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Background: Tibial slope measurements performed using only the proximal part of tibia ignore the native tibial anatomical axis. Our first aim is to measure the native medial, lateral and total tibial slope angles of gender groups using the whole tibial anatomical axis on computerized tomography-based three-dimensional anatomical models. The second aim is to determine the correlation between proximal and whole tibial anatomical axis for measurement of medial, lateral, and total tibial slope angles. Methods: We randomly selected 100 females and 100 males between 18-60 years of age. Three-dimensional anatomical models of right and left tibia were created. The gender-specific differences of medial, lateral, and total tibial slope angles according to proximal and whole tibial anatomical axis were measured. Correlation coefficients (r) of medial, lateral, and total tibial slope angles measured with proximal and whole tibial anatomical axis were calculated. Results: The mean age was 47.1 years. A statistically significant difference was observed between female (7.1 ± 3) and male (8.2 ± 2.5) groups in terms of mean lateral tibial slope angles according to the whole tibial anatomical axis (p=0.008). A strong correlation between proximal and whole tibial anatomical axis for all tibial slope angle measurements was detected. Conclusion: The method we determined for 3D measurement of medial, lateral and total tibial slope angles using proximal tibial anatomical axis has a strong correlation with slope angles measured in accordance with the whole tibial anatomical axis. Our 3D tibial slope angle measurement method on the proximal tibia has high reliability and could be used in the daily practice.

Difficulties in graft harvesting of the hamstring have been the topic of many studies. These difficulties are related to the aponeurotic or fibrous attachments of the hamstrings with the medial head of the gastrocnemius muscle, soleus muscle, and leg fascia. Freeing the graft from these attachments is important because insufficient release prior to stripper insertion can lead to premature transection or amputation. We describe a reliable intraoperative physical examination sign to help understand the sufficient amount by which a tendon graft needs to be released prior to stripper insertion. The presence of the motionless gastrocnemius (“motionless gastroc”) phenomenon is used in our clinic as a sign that the grafts have been sufficiently freed and that a tendon stripper can be used without fear of transection or graft amputation.

Three-point index (TPI) has been reported to be effective in predicting the displacement of forearm fractures. The aim of this prospective study was to investigate the clinical efficacy of recasting critical but acceptable casts according to three-point index (0.6 < TPI < 0.8) before a redisplacement occurs in childhood forearm fractures. A TPI of 0.6–0.8 was determined in 68 patients, and these were separated as group 1 (n = 34) applied with prophylactic recasting and group 2 (n = 34) where treatment was continued with same cast. The remaining 28 patients had TPI < 0.6 and were assigned as group 3. Groups were compared in respect of age, initial displacement, cast type, location of fracture, initial and late three-point index values and inter- and intraobserver reliabilities of TPI measurements. Significantly less displacement was seen in group 1 than in group 2 (P = 0.004). It was found that a 0.1 increase of index value in the initial and late TPIs increases the probability of redisplacement by 5.06 and 7.78 times, respectively. Late TPI, measured 1 week after casting, had better predictive value than the initial TPI with a sensitivity of 77.8%, specificity of 92.3%, positive predictive value of 70% and negative predictive value of 94.7%. Patients in the grey zone will be able to safely complete the cast treatment with prophylactic recasting without surgical intervention. TPI should be remeasured at the end of first week, as its predictive value becomes more accurate after swelling subsides.