Acta Orthopaedica Et Traumatologica Turcica[JOURNAL]
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200 papers
Multiple Finger Reconstruction with Syndactylized Free Lateral Arm Flap.
Erol K, Yener C, Er E … +1 more , Güntürk ÖB
Acta Orthop Traumatol Turc · 2026 Apr · PMID 42364237 · Full text
OBJECTIVE: This study aimed to retrospectively evaluate the clinical and functional outcomes of multiple finger reconstructions using a syndactylized free lateral arm flap. METHODS: Patients who underwent reconstruction...
OBJECTIVE: This study aimed to retrospectively evaluate the clinical and functional outcomes of multiple finger reconstructions using a syndactylized free lateral arm flap. METHODS: Patients who underwent reconstruction with a syndactylized free lateral arm flap between 2013 and 2024 were retrospectively reviewed. Recorded variables included the localization of finger soft-tissue defects, associated injuries, flap dimensions, recipient vessels for anastomosis, vascular complications, and timing of flap separation. At final follow-up, finger joint range of motion was assessed using goniometry, and sensory recovery was evaluated using two-point discrimination (2PD) and Semmes-Weinstein monofilament (SWM) testing. Functional outcomes were assessed using the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire. RESULTS: Fifteen patients with extensive soft-tissue defects involving 37 fingers were included. The mean flap size was 5.2 Å~ 10.7 cm. One flap was lost due to venous insufficiency. Flap separation was performed between 20 and 92 days postoperatively (mean, 58 days). Twopoint discrimination exceeded 15 mm in all patients, including those who underwent nerve coaptation. All patients demonstrated varying degrees of protective sensation on SWM testing. Elbow joint range of motion at the donor site was preserved in all cases. The mean QuickDASH score was 31.2. CONCLUSION: The lateral arm flap provides thin, pliable tissue with reliable vascular anatomy, allows harvesting from the same extremity, and offers the possibility of osteocutaneous reconstruction. A syndactylized free lateral arm flap represents a viable option for the reconstruction of extensive soft-tissue defects involving multiple fingers. Careful patient selection and consideration of patient compliance are critical when deciding between complex reconstruction and amputation. Cite this article as: Erol K, Yener C, Er E, Güntürk ÖB. Multiple finger reconstruction with syndactylized free lateral arm flap. Acta Orthop Traumatol Turc., 2026; 60(2), 0668, doi: 10.5152/j.aott.2026.25668.
Which implant for Pauwels type 2 femoral neck fractures: a biomechanical study.
Aydın O, Kazez M, Say Y … +1 more , Belhan O
Acta Orthop Traumatol Turc · 2026 Mar · PMID 42364236 · Full text
Femoral neck fractures (FNF) in young patients are relatively rare but can lead to severe complications if not treated appropriately. Pauwels type 2 fractures, characterized by moderate inclination, require surgical stab...
Femoral neck fractures (FNF) in young patients are relatively rare but can lead to severe complications if not treated appropriately. Pauwels type 2 fractures, characterized by moderate inclination, require surgical stabilization. However, no consensus exists regarding the optimal implant that provides superior biomechanical stability. This study aims to compare the biomechanical properties of 3 different fixation systems for the surgical treatment of Pauwels type 2 FNF. Methods: A total of 21 bovine femurs of similar age and size were selected and divided into 3 fixation groups: dynamic hip screw (DHS), cannulated screws (CS), and major plate (MP). Each specimen underwent axial compression testing to assess the maximum load-bearing capacity, shear force resistance, and deformation characteristics of the fixation methods. Results: The results showed that the CS group exhibited the highest shear stress resistance, followed by the DHS group, while the MP group showed significantly lower mechanical strength and elongation (P < .05). Although DHS provided substantial stability, CS demonstrated superior overall mechanical performance. In contrast, the MP system showed significantly lower resistance compared to the other 2 fixation methods. Conclusion: This biomechanical study highlights the importance of implant selection in the management of Pauwels type 2 FNF. Although previous investigations have questioned the adequacy of CS fixation in highly unstable Pauwels type 3 fractures, the results suggest that CS may be a reliable and effective option for the relatively more stable Pauwels type 2 pattern. Because the tests were performed on bovine femur models, which do not fully reflect the structural characteristics of human bone, these findings should be interpreted with caution. Further biomechanical studies using human cadaveric specimens are required to confirm the applicability of these results to clinical practice. Cite this article as: Aydın O, Kazez M, Say Y, Belhan O. Which implant for Pauwels type 2 femoral neck fractures: A biomechanical study. Acta Orthop Traumatol Turc., 2026; 60(1), 0345, doi: 10.5152/j.aott.2026.25345.
Adult Gait Kinematics and Muscle Strength After Childhood Pemberton Osteotomy for Developmental Dysplasia of the Hip.
Demirci A, Karabak B, Hoyur FY … +3 more , Dzhumukov A, Aydın A, Karsan O
Acta Orthop Traumatol Turc · 2026 Apr · PMID 42364234 · Full text
OBJECTIVE: This study aimed to evaluate the long-term functional and kinematic outcomes of patients with developmental dysplasia of the hip (DDH) who underwent Pemberton osteotomy (PO) during childhood and to compare the...
OBJECTIVE: This study aimed to evaluate the long-term functional and kinematic outcomes of patients with developmental dysplasia of the hip (DDH) who underwent Pemberton osteotomy (PO) during childhood and to compare their adult hip motion, muscle strength, and gait characteristics with those of healthy controls. METHODS: This retrospective cross-sectional study included 12 adult patients (mean age 18.6 years) who underwent PO for DDH (6 bilateral, 6 unilateral) and 15 healthy controls (mean age 17.1 years). Hip range of motion (ROM), Harris Hip Score (HHS), and isokinetic muscle strength were evaluated. Three-dimensional gait and running analyses were performed using a motion capture system at 3, 6, and 9 km/h. RESULTS: Mean HHSs were 92.8 Å} 4.2 and 92.7 Å} 5.1 in the bilateral and unilateral groups, respectively, and 100 in controls (P < .001). Hip ROM showed no significant inter- or intra-group differences. Isokinetic testing revealed reduced hip flexion total work in the bilateral (116 Å} 114 J) and unilateral (181 Å} 42 J) groups compared with controls (340 Å} 143 J; P = .007). Similarly, abduction strength in the bilateral group (75 Å} 52 J) was lower than in controls (143 Å} 73 J; P < .05). During slow walking (3 km/h), the unilateral group had a shorter stance time (0.30-0.32 s) than the healthy group (P < .01), while gait symmetry was comparable across all groups during fast walking and running. CONCLUSION: Patients who underwent early PO and appropriate rehabilitation achieved normal gait and running kinematics in adulthood despite mild flexion and abduction strength deficits. These findings demonstrate successful long-term adaptation and highlight the importance of timely surgical correction in DDH for preserving functional capacity. Cite this article as: Demirci A, Karabak B, Hoyur FY, Dzhumukov A, Aydın A, Karsan O. Adult gait kinematics and muscle strength after childhood Pemberton osteotomy for developmental dysplasia of the hip. Acta Orthop Traumatol Turc., 2026, 60(2), 0538, doi: 10.5152/j.aott.2025.25538.
Short-term effects of combined kinesio taping and extracorporeal shock wave therapy in patients with plantar fasciitis.
Çelik G, Sarı MH, Koldaş Doğan Ş … +1 more , Bal A
Acta Orthop Traumatol Turc · 2026 Mar · PMID 42364232 · Full text
Plantar fasciitis (PF) is a common cause of plantar heel pain leading to functional limitation and reduced quality of life. While extracorporeal shock wave therapy (ESWT) is a well-established treatment option, the addit...
Plantar fasciitis (PF) is a common cause of plantar heel pain leading to functional limitation and reduced quality of life. While extracorporeal shock wave therapy (ESWT) is a well-established treatment option, the additional benefit of kinesio taping (KT) as an adjunct modality remains unclear. This study aimed to evaluate the short-term effects of combining KT with ESWT on pain and foot function in patients with PF. Methods: This retrospective comparative study included 116 patients (54 in the KT+ESWT group and 62 in the ESWT-only group) with clinically diagnosed unilateral PF persisting for at least 3 months. Pain and functional status were assessed using the Visual Analog Scale (VAS), Roles and Maudsley Score (RMS), and Foot Function Index (FFI) subscales (pain, disability, and activity restriction) before and after a 3-week treatment period. Between-group differences were evaluated using analysis of covariance (ANCOVA) adjusted for baseline scores and demographic variables. Effect sizes were reported using partial eta-squared (η2) and post-hoc power analysis confirmed adequate study power. Results: Both treatment groups demonstrated significant improvements from baseline to post-treatment in VAS, RMS, and FFI subscales (all P < .001). After adjustment for baseline scores, the KT+ESWT group showed significantly greater improvement than the ESWT group across all outcome measures (adjusted P < .001 for VAS, RMS, FFI-Pain, FFI-Disability, and FFI-Activity restriction). The observed effect sizes were large (η2 = 0.165-0.280), and the reduction in VAS pain exceeded the minimally clinically important difference, indicating clinically meaningful improvement. Conclusion: The combined application of KT with ESWT resulted in superior short-term improvements in pain and foot function compared with ESWT alone in patients with PF. The complementary effects of KT in reducing plantar fascia load and enhancing proprioceptive control may augment ESWT's established regenerative and analgesic benefits. Given its simplicity, low cost, and accessibility, KT may be considered a practical adjunct to ESWT in clinical rehabilitation settings. However, as the follow-up period was limited to 3 weeks, the long-term durability of treatment effects remains uncertain. Future randomized controlled trials with extended follow-up are needed to validate these findings. Cite this article as: Çelik G, Sarı MH, Doğan ŞK, Bal A. Short-term effects of combined kinesio taping and extracorporeal shock wave therapy in patients with plantar fasciitis. Acta Orthop Traumatol Turc. 2026; 60(2), 0640, doi: 10.5152/j.aott.2026.25640.
Gonarthrosis Advisor vs ChatGPT-5: quality and readability of artificial intelligence-generated patient education for knee osteoarthritis.
Öner SK, Demirkiran ND, Canlı EA … +1 more , Bilir A
Acta Orthop Traumatol Turc · 2026 Apr · PMID 42364231 · Full text
The primary objective of this study is to compare the quality and readability of patient education materials generated by a general-purpose large language model (ChatGPT-5) versus a guideline-based, fine-tuned model (the...
The primary objective of this study is to compare the quality and readability of patient education materials generated by a general-purpose large language model (ChatGPT-5) versus a guideline-based, fine-tuned model (the Gonarthrosis Advisor). The study aims to quantify the performance gains achieved through domain-specific, fine-tuning, and reinforcement learning using osteoarthritis clinical guidelines. Methods: Thirty frequently asked patient questions regarding knee osteoarthritis were compiled from Google's "People Also Ask" feature and outpatient clinical observations in May 2025. Responses were generated in Turkish by both the Gonarthrosis Advisor and ChatGPT-5 to reflect real-world patient education materials. Content quality was assessed by 2 independent orthopedic surgeons who were blinded to model identity to minimize bias. Both reviewers were co-authors of the article yet did not participate in model construction or data analysis. The assessments utilized the DISCERN instrument, a validated 16-item measure for evaluating the reliability and quality of treatment-related information. Readability was analyzed using the Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease Score (FRES), and Turkish specific indices (Ateşman and Çakır-Demir). For comparability, English-based indices were applied to translated versions of the responses, whereas Turkish indices were applied to the original texts. All responses were anonymized and randomized prior to evaluation. Model identifiers were removed, and each response was presented in a standardized format to ensure blinding of reviewers. Inter-rater reliability was measured using Cronbach's α. Normality assumptions were tested, and Wilcoxon signed-rank tests were used for statistical comparisons. As no human subjects or personal data were involved, ethical approval was not required. Results: Mean DISCERN scores corresponded to the "good" category (66.4) for the Gonarthrosis Advisor and the 'moderate' category (54.2) for ChatGPT-5, according to established cut-off thresholds. The Gonarthrosis Advisor achieved significantly higher DISCERN scores than ChatGPT-5 (66.4 ± 4.8 vs. 54.2 ± 5.6; P < .001) with high inter-rater reliability (Cronbach's α = 0.86). Readability metrics favored the Gonarthrosis Advisor across all indices: lower FKGL (7.8 ± 0.7 vs. 9.6 ± 0.9) and higher FRES (54.3 ± 3.4 vs. 46.7 ± 3.7), Ateşman (92.0 ± 4.2 vs. 84.3 ± 4.9), and Çakır-Demir (111.7 ± 5.1 vs. 106.9 ± 5.4) scores (all P <.001). Conclusion: Fine-tuning large language models with guideline-based content and reinforcement learning improves the quality, neutrality, and accessibility of artificial intelligence-generated patient education materials, offering a scalable tool to enhance health literacy and support shared decision-making in knee osteoarthritis care. Cite this article as: Öner SK, Demirkiran ND, Canlı EA, Bilir A. Gonarthrosis Advisor vs ChatGPT-5: quality and readability of AI-generated patient education for knee osteoarthritis. Acta Orthop Traumatol Turc., 2026, 60(2), 0618, doi: 10.5152/j.aott.2026.25618.
The invisible double life of a manuscript: Concurrent submission and the limits of editorial trust.
Berk H
Acta Orthop Traumatol Turc · 2026 Apr · PMID 42364230 · Publisher ↗
We are at the doorstep of spring. The first warmth of the season is in the air. One can almost feel the transition taking place. The air carries the promise of renewal. Nature, in its quiet determination, has nearly comp...
We are at the doorstep of spring. The first warmth of the season is in the air. One can almost feel the transition taking place. The air carries the promise of renewal. Nature, in its quiet determination, has nearly completed its preparations for transformation. Look closely at the trees. Buds are on the verge of bursting. Observe the birds and stray cats who have endured the harshness of winter; one can sense, in their movements and sounds, their anticipation of brighter days ahead. Despite all that humanity imposes upon it, nature remains ready for change. Cite this article as: Berk H. The invisible double life of a manuscript: concurrent submission and the limits of editorial trust. Acta Orthop Traumatol Turc., 2026;60(2), 0003, doi: 10.5152/j.aott.2026.260003.
Perioperative risk factor analysis for mortality in patients undergoing total hip arthroplasty: A national database study from Türkiye.
Artuç M, Birinci M, Hakyemez ÖS … +7 more , Bingöl İ, Ata N, Ülgü MM, Birinci Ş, Yıldız C, Tuncay İ, Azboy İ
Acta Orthop Traumatol Turc · 2026 Mar · PMID 42364228 · Full text
OBJECTIVE: Mortality is a devastating complication after primary total hip arthroplasty (THA). The aim of this study was to investigate the prevalence and risk factors associated with 1-year postoperative mortality in pa...
OBJECTIVE: Mortality is a devastating complication after primary total hip arthroplasty (THA). The aim of this study was to investigate the prevalence and risk factors associated with 1-year postoperative mortality in patients undergoing primary THA. METHODS: The authors reviewed the e-health database (e-Nabız) of the Republic of Türkiye Ministry of Health to identify patients who underwent primary THA between January 2016 and June 2022. The study included 98 622 patients with a mean age of 59.9 Å} 13.6 years. Hip fractures were excluded. Demographic data, body mass index, and Charlson Comorbidity Index scores were recorded. The incidence of 1-year mortality was investigated. A multivariate Cox regression model was created to identify risk factors for 1-year postoperative mortality. RESULTS: The postoperative 1-year mortality of patients who underwent primary THA was 2.8%. Cox regression analysis revealed that male gender and advanced age were independent risk factors for 1-year mortality and the risk of 1-year mortality increased with comorbidities such as cancer (hazard ratio (HR) = 2.46; 95% CI = 2.21-2.71), renal disease (HR = 2.29; 95% CI = 2.1-2.5), dementia (HR = 1.83; 95% CI = 1.63- 2.05), liver disease (HR = 1.69; 95% CI = 1.25-2.27), heart failure (HR = 1.65; 95% CI = 1.49-1.83), cerebrovascular accident (CVA) (HR = 1.43; 95% CI = 1.3-1.57), and acute myocardial infarction (AMI) (HR = 1.25; 95% CI = 1.07-1.45). CONCLUSION: Advanced age, male gender, cancer, renal disease, dementia, liver disease, heart failure, CVA, and AMI were identified as risk factors for 1-year mortality in patients undergoing THA. Meticulous preoperative medical optimization and standardized postoperative care may reduce mortality among patients with these comorbidities. Cite this article as: Artuç M, Birinci M, Hakyemez ÖS, et al. Perioperative risk factor analysis for mortality in patients undergoing total hip arthroplasty: A national database study from Türkiye. Acta Orthop Traumatol Turc., 2026; 60(2), 0052, doi:10.5152/j.aott.2026.24052.
Combined subscapularis and supraspinatus tears markedly increase the risk of long head of the biceps tendon pathology.
Kaya İ, Yaş S, Bircan R … +3 more , Ahmadov A, Sarıkaya B, Kanatlı U
Acta Orthop Traumatol Turc · 2026 Apr · PMID 42364225 · Full text
OBJECTIVE: This study aimed to examine the frequency of long head of the biceps tendon (LHBT) pathologies in anterosuperior rotator cuff tears (RCT) involving the LHBT pulley system and investigate the relationship betwe...
OBJECTIVE: This study aimed to examine the frequency of long head of the biceps tendon (LHBT) pathologies in anterosuperior rotator cuff tears (RCT) involving the LHBT pulley system and investigate the relationship between RCT types and LHBT pathology subtypes. METHODS: A retrospective review was conducted of 555 shoulder arthroscopies performed for rotator cuff tears between 2017 and 2023. Patients were classified into 3 groups: isolated subscapularis (SSC) tears (n=74), isolated supraspinatus (SSP) tears (n=177), and combined SSC+SSP tears (n=304). The severity of the subscapularis tear was graded using the Lafosse classification. The LHBT pathologies were categorized as tendinitis, subluxation, dislocation, partial rupture, and full-thickness rupture. RESULTS: The LHBT pathology was present in 86.1% of cases. The most common pathologies were tendinitis (44.7%), complete rupture (13.5%), partial rupture (12.1%), subluxation (8.5%), and dislocation (7.4%). The SSC+SSP group had the highest LHBT pathology rate (99.0%) compared to isolated SSC (70.3%) and SSP (70.6%) groups (P < .001). The SSC+SSP group had a 36.04 times higher risk of LHBT pathology than the SSP group (P < .001). Dislocation and complete rupture were most frequent in the SSC+SSP group (P < .001). The LHBT pathology prevalence increased with Lafosse grade (P < .001), and higher grades were strongly associated with dislocation and rupture. CONCLUSION: Anterosuperior rotator cuff tears are strongly associated with LHBT pathologies, and the severity of LHBT pathologies increases in parallel with the Lafosse grade. Combined SSC+SSP tears significantly increase the risk of LHBT pathology, particularly dislocation and complete rupture, highlighting the need for thorough LHBT evaluation in anterosuperior RCT cases. LEVEL OF EVIDENCE: Level III, Prognostic Study. Cite this article as: Kaya I, Yaş S, Bircan R, Ahmadov A, Sarikaya B, Kanatli U. Combined subscapularis and supraspinatus tears markedly increase the risk of long head of the biceps tendon pathology. Acta Orthop Traumatol Turc., 2026, 60(2), 0483, doi: 10.5152/j.aott.2026.25483.
Bilateral Sprengel deformity with asymmetrical omovertebral connections in a child with Klippel-Feil syndrome: a rare case report.
Güneş Z, Danışman M, Bekmez Ş
Acta Orthop Traumatol Turc · 2026 Mar · PMID 42364219 · Full text
An 8-year-old male patient with bilateral Sprengel deformity, characterized by a right-sided bony omovertebral bar and a left-sided fibrous band, in the context of Klippel-Feil syndrome is presented in this case report....
An 8-year-old male patient with bilateral Sprengel deformity, characterized by a right-sided bony omovertebral bar and a left-sided fibrous band, in the context of Klippel-Feil syndrome is presented in this case report. The patient had limited shoulder movement, a short neck, and considerable cosmetic issues. The radiological evaluation showed the omovertebral structures to be asymmetrical and a cervical fusion at C2-C3. The patient underwent 2 separate surgical procedures: the right side was operated on when the patient was 8 years old, and the left side was operated on 8 months later. The procedures involved the resection of the omovertebral structures and modified Woodward procedures for scapular repositioning. The postoperative results showed a marked improvement in shoulder abduction and cosmetic appearance with no neurovascular complications. This report emphasizes the need for early diagnosis, comprehensive imaging, and individualized surgical planning in the management of complex congenital shoulder deformities. Cite this article as: Güneş Z, Danışman M, Bekmez Ş. Bilateral Sprengel deformity with asymmetrical omovertebral connections in a child with Klippel-Feil syndrome: a rare case report. Acta Orthop Traumatol Turc., 2026; 60(2), 0313, doi: 10.5152/j.aott.2026.25313.
A new reconstruction technique of tumor-induced large patellar defect, and its 8-year follow-up.
Özgezmez FT
Acta Orthop Traumatol Turc · 2026 Apr · PMID 42364207 · Full text
Patellar tumors are rare. However, aggressive tumors such as giant cell tumors of the bone can cause large defects. The treatment of large patellar defects remains controversial. This case report presents the results of...
Patellar tumors are rare. However, aggressive tumors such as giant cell tumors of the bone can cause large defects. The treatment of large patellar defects remains controversial. This case report presents the results of a new reconstruction method applied to a 40-year old man with a large patellar defect due to a giant cell tumor of the bone, along with an 8-year follow-up. The defect was reconstructed using a handmade neopatella. This neopatella was created using a bony Achilles tendon allograft and patellar polyethylene. Postoperatively, good results were achieved without hindering the patient's ability to farm. These excellent functional results were still maintained at the eighth year of follow-up. This reconstruction method allowed for the restoration of extension strength by re-establishing the lever arm of the extensor mechanism. The main advantages of this method compared to fresh-frozen allografts are the longer shelf life of the materials used and the modularity of both patellar thickness and patellar height. This method may be a new and promising alternative to fresh frozen quadriceps-patella-patellar tendon allografts in the reconstruction of large patellar defects. Cite this article as: Özgezmez FT. A new reconstruction technique of tumor-induced large patellar defect, and its 8-year follow-up. Acta Orthop Traumatol Turc. Published online April 24, 2026. doi: 10.5152/j.aott.2026.25434.
Assessing The Ability of ChatGPT 5.2 to Answer Patient Questions Regarding Hip Avascular Necrosis.
Şahin E, Baltacı Ç, Kocaoğlu H … +1 more , Kalem M
Acta Orthop Traumatol Turc · 2026 Mar · PMID 42364206 · Full text
This study aimed to evaluate the quality and readability of Chat Generative Pretrained Transformer (ChatGPT) 5.2's responses to frequently asked patient questions about hip avascular necrosis (AVN), a challenging conditi...
This study aimed to evaluate the quality and readability of Chat Generative Pretrained Transformer (ChatGPT) 5.2's responses to frequently asked patient questions about hip avascular necrosis (AVN), a challenging condition often requiring clear communication and shared decision-making. Methods: Sixteen commonly asked patient questions regarding hip AVN were submitted to ChatGPT 5.2 without follow-up queries. Each response was independently evaluated by 2 orthopedic surgeons with over 20 years of experience in hip arthroplasty. The quality of responses was assessed using the grading system proposed by Mika et al. Readability was analyzed using the Flesch-Kincaid Reading Ease Score (FRES) and Flesch-Kincaid Reading Level (FKRL). Interrater reliability (IRR) was calculated using Cohen's kappa test. Results: Reviewer 1 rated 11/16 responses as "excellent-no clarification required" and 5/16 as "satisfactory-minimal clarification needed." Reviewer 2 rated 10/16 responses as excellent and 6/16 as satisfactory. The mean FRES score was 27.1 (range: 12.4-45.6), indicating the content was "difficult to read." The FKRL scores corresponded to college or college graduate reading levels. The IRR between reviewers was moderate (κ = 0.59, 95% CI: 0.09-1.00). Conclusion: ChatGPT 5.2 provided overall satisfactory to excellent responses regarding hip AVN. However, the high reading level required to understand these answers may limit their effectiveness in patient education unless simplified language is employed. Cite this article as: Şahin E, Baltacı Ç, Kalem M, Kocaoğlu H. Assessing the ability of ChatGPT 5.2 to answer patient questions regarding hip avascular necrosis. Acta Orthop Traumatol Turc., 2026; 60(2), 0629, doi:10.5152/j.aott.2026.25629.
Comparison of Kirschner wire versus volar locking plate fixation for distal radius fractures: clinical and functional outcomes.
Yiğit O, Kart H, Çat G … +4 more , Özgür EG, Koç E, Özmusul VB, Baysal Ö
Acta Orthop Traumatol Turc · 2026 Mar · PMID 42364204 · Full text
This study aimed to compare the clinical and functional outcomes of Kirschner wire (K-wire) fixation versus volar locking plate (VLP) fixation for intra-articular distal radius fractures (DRFs). It also aimed to identify...
This study aimed to compare the clinical and functional outcomes of Kirschner wire (K-wire) fixation versus volar locking plate (VLP) fixation for intra-articular distal radius fractures (DRFs). It also aimed to identify key patient- and fracture-related factors that influence the choice of surgical technique and to evaluate the responsiveness of specific patient-reported outcome measures in assessing recovery. Methods: A total of 201 consecutive patients with Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association-classified DRFs (Type A: n = 51; B: n = 90; C: n = 60) treated surgically between 2005 and 2022 were analyzed. Treatment allocation was based on fracture complexity and surgeon preference, resulting in a distribution where K-wire (n = 63) was primarily used for partial articular fractures (72.4% of K-wire cases were Type B), while VLP (n = 138) was preferred for complete articular fractures (83.6% of plate cases were Type C). Functional outcomes were assessed using Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) (primary endpoint), Green-O'Brien, Gartland-Werley, and SF-12 at standardized intervals (6/12/24 months) during supervised physiotherapy. Results: Significant predictors of plate fixation included older age (58.1 ± 14.7 vs. 42.3 ± 12.1 years, P < .001), polytrauma (aOR: 2.4, 95% CI: 1.5-3.8), and complete articular fractures (83.6% Type C, P = .01). No statistically significant associations were found between injury type and fixation method (P = .20) or between complications and fixation method (4.8% vs. 2.2%, P = .41). Functional outcomes were comparable across all metrics, with no statistically significant differences observed: QuickDASH (34.9 ± 18.2 K-wire vs. 31.2 ± 16.8 plate, P = .146), Green-O'Brien (excellent-good: 76.2% vs. 82.6%, P = .552), Gartland-Werley (78.1% vs. 71.1% excellent-good, P = .591), and 12-Item Short Form Health Survey (SF-12) (100% vs. 99.3% good results, P = .32). Multivariable regression identified reduction quality (β = 0.81, P < .01), not implant type, as the primary outcome determinant. Conclusion: This study suggests that anatomical reduction quality-not fixation method-is the primary determinant of functional success in DRFs, with both K-wire and VLP achieving comparable outcomes (QuickDASH/Gartland-Werley P > .05). K-wires represent a cost-effective alternative for partial articular fractures (72.4% of cases), while plates were more frequently used in complex fractures and polytrauma cases (adjusted odds ratio [aOR] = 2.4). Early rehabilitation (median 4 days post-op) and condition-specific metrics (QuickDASH, Green-O'Brien) are critical for optimal recovery, whereas SF-12 proves less sensitive for wrist-specific assessment. These findings advocate for surgeon-tailored technique selection based on fracture pattern and emphasize the need for multicenter randomized controlled trials (RCTs) to evaluate long-term outcomes. Cite this article as: Yigit O, Kart H, Cat G, et al. Comparison of Kirschner wire versus volar locking plate fixation for distal radius fractures: clinical and functional outcomes. Acta Orthop Traumatol Turc. 2026; 60(2), 0585, doi: 10.5152/j.aott.2026.25585.
Comparison of clinical outcomes of enoxaparin and aspirin for postoperative venous thromboembolism prophylaxis in hip fractures.
Korkmaz O, Hakyemez ÖS, Çakır N … +4 more , Özdenboyacı A, Uzunlu İ, Demirtaş A, Azboy İ
Acta Orthop Traumatol Turc · 2026 Mar · PMID 42364203 · Full text
OBJECTIVE: The risk of symptomatic venous thromboembolism (VTE) following hip fracture surgery is estimated at 1%-6%, necessitating effective prophylactic measures. While aspirin has been widely used in total hip and kne...
OBJECTIVE: The risk of symptomatic venous thromboembolism (VTE) following hip fracture surgery is estimated at 1%-6%, necessitating effective prophylactic measures. While aspirin has been widely used in total hip and knee arthroplasty due to its comparable efficacy, reduced bleeding risk, and cost-effectiveness, its role in trauma patients remains under researched. This study aims to evaluate the efficacy and safety of aspirin and enoxaparin for VTE prophylaxis in hip fracture patients. METHODS: This two-center, retrospective study analyzed 306 adult patients who underwent hip fracture surgery between 2019 and 2023. Patients were divided into 2 groups: the aspirin group (81 mg twice daily) and the enoxaparin group (40 mg subcutaneous once daily), both receiving prophylaxis for 4 weeks postoperatively. Demographics, comorbidities, surgical details, and clinical outcomes-including major bleeding events, symptomatic VTE (deep vein thrombosis and pulmonary embolism), periprosthetic joint infection (PJI), blood transfusion requirements, and 90-day mortality-were recorded. Statistical analyses were performed using Pearson chi-square and independent t-tests, with significance set at P < .05. RESULTS: The aspirin group (n = 136) and enoxaparin group (n = 170) had mean ages of 67.66 Å} 19.67 and 63.42 Å} 19.71 years, respectively. Hemoglobin decrease was significantly lower in the aspirin group (1.75 Å} 1.07 g/dL vs. 2.73 Å} 1.56 g/dL, P = .001). In addition, the amount of postoperative blood transfusion was statistically significantly lower in the aspirin group compared to in the enoxaparin group (0.89 vs. 1.31 units, respectively, P = .034). There was no significant difference in mean hospital stay (6.84 vs. 6.65 days, P = .751). The incidence of major bleeding was higher in the enoxaparin group (3.7% (n = 5) vs. 5.3% (n = 9)), though not statistically significant (P = .789). Symptomatic VTE occurred in 3.7% (n = 5) of the aspirin group and 5.3% (n = 9) of the enoxaparin group (P = .453). Periprosthetic joint infection was observed in 2 patients in the enoxaparin group but none in the aspirin group (P = .447). Mortality within 90 days was lower in the aspirin group (8.8% (n = 12) vs. 15.9% (n = 27)), but the difference was not statistically significant (P = .066). CONCLUSION: This study suggests that aspirin appears to be a reasonable alternative to enoxaparin for VTE prophylaxis in hip fracture patients, demonstrating comparable efficacy with a lower blood transfusion requirement and similar rates of major bleeding and symptomatic VTE. Given its affordability, ease of administration, and favorable safety profile, aspirin appears to be a reasonable and costeffective alternative for high-risk trauma patients. Cite this article as: Korkmaz O, Hakyemez ÖS, Çakır N, et al. Comparison of clinical outcomes of enoxaparin and aspirin for postoperative venous thromboembolism prophylaxis in hip fractures. Acta Orthop Traumatol Turc. 2026; 60(2), 0305, doi: 10.5152/j.aott.2026.25305.
Evaluation of surgical recommendation algorithms in hallux valgus cases using ChatGPT models: an artificial intelligence approach based on 50 simulated scenarios.
Karadamar ÖL, Aydilek A
Acta Orthop Traumatol Turc · 2026 Mar · PMID 42364201 · Full text
OBJECTIVE: The integration of large language models (LLMs) into orthopedic surgical decision-making represents a growing area of research. This study aimed to compare the surgical recommendation capabilities of ChatGPT-4...
OBJECTIVE: The integration of large language models (LLMs) into orthopedic surgical decision-making represents a growing area of research. This study aimed to compare the surgical recommendation capabilities of ChatGPT-4.0, ChatGPT-4o, and ChatGPT-5 models in simulated cases of hallux valgus deformity. METHODS: A total of 50 simulated cases were constructed using fundamental clinical data related to hallux valgus pathology and were individually submitted to 3 models. For each case, a surgical recommendation and a brief rationale were obtained. The responses were compared based on content alignment, adequacy of justification, and consistency with established surgical algorithms. Additionally, textual outputs were evaluated using DISCERN and multiple readability indices. RESULTS: All 3 models demonstrated overall algorithmic consistency. However, the ChatGPT-5 model provided the most context-aware and clinically consistent recommendations, followed by ChatGPT-4o and ChatGPT-4.0. Concordance rates with surgical algorithms were 70% for ChatGPT-4.0, 82% for ChatGPT-4o, and 90% for ChatGPT-5. DISCERN scores were 51, 56, and 62, respectively. ChatGPT-5 also achieved superior performance across readability metrics, including Flesch Reading Ease Score, Simple Measure of Gobbledygook, and Gunning-Fog Index, indicating improved textual clarity and reduced complexity. CONCLUSION: The ChatGPT-5 model demonstrated the highest contextual accuracy, consistency, and readability in surgical decision support for hallux valgus surgery, highlighting the progressive improvements of newer LLMs. Nonetheless, ChatGPT-4.0 and ChatGPT-4o also exhibited compatibility with surgical algorithms, indicating potential utility in generating patient education and informational content. Cite this article as: Karadamar ÖL, Aydilek A. Evaluation of surgical recommendation algorithms in hallux valgus cases using ChatGPT models: an artificial intelligence approach based on 50 simulated scenarios. Acta Orthop Traumatol Turc. 2026; 60(2), 0580, doi: 10.5152/j.aott.2026.25580.
O-arm navigation vs. freehand screw placement in adolescent idiopathic scoliosis: A comparative analysis of screw size and reoperation rates.
Ramanathan R, Luck C, Dede Ö … +1 more , Ward T
Acta Orthop Traumatol Turc · 2026 Apr · PMID 42364200 · Full text
OBJECTIVE: Pedicle screw fixation is the gold standard for surgical correction of adolescent idiopathic scoliosis (AIS). Prior to the adoption of intraoperative O-arm navigation, surgeons relied on freehand pedicle screw...
OBJECTIVE: Pedicle screw fixation is the gold standard for surgical correction of adolescent idiopathic scoliosis (AIS). Prior to the adoption of intraoperative O-arm navigation, surgeons relied on freehand pedicle screw insertion. While freehand insertion demonstrates acceptable safety, comparative data on screw size selection between techniques remain limited. Screw size selection, screw size variability, and complication rates between O-arm navigation and freehand pedicle screw techniques in AIS surgery were compared. METHODS: This was a retrospective comparative cohort study of AIS patients treated with either freehand or navigated pedicle screw insertion by a single senior surgeon. Two cohorts of consecutive AIS patients were analyzed: freehand (n=137; February 2014-November 2018) and navigated (n=137; September 2018-August 2024). Data were extracted from a prospectively maintained surgical registry. Measured outcomes included: (1) screw diameter distribution per vertebral level; (2) pedicles deemed too small to cannulate; (3) intra- and intervertebral screw size variability; (4) intraoperative cerebrospinal fluid (CSF) leak rates; and (5) reoperation for symptomatic screws. Screw diameter distributions were analyzed by region and vertebral level. Variability in screw size was evaluated within vertebrae and between adjacent vertebrae. Rates of non-cannulatable pedicles, CSF leaks, and symptomatic screw reoperations were compared using chi-square and t-tests. RESULTS: Operative time was longer in the navigated cohort (312 ± 54 minutes) compared to the freehand cohort (279 ± 48 minutes, P < .001). Navigation resulted in a broader range of screw diameters. Screws sized 4.0-4.5 mm were used in 49.6% of navigated cases vs. 0.4% of freehand cases (P < .0001), while screws ≥7.0 mm were used in 1.5% vs. 0%, respectively (P = .003). Use of 5.0 mm screws was similar (18.0% vs. 13.7%, P=.16), while screws sized 5.5-6.5mm were more common in freehand cases (85.9% vs. 30.8%, P < .0001). Intravertebral screw size differences ≥1.5 mm were seen in 3.6% of navigated vertebrae vs. 0.2% in freehand (P < .0001), and intervertebral (adjacentlevel) differences occurred in 6.9% vs. 0% (P < .0001). Pedicles too small to cannulate were identified in 5.0% of navigated cases vs. 1.9% freehand (P < .0001), with greater right-sided prevalence in both cohorts. Intraoperative CSF leaks occurred in 2.7% of navigated cases vs. 0.7% freehand (P=.397). Symptomatic screw-related reoperations were infrequent in both cohorts (1.5% navigation vs. 3.6% freehand, P=.44). CONCLUSION: Navigation was associated with broader screw size utilization, greater intra- and intervertebral screw diameter variability, and improved identification of pedicles too small to safely instrument. Although complication and reoperation rates were low in both groups, there was a non-significant trend toward fewer symptomatic screw-related reoperations in the navigated cohort. These findings suggest that navigation enhances intraoperative matching of screw size to pedicle anatomy. LEVEL OF EVIDENCE: Level IV, Therapeutic Study. Cite this article as: Ramanathan R, Luck C, Dede O, Ward T. O-arm navigation vs. freehand screw.
Comparison of the effects of injectable platelet-rich fibrin and concentrated growth factor on tendon-bone interface healing in the rabbit rotator cuff tear model.
Sözgen E, Ünal MS, Yörükoğlu AÇ
Acta Orthop Traumatol Turc · 2026 Mar · PMID 42364199 · Full text
OBJECTIVE: The aim of this study was to evaluate and compare the effects of injectable platelet-rich fibrin (I-PRF) and concentrated growth factor (CGF) on tendon-to-bone interface healing in a rabbit model of rotator cu...
OBJECTIVE: The aim of this study was to evaluate and compare the effects of injectable platelet-rich fibrin (I-PRF) and concentrated growth factor (CGF) on tendon-to-bone interface healing in a rabbit model of rotator cuff tear. METHODS: A full-thickness supraspinatus tendon tear was surgically induced in both shoulders of 18 adult New Zealand White rabbits. The animals were randomly assigned into 3 groups: Group 1 received CGF, Group 2 received I-PRF, and Group 3 served as the control group with no biological augmentation. In Groups 1 and 2, CGF and I-PRF were applied to the repair site of the rotator cuff tendon following surgical reattachment. Six weeks postoperatively, all rabbits were sacrificed. The supraspinatus tendon along with the humeral head was harvested. Histological analysis was performed on specimens from the left shoulders, while biomechanical testing was conducted on those from the right shoulders. Biomechanical evaluation included measurements of failure load and elongation. Histological and immunohistochemical assessments were carried out using the Nourissat tendon-bone interface scoring system. RESULTS: Biomechanical testing demonstrated that the CGF group exhibited significantly greater failure load compared to the other groups P = .001. Mean elongation values were 3.9 mm in the CGF group, 3.1 mm in the I-PRF group, and 2.5 mm in the control group, with a statistically significant difference favoring CGF P = .03. Although no significant differences were observed among the groups regarding cell density at the tendon-bone interface P = .237 or chondrocyte organization P = .327, the CGF group showed significantly higher scores for type 2 collagen content P = .0001, glycosaminoglycan content P = 0.001, and collagen fiber organization P = .004. CONCLUSION: The application of CGF significantly enhanced tendon-to-bone healing in a rabbit rotator cuff repair model when compared to I-PRF, as evidenced by superior biomechanical and histological outcomes. Cite this article as: Sözgen E, Önal MS, Yörükoğlu A.. Comparison of the effects of injectable platelet-rich fibrin (I-PRF) and concentrated growth factor (CGF) on tendon-bone interface healing in the rabbit rotator cuff tear model. Acta Orthop Traumatol Turc., 2026; 60(2), 0431, doi: 10.5152/j.aott.2026.25431.
Rising burden of fall-induced hip fractures in China: accelerating male-specific trends and persistent gender disparities from Global Burden of Disease 2021.
Xu D, Lu Z, Yan H … +1 more , Yang Z
Acta Orthop Traumatol Turc · 2026 Mar · PMID 42364197 · Publisher ↗
OBJECTIVE: To develop effective strategies for addressing hip fractures caused by falls in China, a comprehensive assessment of the disease burden is essential. METHODS: Data on the characteristics of fall-related hip fr...
OBJECTIVE: To develop effective strategies for addressing hip fractures caused by falls in China, a comprehensive assessment of the disease burden is essential. METHODS: Data on the characteristics of fall-related hip fractures in China-including incidence, prevalence, years lived with disability (YLDs), and their age-standardized rates-were obtained from the Global Burden of Disease 2021 study. Joinpoint regression analysis was used to examine the changes in disease burden; decomposition analysis was applied to quantify the contributions of aging, population growth, and epidemiological factors to burden changes; and autoregressive integrated moving average model was employed to forecast the burden through 2036. RESULTS: In 2021, there were 2.537 million new cases of fall-related hip fractures in China (ASIR = 144.12 per 100 000), with a higher burden among females (age-standardized incidence rate [ASIR]: 158.47 vs. 117.93 per 100 000 for males). From 1990 to 2021, the total number of incident cases increased by 386.1%, and the ASIR rose by 83.43%, with a marked acceleration after 2010 (age-period-cohort = 6.72%). The age-period-cohort model indicated a stronger period effect in males (net drift 0.74% per year vs. 0.5% per year in females), and an exponential increase in age effect among those aged 65 years and above. Decomposition analysis revealed epidemiological factors contributed 56.6%-75.3% to incidence/prevalence, while aging accounted for 57.4%-165.2% of YLDs growth. Autoregressive integrated moving average projections suggest that by 2036, the ASIR will decline to 109.85 per 100 000, but the age-standardized prevalence rate in males will rise by 2.01%. CONCLUSION: The burden of hip fractures due to falls in China continues to intensify, with a higher incidence in females but a more rapid long-term increase in males. Integrated fall prevention strategies are urgently needed to address the challenges posed by an aging population. Cite this article as: Xu D, Lu Z, Yan H, Yang Z. Rising burden of fall-induced hip fractures in China: accelerating male-specific trends and persistent gender disparities from GBD 2021. Acta Orthop Traumatol Turc. 2026; 60(2), 0673, doi: 10.5152/j.aott.2026.25673.
Functional and Radiological Outcomes of Resurfacing Capitate Pyrocarbon Implantation after Proximal Row Carpectomy in Advanced Wrist Osteoarthritis.
Bruyneel J, Gkotsi A, Madani A … +1 more , El Kazzi W
Acta Orthop Traumatol Turc · 2026 Mar · PMID 42364195 · Full text
Placement of a Resurfacing Capitate Pyrocarbon Implant (RCPI) after proximal row carpectomy represents a reliable option for patients with osteoarthritis of the capitate head. Methods: This is a retrospective study that...
Placement of a Resurfacing Capitate Pyrocarbon Implant (RCPI) after proximal row carpectomy represents a reliable option for patients with osteoarthritis of the capitate head. Methods: This is a retrospective study that evaluated clinically and radiologically 18 patients who underwent RCPI implantation, with a mean follow-up of 34 months. Results: The postoperative pain decreased significantly in all patients (from 6 to 2 on a scale of 1 to 10), and mobility and grip strength remained sufficient for activities of daily living in most patients. Radiological assessment showed progression of osteoarthritic changes in all wrists, and 11 demonstrated an increase in the radiolucent line around the implant, which stabilized after 1 year. One implant presented distal protrusion without clinical repercussion. Nearly 80% of patients reported satisfaction with the placement of the implant. The remaining 20% had residual pain in daily activities. Only 1 patient required total wrist arthrodesis. Conclusion: Despite the evolution of osteoarthritic changes in all radiographs, such as osteophyte formation or rise of the radiolucent line around the implant, most patients were satisfied with the clinical outcomes, underscoring the discordance between the clinical status and radiologic images and supporting the use of interposition pyrocarbon materials. Cite this article as: Bruyneel J, Gkotsi A, Madani A, Kassi WE. Resurfacing capitate implant after proximal row carpectomy in advanced wrist osteoarthritis: A retrospective study. Acta Orthop Traumatol Turc., 2026; 60(2), 0308 doi:10.5152/j.aott.2026.25308.
Parent-reported activity and health-related quality of life after botulinum toxin in spastic cerebral palsy.
Kaya Yavuz G, Yılmaz G, Kerem Günel M
Acta Orthop Traumatol Turc · 2026 Apr · PMID 42364191 · Full text
OBJECTIVE: This study aimed to investigate changes in activity levels and health-related quality of life (HRQoL) in children with spastic cerebral palsy (CP) before and after botulinum toxin (BTX) injection, based on par...
OBJECTIVE: This study aimed to investigate changes in activity levels and health-related quality of life (HRQoL) in children with spastic cerebral palsy (CP) before and after botulinum toxin (BTX) injection, based on parental reports within the International Classification of Functioning Disability and Health (ICF) framework. METHODS: This retrospective study included 60 children with spastic CP (20 girls, 40 boys) who underwent BTX injection for spasticity management. The age range was 2-11 years (mean age, 5.44 Å} 2.09 years). Gross motor function level was classified using the Gross Motor Function Classification System-Family Report. Activity was evaluated with the Pediatric Outcome Data Collection Instrumen (PODCI), and HRQoL was assessed using the Pediatric Quality of Life Inventory (PedsQL) before and after BTX injection. Parents completed all questionnaires 6-12 months after BTX injection; pre- and post-injection scores were compared. RESULTS: The PODCI scores improved significantly after BTX in upper extremity function (P = .001), transfers/basic mobility (P = .005), pain/comfort (P = .009), happiness/satisfaction (P < .001), and global score (P < .001), while the physical function/sports subscale did not change significantly (P = .136). The PedsQL total score improved (P < .001), with significant improvements in daily activities (P < .001), school (P = .034), activity/balance (P < .001), pain/ache (P = .015), fatigue/prostration (P = .002), and nutrition (P = .027); the speech/communication domain showed no significant change (P = .150). CONCLUSION: From a parental perspective, BTX injection was associated with improved activity and HRQoL in children with spastic CP, with gains seen across multiple functional and well-being domains. Clinically, these findings support counseling families that BTX within an ICF-oriented rehabilitation approach may translate into meaningful improvements in daily function and overall well-being, although speech-related outcomes may be less responsive. Cite this article as: Yavuz GK, Yılmaz G, Günel MK. Parent-reported activity and health-related quality of life after botulinum toxin in spastic cerebral palsy. Acta Orthop Traumatol Turc., 2026; 60(2), 0612, doi: 10.5152/j.aott.2026.25612.
Pediatric Femoral Shaft Fractures Treated with Greater-Trochanter-Entry Antegrade Rigid Nail in Level 1 Trauma Center.
Lee JW, Cho JH, Kim TH
Acta Orthop Traumatol Turc · 2026 Mar · PMID 42364190 · Publisher ↗
OBJECTIVE: The treatment of pediatric femoral shaft fractures, especially in adolescents, presents unique challenges. This manuscript aims to report clinical outcomes associated with the use of greater-trochanter-entry a...
OBJECTIVE: The treatment of pediatric femoral shaft fractures, especially in adolescents, presents unique challenges. This manuscript aims to report clinical outcomes associated with the use of greater-trochanter-entry antegrade rigid nail (GTARN) and provide insights on the age at which this method becomes safe. METHODS: This study is a retrospective review of cases who treated femoral shaft fractures using GTARN between 2006 and 2023. Fractures were classified according to the AO classification. Operative time, union time, duration of follow-up, and complications were reviewed. The study population was stratified into 2 age groups (<12 years and ≥12 years) in accordance with prior recommendations. Fisher's exact test was used to compare categorical variables between the groups. For the analysis of proximal femur development, femoral neck widths and femoral head sizes were recorded bilaterally on final radiographs. Paired samples t-test was used. RESULTS: A total of 38 patients were included in the study. The mean age at the time of surgery was 13.4 ± 1.68 years. Complications were documented in 11 cases, including 5 cases of limb length discrepancies (LLDs), 4 cases of greater trochanter undergrowth, and 1 case of each valgus and varus deformity of the femur. All 5 LLDs were due to overgrowth of the fractured side. There was no reported coxa vara or coxa valga deformity. Notably, there were no cases of femoral head avascular necrosis (AVN). In addition, the younger group demonstrated a significantly higher rate of LLD complications compared to the older group. Femur neck widths and head sizes between fracture side and contralateral side displayed no distinct statistical significance. CONCLUSION: The GTARN is an effective treatment option for femoral shaft fractures in adolescents. The use of this technique was not associated with femoral head AVN or proximal femur development. However, clinicians should be mindful that secondary complications, particularly LLDs exceeding 1 cm, may occur more frequently in patients under 12 years of age. Cite this article as: Lee JW, Cho JH, Kim TH. Pediatric femoral shaft fractures treated with greater-trochanter-entry antegrade rigid nail in level 1 trauma center. Acta Orthop Traumatol Turc., 2026; 60(2), 0489, doi:10.5152/j.aott.2026.25489.
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