All trauma cases flown over a 3.5 year period by the Metropolitan Helicopter Ambulance (MHA) from the accident scene to the Alfred Hospital were analysed. The MHA carries paramedics trained in advanced life support and is not under direct medical control. There were 254 patients (226 males, 28 females, mean age 34 years) of whom 242 had sustained blunt trauma. The mean distance from the accident scene to hospital was 28 nautical miles. The mean time from dispatch of the MHA to arrival at the Alfred was 82 min. The mean ground time at the scene was 32 min. Major trauma (an injury severity score (ISS) of 15 or more) was present in 62% of patients, and the mean ISS was 22.4. The major treatments at the accident scene by the paramedics were insertion of an intravenous (i.v.) cannula (242 cases), application of splints (197 cases), endotracheal intubation (35 patients) and needle thoracostomy to exclude tension pneumothorax (18 cases). There were 25 patients with a Glasgow Coma Score (GCS) less than 8 who were not intubated at the scene. Review of paramedic management identified four cases where prehospital care could have been improved but it is unlikely the final outcome would have changed: delay in transport (1 case), inadequate i.v. fluid resuscitation (2 cases) and delay in intubation (1 case). There was 1 case of undiagnosed tension pneumothorax that contributed to the patient's death and 1 case of non‐intubation where the outcome may have been altered. Overall there were 38 deaths (14% mortalitjl), which was not significantly different from the predicted mortality of 17%. Paramedics who followed specific protocols, but who were unable to communicate directly with the Alfred Hospital, performed well in the selection of injured patients most likely to benefit from helicopter transport. The prehospital treatment of major trauma patients was good, except for the high (42%) non‐intubation rate in patients with a GCS less than 8.

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Intertrochanteric fractures of femur (IFF) that comprise 8%-10% of all fractures are most commonly seen in people over 65 years old. Fractures of this region not only affect general state of health of patients, but also affect their lives mentally, socially and economically. Sufficient reduction and rigid internal fixation are still the best method for unstable IFF. Because of its biomechanical and anatomical design, proximal femoral nail (PFN) is a fixation material that has started to be increasingly used by orthopedic surgeons recently. In orthopedic traumatic surgery, implant failure is one of the most serious complications. To avoid these complications, many surgical techniques have been reported. Break of intramedullary nails especially in case of a nonunion requires to be extracted, which is a very difficult and challenging procedure for the surgeon. Many methods and materials have been described for this procedure. In this study we aim to review these topics.

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Tibiofibular syndesmosis is defined as a fibrous complex of the intraosseous membrane, the anterior and posterior tibiofibular ligaments connecting tibia and fibula to each other. Proximal tibiofibular syndesmosis injuries, especially without tibiofibular dislocation are very rarely seen in the literature. In this paper, the case of a professional football player with proximal tibiofibular syndesmosis injury is presented. He was a 26 year old football player who could not resume the game after an opponent's tackle. On examination, meniscal and ligamentous tests were normal, but edema, pain with palpation and (+) tinel sign with percussion of the fibular head were obtained. Additionally, increase in mobility of the fibular head was observed. After all radiological tests, the patient was diagnosed with "Proximal Tibiofibular Syndesmosis Sprain Grade-II", and a return to play period of 4-6 weeks was predicted. The player started to train with the team following the 30 days long rehabilitation protocol. There is no specific information about clinical and radiological signs to explain proximal tibiofibular joint (PTFJ) injuries in textbooks of orthopedics and sports medicine. Therefore, PTFJ injuries can be missed or misdiagnosed due to lack of information and experience. Our case is one of the two cases in the literature with no dislocation of PTFJ. Studies with larger series will help physicians to cover the lack of information and experience about proximal syndesmosis injuries. Moreover, it will help obtaining the right treatment protocol, and receiving a more effective answer without delay. ÖZTibia ve fibulayı birbirine bağlayan; interosseöz membran ile anterior ve posterior tibiofibular bağlardan oluşan fibröz yapı "tibiofibular sindesmoz" olarak adlandırılır. Literatürde tibiofibular dislokasyon olmaksızın proksimal tibiofibular sindesmoz bağ yaralanmasının oldukça ender rastlanan bir durum olduğu görülmektedir. Bu olgu sunumunda, Türkiye Süper Liginde mücadele eden bir profesyonel futbolcuda meydana gelmiş proksimal tibiofibular sindesmoz yaralanması tartışılacaktır. Olgu 26 yaşında ve erkekti; maç sırasında rakibinin müdahalesi sonrası oyuna devam edememişti. Fizik muayenesinde, menisküs ve bağ testleri normal olmakla birlikte; fibula başı düzeyinde ödem, palpasyonla ağrı ve perküsyon ile tinel bulgusu saptandı. Ayrıca fibula başının mobilitesinde artış gözlendi. Fizik muayene ve radyolojik görüntüleme tetkikleri sonucunda, sporcuya "Proksimal Sindesmoz Sprain Evre-2" tanısı konuldu ve 4-6 hafta iyileşme süresi öngörüldü. Sporcunun rehabilitasyon süreci sonrası 30 gün içinde takımla birlikte çalışmalara katılması