaster Osteoartrit (WOMAC) A¤r› ‹ndeksi ile de¤erlendirildi. Fonksiyonel kapasite ise WOMAC ve Fulkerson-Shea Patellofemoral De¤erlendirme Skoru (FSPDS) ile de¤erlendirildi. B Bu ul lg gu ul la ar r: : Tedavi sonras›, Grup 1 ve 2'de GAS ve WOMAC a¤r› skorunda istatistiksel anlaml› azalma gözlendi (p<0,001). Ayn› zamanda her iki grupta WOMAC fonksiyonel indeks ve FSPDS'unda istatistiksel anlaml› art›fl gözlendi (p<0,001). Gruplar aras›nda de¤erlendirme parametreleri aç›s›ndan istatistiksel anlaml› fark yoktu. S So on nu uç ç: : PFAS ola...

In this study, we aim to evaluate the clinical and radiological results of children who were treated with four different surgical approaches. In our clinics between February 2004 and November 2012, the children who underwent surgical treatment for supracondylar humeral fractures and whose data were available with regular follow-up of at least 1 year were included in the study. Clinical outcomes were evaluated for 54 patients with Gartland type 3 extension supracondylar fractures. Functional and cosmetic results of the patients were determined according to the Flynn criteria. Mean age of the patients was 4.9 (between 2 and 14) among which 26 of them were girls and 28 were boys. Mean operation time was 45 (35–85) min. Average length of hospital stay (LHS) was 2.9 (1–7) days. Average duration of splints was 3.5 (2–6) weeks, while the average removal period of the wires was 4.6 (3–8) weeks. Mean consolidation time was 4.6 weeks (3–8). Mean follow-up was 14.36 months. In our study, we performed 54 patients functional and cosmetic results. While 48 of the patients had satisfying results (excellent, good, or fair), six of them had unsatisfactory (poor) results. The results of this study suggest that clinical results with surgical treatment of Gartland type 3 extension fractures were satisfactory. However, the delay in the surgical treatment may cause a number of complications.

Complication rates of hip fractures after proximal femoral nail are not rare. In such fractures, treatment invariably comprises the extraction of proximal femoral nail and the introduction of a different hip prosthesis. To solve this problem, we aimed to develop a new implant, the modular nail prosthesis, which combines an intramedullary nail with a hip prosthesis. The aim of this study was to determine the effect of stress load distribution on the stem using finite element analysis under laboratory conditions. For this, the shortest stem of 175 mm was chosen. In addition, six proximal femoral nail-hip prosthesis combinations were produced and tested with a biomechanical test device and passed 2300-N load bearing. According to the test results, our newly developed modular nail prosthesis can be converted to hip prosthesis securely.