Biomedical subjects

Ibrahim Tekdemir

Publications and source records attributed to Ibrahim Tekdemir.

At least 37 records · Page 2Linked to original sources

PubMed2005

Anatomy of the platysma muscle and the evaluation of it for the reconstruction of facial defects.

Reconstruction of the defects with various flaps is the main issue in plastic and reconstructive surgery. Tissues used for the repair of the defects of the face should be convenient for this most important aesthetic unit. Color, elasticity, and volume of the transferred tissues have the utmost importance for successful results. Platysma muscle flap appears to be a good alternative method for the reconstruction of the facial defects. Anatomic dissections on five fresh cadavers for the evaluation of the vascular structures and 11 clinical cases of reconstruction of the defects of the face and the neck with platysma muscle and musculocutaneous flaps are performed in this study to evaluate the efficacy and reliability of platysma flaps. Cadaveric dissections were performed on the face and the neck regions on both sides. Eleven patients with various defects on the face and the upper neck regions were surgically treated: three transverse cervical artery-based transverse musculocutaneous platysma flaps, seven facial artery-based vertical musculocutaneous platysma flaps, and one superior thyroidal artery-based platysma muscle flap were used for the repairs. The patients ranged in age from 42 to 74 years. The defects measured 2x3 cm to 6x9 cm and the flaps 3x3 cm to 7x10 cm. The follow-up periods were 2 to 21 months. Postoperative venous congestion between the 5th and 9th days was observed in seven patients. One patient had infection of the donor site, and another had infection of the recipient site; both recovered with systemic and topical antibiotherapy. Partial flap loss occurred in one patient. Our study concluded that platysma flaps showed sufficient tissue match with successful results for the reconstructive procedures of facial defects.

Adult↗

PubMed2005

A new approach for pudendal nerve exposure and its clinical significance.

Analgesia of the pudendal nerve is used in patients undergoing gynecologic, obstetric and penile surgery. Stimulation techniques are used to determine the functions of the nerve. In these interventions, different landmarks are used to describe the localization of this nerve. Although some authors use perineal approaches, others prefer a transvaginal (rectal in males) approach. Knowledge regarding the anatomy of the pudendal nerve and its blockade allows an easy approach to the clinical problems like perineal neuralgia, neurogenic bladder dysfunction and penile implant operations. However, in the descriptions of these different approaches, there is no clear information regarding the depth of the nerve and the branches of the pudendal nerve that are blocked. The aim of the present study was to determine the depth and location of the pudendal nerve and, thus, describe certain and easily identified surface landmarks for clinical use. According to our examinations, the distance between the ischial tuberosity and the coccyx (the base of a triangle defined by the ischial tuberosity, coccyx and ischial spine) was 8.62 +/- 0.92 cm (range 6.74-9.77 cm). The distance between the ischial tuberosity and the ischial spine was 5.23 +/- 0.33 cm (range 4.76-5.81 cm) and the distance from the ischial spine to the coccyx was 5.42 +/- 0.52 cm (range 4.02-6.32 cm). Because the pudendal nerve intersected the distance between the posterior superior iliac spine and the ischial tuberosity, the distance between these two landmarks was also measured and found to be 13.31 +/- 0.91 cm (range 10.58-15.13 cm); the depth of the nerve was 4.14 +/- 0.83 cm (range 3.13-5.25 cm).

Anesthesia, Epidural↗

PubMed2005

Implant design and intraosseous stability of immediately placed implants: a human cadaver study.

OBJECTIVE: The objective of this study was to explore effects of implant macrodesign and diameter on initial intraosseous stability and interface mechanical properties of immediately placed implants. MATERIAL AND METHOD: Mandibular premolars of four fresh-frozen human cadavers were extracted. Ø 4.1/4.8 mm ITI TE, Ø 4.1 and 4.8 mm solid screw synOcta ITI implants were placed into freshly prepared extraction sockets. Resonance frequency analysis was conducted to quantify primary implant stability quotient (ISQ). Installation torque value (ITV) and removal torque value (RTV) of the implants were measured using a custom-made strain-gauged torque wrench connected to a data acquisition system at a sample rate of 10,000 Hz. The vertical defect depth around the collar of each implant was measured directly by an endodontic spreader. The bone-implant contact was determined in digitalized images of periapical radiographs and expressed as percentage bone contact. RESULTS: The ISQ values of the TE implant was higher than the Ø 4.1 mm implant (P<0.01), and comparable with the Ø 4.8 mm implants (P>0.05). ITVs and RTVs of TE and Ø 4.8 mm implants were higher than the Ø 4.1 mm implant, although the differences between groups were statistically insignificant (P>0.05). The vertical defect depths around all types of implants were similar. In the radiographic analyses, percentage bone-implant contact of the TE and Ø 4.8 mm implants were comparable at the marginal bone region and both were higher than that of the Ø 4.1 mm ITI implant. Nonparametric correlations between groups revealed a significant correlation between ITV and RTV (r=0.838; P<0.001), but not between ISQ values and ITVs and RTVs (P>0.05). CONCLUSION: Immediately placed ITI TE implant leads to initial intraosseous stability and interface mechanical properties comparable with a wide diameter implant.

Adult↗

PubMed2005

Human ex vivo bone tissue strains around natural teeth vs. immediate oral implants.

PURPOSE: To compare ex vivo bone tissue strains around natural teeth with immediate implants supporting unsplinted and splinted fixed prostheses. MATERIAL AND METHODS: Six linear strain gauges were bonded on the labial marginal bone of bilateral maxillary anterior teeth in two fresh-frozen human cadavers. The natural teeth were loaded in centric occlusion via an occlusal splint with integrated miniature load cells. Strain measurements were performed at a sample rate of 10 kHz and under a maximum load of 100 N, simultaneously monitored from a computer connected to data acquisition system. Upon extraction of the anterior teeth, Ø 4.1 mm and Ø 4.8 mm ITI dental implants were placed into sockets of incisors and canines, respectively. Installation torque value (ITV) of each implant was measured by a custom-made torque wrench and resonance frequency analyses (RFA) were also undertaken. Strain measurements were performed for (1) single-tooth implant restorations, (2) unilateral splinted anterior implants, and (3) bilateral splinted anterior implants. Finally, an autopolymerizing acrylic resin was injected into the implant sockets for simulation of osseointegration and strain measurements were performed. RESULTS: Microstrains of all groups were statistically comparable (P>0.05), although lower strains were elicited for implants in sockets of incisors in comparison with natural teeth. Microstrains around canine implants were comparable or higher than those induced around natural canines. For all groups, microstrains around canines were higher than those around lateral (P<0.05) and central incisors (P<0.01), which had similar strain levels (P>0.05). The RFA values of implants were comparable. The ITVs of implants in sockets of lateral incisors and canines were similar and were higher than those of implants in central incisor regions. CONCLUSION: The labial marginal bone having no contact with immediate implants may experience strain gradients within physiologic levels due to deformation of bone under load. Although one prosthetic design does not seem to have clear advantages over another, splinting of implants may be considered as a safety measure for immediately loaded immediate implants, if possible.

Adult↗

PubMed2005

Human ex vivo bone tissue strains around immediately loaded implants supporting maxillary overdentures.

PURPOSE: To evaluate ex vivo bone tissue strains around maxillary implants supporting immediately loaded bar-retained overdentures. MATERIAL AND METHODS: Ninety degree two-element rosette strain gauges were bonded on the labial bone of four ITI dental implants placed in the maxillary anterior region of four completely edentulous maxilla of fresh human cadavers. The installation torque value (ITV) of each implant was measured by a custom-made torque wrench and resonance frequency analyses (RFAs) were undertaken. A bar-retained overdenture was fabricated for each cadaver, and two miniature load cells were integrated in the first molar region of the overdentures for controlled loading experiments. Strain measurements were performed at a sample rate of 10 kHz and under a maximum load of 100 N, simultaneously monitored from a computer connected to a data acquisition system. Finally, removal torque values (RTVs) of the implants were measured. RESULTS: RFA values did not mirror ITVs, while RTVs of implants were slightly lower than the ITVs. Any correlation could not be obtained between RFA values and ITVs or RTVs. Maximum strains around loaded implants ranged between -100 and -550 microepsilon under 25-100 N. The axial and lateral strain values of posterior implants of both sides were higher than those of anterior implants under all loads (P<0.05). CONCLUSION: Because occlusal forces in humans tend to decrease because of age-related factors, maximum strains around immediately loaded implants supporting maxillary overdentures fall within physiologic levels.

Aged↗

PubMed2005

The annular ligament: an anatomical study.

BACKGROUND: Despite documentations of ligamentous structures of the elbow, the anatomy and clinical and functional importance of the annular ligament has not been comprehensively defined in the orthopaedic literature. HYPOTHESIS: The annular ligament is an important component of both the proximal radioulnar and humeroradial joints, as well as an important component of the neighboring muscles and ligaments. STUDY DESIGN: Descriptive laboratory study. MATERIALS AND METHODS: To investigate the annular ligament and its relationship with neighboring structures, macroscopic and microscopic dissections were performed on both upper extremities of 30 cadavers (12 female and 18 male) fixed in 10% formaldehyde and on 1 upper extremity of a fresh cadaver (male). RESULTS: The distal ulnar insertion of discrete fibers on the supinator crest was defined as the inferior oblique band of the annular ligament, and the proximal insertion of the annular ligament was defined as the superior oblique band of the annular ligament. These patterns were noted in all specimens. It was difficult to distinguish the fibers of the supinator muscle in every specimen because they were intimately fused with the fibers of the annular ligament. CONCLUSIONS: The superior and inferior oblique bands of the annular ligament attached proximally and distally onto the ulna, thus helping to secure the annular ligament in place.

Cadaver↗

PubMed2005

The use of computed tomography to determine femoral component size: a study of cadaver femora.

Computed tomography is used to assess whether ideal femoral component size in knee arthroplasty can be made more accurately. Ideal femoral component size was measured on radiography, computed tomography, and by direct measurement of 20 cadaver femora and analyzed statistically. There was no significance between the tomographically anticipated ideal femoral component size and ideal femoral size values (Wilcoxon W 388.5; p 0.565). There was difference between radiographically anticipated ideal femoral size and ideal femoral size values (Wilcoxon W 324.5; p 0.020). Anticipating the ideal femoral size can be made more precisely with computed tomography than radiographs in cadaver femora. Anticipating the ideal femoral component size by computed tomography may solve the problems in "in-between sizes." Future total knee designs may be manufactured in more anatomic sizes.

Cadaver↗

PubMed2004

Determination of the length of anteromedial screw trajectory by measuring interforaminal distance in the first sacral vertebra.

STUDY DESIGN: Measurements of the length of pediculocorporeal screw trajectory were performed on bony sacra. Outer interforaminal distances of the first sacral vertebra were measured on bony sacra and anteroposterior sacral radiographs. OBJECTIVES: To demonstrate the correlation of the length of pediculocorporeal screw trajectory of the first sacral vertebra on bony specimens with outer interforaminal distances on their anteroposterior radiographs. SUMMARY OF BACKGROUND DATA: Posterior fixation of the lumbosacral vertebra has been used in the treatment of unstable lumbar spine disorders. To achieve the strongest biomechanical stability and to avoid injury to anterior sacral structures for anteromedial insertion of the posterior transpedicular screw to the first sacral vertebra (S1), it is crucial to determine the optimum screw length for both unicortical and bicortical screw placement. METHODS: Fifty-one dry bony adult sacra were measured and correlated with anteroposterior lumbosacral radiographs. The length of S1 screw trajectory, which was accepted as between inferolateral border of superior articular facet of S1 and sacral promontory, and the outer interforaminal distances of anterior S1 foramens were measured on bony specimens. The outer interforaminal distances of anterior S1 foramens were also measured on anteroposterior sacral radiographs. RESULTS: The outer interforaminal distances were not statistically different from the length of the S1 screw trajectory on bony specimens. Radiographs of the S1 vertebra have also shown that outer interforaminal distances were not statistically different from the length of the S1 screw trajectory. CONCLUSION: In this study, we described an easy and a reliable method to determine the length of anteromedial screw by measuring outer interforaminal distance of S1 vertebra on anteroposterior radiograph of the sacrum.

Adult↗

PubMed2004

A ligament in the lumbar foramina: inverted Y ligament: an anatomic report.

OBJECTIVES: The objective of this study was to investigate the ligaments in the exit zone of lumbar foramen and describe their anatomic relationships with adjacent structures. Few studies have been reported on the ligaments of foramen and the anatomic relationships on the lumbar level. The ligament described in this study is novel since it has not been reported previously. METHODS: Ten male and five female cadavers were used to investigate intraforaminal area and ligaments of the lumbar level. The cadavers were filled with colored latex, and the lumbar foramen were examined under operative microscope. RESULTS: A lumbar foramen branched off into two or three main passages, composed of inverted Y ligament form. The medial lower arm of Y ligament was attached to the upper and anterior surface of the superior articular process of the lower corpus vertebra. Its lateral lower arm was attached to the upper surface of the area where the lower corpus vertebra and its pedicle met, and the upper arm was attached to the lower surface of the pedicle of upper vertebra where it met with transverse process. The anatomic properties of vascular and nervous structures in foramen and the relations among them are described. CONCLUSION: The ligament detected in the study was different from the other reported descriptions of foraminal ligaments. It divided the lumbar foramen into three passages. Because of its relations with adjacent structures, such as nerves and vessels, the inverted Y ligament may be an important structure for lumbar foramen. Thus, it may be an important anatomic landmark.

Adult↗

PubMed2004

Important anatomical structures used in paravaginal defect repair: cadaveric study.

OBJECTIVE: To examine the variations and the anatomical characteristics of the tendinous arch of pelvic fascia (TAPF), the tendinous arch of levator ani (TALA) and the obturator fascia (Ofa) that are important structures in paravaginal defect repair and their relations with important neurovascular structures. STUDY DESIGN: We carried our study on 10 pelvic halves of five female cadavers fixed in 10% formaldehyde. RESULTS: TALA could show a very high location or a low location near to inferior edge of obturator internus. TAPF was not observed in four of the cases. It was examined as a quite weak structure in two of the cases. The location of obturator vessel-nerve bundle could show difference. Obturator artery (OA) and vein sometimes do not course parallel to obturator vein (OV) and make an inclination and extend to the obturator foramen (OF). The distance between TAPF and the pectineal ligament (PL) (Cooper ligament) was measured as 5 cm on average. The distance between TAPF and the entrance of obturator canal was measured as 3.2 cm on average. While the distance of pudendal vessel-nerve bundle from levator ani (LA) at the anterior border of the spine was 0 mm, 2 cm anteriorly it was measured as 4.4 mm on average. CONCLUSION: Since TAPF does not develop in every case, it is not a safe structure to be used in surgery. If TALA develop downward as a variation, it could be difficult to distinguish from TAPF. Since the obturator fascia is a thin membrane, it is not a strong structure for suture placement. The region that is 2 cm in front of the ischial spine (IS) is a dangerous zone for pudendal vessel-nerve bundle.

Aged↗

PubMed2004

Anatomic limitations of posterior exposure of the sinus tympani.

OBJECTIVE: The sinus tympani is a challenging area for the otologic surgeon to access and from which to remove the disease process. Recently, a posterior approach to the sinus tympani through the mastoid was proposed as an alternative technique in cases of deep sinus tympani. STUDY DESIGN AND SETTING: The posterior approach was performed by dissecting the triangular bony area formed by the facial nerve, lateral semicircular canal, and posterior semicircular canal in 8 temporal bone specimens. RESULTS: The edges of the triangle on the facial nerve and lateral semicircular canal were almost constant at 5 mm. The edge on the posterior semicircular canal was about 4 mm. CONCLUSION: It is possible to expose the sinus tympani from the posterior by careful dissection through this triangle, which has almost constant dimensions.

Ear Diseases↗

PubMed2004

Transethmoidal approach to the optic canal: surgical and radiological microanatomy.

BACKGROUND: The purpose of the study is to describe anatomic topographic landmarks for transethmoidal approach to optic canal for optic nerve decompression. The study focuses on microsurgical/radiologic anatomies and their relationships in the region of the optic canal and orbit. METHODS: Human optic canal and related anatomic structures were studied in orbits of 6 formalin preserved adult human cadavers. In addition, anatomic measurements were made with digital vernier caliper on the orbits of 25 adult human skulls. The relation between ethmoidal and sinus was assessed with computed tomography (CT) scan in 25 living human heads needing cranial CT scan for any reason. RESULTS: The suture on the conjunction of frontal, maxilla, and lacrimal bones with a location in medial side of the orbit was accepted as a landmark. When the measurements were taken from this landmark, the distances to supraorbital margin were: right(R): 16.76 +/- 2.62 mm, left (L): 17.10 +/- 1.97 mm, and to infraorbital margin were R: 20.18 +/- 3.24 mm, L: 18.94 +/- 2.19 mm. The distances to the anterior ethmoidal foramen were R: 19.66 +/- 3.96 mm, L: 19.11 +/- 2.84 mm, and to the posterior ethmoidal foramen were R: 32.01 +/- 2.90 mm, L: 32.62 +/- 3.33 mm. Mean distance between the anterior and posterior ethmoidal foramen were R: 12.55 +/- 3.4 mm, L: 13.51 +/- 4.2 mm. The posterior ethmoidal foramen and optic ring were separated only by the mean distances of R: 5.34 +/- 2.81 mm, L: 4.9 +/- 3.35 mm. The distance from the suture to the distal (orbital) opening of the optic canal was R: 37.35 +/- 2.73 mm, L: 37.52 +/- 3.47 mm and to proximal (intracranial) opening of the canal were R: 49.52 +/- 2.62 mm, L: 50.94 +/- 3.35 mm. The average widths of proximal (intracranial) canal measured were R: 7.43 +/- 1.95 mm, L: 7.38 +/- 2.01 mm and those of distal canal (orbital) were R: 5.12 +/- 1.1 mm, L: 4.95 +/- 1.32 mm. The mean lengths of the optic canal were R: 11.19 +/- 2.68 mm, L: 12.42 +/- 3.38 mm. In radiologic examinations, the mean numbers of anterior group ethmoidal cells were R: 7, L: 6 and those of posterior group ethmoidal cells were R: 4, L: 3. The results of CT demonstrated 7 (14%) Onodi or sphenoethmoidal cells in 50 orbits of living humans. CONCLUSION: The examination of radiologic anatomy in addition to microanatomy can significantly contribute to preoperative and postoperative evaluation of the patients.

Adult↗

PubMed2004

Extraforaminal lumbar arterial anatomy.

BACKGROUND: There are few studies carried out to reveal lumbar arterial anatomy. The studies of vascular anatomy of the lumbar zone are usually based on the angiographic imaging methods and barium injected radiographic sections of human specimens. METHODS: Upon the recent breakthroughs in the microscopic anatomic dissections, the vascular structure of this zone is examined in 16 cadavers. Arterial anatomies of the extraforaminal zones of 80 lumbar vertebral objects were studied. RESULTS: In each segment, lumbar artery, extraforaminal branches of the lumbar artery and the spinal (foraminal) branch were described. The spinal branch is originated from lumbar artery and extends as the dorsal branch. The dorsal branch is divided into 4 branches: ganglionic, transverse, ascending, and descending. Diameters of the lumbar artery, spinal, dorsal, and ganglionic branches were measured at each stage. The mean diameter of the lumbar artery was 2.7 mm, the dorsal branch was 2.0 mm, the foraminal branch was 1.9 mm, and the ganglionic branch was 1.0 mm, respectively. CONCLUSION: Knowledge of lumbar arterial anatomy is needed for carrying out a successful surgical operation and reducing complications.

Adolescent↗

PubMed2004

Anatomy of the posterior iliac crest as a reference to sacral bar insertion.

There are no detailed anatomic studies focusing on the posterior iliac crest although it frequently is used for posterior stabilization of unstable pelvic fractures. Anatomic dissections were done to evaluate the size of the extraarticular region of the posterior iliac crest and its relationship to the lumbosacral lamina and to show on cadavers the level of sacral bar placement that offers safe and solid fixation. Sixty cadavers were dissected bilaterally. Fifty-one were male and nine were female. The distance between the posterior wall of the sacral canal and the tip of the iliac crest was measured at various levels between the level of the upper border of L5 lamina to the level of the posterosuperior iliac spine. In all the dissections the greatest distances were at the level of the L5-S1 junction, which consequently is the safest level for good bony purchase. The entire length of the posterior iliac crest from the level of the upper border of L5 lamina to the posterosuperior iliac spine was shown to be appropriate for safe and solid bar fixation because all of the distance measurements were greater than 13 mm, which is the smallest safe distance. Below the posterosuperior iliac spine level, insertion of the sacral bars was dangerous because the average measured distance was only 10.38 mm.

Adult↗

PubMed2003

An anatomical study of the meniscofibular ligament.

We examined the anatomical structure of a ligament (ligamentum meniscofibulare) between apex fibulae and lateral meniscus by macroscopic and microscopic dissection and transillumination method in 50 knees of 25 cadavers (5 were fresh). We analyzed the function of this ligament, which runs between the head of the fibulae and lateral meniscus. The existence of a connection between knee joint and proximal tibiofibular joint was demonstrated by injecting colored liquid into the knee joint space and transillumination. The mensicofibular ligament is a capsular ligament originating from the lateral meniscus that is anterior to the popliteal muscle tendon. The meniscofibular ligament, which is attached to fibula with rotatory motion at one end and to the lateral meniscus at the other, is believed to position the lateral meniscus and therefore to play a key role in the knee joint.

Cadaver↗

PubMed2003

Clinical importance of ligamentous and osseous structures in the cervical uncovertebral foraminal region.

The vertebral artery, cervical spinal nerves, spinal nerve roots, and the bony and ligamentous tissue related to the cervical vertebrae are structures whose anatomy determines the path of a surgical approach. Defining the anatomy and, in particular, determining the precise location of vulnerable structures at the intervertebral foramen and the uncovertebral foraminal region (UVFR), a region defined by the uncinate process anteriorly, the facet joint posteriorly and the foramen transversarium laterally, has critical significance when selecting the safest surgical approach. We studied the anatomy of the vertebral artery, cervical spinal nerves, and spinal nerve roots within the UVFR in six cadaver specimens. We also obtained measurements of bony structures in 35 dry cervical vertebral columns, from C3-C7. The uncinate process (UP) projects superiorly from the posterolateral aspect of each cervical vertebral body, except for the first and second vertebrae. Because the posterior part of the UP lies adjacent to the vertebral artery, spinal nerve, and spinal nerve roots, its resection creates sufficient space to decompress these structures directly. The posterolateral surface of the UP is covered by ligamentous tissue that originates from the posterior longitudinal ligament and protects the neural and vascular structures during their decompression in the UVFR.

Cervical Vertebrae↗

PubMed2003

Microscopic anatomy of the infraorbital canal, nerve, and foramen.

OBJECTIVE: We performed this study to investigate the morphologic and topographic anatomy, and variations of the infraorbital canal (IOC), infraorbital nerve (ION), and infraorbital foramen (IOF). STUDY DESIGN AND SETTING: This study was performed at the Anatomy Department of Ankara University School of Medicine between 1999 and 2000. The morphometry of these anatomic areas on cadaver heads were studied microscopically. The morphologic and topograpic anatomies of IOC, ION, and IOF were carried out microscopically with x 25 to x 40 magnification on 10 cadaver heads (20 sides). RESULTS: We found the shape of the IOF as oval in 30% (6 sides), round in 40% (8 sides), and semilunar in 30% (6 sides) of the cadaver heads. We detected the IOF as single in 90% (18 sides), double in 5% (1 side), and triple in 5% (1 side) of the cases. We determined a complete roof (we called it as "canal") in 50% of cases and groove plus canal in 50% of the heads. The mediolateral relationship of the vessels to the nerve while emerging from the IOF was investigated, and the artery was always found in a mediosuperior position and the vein was inferior to it. In all specimens, the ION was found to be consisting of 3 to 8 fascicles interwoven with the artery and the vein in the loose connective tissue sheath. CONCLUSION: A detailed knowledge of the anatomic morphometry of this area is necessary for a surgeon while performing maxillofacial surgery and regional block anesthesia. Anatomic variations on this area may take place and a surgeon must take this into consideration so as to increase the surgical success.

Female↗

PubMed2003

The proximal tibiofibular joint: an anatomic study.

In the first stage of the current study, 14 fresh specimens from above-the-knee amputations were examined by magnetic resonance imaging arthrography. In the second part of the study, these amputation specimens and 38 embalmed knees from cadavers were dissected. The types of the joint and insertion of the biceps femoris tendon and the other structures were observed. Of 14 fresh specimens from above-the-knee amputations examined by magnetic resonance imaging arthrography, nine had a clear communication between the proximal tibiofibular joint and the knee. It was difficult to distinguish the anterior tibiofibular ligament in 30 specimens as a separate band because it was fused intimately with the biceps femoris tendon. Of these specimens, 24 had an oblique type of joint. Because of this communication, the proximal tibiofibular joint might be construed as the fourth compartment of the knee to explain subtle knee problems.

Amputation, Surgical↗