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Introduction The Both Column Fixation Corridor (BCFC) and Both Column Screws (BCS) represent innovative concepts in orthopedic surgery, yet they have not been extensively studied in the literature. This study aims to validate the BCFC as a consistent fixation pathway across genders, evaluate its axial fluoroscopic visualization, and investigate gender-specific anatomical variations for surgical planning. Materials and methods In this study, pelvic CT data from 400 adults (200 males, 200 females) were analyzed using Fujifilm-Synapse 3D software. In the initial step, axial fluoroscopic visualization of the corridor was simulated, and the optimal antegrade entry point (OAEP) was identified. Subsequently, virtual placement of anterior and posterior screws (aBCS, pBCS) was performed radiologically within the corridor. Measurements included screw thickness (R), length (L), distances to the spina iliaca anterior superior (SIAS-aBCS, SIAS-pBCS), and the caudo-cranial (CCT) and centro-lateral (CLT) fluoroscopic tilts required for axial visualization of the BCFC and its OAEP. Results Fluoroscopic axial visualization of the BCFC and identification of the OAEP were successfully achieved in all models, enabling the placement of both anterior and posterior screws across genders. Measurements revealed the following average values for female and male pelvises, respectively: aBCS thicknesses were 6.5 ± 0.8 mm and 7.9 ± 0.9 mm ( p  < 0.001); lengths were 131.6 ± 8.8 mm and 146.8 ± 9.9 mm ( p  < 0.001); pBCS thicknesses were 6.5 ± 0.8 mm and 7.5 ± 0.7 mm ( p  < 0.001); lengths were 132.6 ± 9.7 mm and 148.3 ± 9.6 mm ( p  < 0.001); caudo-cranial tilts were 42.8°± 5.4 and 39.5°± 5.2 ( p  < 0.001); and centro-lateral tilts were 43.1°± 4.3 and 40.0°± 5.3 ( p  < 0.001). SIAS-pBCS distances were 38.5 ± 6.9 mm and 40.7 ± 7.5 mm ( p  = 0.003), while SIAS-aBCS distances were 29.7 ± 6.9 mm and 30.2 ± 6.7 mm ( p  = 0.467). All parameters, except for the SIAS-aBCS distance, exhibited statistically significant gender-specific differences. Conclusion The Both Column Fixation Corridor is a universally valid and consistent osseous fixation pathway present in both genders. It is suitable for the placement of two screws in pelvic and acetabular surgery, with careful consideration of gender-specific anatomical differences to optimize its application.

Introduction This study aims to describe a novel axial fluoroscopic imaging technique for visualizing the anterior column fixation corridor (ACFC) of the acetabulum in the supine position, define the patient-specific optimal antegrade entry point (OAEP), and evaluate the feasibility of screw placement using this approach. Materials and methods Pelvic computed tomography (CT) data from 500 healthy adults (250 men and 250 women) were collected. Using Fujifilm-Synapse 3D software, 3D reconstructions of the pelvis were created. Through fluoroscopy simulation, the axial view of the ACFC and OAEP was obtained for each individual. To simulate screw placement radiologically, a cylinder was placed through the OAEP, completely filling the corridor without protruding. The position was verified using both fluoroscopic simulations and three different CT sections (axial, coronal, sagittal). The corridor’s diameter (ACFC-R), length (ACFC-L), and the coronal plane inclination (CPI) and sagittal plane inclination (SPI) required for fluoroscopic visualization of the OAEP were measured in all pelvic models. Results The axial view and patient-specific optimal antegrade entry point (OAEP) of the fixation corridor were successfully visualized in all pelvises. Radiological virtual screw placement was successfully performed in all models by visualizing the OAEP, enabling precise axial screw insertion through the corridor. The average ACFC diameters were 6.2 mm in females and 8.6 mm in males ( p  < 0.001); ACFC lengths were 116.8 mm in females and 122.5 mm in males ( p  < 0.001). The SPI was 14.3 degrees in females and 14.7 degrees in males ( p  = 0.263). The CPI was 35.5 degrees in females and 33.2 degrees in males ( p  < 0.001). Except for the SPI, statistically significant differences were observed in all parameters between genders. Conclusion The axial fluoroscopic imaging technique enables accurate identification of patient-specific entry points and screw placement that fills the fixation corridor without boundary breach, potentially enhancing the precision and safety of anterior column fixation.

Purpose Fasciotomy is a surgical procedure that involves the incision of fascial compartments in the body to relieve pressure, prevent tissue damage, and maintain blood flow. This study aimed to investigate the effectiveness of the Bogota Bag technique in closing fasciotomy wounds in patients with lower limb compartment syndrome. Methods A prospective cohort study was conducted between October 2022 and October 2023 to document our experience in employing the Bogota Bag technique for fasciotomy closure. The study included the evaluation of medical files from fifteen patients aged 17 to 61. Results The outcomes of the study present the initial series of limb fasciotomies treated with the Bogota Bag technique. Fifteen patients (14 male, 1 female) were included in the study. The average age of the patients was 34.73 ± 13.9 years and the average hospitalization was 8.33 ± 3.2 days. The average closure time of fasciotomy is 3.6 ± 1.4 days. Conclusion This report makes a significant contribution as the first documented series of limb fasciotomies treated with the Bogota Bag technique. This method exhibits simplicity in execution, cost-effectiveness, and a low incidence of complications.

Purpose The aim of this study was to evaluate the musculoskeletal injury types, injury mechanisms, surgical techniques and treatment costs of Syrian refugees. Methods Totally 158 patients (67 female, 91 male) treated in our clinic in 34 months period between January 2012 and October 2014 were included in the study. The mean age of the patients was 39.3 years (range: 18–82 years). The patients were evaluated for age, gender, mechanism of injury, location and type of fracture, presence of accompanying injuries, injury severity score, surgical technique, complications, mortality/morbidity and treatment cost. Results The injuries were more frequently reported in lower extremities, upper extremities and axial skeleton, respectively. Blunt trauma was significantly higher in upper extremity injuries compared with the other types of injuries ( p  = 0.001). Fractures were most commonly reported in foot/ankle region and in males, hand/wrist fractures were significantly higher than that of the females. Plate fixation of upper extremity fractures and intramedullary nailing in lower extremity fractures were the most commonly preferred treatment modalities. The mean hospitalization period of patients was 5.6 days and the mean treatment cost was 3844 Turkish Liras (TL). Conclusions In this study, it was shown that there was a statistically significant increase in the cost of health expenses in patients with fall from heights or gunshot wound, with fractures in axial skeleton or with the ISS score between 16 and 66. The cost rise was associated with worse prognosis, complications, intensive care treatments and prolonged hospitalization periods.

PurposeThe study aims to determine the effect of fibular fixation on alignment and fracture healing of tibia, and ankle functional outcomes in the treatment of distal third tibiofibular diaphyseal fractures.MethodsConsecutive 111 patients (33 females and 78 males) with distal third tibiofibular diaphyseal fracture who met the inclusion criteria were included in the study. Patients were divided into two groups as those who underwent fibular fixation with tibia intramedullary nailing (study group) and those who did not (control group). Groups were compared in terms of demographic features, trauma and fracture characteristics, functional and radiological outcomes.ResultsNo significant difference was observed between the groups in terms of demographic features, trauma characteristics, complications, and follow-up time (p > 0.05). Surgery time was significantly lower in the control group (p = 0.001). Ankle joint range of motion, AOFAS score, OMAS score, and full weight-bearing time were significantly better in the fibular fixation group (p = 0.023, p = 0.001, p = 0.001 and p = 0.039, respectively). Significantly better coronal alignment and sagittal alignment were found in the fibular fixation group (p = 0.001 and p = 0.001, respectively). Patients who underwent fibular fixation had significantly better radiological outcomes in terms of fibular rotation angle and ankle arthrosis (p = 0.000 and p = 0.022, respectively).ConclusionFibular fixation not only contributes to fracture union, early full weight-bearing, and alignment but also improves ankle functional outcomes in the distal third tibiofibular fractures treated with intramedullary nailing for tibia.Level of evidenceLevel III, retrospective study.

IntroductionThe most common variant muscle of the ankle, peroneus quartus muscle, is located in the lateral leg compartment. In literature there is ambiguous nomenclature of this muscle because of its different origin and insertion sides. It is related to many pathologic conditions in the lateral ankle compartment but also it can be used as a tendon graft for reconstructive procedures.Material and methodWe dissected 115 cadaver legs and investigated prevalence of peroneus quartus. We also present 2 year result of a patient who had torn superior peroneal retinaculum reconstructed with peroneus quartus tendon.ResultsThe peroneus quartus muscle, with a number of different attachments, was present in 5.2 % (6/115) of the legs. It most commonly arose from the peroneus brevis muscle and inserted into the retrotrochlear eminence of the calcaneus. Associated pathologies are longitudinal degeneration and tear in the tendon of peroneus brevis. There is no any association between the prevalence of peroneus quartus and the height of retrotrochlear eminence or presence of peroneal tubercule (p > 0.05). But there is strong relationship between peroneus brevis degeneration and peroneus quartus existence (p: 0.03). We also defined a new type of peroneus quartus with a bifurcated insertion around the peroneus brevis. In literature our case report is unique because we present a patient who has torn superior peroneal retinaculum which is reconstructed with peroneus quartus tendon with 2 year follow up.ConclusionPeroneus quartus may lead to some pathologic conditions (pain, snapping, tear, synovitis, etc.) in the lateral ankle compartment but it may be used to reconstruct some pathologic conditions. Orthopaedics, anatomists and radiologists should be aware of this accessory tendon structure because of its clinical importance.

PurposeThe aim of the study was to identify the incidence of new sexual dysfunction reported by the patient in surgical treatment of pelvic ring injuries, and to describe the relationship between new sexual dysfunction and type of fracture.MethodsNinety-five patients who were operated for pelvic fracture were included in the study. Patients were evaluated according to age, gender, marital status, body mass index, trauma mechanism, fracture classification, genitourinary injury, accompanying injury, injury severity score, surgical technique, fixation material, duration of operation, functional outcomes, blood loss, complications, and sexual dysfunction. Functional outcomes were assessed with Female Sexual Functioning Index (FSFI), International Index of Erectile Function-5 (IIEF5), Arizona Sexual Experience Scale (ASEX), and Modified Majeed’s pelvic outcomes grading scale (MPS).ResultsGenitourinary symptoms were erectile dysfunction (ED) in 13 men, ejaculatory dysfunction in 9 men, and dyspareunia in 23 women. Urethral stricture developed in 4 males and 1 female with the urethral injury. FSFI score, ASEX score, and MPS score showed the statistically significant difference between the fracture types (p = 0.021, p = 0.032 and p = 0.020, respectively). There were no significant difference between fracture types in terms of the IIEF5 score, and no significant relationship between fracture type and ED development (p = 0.141).ConclusionAnteroposterior compression (APC) is the most common cause of sexual dysfunction in both sexes, independent of surgery. In addition, the most common cause of ED in men is vertical shear (VS). Especially patients with APC and VS injuries should be multidisciplinary evaluated with gynecology, urology, and psychiatry departments.

Background Tibial shaft fractures caused by low-energy gunshot injuries represent a rare but challenging clinical problem. The optimal treatment approach, particularly in comparison with Gustilo-Anderson Type I open fractures, remains controversial. Methods This was a retrospective comparative study that included patients who underwent intramedullary nailing for tibial shaft fractures. Group 1 consisted of low-energy gunshot-induced fractures, while Group 2 included Gustilo-Anderson Type I open fractures. Demographic data, union time, Radiographic Union Score for Tibial Fractures (RUST), Johner-Wruhs functional classification, need for additional surgical intervention, and infection rates were compared. Results A total of 128 patients were included (68 in Group 1 and 60 in Group 2). No significant differences were observed between the groups regarding demographic characteristics, follow-up duration, union time, RUST scores, or Johner–Wruhs functional outcomes ( p  > 0.05). However, the infection rate was significantly higher in the low-energy gunshot group compared with the Gustilo–Anderson type I group (20.6% vs. 5.0%, p  = 0.020).Nonunion and reoperation rates did not differ significantly between the groups. Conclusion Intramedullary nailing for tibial shaft fractures caused by low-energy gunshot injuries provides clinical and radiological outcomes comparable to those observed in Gustilo–Anderson type I open fractures. Nevertheless, these injuries appear to be associated with a higher risk of infection, warranting careful perioperative management and closer postoperative surveillance.