Purpose: The aim of this study was to redefine the localization of the thenar motor branch (TMB) of the median nerve in relation to the surface landmarks which are in routine use.

Methods: The study was performed in 37 hands of 34 patients who underwent carpal tunnel release. All of the patients were women and the mean age was 50 (35–67). A radiological marking technique was used to determine the localization of the TMB, the middle finger radial side line and the Kaplan’s cardinal line. For marking TMB a circumscribing soft radioopaque yarn was used while the surface landmark lines were demonstrated by taping one K-wire for each. An image intensifier print image was obtained for each case and the distances between the markers of the TMB and the wires were measured.

Results: The TMB had a mean ulnar offset of 12.6 mm (4.0–19.7) from the middle finger radial side line and located 4.4 (0–9.5) mm proximal to the cardinal line.

Conclusion: During the carpal tunnel release operations one must pay more attention to the localization of the TMB of the median nerve because it was found to be 12.6 mm ulnar than that was described in classic literature.

Background: Bacterial translocation is defined as a phenomenon in which live bacteria cross the intestinal barrier and spread the other systemic organs after various type of traumatic insults such as hemorrhagic shock, burn, malnutrition and abdominal trauma. It has also been shown that multiple fractures of long bones associated with head injury promote bacterial translocation.

Aim: To determine whether early internal fixation of long bone fractures helps to prevent bacterial translocation

Materials and methods: Thirty-seven male Sprague-Dawley rats were divided into three groups. 1) anesthesia only (control group, n=12); 2) anesthesia + tibia fracture + femur fracture + moderate head trauma (trauma group, n=14), and 3) anesthesia + fixation of both tibia and femur fractures + moderate head trauma (fixation group, n=11). Head injury was created by using Marmarou’s impaction-acceleration model and fractures were created by using a blunt guillotine. After 24 hours, mesenteric lymph nodes, liver, spleen and systemic blood samples were quantitatively cultured to detect bacterial translocation. Finally, ileum was cultured to determine the indigenous intestinal flora.

Results: The most commonly translocating bacteria were enterococci, E.coli, and group D streptococci. The incidence of bacterial translocation was lower in fixation group (2/11) than the trauma group (10/14) (Fishers exact test, p=0.025). No statistical difference was detected between the control and the fixation group.

The number of organs containing viable bacteria was significantly lower in the control and fixation groups than the trauma group (Mann Whitney U test, p=0.002).

Conclusion: Multiple organ failure which is the most severe complication after trauma has a mortality rate of 50–70%. It is believed that MOF results from sepsis from organisms in the intestinal flora; a process termed bacterial translocation. Our data revealed that in case of multiple long bone fractures combined with moderate head injury, systemic translocation of the gut bacteria may be prevented by early internal fixation of the bones.