ObjectivesFemoroacetabular impingement (FAI) is one of the causes of hip pain in young-adult patients. The purpose of our study is to determine the prevalence of radiological FAI findings in asymptomatic population in Turkey.MethodsTrauma patients aged 18–65 years who applied to the emergency service between September 2015 and September 2016 were retrospectively evaluated for this study. After a preliminary study and power analysis, 2152 hips of the 1076 previously asymptomatic patients were evaluated radiologically with pelvis antero-posterior and frog-leg radiographs. On radiographs of these patients; alpha angle, lateral central edge angle (LCEA), Tönnis angle (TA) and collodiaphyseal angle were measured. Alpha angle values higher than 55° were noted as cam type FAI. TA values lower than 0° or LCEA values higher than 39° were noted as pincer type FAI. LCEA values lower than 25° or TA values higher than 10° were noted as acetabular dysplasia.ResultsMean age of 1076 patients (602 female, 474 male) was 42.1 ± 15.6 years. The assessment showed that 15.9% of the patients had cam type, 10.6% had pincer type, 3.1% had combined type FAI and 9.3% had findings of acetabular dysplasia. The prevalence of asymptomatic FAI is significantly more in males (46%) in comparison to females (17%) in Turkey.ConclusionEven though FAI is considered to be a pathology associated with hip osteoarthritis; it is very common in asymptomatic population. In this respect, our study showed that prevalence of radiological FAI findings in asymptomatic adult population was 29.6% in Turkey.

Coagulation factor XIII (FXIII) is a fibrin-stabilizing factor with additional roles in wound healing and interactions between the decidua and fetus. Congenital FXIII deficiency is rare bleeding disorder. Inhibitor development against FXIII in inherited FXIII deficency is also uncommon, but may cause severe, life-threatening bleeding. FXIII is the last step in the coagulation cascade with normal coagulation paramaters (PT, aPTT), the detection of inhibitor to FXIII is quite difficult. The treatment of inhibitor-positive congenital FXIII deficiency is challenging due to the lack of a role of by-pass agents such as FVII. The best known ways of treatment in these cases are the use of high-dose FXIII concentrates and immunosuppression. Herein, we report the management of postoperative bleeding diathesis in a patient with FXIII deficiency who developed inhibitors, and to follow the clinical course of the disease with FXIII concentrate and immunosuppression.

Background: The effect of limb lengthening on neural structures was assessed with use of intraoperative neuromonitoring (IONM) during primary total hip arthroplasty (THA). The relationship between the critical limit of lengthening and anthropometric measurements was evaluated. Methods: Motor evoked potentials (MEPs) from the deep peroneal nerve (tibialis anterior muscle), tibial nerve (gastrocnemius muscle), and femoral nerve (quadriceps muscle), as well as somatosensory evoked potentials (SEPs) from the posterior tibial nerve, were recorded in 16 patients undergoing THA. Height, weight, the distance between the anterior superior iliac spine and the medial malleolus (ASIS-MM distance), and the total femoral length were measured preoperatively. Lower-extremity traction was performed after resection of the femoral head, and the amount of extremity lengthening was measured with use of an image intensifier. A maximum of 50% reduction in any one of the SEP or MEP amplitudes or a 10% increase in the SEP latency were considered to be indicative of the critical limit of lengthening. Results: Initial IONM changes (indicating the safe limit of lengthening) and maximum allowed IONM changes (indicating the critical limit of lengthening) were reached in the deep peroneal nerve in all cases. The mean safe limit of lengthening (and standard deviation) was 14.9 ± 6.2 mm (3% relative to femoral length and 1.7% relative to ASIS-MM distance), whereas the critical limit of lengthening was exceeded at a mean of 22.4 ± 5.6 mm (5% relative to femoral length and 2.6% relative to ASIS-MM distance). When the critical limit was reached in the deep peroneal nerve, the mean decrease in MEP amplitudes was 27% (95% confidence interval [CI], 22.1% to 32.7%) for the tibial nerve and 12% (95% CI, 6.9% to 18.1%) for the femoral nerve. There was a positive correlation between critical lengthening and femoral length (r = 0.782; p < 0.001), ASIS-MM distance (r = 0.811; p < 0.001), and height (r = 0.835; p = 0.001). No correlation existed between the critical lengthening amount and the decrease in amplitude in the tibial and femoral nerves. Conclusions: The critical limit of nerve lengthening was directly correlated with anthropometric measurements. Nerve lengthening of 5% relative to femoral length and of 2.6% relative to ASIS-MM distance was found to be critical; however, these limits depended on the predetermined threshold values for IONM. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Case: A 42-year-old man presented with distal radius fracture. We performed external fixation combined with Kirschner wiring, which was removed 6 weeks postoperatively. After the removal of the implants, the patient could not achieve any pronation-supination, and distal radioulnar synostosis became apparent during the follow-up. The patient underwent distal ulnar osteotomy, and 60° pronation and full supination were achieved. No complications were reported at the 32-month follow-up. Conclusion: This is a rare case of radioulnar synostosis after percutaneous fixation surgery for distal radius fracture. The modified Sauve-Kapandji procedure can help restore motion, together with other appropriate postoperative interventions, and provides early mobilization.

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