Acta Orthopaedica Et Traumatologica Turcica[JOURNAL]
Sun
200 papers
Single lag-screw-augmented dorsal plating yields superior union and lower costs in first metatarsophalangeal arthrodesis.
Kazez M, Batur ÖC, Önce G … +3 more , Kürüm H, Kaya O, Yalın M
Acta Orthop Traumatol Turc · 2026 Apr · PMID 42364183 · Publisher ↗
This study aimed to compare clinical outcomes and total treatment costs of 3 fixation strategies-isolated dorsal plating, dorsal plating with a single lag screw, and dorsal plating with dual lag screws-in patients underg...
This study aimed to compare clinical outcomes and total treatment costs of 3 fixation strategies-isolated dorsal plating, dorsal plating with a single lag screw, and dorsal plating with dual lag screws-in patients undergoing first metatarsophalangeal (MTP) joint arthrodesis for advanced hallux rigidus. Methods: This retrospective study included 99 patients who underwent primary first MTP joint arthrodesis between 2019 and 2024. Patients were categorized into Group 1 (dorsal plate only; n = 27), Group 2 (plate + 1 lag screw; n = 42), and Group 3 (plate + 2 lag screws; n = 30). Demographic variables, radiographic union, revision rates, functional outcomes (American Orthopaedic Foot and Ankle Society [AOFAS], Visual Analog Scale [VAS], Foot Function Index [FFI]), and total 12-month treatment costs were evaluated. The primary outcome measures were union rate, time to union, revision surgery, functional scores, and cumulative cost. Results: Group 1 demonstrated significantly lower union rates compared with Groups 2 and 3 (88.9% vs. 100% for both; P = .027) and a longer mean time to union (75 days vs. 65.8 and 62 days, respectively; P = .001). Revision surgery was required only in Group 1 (11.1%). The AOFAS scores were significantly higher in the screw-augmented groups (P = .013), while VAS and FFI scores showed no between-group differences. Cost analysis identified Group 2 as the most cost-effective strategy (9500 ± 1100 TL ≈ $310 ± 36), compared with Group 1 (11 200 ± 1400 TL ≈ $365 ± 46, P = .021) and Group 3 (11 600 ± 1300 TL ≈ $378 ± 42, P = .038). Conclusion: Single lag-screw augmentation of dorsal plate fixation provides superior union, fewer revisions, improved functional scores, and the lowest overall 12-month cost. These findings support dorsal plating with a single lag screw as a practical, value-based fixation strategy for advanced hallux rigidus, offering optimal clinical and economic outcomes. Cite this article as: Kazez M, Batur ÖC, Önce G, Kürüm H, Kaya O, Yalın M. Single lag-screw-augmented dorsal plating yields superior union and lower costs in first metatarsophalangeal arthrodesis. Acta Orthop Traumatol Turc., 2026; 60(2), 0417, doi: 10.5152/j.aott.2025.25417.
Lunatum excision and limited intercarpal fusion in advanced Kienböck's disease: scaphocapitate versus capitohamate fusion.
Şener İM, Öztürk T, Aldemir C … +3 more , Ertem H, Yamak K, Zengin EC
Acta Orthop Traumatol Turc · 2026 Feb · PMID 41942482 · Full text
OBJECTIVE: This study aimed to compare the clinical and radiological results of scaphocapitate fusion (SCF) and capitohamate fusion (CHF) combined with lunate excision in advanced Kienböck's disease. METHODS: Patients ov...
OBJECTIVE: This study aimed to compare the clinical and radiological results of scaphocapitate fusion (SCF) and capitohamate fusion (CHF) combined with lunate excision in advanced Kienböck's disease. METHODS: Patients over 18 years of age who were in stages IIIB-IIIC according to the Lichtman classification, and who had at least 1 year of follow-up, were included in the study. All patients had unilateral disease. Patients were divided into 2 groups according to whether they had CHF or SCF. The range of motion (ROM) and grip strength of the operated and contralateral active wrist joint were measured. Radiological evaluation of the severity of the disease was determined preoperatively using Lichtman staging. Preoperative and postoperative carpal height ratios (CHRs) were measured on anteroposterior radiographs. The presence of osteoarthritis was evaluated. Functional outcome was assessed using the Disability of the Arm, Shoulder, and Hand (DASH) and Visual Analogue Scale (VAS) scores. RESULTS: The mean age of the 27 patients (12 CHF and 15 SCF) was 32.5 years. There was no statistically significant difference between the 2 groups in terms of demographic characteristics, Lichtman stages, and mean follow-up time. No difference between the groups regarding ROM, grip strength, VAS, and DASH scores could be found. The preoperative and postoperative CHRs were compared, and no difference was found between the groups. CONCLUSION: Although SCF has some advantages over CHF regarding joint ROM and clinical scores, no difference was found between the groups (clinically and radiologically). Both SCF and CHF combined with lunate excision seem to be effective in the treatment of advanced Kienböck's disease in the mid-term. Cite this article as: Sener İM, Ozturk T, Aldemir C, et al. Lunatum excision and limited intercarpal fusion in advanced Kienb.ck's disease: scaphocapitate versus capitohamate fusion. Acta Orthop Traumatol Turc. 2026, 60 (1), 0270, doi:10.5152/j.aott.2026.25270.
Prevalence of os acromiale and concomitant rotator cuff tears: a focused assessment of 3697 shoulder magnetic resonance imagings.
Birsel O, Timoçin Yığman G, Günerbüyük C … +3 more , Baş A, Chodza M, Eren İ
Acta Orthop Traumatol Turc · 2026 Feb · PMID 41942481 · Full text
The purpose of this study was to define the prevalence of os acromiale on magnetic resonance imaging (MRI) in patients presenting with shoulder pain, to document how often it coexists with rotator cuff tears, and to asse...
The purpose of this study was to define the prevalence of os acromiale on magnetic resonance imaging (MRI) in patients presenting with shoulder pain, to document how often it coexists with rotator cuff tears, and to assess whether focused review detects this variant more reliably than routine radiology reporting. Methods: A retrospective review was conducted on 3697 shoulder MRI examinations obtained between 2020 and 2025 at a tertiary referral center. All studies were independently evaluated by 2 fellowship-trained shoulder surgeons and 1 musculoskeletal radiologist, focusing specifically on the presence, subtype, and coexistence of os acromiale with rotator cuff pathology. Interobserver reliability was assessed using Cohen's kappa coefficient, and findings were compared with the original radiology reports. Results: Os acromiale was identified in 26 cases, corresponding to a prevalence of 0.7%. Only 11 cases were mentioned in the original radiology reports. Interobserver agreement between shoulder surgeons was almost perfect (κ = 0.98) and excellent between surgeons and the radiologist (κ = 0.92). Subtypes included 12 preacromion, 13 mesoacromion, and 1 metaacromion. Rotator cuff tears were present in 20 of 26 patients with os acromiale (77%), including isolated supraspinatus tears (n = 9), combined supraspinatus-infraspinatus tears (n = 4), supraspinatus-subscapularis tears (n = 3), massive tears (n = 2), and cuff tear arthropathy (n = 2). Conclusion: Os acromiale was uncommon in this MRI-based cohort but frequently coexisted with full-thickness rotator cuff tears. Although causality cannot be inferred, this coexistence may carry clinical relevance. Notably, focused evaluation documented more cases than routine radiology reports, underscoring the added value of targeted assessment. Cite this article as: Birsel O, Yığman GT, Günerbüyük C, Baş A, Chodza M, Eren İ. Prevalence of os acromiale and concomitant rotator cuff tears: a focused assessment of 3697 shoulder magnetic resonance imagings. Acta Orthop Traumatol Turc. 2026; 60(1), 0714P doi: 10.5152/j.aott.2026.25714.
Psychological correlates of pain catastrophizing and disability in patients with Achilles tendinopathy: The roles of resilience and psychological inflexibility.
Akça E, Kart H, Demir U … +1 more , Akpınar F
Acta Orthop Traumatol Turc · 2026 Feb · PMID 41942461 · Full text
OBJECTIVE: This study aimed to clarify the contribution of psychological factors to pain adjustment in patients with Achilles tendinopathy. It specifically investigated the associations of psychological inflexibility, di...
OBJECTIVE: This study aimed to clarify the contribution of psychological factors to pain adjustment in patients with Achilles tendinopathy. It specifically investigated the associations of psychological inflexibility, distress, and resilience with pain catastrophizing, and their indirect associations between pain intensity and pain disability. METHODS: A total of 120 participants (65% female; mean age = 49.17 years, SD = 12.06) completed validated measures of visual analog scales for pain level, psychological distress, psychological inflexibility, resilience, pain disability index, and pain catastrophizing. Hierarchical regressions identified correlates of pain catastrophizing. Bootstrapped mediation analyses (5000 samples) tested indirect effects of psychological variables on the pain intensity-disability relationship. RESULTS: Pain catastrophizing was most strongly associated with psychological inflexibility (β = 0.413, P < .001) and distress (β = 0.284, P < .001); resilience also showed a significant inverse association (β = -0.181, P = .021). Pain intensity had a weaker yet significant association with catastrophizing in both final steps. Mediation models revealed an indirect-only pattern of association between pain intensity and disability through both pain catastrophizing and psychological inflexibility, as the direct effects were not statistically significant (c' = 0.044, 95% CI [-0.092, 0.180]; 0.143, 95% CI [-0.014, 0.301], respectively). Resilience partially mediated this relationship (c' = 0.207, 95% CI [0.044, 0.370]), while distress was not a significant mediator. CONCLUSION: Psychological processes, particularly catastrophizing and inflexibility, are strongly associated with the extent to which pain is linked to disability. These findings support the integration of psychological assessment into routine musculoskeletal rehabilitation in orthopedic practice. Addressing emotional processes and promoting psychological flexibility may improve treatment outcomes and prevent long-term disability. Cite this article as: Akça E, Kart H, Demir U, Akpınar F. Psychological correlates of pain catastrophizing and disability in patients with Achilles tendinopathy: the roles of resilience and psychological inflexibility. Acta Orthop Traumatol Turc. 2026, 60 (1), 0477, doi: 10.5152/j.aott.2026.25477.
The relationship between joint health, kinesiophobia, physical activity level, and functional capacity in hemophilia patients: a case-control study.
Özdemir H, Tuna F, Sezer T … +5 more , Comert M, Demirci U, Gulsum Umit E, Demirbağ Kabayel D, Demir AM
Acta Orthop Traumatol Turc · 2026 Feb · PMID 41942456 · Full text
OBJECTIVE: The objective of this research was twofold: to compare the physical activity levels and functional capacity of patients with hemophilia A to healthy individuals and to determine the interrelationships among jo...
OBJECTIVE: The objective of this research was twofold: to compare the physical activity levels and functional capacity of patients with hemophilia A to healthy individuals and to determine the interrelationships among joint health, kinesiophobia, physical activity, and functional capacity. METHODS: In the case-control study, 15 hemophilia A patients with a median age of 36 years (interquartile range (IQR), 27-48) and 15 age- and sex-matched healthy volunteers with a median age of 30 years (IQR, 27-41) were examined. The International Physical Activity Questionnaire - Short Form and a 6-minute walk test were administered to both groups. The Hemophilia Joint Health Score and Tampa Kinesiophobia Scale score were recorded in the hemophilia group. RESULTS: While there was no statistically significant difference between the 2 groups in terms of total physical activity level (P = .902), hemophilia patients exhibited a lower 6-minute walk distance (6MWD) than healthy controls (P < .001). The median Tampa Scale of Kinesiophobia score for the hemophilia patient group was 41 (IQR, 33-45), with 73.3% (n = 11) exhibiting a high degree of kinesiophobia. A negative correlation was observed between the 6MWD and age in hemophilia patients. However, no statistically significant relationship was found between kinesiophobia and Hemophilia Joint Health Score, physical activity level, or 6MWD. CONCLUSION: Kinesiophobia is common in adults with hemophilia. Although they engage in similar physical activities as their peers, their decreased functional capacity is related to demographic characteristics such as age, not clinical characteristics such as pain intensity, joint health, or kinesiophobia. The results of this study may help identify the rehabilitation needs of hemophilia patients and factors that may influence the design and implementation of exercise programs for this population. Cite this article as: Özdemir H, Tuna F, Sezer T, et al. The relationship between joint health, kinesiophobia, physical activity level, and functional capacity in hemophilia patients: A case-control study. Acta Orthop Traumatol Turc. 2026, 60 (1), 0566, doi: 10.5152/j.aott.2026.25566.
Endobutton combined with reinforced anchor effectively treated Tossy III acromioclavicular joint dislocation.
Sun X, Cai C, Li Q … +1 more , Huang L
Acta Orthop Traumatol Turc · 2026 Feb · PMID 41942454 · Full text
OBJECTIVE: This study aimed to evaluate the clinical efficacy of endobutton combined with a reinforced anchor in the treatment of Tossy III acromioclavicular joint (ACJ) dislocation. METHODS: A total of 42 patients with...
OBJECTIVE: This study aimed to evaluate the clinical efficacy of endobutton combined with a reinforced anchor in the treatment of Tossy III acromioclavicular joint (ACJ) dislocation. METHODS: A total of 42 patients with Tossy Ⅲ ACJ dislocation treated between July 2017 and June 2023 were retrospectively analyzed. Operation time, intraoperative blood loss, length of hospital stay, and postoperative outcomes were assessed. Outcomes included Visual Analog Scale (VAS) scores for pain at 1 and 6 months, Constant-Murley scores for shoulder function, Karlsson scores for treatment efficacy, and postoperative complications. RESULTS: The mean follow-up period was 23.43 Å} 7.70 months. All patients achieved effective reduction and incision healing. The mean operation time was 64.29 Å} 5.13 minutes, intraoperative blood loss was 46.79 Å} 4.25 mL, and hospital stay was 4.95 Å} 1.29 days. Postoperative VAS scores significantly decreased compared with preoperative values (P < .001), while Constant-Murley scores markedly improved at 1 and 6 months (P < .001). Karlsson scores showed 40 excellent and 2 good outcomes. Magnetic resonance imaging confirmed satisfactory healing at 1 and 6 months. Two patients demonstrated partial loss of ACJ reduction at 3 months, without clinical symptoms. No cases of complete radiological failure occurred. CONCLUSION: Endobutton combined with reinforced anchor demonstrated satisfactory early clinical efficacy in the treatment of Tossy Ⅲ ACJ dislocation, with improved pain relief, functional recovery, and a low complication rate. Cite this article as: Sun X, Cai C, Li Q, Huang L. Endobutton combined with reinforced anchor effectively treated Tossy III acromioclavicular joint dislocation. Acta Orthop Traumatol Turc. 2026, 60 (1), 0088, doi:10.5152/j.aott.2026.24088.
Examination of the coexistence of scoliosis and hallux valgus in females.
Sabır MA, Kayıkçı K, Taşkin R … +3 more , Uğur F, Topal M, Çiftdemir M
Acta Orthop Traumatol Turc · 2025 Oct · PMID 41942451 · Full text
OBJECTIVE: Both idiopathic scoliosis and hallux valgus are common in females, with risk factors including joint hypermobility, age, gender, hormonal factors, and family history. The aim of this study was to examine the f...
OBJECTIVE: Both idiopathic scoliosis and hallux valgus are common in females, with risk factors including joint hypermobility, age, gender, hormonal factors, and family history. The aim of this study was to examine the frequency of co-occurrence of scoliosis and hallux valgus and the severity of these 2 conditions. METHODS: Evaluation was made of 497 females who female police candidates presented at the hospital to obtain a health report between January 1, 2023, and June 1, 2023 and met the study criteria. Cobb, kyphosis, hallux valgus, and intermetatarsal angles were measured from radiographs, and the data of height, weight, and body mass index (BMI) were recorded. RESULTS: Of the 497 participants, scoliosis was observed in 22.3% and hallux valgus in 74.8%. The rate of hallux valgus was found to be significantly higher in the group with scoliosis than in the group without (P < .001). Individuals with scoliosis had approximately 3 times higher odds of having hallux valgus compared to those without scoliosis (OR: 3.08; 95% CI: 1.66-5.72; P < .05). When the groups with and without scoliosis were compared, the females with scoliosis were determined to be significantly younger (P=.007). No significant difference was seen between scoliosis and height (P=.766). The weight and BMI values of the females with scoliosis were found to be significantly lower compared to those without (P < .05). CONCLUSION: The study results showed that hallux valgus was determined in 88.3% of the females with scoliosis, which was significantly higher than the rate of 71% in those without (P < .001). No difference was seen between the scoliosis apex orientation and the hallux valgus side (P=.511), thus showing similar orientations of the scoliosis apex and hallux valgus side. There is a need for further studies to examine possible etiological causes in more detail. Cite this article as: Sabır MA, Kayıkçı K, Taşkin R, Uğur F, Topal M, Çiftdemir M. Examination of the coexistence of scoliosis and hallux valgus in females. Acta Orthop Traumatol Turc., 2026, 60(1), 0058, doi:10.5152/j.aott.2025.24058.
Osteosynthesis with a muscle advancement for a severely retracted greater tuberosity avulsion fracture: a case report.
Furuhata R, Shiba Y, Tanji A … +1 more , Matsumura N
Acta Orthop Traumatol Turc · 2025 Oct · PMID 41942440 · Full text
Greater tuberosity fractures with severe retraction are surgically challenging, with no universally accepted surgical procedure. This case report presents a case in which a muscle advancement technique was successfully a...
Greater tuberosity fractures with severe retraction are surgically challenging, with no universally accepted surgical procedure. This case report presents a case in which a muscle advancement technique was successfully applied to facilitate the reduction and fixation of a severely retracted greater tuberosity fracture. A 75-year-old female presented with persistent left shoulder pain for more than 3 weeks following a fall. Radiographs revealed a displaced greater tuberosity fracture. During surgery, via a deltoid-split approach, initial attempts to reduce the fragments using sutures placed in the rotator cuff tendons were unsuccessful due to strong traction from the rotator cuff muscles. To overcome this, the supraspinatus and infraspinatus were elevated from the scapular body, allowing the greater tuberosity fragments to slide laterally and achieve anatomical reduction. The fracture was then stabilized using the suture-bridge technique. Postoperative recovery resulted in satisfactory shoulder functional outcomes and complete bone union. To the best of knowledge, this is the first reported case of utilizing a muscle advancement technique in the treatment of a greater tuberosity fracture, providing an effective method to reduce rotator cuff traction and enable stable anatomical fixation. Cite this article as: Furuhata R, Shiba Y, Tanji A, Matsumura N. Osteosynthesis with a muscle advancement for a severely retracted greater tuberosity avulsion fracture: A case report. Acta Orthop Traumatol Turc., 2026, 60(1), 0415, doi:10.5152/j.aott.2025.25415.
The impact of preoperative serum albumin on postoperative recovery and healthrelated quality of life in older hip fracture patients.
Sirichativapee W, Chotiyarnwong P, Unnanuntana A … +1 more , Vanitcharoenkul E
Acta Orthop Traumatol Turc · 2025 Nov · PMID 41942432 · Full text
OBJECTIVE: The primary objective was to evaluate the predictive value of serum albumin levels for long-term functional recovery after hip fracture surgery. METHODS: Data from a university hospital's Fracture Liaison Serv...
OBJECTIVE: The primary objective was to evaluate the predictive value of serum albumin levels for long-term functional recovery after hip fracture surgery. METHODS: Data from a university hospital's Fracture Liaison Service Registry (2016-2021) were retrospectively analyzed. Hypoalbuminemia was defined as a serum albumin level below 35 g/L upon admission, in line with established clinical thresholds from previous studies. Functional outcomes were assessed at baseline, 3 months, and 1 year after surgery using the Barthel Index to measure basic activities of daily living and the EuroQol Visual Analog Scale to assess overall health-related quality of life. Multivariate logistic regression identified risk factors for poor Barthel Index scores (<60) at 1 year postoperatively. RESULTS: The analysis included 1086 patients (mean age 79.9 years, 75.8% female) with a 28.9% prevalence of hypoalbuminemia (309 patients). All functional outcomes improved over the 1-year follow-up. However, in the hypoalbuminemia group, gains in quality of life plateaued after the first 3 months. Lower serum albumin and a higher comorbidity burden were associated with unfavorable long-term functional recovery. A serum albumin level below 38 g/L (identified using the Youden Index) emerged as a threshold for predicting poor outcomes with Area Under Curve of 0.62. CONCLUSION: Older adults with serum albumin levels below 38 g/L may be at increased risk of poor functional recovery following hip fracture surgery. Although hypoalbuminemia is traditionally defined as levels below 35 g/L, the findings suggest that adverse outcomes may begin to emerge at slightly higher levels. Early recognition of this risk, along with timely nutritional and rehabilitative interventions around the 38 g/L threshold, may help support improved long-term outcomes and reduce post-fracture disability Cite this article as: Sirichativapee W, Chotiyarnwong P, Unnanuntana A, Vanitcharoenkul E. The impact of preoperative serum albumin on postoperative recovery and health-related quality of life in older hip fracture patients. Acta Orthop Traumatol Turc., 2026, 60(1), 0253, doi:10.5152/j.aott.2025.25253.
Surgical findings and timing in re-exploration of free flaps in extremity reconstruction.
Erol K, Güntürk ÖB
Acta Orthop Traumatol Turc · 2025 Oct · PMID 41942431 · Full text
OBJECTIVE: This study aims to evaluate the salvage rates of re-explored free flaps in extremity reconstruction, focusing on the timing of re-exploration, types of vascular compromise, and related factors that affect outc...
OBJECTIVE: This study aims to evaluate the salvage rates of re-explored free flaps in extremity reconstruction, focusing on the timing of re-exploration, types of vascular compromise, and related factors that affect outcomes. METHODS: A retrospective review of 527 free flap surgeries conducted between January 2010 and July 2024 was performed. Cases requiring re-exploration within seven days postoperatively (n=78) 14.8% were analysed. Data collected included demographics, flap types, timing of vascular compromises and re-explorations, and surgical outcomes. Statistical analyses were performed to identify relationships between variables. RESULTS: Among the re-explored cases, a salvage rate of 71.7% (n=56) was achieved. Venous thrombosis emerged as the leading cause of re-exploration (44.9%) (n=35). Significant findings included a median time to re-exploration of 12.2 hours from the initial surgery and 2.5 hours from the first sign of compromise. The first signs of flap compromise were observed in 91.1% (n=71) of cases within the first 24 hours postoperatively and no instances of flap compromise were recorded after 72 hours. CONCLUSION: Timely intervention was found to be strongly associated with improved flap salvage rates. These findings underscore the critical importance of early monitoring and prompt surgical management in free flap reconstructions, particularly for extremity cases. The study supports re-exploration within 2.5 hours of detecting vascular compromise as essential for maximizing salvage success. High re-exploration and survival rates demonstrate that effective and timely management protocols are vital for optimizing outcomes in microsurgical procedures. Cite this article as: Erol K, Güntürk ÖB. Surgical findings and timing in re-exploration of free flaps in extremity reconstruction. Acta Orthop Traumatol Turc., 2026, 60(1), 0353, doi:10.5152/j.aott.2025.25353.
Comparison of subacromial volume and clinical parameters of patients who underwent biceps tenotomy or tenodesis due to long head of biceps tendon pathologies during rotator cuff repair surgery.
Güneş Z, Erdoğan E, Aktekin CN
Acta Orthop Traumatol Turc · 2026 Feb · PMID 41942397 · Full text
The aim of this study was to compare the results of patients who underwent biceps tenotomy or tenodesis alongside rotator cuff rupture repair (RCRR), as well as to assess its relationship with alterations in subacromial...
The aim of this study was to compare the results of patients who underwent biceps tenotomy or tenodesis alongside rotator cuff rupture repair (RCRR), as well as to assess its relationship with alterations in subacromial volume. The hypothesis was that patients undergoing biceps tenodesis would experience greater improvements in outcome scores 2 years after the surgery and larger subacromial volumes as the long head of the biceps tendon maintains its tension. Methods: This is a retrospective study including patients who underwent an RCRR concomitant with a biceps procedure (88 tenotomy and 63 tenodesis) with a minimum of 2 years of follow-up between January 2015 and December 2022. Results: Preoperative subacromial volumes of the tenotomy and tenodesis groups were 3.89 cm3 and 3.87 cm3, respectively, which were similar (P = .287). Postoperative subacromial volume was 4.29 cm3 in the tenotomy group and 4.51 cm3 in the tenodesis group (P = .000). Preoperative, postoperative first year and postoperative final follow-up Constant scores were 43.3, 83.1 and 84.8, respectively, in the tenotomy group and 43.7, 86.9 and 89.0, respectively, in the tenodesis group. A statistically significant difference was found between the 2 groups in terms of postoperative Constant scores (P = .000 for both parameters). Volume changes and Constant score changes were significantly correlated (P = .012 and r = 0.513). Although preoperative Visual Analog Scale scores were comparable between the tenodesis and tenotomy groups (P = .076), the tenodesis group demonstrated significantly lower pain scores at both the 1-year follow-up and final evaluation (P = .002 and P = .007, respectively). Conclusion: In this study, biceps tenodesis was superior to tenotomy in terms of outcome scores. The results also revealed that subacromial volume increases significantly following biceps tenodesis compared to biceps tenotomy and has a moderate relationship with postoperative Constant scores, unlike Visual Analog Scale score. Cite this article as: Gunes Z, Erdogan E, Aktekin CN. Comparison of subacromial volume and clinical parameters of patients who underwent biceps tenotomy or tenodesis due to long head of biceps tendon pathologies during rotator cuff repair surgery. Acta Orthop Traumatol Turc. 2026; 60(1), 0528, doi: 10.5152/j. aott.2026.25528.
Predictive value of shock indices in 30-day mortality for elderly hip fracture patients: a retrospective cohort study.
İğde N, Keskin A, Başkaya N … +1 more , Yuvacı F
Acta Orthop Traumatol Turc · 2026 Feb · PMID 41942396 · Full text
OBJECTIVE: To determine the predictive value of the Shock Index (SI), Modified Shock Index (MSI), and Age Shock Index (ASI) for 30-day mortality in elderly patients with hip fractures and to compare these indices with es...
OBJECTIVE: To determine the predictive value of the Shock Index (SI), Modified Shock Index (MSI), and Age Shock Index (ASI) for 30-day mortality in elderly patients with hip fractures and to compare these indices with established measures such as the American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR). METHODS: This retrospective cohort study was conducted at a single-center, tertiary care hospital. The study included 2771 patients aged 65 and older who presented with hip fractures between January 1, 2014, and December 31, 2022. The primary outcome measure was 30-day mortality, while the secondary analysis focused on 1-year mortality. Comparisons were made between SI, MSI, ASI, ASA score, CCI, NLR, and PLR using receiver operating characteristic curve analyses to determine their predictive value for mortality. RESULTS: The mean age was 80.85 ± 7.48, with 63% being female (n = 1747). Modified Shock Index demonstrated the highest predictive performance for 30-day outcomes with a sensitivity of over 70%, a specificity of over 80%, and an area under the curve (AUC) value above 0.8, outperforming the other indices. Neutrophil-to-lymphocyte ratio was also significantly associated with mortality (AUC = 0.779), with a cutoff value of 5.76. For 1-year mortality, MSI showed superior performance (AUC = 0.669-0.673), although the sensitivity and specificity were lower than for 30-day mortality. CONCLUSION: Modified Shock Index can aid in identifying high-risk elderly hip fracture patients for short-term mortality and contribute to preoperative planning. Integrating MSI with traditional scoring systems like ASA and CCI may enhance early intervention strategies. Future studies should validate the use of MSI across different populations and orthopedic conditions. Cite this article as: İğde N, Keskin A, Başkaya N, Yuvacı F. Predictive value of shock indices in 30-day mortality for elderly hip fracture patients: a retrospective cohort study. Acta Orthop Traumatol Turc., 2026, 60 (1), 0225, doi: 10.5252/j.aott.2026.25225.
Challenging aggressive surgical strategies in extraabdominal desmoid tumors: Is tumor volume the missing key?
Şirin E, Koç E, Yiğit O … +2 more , Şahbat Y, Sofulu Ö
Acta Orthop Traumatol Turc · 2026 Feb · PMID 41942392 · Full text
OBJECTIVE: Desmoid tumors are fibroblast-derived rare soft tissue neoplasms with unclear borders that invade the surrounding structures. Despite the non-metastasizing nature, these tumors often relapse due to strong loca...
OBJECTIVE: Desmoid tumors are fibroblast-derived rare soft tissue neoplasms with unclear borders that invade the surrounding structures. Despite the non-metastasizing nature, these tumors often relapse due to strong local aggressive behavior. The aim of this study was to analyze the demographic and clinical characteristics of patients with extraabdominal desmoid tumor, who underwent surgery between 2012 and 2022 and to determine the risk factors affecting recurrence. METHODS: Thirty-five patients (14 males, 21 females; mean age 41.2 years (range: 11-80) underwent operation between the years 2012 and 2022 and followed up for a mean of 52 months. The diagnosis was confirmed with biopsy, and the plan for surgery and adjuvant radiotherapy was decided by the multidisciplinary tumor council. Demographic, radiologic, and management data of the patients were collected. Potential effects of surgical margin status, estimated tumor volume (ETV), and radiotherapy on recurrence were investigated. Estimated tumor volume was calculated from dimensions on pathologic specimens. RESULTS: While wide surgical resection was aimed for all patients, R0 margins were achieved only in 40%, whereas R1 and R2 margins were obtained in 22.9% and 37.1% of these patients respectively. The local recurrence rate was 40%. No significant correlation was observed between surgical margin positivity and the recurrence or progression of the tumor, when patients with R0 margin are sta-tistically compared with the rest (P = .067). On the other hand, when R0 and R1 margins were compared with each other in terms of recurrence or progression, there was a statistically significant difference (P = .006). While the impact of radiotherapy on recurrence or pro-gression could not be determined due to inadequate sample size, the recurrence rate increased significantly with increasing ETV (P = .01). CONCLUSION: Extraabdominal desmoid tumors are ill-defined locally aggressive neoplasms with an unpredictable and challenging clinical course. When the disease-free and recurring patients were compared, the recurrence rate increased significantly as the ETV increased. Achieving negative margins is still the benchmark for surgery; however, the risks and benefits of an aggressive surgery should always be reevaluated when there is a high possibility of a complex reconstructive surgery that has the capability to affect the functional outcome adversely. Cite this article as: Şirin E, Koç E, Yiğit O, Şahbat Y, Sofulu Ö. Challenging aggressive surgical strategies in extraabdominal desmoid tumors: is tumor volume the missing key? Acta Orthop Traumatol Turc., 2026, 60(1), 0103, doi: 10.5152/j.aott.2026.24103.
Dose-dependent effects of estrogen-enriched bone cement on membrane quality in the Masquelet technique: experimental rat model.
Çiftçi MU, Purelku M, Özönder F … +4 more , Ziroğlu N, Tanrıverdi B, Tanrıverdi G, Bilgili MG
Acta Orthop Traumatol Turc · 2026 Feb · PMID 41942389 · Full text
The Masquelet technique is a 2-stage surgical method used for the reconstruction of critically sized bone defects due to various etiologies. Estrogen is known to have anabolic effects on bone metabolism. In this study, b...
The Masquelet technique is a 2-stage surgical method used for the reconstruction of critically sized bone defects due to various etiologies. Estrogen is known to have anabolic effects on bone metabolism. In this study, based on literature data, the aim is to systematically evaluate the histological and immunohistochemical effects of adding different doses of estrogen to polymethylmethacrylate cement on induced membrane tissue. Methods: Twenty-eight male rats were included in the study and divided into 4 groups. Three experimental groups received different doses of estradiol, a subtype of estrogen mixed with bone cement, while a control group received only bone cement. Approximately 10 mm defects were created in single femurs of all rats. Bone cement appropriate for each experimental group was placed in these defects, and bone fixation was performed with mini plates and screws. Tissue samples taken from all animals at the end of the sixth week were evaluated by histological and immunohistochemical methods. Results: Histological and immunohistochemical evaluations of the induced membranes obtained at the end of the experiment revealed signs of bone formation in all subgroups. A significant increase in bone formation was observed with increasing doses in groups E1, E2, and E3 compared to the control group (P < .05). The histological scores of the study groups were found to increase statistically significantly with increasing estrogen dose (P < .05). Furthermore, immunohistochemical analyses revealed that the immuno-reactive scores for bone morphogenetic protein-4 and insulin-like growth factor-1 expression were significantly higher in the E3 group compared to the other groups (P < .05). Conclusion: In this study, it was found that enriching the cement content with estrogen during bone cement placement, the first step of the Masquelet technique, improved the quality of the formed membrane. This improvement in membrane quality is promising for increasing treatment efficacy and shortening the treatment duration. Cite this article as: Çiftçi MU, Purelku M, Özönder F, et al. Dose-dependent effects of estrogen-enriched bone cement on membrane quality in the masquelet technique: experimental rat model. Acta Orthop Traumatol Turc., 2026; 60(1), 0355, doi: 10.5152/j.aott.2026.25355.
Evaluation of the reliability of novel pelvic X-ray assessment software: CalculOrther.
Yılmaz A, Selçuk T, Aksoy T … +1 more , Atilla B
Acta Orthop Traumatol Turc · 2026 Feb · PMID 41942388 · Full text
The anteroposterior (AP) pelvic X-ray is commonly used for assessing conditions affecting the bony pelvis. The objective of this study was to develop new pelvic X-ray assessment software (CalculOrther) to assess AP pelvi...
The anteroposterior (AP) pelvic X-ray is commonly used for assessing conditions affecting the bony pelvis. The objective of this study was to develop new pelvic X-ray assessment software (CalculOrther) to assess AP pelvic X-rays and evaluate its reliability. Methods: CalculOrther was developed in 4 stages. Initially, a dataset comprising pelvic X-rays was generated. During the second stage, the convolutional neural network model was trained to identify anatomical landmarks in the pelvic X-ray images. The Hough transform was used to locate the circle and center of the femoral head in the third stage. The border pixels were generated using mathematical morphological processes, and the requisite angles were measured in the fourth stage. Then manual measurements and the software developed were analyzed with Pearson's correlation and intraobserver and interobserver correlation coefficients. Subsequently, the mean error and the root mean square error (RMSE) were acquired. Results: The Pearson's correlation coefficients varied from 0.84 to 0.99 (P < .001). The interobserver and intraobserver correlation coefficients ranged from 0.77 to 0.99 and from 0.75 to 0.94, respectively. The RMSE ranged from 0.31 to 4.38 and the mean error from 0.05 to 2.86. The mean duration for manual measurements was 230 (177-284) seconds and 215 (160-255) seconds, respectively. The software required an average time of 3.18 (2.95-3.52) seconds to make the same measurements. Conclusion: Regarding femoroacetabular impingement and hip dysplasia, artificial intelligence can analyze pelvic radiographs and generate equally accurate results within a shorter duration compared to traditional measuring methods. Cite this article as: Yilmaz A, Selcuk T, Aksoy T, Atilla B. Evaluation of the reliability of novel pelvic X-ray assessment software: CalculOrther. Acta Orthop Traumatol Turc., 2026; 60(1), 0268, doi: 10.5152/j.aott.2026.25268.
Patient-specific 3D-printed spinal models improve pedicle screw placement accuracy in severe kyphoscoliosis: a comparative study.
Çetin E, Albayrak A
Acta Orthop Traumatol Turc · 2026 Feb · PMID 41942374 · Publisher ↗
Accurate pedicle screw placement in severe kyphoscoliosis remains a major challenge due to distorted and rotated spinal anatomy. This study aims to evaluate whether the use of patient-specific 3-dimensional (3D) printed...
Accurate pedicle screw placement in severe kyphoscoliosis remains a major challenge due to distorted and rotated spinal anatomy. This study aims to evaluate whether the use of patient-specific 3-dimensional (3D) printed spinal models improves pedicle screw placement accuracy. Methods: Fourteen patients with severe kyphoscoliosis (Cobb angle >100°) were included in the study. The study group (n = 7) underwent surgery using patient-specific 3D-printed spine models to assist freehand pedicle screw placement, while the control group (n = 7) underwent surgery using the standard freehand technique alone. Pedicle screw accuracy was scored from 0 to 3 on postoperative computed tomography scans. The Mann-Whitney U-test and Cliff's Delta were used for statistical analysis. Results: Maximum preoperative coronal and sagittal Cobb angles were higher in the control group (mean coronal angle, 106.57 ± 19.76 vs. 128.86 ± 21.42° and mean sagittal angle, 105.00 ± 17.38 vs. 125.00 ± 19.27°) but the statistical difference between the groups was not significant. The mean screw malposition score was significantly lower in the 3D model group (Mean: 0.49 ± 0.93) compared to the control group (Mean: 1.45 ± 1.10) (U = 4802.5, P < .001). Effect size was large (Cliff's Delta = -0.66). Conclusion: The use of 3D-printed patient-specific spinal models significantly improves the accuracy of pedicle screw placement in severe spinal deformities and should be considered as an adjunct tool in complex deformity surgeries. Cite this article as: Çetin E, Albayrak A. Patient-specific 3D-printed spinal models improve pedicle screw placement accuracy in severe kyphoscoliosis: a comparative study. Acta Orthop Traumatol Turc., 2026; 60(1), 0593 doi: 10.5152/j.aott.2026.25593.
Assessment of 3-dimensional acetabular coverage based on acetabular sector angles following periacetabular osteotomy: long-term clinical, radiological, and survivorship outcomes.
Güneş Z, Çağlar Ö, Aksoy MC … +3 more , Atilla B, Tokgözoğlu AM, Yılmaz G
Acta Orthop Traumatol Turc · 2026 Feb · PMID 41942373 · Publisher ↗
OBJECTIVE: Periacetabular osteotomy (PAO) is a well-established surgical technique that is used to enhance femoral head coverage in patients with developmental dysplasia of the hip (DDH). Although 2-dimensional radiograp...
OBJECTIVE: Periacetabular osteotomy (PAO) is a well-established surgical technique that is used to enhance femoral head coverage in patients with developmental dysplasia of the hip (DDH). Although 2-dimensional radiographs remain standard for evaluating acetabular coverage, 3-dimensional (3D) computed tomography (CT)-based measurements using acetabular sector angles (ASAs) provide higher precision. This study aimed to analyze acetabular coverage through ASA parameters and to investigate the long-term clinical outcomes following PAO. METHODS: This retrospective study included 35 hips from 29 patients who underwent PAO for DDH. Radiographic measurements comprised the T.nnis angle, Sharp angle, lateral center-edge angle (LCEA) and anterior center-edge angles (ACEA), anterior center margin angle (ACMA), extrusion index, and hip lateralization index (HLI). The CT-derived variables included acetabular version (AV), anterior ASA (AASA), posterior ASA (PASA), and horizontal ASA (HASA). Clinical outcomes were assessed by using the Harris Hip Score (HHS). RESULTS: The mean patient age was 19.9 years, with a mean follow-up period of 8.7 years. Significant postoperative improvements were noted in AASA, HASA, T.nnis angle, Sharp angle, extrusion index, AV, LCEA, ACEA, acetabular depth, and HHS (all P < .05). No significant differences were observed in PASA, HLI, or ACMA. The HHS showed a negative correlation with HLI (P < .05) and a positive correlation with postoperative LCEA (P < .01). Patients with postoperative LCEA < 25Åã demonstrated superior functional outcomes compared with those with LCEA ≥ 35Åã (P = .034). Eight patients experienced complications, and 2 patients required conversion to total hip arthroplasty. CONCLUSION: The PAO provides durable long-term results in the management of DDH. Incorporating 3D ASA analysis enhances both preoperative planning and postoperative evaluation, contributing to more precise acetabular reorientation and improved clinical assessment Cite this article as: Güneş Z, Çağlar Ö, et al. Assessment of 3-dimensional acetabular coverage based on acetabular sector angles following periacetabular osteotomy: long-term clinical, radiological, and survivorship outcomes. Acta Orthop Traumatol Turc., 2026; 60(1), 0334, doi: 10.5152/j.aott.2026.25334.
Implementation of a Fresh Osteochondral Allograft Protocol for the Knee: A Case Series from Türkiye.
Meriç G, Eren O, Kocadal O … +1 more , Ateş U
Acta Orthop Traumatol Turc · 2026 Feb · PMID 41942367 · Full text
Objective: This retrospective case series aimed to establish a standardized protocol for the procurement, processing, and surgical application of fresh osteochondral allografts (OCA) in Türkiye and to report the early c...
Objective: This retrospective case series aimed to establish a standardized protocol for the procurement, processing, and surgical application of fresh osteochondral allografts (OCA) in Türkiye and to report the early clinical outcomes of this biological salvage treatment for knee cartilage defects. Methods: Ten fresh OCA transplantations were performed between July 2019 and June 2024, with a mean follow-up of 26.1 months. Patients were evaluated using the International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), and a 10-cm Visual Analog Scale (VAS) for knee pain. Magnetic resonance imaging was obtained at >12 months postoperatively to assess graft survival. Results: The mean patient age was 30.3 ± 5.7 years (6 males, 4 females). The mean graft area was 5.1 cm² (range: 2.5-7.5 cm²). The IKDC scores improved from 37.5 to 65.4, KOOS scores from 38 to 69.6, and VAS scores from 6 to 1.6. Magnetic resonance imaging evaluation beyond 12 months showed no evidence of graft failure. Conclusion: Fresh OCA represents a reliable and effective treatment option for knee cartilage defects. Establishing its availability in Türkiye has the potential to broaden access, enabling more surgeons to adopt the technique and more patients to benefit from this biological salvage procedure. Cite this article as: Meriç G, Eren O, Kocadal O, Ateş U. Implementation of a fresh osteochondral allograft protocol for the knee: a case series from Türkiye. Acta Orthop Traumatol Turc., 2026, 60(1), 0310, doi:10.5152/j.aott.2026.25310.
Anesthesia for vertebral compression fractures treated with percutaneous kyphoplasty: Comparison of erector spinae plane block, extrapedicular infiltration anesthesia, and conventional local infiltration anesthesia.
Eşkin MB, Özhan MÖ, Şimşek F … +3 more , Eksert S, Ceylan A, Başak AM
Acta Orthop Traumatol Turc · 2026 Feb · PMID 41942365 · Full text
Local anesthesia with sedoanalgesia and general anesthesia are widely used in percutaneous kyphoplasty (PKP) for vertebral compression fractures (VCF). The aim of this study was to compare erector spinae block (ESP) with...
Local anesthesia with sedoanalgesia and general anesthesia are widely used in percutaneous kyphoplasty (PKP) for vertebral compression fractures (VCF). The aim of this study was to compare erector spinae block (ESP) with conventional local infiltration anesthesia (CLIA) and extrapedicular infiltration anesthesia (EPIA) with respect to analgesic efficacy in patients who underwent elective PKP for VCF. Methods: A total of 90 American Society of Anesthesiologists (ASA) 1-3 patients were randomly assigned into 3 groups: group CLIA (n = 30), group EPIA (n = 30), and group ESP (n = 30). The same amount of local anesthetic mixture (6 mL lidocaine 1% and 14 mL bupivacaine 0.5%) was used for regional anesthetic techniques in all groups. Fentanyl 0.1 μg/kg and midazolam 0.1 mg/kg were administered intravenously (IV) before prone positioning. Pain was evaluated using the visual analog scale (VAS) and sedation level using the Ramsay Sedation Scale (RSS) during the procedure. Primary outcome measure were VAS and RSS scores. Secondary outcome measures were hemodynamic changes and additional analgesic and sedative consumptions. Results: Mean baseline VAS scores were similar between groups (5.62 ± .39; P > .05). Intraoperative mean VAS scores were significantly higher in group CLIA compared to EPIA and ESP groups at all timepoints (P < .01). Time-bound changes in VAS scores showed a progressive decrease from baseline until the end of the procedure in EPIA (5.60 ± 1.38 to 1.10 ± 0.85; P < .01) and ESP groups (5.30 ± 1.44 to 1.17 ± 0.95; P < .01), while an increase was detected from baseline to the 20th minute in group CLIA (5.97 ± 1.35 to 7.07 ± 0.94; P < .01) that followed a decrease until the end of the procedure (3.47 ± 0.86; P < .01). The mean RSS scores were similar at baseline and at the end of the procedure in all groups (P > .01), but significantly lower in group CLIA compared to EPIA and ESP groups at the other timepoints (P < .001). Time-bound changes in RSS scores showed a progressive increase from baseline until the 20th minute of the procedure that followed a decrease until the end of the procedure in EPIA (5.60 ± 1.38 to 1.10 ± 0.85; P < .01) and ESP groups (5.30 ± 1.44 to 1.17 ± 0.95; P < .01). Conclusion: Better anesthetic advantages of ESP and EPIA over CLIA concerning intra-operative analgesia, analgesic and sedative consumption were demonstrated. ESP and EPIA can be used as a suitable anesthetic method in VCF patients undergoing single-level PKP, with stable hemodynamic parameters and analgesia in the intra-operative period. Cite this article as: Eşkin MB, Özhan MÖ, Şimşek F, Eksert S, Ceylan A, Başak AM. Anesthesia for vertebral compression fractures treated with percutaneous kyphoplasty: comparison of erector spinae plane block, extrapedicular infiltration anesthesia, and conventional local infiltration anesthesia. Acta Orthop Traumatol Turc., 2026; 60(1), 0549, doi: 10.5152/j.aott.2026.25549.
Raising the bar: The EBOT-TK Turkish Oral Exam milestone and AOTT's commitment to orthopaedic education.
Yalçınkaya M, Akan K, Aydıngöz Ö … +4 more , Berk H, Demirhan M, Mineiro J, Gómez-Barrena E
Acta Orthop Traumatol Turc · 2025 Dec · PMID 41578828 · Full text
Cite this article as: Yalçınkaya M, Akan K, Aydıngöz Ö, et al. Raising the bar: The EBOT-TK Turkish Oral Exam milestone and AOTT's commitment to orthopaedic education. Acta Orthop Traumatol Turc. 2025;59(6):334-336.
Cite this article as: Yalçınkaya M, Akan K, Aydıngöz Ö, et al. Raising the bar: The EBOT-TK Turkish Oral Exam milestone and AOTT's commitment to orthopaedic education. Acta Orthop Traumatol Turc. 2025;59(6):334-336.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe