Acta Orthopaedica Et Traumatologica Turcica[JOURNAL]
Sun
200 papers
Modified Gritti-Stokes amputation for periprosthetic fracture with irremovable femoral nail: case report and review of an overlooked procedure.
Tseng HP, Chien CS, Wu TM
Acta Orthop Traumatol Turc · 2025 Jun · PMID 40728084 · Full text
The management of retained orthopedic hardware during amputation procedures presents significant challenges. A case utilizing a modified Gritti-Stokes through-knee amputation to address a periprosthetic fracture with an...
The management of retained orthopedic hardware during amputation procedures presents significant challenges. A case utilizing a modified Gritti-Stokes through-knee amputation to address a periprosthetic fracture with an exposed intramedullary nail (IMN) in a patient with multiple comorbidities is reported. A 47-year-old male with a history of human immunodeficiency virus, hepatitis C virus, and type 2 diabetes mellitus presented with a left femoral periprosthetic supracondylar fracture. The patient had an existing IMN from a previous femoral shaft fracture 20 years prior, along with a left below-knee amputation. Due to the newly occurred periprosthetic fracture and the patient's immunocompromised status, further amputation was deemed necessary. However, removal of the well-integrated IMN posed significant risks. A modified Gritti-Stokes through-knee amputation was performed, adapting the procedure to use the patella as a biological cap to cover the exposed IMN tip. At 4-month follow-up, the patient demonstrated satisfactory wound healing and stable positioning of the patellar cap. The patient achieved ambulation with an above-knee prosthesis and crutch assistance, reporting high satisfaction and no pain or discomfort. This case highlights the versatility of the Gritti-Stokes procedure in addressing complex scenarios involving retained hardware. By utilizing the patella as a biological cover for the exposed IMN, the risks associated with hardware removal was avoided while achieving a stable, well-healed amputation stump. This modification of the Gritti-Stokes technique offers a viable solution for patients with retained IMNs requiring through-knee amputation, particularly in cases where hardware removal is contraindicated or highly risky.
Correspondence on "exploring the role of artificial intelligence in turkish orthopedic progression exams".
Daungsupawong H, Wiwanitkit V
Acta Orthop Traumatol Turc · 2025 Jul · PMID 40728065 · Full text
Abstract loading — click title to view on PubMed.
Assessing the role of large language models in adolescent idiopathic scoliosis care: a comparison between ChatGPT and Google Gemini.
Yaş S, Yapar D, Yapar A … +4 more , Özel T, Tokgöz MA, Baymurat AC, Şenköylü A
Acta Orthop Traumatol Turc · 2025 Jul · PMID 40728044 · Full text
Objective: To evaluate the accuracy, applicability, comprehensiveness, and communication quality of responses generated by ChatGPT and Google Gemini in adolescent idiopathic scoliosis (AIS)-related scenarios, with the ai...
Objective: To evaluate the accuracy, applicability, comprehensiveness, and communication quality of responses generated by ChatGPT and Google Gemini in adolescent idiopathic scoliosis (AIS)-related scenarios, with the aim of assessing their potential utility as tools in patient management. Methods: Six case-based questions reflecting common patient concerns related to adolescent idiopathic scoliosis were developed by orthopedic specialists. Responses generated by ChatGPT and Google Gemini were independently evaluated by 61 orthopedic surgeons using a standardized rubric assessing accuracy, applicability, comprehensiveness, and communication clarity, each rated on a 1-5 Likert scale. Comparative analyses between platforms were performed using the Mann-Whitney U and Wilcoxon signed-rank tests. Additionally, open-ended feedback was collected to explore participants' perspectives on the potential and limitations of AI-based consultations. Results: ChatGPT outperformed Google Gemini in terms of accuracy (P = .013) in postoperative care scenarios. The results for applicability (P = .119), comprehensiveness (P = .619), and communication (P = .240) were not statistically significant. Orthopedic specialists rated both AI models significantly higher than residents in accuracy, applicability, and comprehensiveness. Most evaluators acknowledged the potential of AI to reduce physician workload and support patient guidance; however, concerns were raised regarding reliability, ethical implications, and the current limitations of AI in ensuring patient safety. Conclusion: ChatGPT and Google Gemini demonstrated moderate accuracy and communication quality in adolescent idiopathic scoliosis-related scenarios, with ChatGPT showing a modest advantage. Although both models show promising results as supportive tools for patient education and preliminary consultations, their current limitations in accuracy and comprehensiveness restrict their clinical reliability. Multidisciplinary collaboration is crucial to ensure e!ective applications of AI in orthopedic practice. Level of Evidence: Level III, Diagnostic Study.
Predicting mechanical complications in adult spinal deformity patients with postoperative proportioned and moderately disproportioned alignment.
Balaban B, Demirci N, Yilgor C … +14 more , Yucekul A, Zulemyan T, Haddad S, Haleem S, Kilic F, Obeid I, Pizones J, Kleinstueck F, Sanchez Perez FJ, Pellise F, Alanay A, Bagci C, Sezerman OU, European Spine Study Group
Acta Orthop Traumatol Turc · 2025 Jul · PMID 40728025 · Full text
Objective: Mechanical complications are common after adult spinal deformity (ASD) surgery and can significantly impair outcomes. This study aimed to predict such complications in proportioned and moderately disproportion...
Objective: Mechanical complications are common after adult spinal deformity (ASD) surgery and can significantly impair outcomes. This study aimed to predict such complications in proportioned and moderately disproportioned patients using a machine learning approach, to inform preoperative planning and enable early preventive care. Methods: Prospectively collected clinical data, including preoperative, intraoperative, and postoperative variables, radiographic param- eters, technical details, and patient-reported outcomes, were obtained from a multi-center ASD surgery database. Parameter tuning of a random forest (RF) classifier was performed using 9-times 3-fold cross-validation over 3 rounds of grid search, with the F-score used as the primary optimization metric. The final RF model was used to derive a clinically interpretable rule set using the inTrees framework. Permutation-based feature importance was assessed for F-score, accuracy, and sensitivity. Results: The model was trained on 295 patients (237 female, 58 male; mean age, 50 ± 19 years) with a minimum 2-year follow-up (mean 53 months, range 24-101). Mechanical complications were observed in 100 patients (34%). A test cohort of 98 patients (33% complication rate) was used for external validation. The RF model achieved 72% accuracy, 91% sensitivity, 64% specificity, and 93% negative predictive value. The derived rule set, comprising 8 rules using 1 to 3 features each, yielded 74% accuracy, 81% sensitivity, 71% specificity, and 83% negative predictive value. The location of the lower instrumented vertebra (LIV) was the most influential predictor. Conclusion: By excluding patients with severe deformities, as defined by the GAP score, this study focused on the more clinically ambiguous group of proportioned and moderately disproportioned patients. To the authors' knowledge, this is the first study to develop predictive tools specifically for this subgroup to assess the risk of mechanical complications following ASD surgery. These tools may assist in early risk stratification and guide preoperative decision-making to reduce postoperative complications and improve patient outcomes. Level of Evidence: Level III, Prognostic Study.
Investigating the role of disulfidoptosis in spinal cord injury and development of a novel diagnostic model.
Wang C, Yu L, Ma H
Acta Orthop Traumatol Turc · 2025 Jun · PMID 40726387 · Full text
Objective: The objective of this study is to explore the role and regulatory mechanisms of disulfidoptosis in spinal cord injury (SCI) and to develop a diagnostic model based on this cell death mechanism. Methods: The pe...
Objective: The objective of this study is to explore the role and regulatory mechanisms of disulfidoptosis in spinal cord injury (SCI) and to develop a diagnostic model based on this cell death mechanism. Methods: The peripheral blood RNA-seq data from SCI patients sourced from dataset GSE151371 was utilized in the study. Various analytical techniques, including differential gene expression analysis, immune infiltration profiling, consistency clustering, and pathway enrichment analysis, were employed to investigate the impact of disulfidoptosis. Machine learning models were also developed to aid in the diagnosis of SCI based on gene expression profiles related to disulfidoptosis. Results: Gene expression analysis revealed significant upregulation of genes such as GYS1, PDLIM1, NDUFA11, and MYL6, and down-regulation of NUBPL, LRPPRC, and CD2AP in SCI patients, with statistical significance (P < .05). Immune infiltration profiling showed a decrease in CD4+ and CD8+ T cells, contrasted by an increase in gamma delta T cells (P < .05), indicating an altered immune landscape. Furthermore, 2 distinct subgroups were identified through consistency clustering, highlighting significant differences in disulfidoptosis- related gene expression. Pathway enrichment analysis revealed different pathways between clusters, suggesting diverse regulatory mechanisms within SCI subtypes. The diagnostic model evaluation using random forest achieved the highest accuracy with an area under the curve (AUC) of 0.955, demonstrating its potential utility in clinical settings for SCI diagnosis. Conclusion: Disulfidoptosis plays a significant role in the pathophysiology of SCI. This study offers novel insights into its molecular mechanisms and presents a potential foundation for diagnostic modeling.
The impact of bursa repair and steroid injection on lateral trochanteric pain following total hip arthroplasty: a retrospective cohort study.
Abul MS, Şahiner D, Sevim ÖF … +3 more , Hekim Ö, Ergün S, Eceviz E
Acta Orthop Traumatol Turc · 2025 Jul · PMID 40726376 · Full text
Objective: This study aimed to evaluate the clinical outcomes of preserving and repairing the bursal tissue-rather than excising it-during total hip arthroplasty (THA), and to assess the additional e!ect of administering...
Objective: This study aimed to evaluate the clinical outcomes of preserving and repairing the bursal tissue-rather than excising it-during total hip arthroplasty (THA), and to assess the additional e!ect of administering a steroid injection into the repaired bursa. Methods: Patients who underwent total hip arthroplasty (THA) via a posterior approach were retrospectively reviewed and divided into three groups based on the intraoperative bursal tissue management technique. The first group (PB) included patients who received an intraoperative injection of corticosteroid (40 mg methylprednisolone) and local anesthetic (bupivacaine 5 mg/mL) into the pre- served bursa. The second group (BR) consisted of patients who underwent bursal repair without injection. The third group (BE) comprised patients who underwent total excision of the bursa. Clinical outcomes were assessed using the Harris Hip Score (HHS), the Visual Analogue Scale (VAS) for pain during daily activities, and VAS for pain while lying on the ipsilateral hip at 6 and 24 months postoperatively. Results: A total of 41 patients (27 females, 14 males) who underwent THA were included in the study. No statistically significant di!erences were observed between the groups in lateral trochanteric VAS scores during daily activities at both 6 and 24 months postoperatively (P > .05). However, a significant di!erence was found in VAS scores assessed while lying on the operated side at 6 months, favoring the PB group (P < .001). Additionally, Harris Hip Score (HHS) values were significantly higher in the PB group compared to the other groups at both 6 months (P < .001) and 24 months (P = .006). Conclusion: Intraoperative corticosteroid and local anesthetic injection, in addition to bursa repair, may improve early postoperative outcomes and pain relief in patients undergoing THA using the posterior approach, without increasing infection risk.
Outcomes of foot and ankle fixation using biointegrative implants-a retrospective study.
O'Neill C, Mehta A, Bhamidipati A … +3 more , Hearns S, Ashkani-Esfahani S, R Waryasz G
Acta Orthop Traumatol Turc · 2025 Jul · PMID 40726350 · Full text
Objective: This study aimed to evaluate mid-term outcomes (>52 weeks) of biointegrative implants in foot and ankle surgery by assessing patient-reported outcome measures (PROMs) and comparing them with standard metal imp...
Objective: This study aimed to evaluate mid-term outcomes (>52 weeks) of biointegrative implants in foot and ankle surgery by assessing patient-reported outcome measures (PROMs) and comparing them with standard metal implants. Additionally, the study examined radiographic changes in diastasis of the Lisfranc and syndesmosis injuries to determine the e!ectiveness of biointegrative implants for maintaining reduction. Methods: This retrospective case-control study included 178 patients who underwent midfoot, hindfoot, or ankle syndesmosis surgeries at 3 centers within the same institution (91 cases, 87 controls). Of the 91 patients in the case group, 46 were female and 45 were male. The control group consisted of 43 females and 44 males. The mean age was 42.45 ± 18.89 years in the case group and 42.68 ± 18.32 years in the control group. Cases received biointegrative implants; controls received metal or flexible fixation. Procedures included fixation or fusion of the Lisfranc joint, tarsometatarsal joints, intercuneiform, navicular, cuneiforms, and cuboid; hindfoot arthrodesis; and medial malleolus or syndesmosis fixation. Visual analog scale (VAS) pain scores were recorded at preoperative, early postoperative, and at 3, 6, and 12 months. Patient-reported outcome measure scores (Pain Interference [PIF], Pain Intensity [PI], and Physical Function [PF]) were collected at baseline, early postoperative, and "1-month postoperative. Diastasis and fixation integrity were assessed via radiographs and Computed Tomography. Re-operation and complication data were extracted from patient charts. Repeated-measures ANOVA was used for analysis. Results: Both groups showed significant reductions in VAS pain scores from preoperative to postoperative time points (P < .001). Further reductions were observed from the first postoperative visit to 3 and 6 months (P < .02), and from 3 to 12 months (P < .01). However, no significant di!erences were found between groups regarding VAS scores (P = .50). PROMIS scores significantly improved over time in both groups (PF: P < .001, PIF: P < .001, PI: P < .001), with no intergroup di!erences (PF: P = .52, PIF: P = .55, PI: P = .37). No di!erence in diastasis measurements was found between groups (P = .214). Hardware failure occurred in 5 cases and 14 controls; 2 surgical site infections were also observed in the control group. Conclusion: This study is among the first to evaluate mid-term outcomes of biointegrative implants in foot and ankle surgery. Patient-reported outcome measure scores showed significant improvement as early as the early postoperative period. Complication rates were comparable to metal implants. While findings support biointegrative screws as a viable fixation method, long-term and prospective studies are needed to confirm their safety and efficacy. Level of Evidence: Level III, Therapeutic Study.
"Think before you speak, read before you think".
Parvizi J
Acta Orthop Traumatol Turc · 2025 Jul · PMID 40726228 · Full text
Abstract loading — click title to view on PubMed.
Catastrophic wound dehiscence in early onset scoliosis secondary to hyperinflammatory response: a case report.
Shihab W, Jha A, Dede O
Acta Orthop Traumatol Turc · 2025 May · PMID 40536386 · Full text
Early onset scoliosis (EOS) poses significant treatment challenges, often exacerbated by postoperative wound complications. A novel case of hyperinflammatory wound complications in a child with a confirmed NFKB1 mutation...
Early onset scoliosis (EOS) poses significant treatment challenges, often exacerbated by postoperative wound complications. A novel case of hyperinflammatory wound complications in a child with a confirmed NFKB1 mutation is presented, successfully managed with immunomodulation. A 6-year-old boy experienced wound dehiscence and persistent inflammation following rod placement, unresponsive to conventional treatments including surgical debridement and antibiotics. Further evaluation identified an NFKB1 mutation associated with hyperinflammatory states. Targeted treatment with Anakinra, an interleukin (IL)-1 receptor antagonist, resulted in rapid wound healing and normalization of inflammatory markers. Subsequent serial rod expansions, pretreated with Anakinra, were complication-free, and the patient remained stable for 4 years post treatment. This case emphasizes the critical role of genetic predispositions, such as NFKB1 mutations, in postoperative complications. Dysregulated IL-1β activity was effectively managed with targeted immunomodulation, highlighting the importance of recognizing and addressing non-infectious hyperinflammatory processes. Patients presenting with very early wound dehiscence, disproportionate inflammatory responses, and unresponsiveness to infection management may benefit from detailed immunologic evaluation. Rare hyperinflammatory conditions should be considered in the differential diagnosis of challenging postoperative wound healing scenarios.
Giant-cell rich osteosarcoma: A report of 3 cases depicting a diagnostic challenge requiring serious attention.
Çiftdemir M, Ünyilmaz C, Ustabaşioğlu FE … +1 more , Usta U
Acta Orthop Traumatol Turc · 2025 May · PMID 40536367 · Full text
Giant cell-rich osteosarcoma (GCRO) is a rare variant of osteosarcoma with unusual radiological and histopathological features that make its diagnosis challenging. The most critical and unusual feature of GCRO is that it...
Giant cell-rich osteosarcoma (GCRO) is a rare variant of osteosarcoma with unusual radiological and histopathological features that make its diagnosis challenging. The most critical and unusual feature of GCRO is that it has a purely osteolytic appearance. Therefore, GCRO cases are frequently subject to delayed diagnosis or incorrect treatment owing to misdiagnosis. This negatively affects the prognosis of these patients. In this study, 3 young adult cases are presented. The first case describes a young female patient who underwent repeated curettages due to a misdiagnosis of a giant-cell bone tumor, and the second case describes a delay in diagnosis in a young male patient who was misdiagnosed with an aneurysmal bone cyst. The final case report describes a young woman who was diagnosed early, treated promptly, and had a good prognosis. One of the poor prognosis cases in this report was treated with amputation, and the other was alive with multiple metastases. Misdiagnosis or delayed diagnosis leads to a poor prognosis in such cases. To make a diagnosis, it is necessary to have knowledge and to be suspicious of the radiological features of this rare variant. Giant cell-rich osteosarcoma should be among the differential diagnosis options when dealing with pure metaphysiodiaphyseal osteolytic bone lesions in young adults. To avoid misdiagnosis or delay, it is necessary to have knowledge and to be suspicious of this rare variant. Level of Evidence: Level IV, Therapeutic study.
Combined coracoclavicular ligament and transacromial capsule reconstruction for chronic acromioclavicular joint instability: clinical and radiological outcomes.
Bascı O, Duymaz B, Erdogdu IN … +1 more , Mustafa H O
Acta Orthop Traumatol Turc · 2025 May · PMID 40536360 · Full text
Objective: Acromioclavicular (AC) joint instability remains a challenging clinical problem, particularly in chronic cases where both vertical and horizontal stability must be restored. Traditional techniques have limitat...
Objective: Acromioclavicular (AC) joint instability remains a challenging clinical problem, particularly in chronic cases where both vertical and horizontal stability must be restored. Traditional techniques have limitations in addressing multidirectional instability and minimizing implant-related complications. The aim of this study was to evaluate the clinical and radiological outcomes of a combined coracoclavicular (CC) ligament and transacromial capsule reconstruction technique in patients with chronic AC joint instability. Methods: A retrospective study was performed on 40 patients who underwent AC joint reconstruction at a single center from 2019 to 2023. Radiological outcomes (clavicle-coracoid distance) were evaluated preoperatively, immediately postoperatively, and at the last follow-up (6 months). Functional results were assessed using the Constant, American Shoulder and Elbow Surgeons score (ASES), and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Data were analyzed using SPSS v28.0. T-tests and repeated measures of Analysis of Variance (ANOVA) were employed to compare outcomes, with significance set at P < .05. Results: The preoperative mean CC distance was 20.3 ± 3.4 mm. Early postoperative measurements showed a significant reduction in CC distance, with a mean of 9.5 ± 1.5 mm in the capsule reconstruction group compared to 10.5 ± 1.6 mm in the non-reconstruction group (P=.053). At the 6-month follow-up, the late postoperative CC distance was maintained at 10.1 ± 1.6 mm in the reconstruction group, while it increased to 14.4 ± 2.0 mm in the non-reconstruction group (P < .001). The mean ASES score was 87.1 ± 8.1. The mean Constant score was 86.2 ± 7.6. Pain levels, evaluated using the Visual Analog Scale (VAS), decreased from a mean of 5.8 ± 1.2 preoperatively to 2.1 ± 1.0 postoperatively, indicating significant pain relief and improved functionality. No hardware failure or infection was noted. About 12.5% of patients experienced short-term anterior knee pain. Conclusion: The results of this study demonstrate that combined CC ligament and transacromial capsule reconstruction improves radiographic outcomes by maintaining the clavicle-coracoid distance and enhances functional scores (ASES and Constant) in patients with chronic AC joint instability. Addressing both vertical and horizontal instability appears to contribute to better short-term clinical recovery. Further studies with larger sample sizes and longer follow-up are needed to confirm these findings. Level of evidence: Level III (Retrospective Comparative Study).
A new perspective on forefoot biomechanics: the dual arch structure of the metatarsal transverse arch and the trimaran effect.
Bayraktar D, Ozyalcin A, Ozyalcin MH
Acta Orthop Traumatol Turc · 2025 May · PMID 40536284 · Full text
Objective: The structure and function of the Metatarsal Transverse Arch (MTA) remain underexplored. It was hypothesized that, during the push-off phase of gait, the MTA does not form a single arch between the first and f...
Objective: The structure and function of the Metatarsal Transverse Arch (MTA) remain underexplored. It was hypothesized that, during the push-off phase of gait, the MTA does not form a single arch between the first and fifth metatarsals; rather, it consists of 2 separate arches-one spanning the first to the third metatarsals and the other spanning the third to the fifth metatarsals-that function like the hulls of a trimaran boat. This study aims to investigate the biomechanical role of the MTA during this critical phase. Methods: Dynamic pedobarographic measurements were utilized from 1250 adults (847 females, 403 males). Maximum pressures on all metatarsal heads during the push-off phase were recorded, and MTA arches were calculated using the SAP2000 program. Statistical significance was set at P < .05. Results: The mean pressure on the third metatarsal was 160.0 (minimum: 9.0, maximum: 1799.0) for the left foot and 142.0 (minimum: 0.0, maximum: 1753.0) for the right foot. The maximum pressure in both feet occurred at the third metatarsal head (left: 67.0%, right: 54.6%). There was no statistically significant difference between genders regarding the maximum load on the metatarsal heads. Conclusion: This study reinterprets the biomechanical behavior of the forefoot and MTA during the push-off phase, potentially aiding in the understanding of forefoot pathologies. Future research on children and adolescents could further illuminate forefoot biomechanics. Level of Evidence: Level III.
Functional outcome comparison of single-radius and multi-radius femur in total knee arthroplasty.
Şentürk F, Demirel M, Yenigün MY … +3 more , Canbolat N, Sağlam Y, Şen C
Acta Orthop Traumatol Turc · 2025 May · PMID 40536261 · Full text
Objective: The aim of this study is to compare the clinical and functional results of single-radius (SR) and multi-radius (MR) femoral components in total knee arthroplasty (TKA). Methods: A total of 74 patients who unde...
Objective: The aim of this study is to compare the clinical and functional results of single-radius (SR) and multi-radius (MR) femoral components in total knee arthroplasty (TKA). Methods: A total of 74 patients who underwent TKA surgery by a single surgeon between 2018 and 2021 were included in the study. The patients were then divided into 2 groups according to their femoral component design: group SR (38 patients) and group MR (36 patients). Except for gender and follow-up duration (P < .05), no significant difference was observed in age, American Society of Anesthesiologists scores, and BMI (P > .05). Knee range of motion, visual analogue scale (VAS), and combined KSS (Knee Society Score) were evaluated at the preoperative and final controls of the patients. In addition, frequency of anterior knee pain (AKP), AKP scale, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Hospital for Special Surgery (HSS) score, and the Forgotten Joint Score-12 (FJS12) were evaluated at the final follow-up. Results: There was no difference between the 2 groups in terms of postoperative range of motion (ROM), VAS, combined KSS, and HSS (P > .05). The frequency of AKP in patients with SR was found to be statistically lower than those with MR (P=.021; P < .05). The AKP scale was found to be statistically significantly lower in patients with prosthetic type MR compared to patients with SR (P=.04; P < .05). Singleradius patients had significantly better FJS-12 (P=.014; P < .05) and WOMAC scores (P=.003; P < .05). Conclusion: The results of this research showed that good clinical and functional results are obtained with TKA regardless of the femoral component design. Single-radius prostheses show better results than MR prostheses in terms of the frequency and severity of AKP. While there is no difference between femoral designs in terms of TKA-specific functional results such as KSS and HSS, the WOMAC score, which measures disease-related functions, provides better clinical results in SR designs. Additionally, SR designs show significantly better results in functional scores indicating patient satisfaction, such as FJS-12.
Comparison of general and spinal anesthesia on outcomes of direct anterior approach total hip arthroplasty: a prospective observational study.
Incesoy MA, Demırkıran CB, Aliyev O … +5 more , Pulatkan A, Yabaci Tak A, Yesıltas S, Tuncay I, Yıldız F
Acta Orthop Traumatol Turc · 2025 May · PMID 40536242 · Full text
Objective: This study aimed to evaluate the impact of spinal anesthesia (SA) compared to general anesthesia (GA) on clinical outcomes in patients undergoing direct anterior approach total hip arthroplasty (DAA-THA) at a...
Objective: This study aimed to evaluate the impact of spinal anesthesia (SA) compared to general anesthesia (GA) on clinical outcomes in patients undergoing direct anterior approach total hip arthroplasty (DAA-THA) at a single institution. Methods: This prospective observational study was conducted at a single institution between 2014 and 2017. A total of 437 patients who underwent primary elective DAA-THA were included. Among them, 363 patients received SA, and 74 patients received GA. Demographic characteristics (age, sex), comorbidities, American Society of Anesthesiologists (ASA) scores, and preoperative hematocrit levels were recorded. The mean age was 59.4 years (range, 26-82 years), and 67.3% of the patients were female. The primary outcome measures included complication rates, estimated blood loss (EBL), changes in hematocrit, length of hospital stay (LOS), duration of surgery, acetabular and femoral component orientation, and stem subsidence. Results: No significant differences were found between the GA and SA groups regarding median EBL (0.9 L vs. 0.9 L, P=.675), hematocrit change (-8.12% vs. -7.70%, P=.727), mean duration of surgery (103 min vs. 105 min, P=.999), and LOS (3.5 days vs. 3.6 days, P=.462). Radiological outcomes, including femoral stem varus/valgus alignment (0.2° vs. 0.3°, P=.877), stem subsidence (0.9 mm vs. 1.0 mm, P=.111), and acetabular component abduction angles (42° vs. 43°, P=.475), were also comparable. The overall complication rates were 8% in the GA group and 5% in the SA group (P=.400). Conclusion: Both general and spinal anesthesia can be safely utilized in DAA-THA, providing comparable clinical and radiological outcomes. The choice of anesthesia did not significantly affect surgical time, blood loss, or complication rates. These findings are clinically relevant for optimizing anesthesia strategies in DAA-THA, offering flexibility for both surgeons and anesthesiologists without compromising patient outcomes. Level of Evidence: Level II, Therapeutic Study.
The relationship between pain and activity participation, quality of life and depression symptoms in traumatic hand injuries.
Kablanoğlu S, Sade SI
Acta Orthop Traumatol Turc · 2025 May · PMID 40536063 · Full text
Objective: This study aimed to investigate the relationship between post-traumatic pain levels in patients with hand-wrist injuries and symptoms of depression, activity participation, and quality of life. Methods: The st...
Objective: This study aimed to investigate the relationship between post-traumatic pain levels in patients with hand-wrist injuries and symptoms of depression, activity participation, and quality of life. Methods: The study included 44 patients who presented to the Physical Therapy and Traumatic Hand Injury Outpatient Clinic with various diagnoses of traumatic hand injuries. Eligible patients had sustained traumatic hand injuries up to 10 cm proximal to the wrist, had no prior diagnosis of depression, and presented to the clinic for the first time between postoperative days 3 and 10. Pain severity was assessed using the Visual Analog Scale (VAS), activity participation was evaluated with the Quick Disability of the Arm, Shoulder, and Hand Questionnaire (Q-DASH), health-related quality of life was measured with the European Quality of Life Five Dimension Five Level Scale (EQ-5D-3L), and depression symptoms were assessed using the Beck's Depression Inventory (BDI). Results: All patients included in the study had at least one injured structure. The majority of the patients were male and worked in blue-collar occupations. The depressive symptoms were classified as moderately severe (BDI score ≥ 17). Among the injured structures, tendon injuries were the most common, and post-traumatic injuries were the most frequently observed type. Visual Analog Scale scores were significantly higher in tendon-fracture and tendon-nerve injuries compared to tendon injuries alone (P=.038 and P < .001, respectively). Quick Disability of the Arm, Shoulder, and Hand Questionnaire scores were significantly higher in tendon-nerve injuries than in tendon injuries (P < .001). Beck's Depression Inventory scores were significantly higher in tendon-nerve injuries than in bone and tendon injuries (P=.006 and P < .001, respectively). European Quality of Life Five Dimension Five Level Scale index scores were significantly lower in tendon-nerve injuries compared to bone and tendon injuries (P=.002 and P < .001, respectively). Correlation analysis revealed that VAS, QuickDASH, and BDI scores were not correlated with age. However, there was a strong positive correlation between VAS and QuickDASH scores, VAS and BDI scores, and QuickDASH and BDI scores. Conclusion: The findings suggest that pain management and psychological support interventions should be integrated into the rehabilitation process for patients with traumatic hand injuries. Addressing both pain and depressive symptoms during recovery may help minimize their negative impact on quality of life and improve activity participation. Level of Evidence: Level IV, Prognostic Study.
Challenges and influencing factors in hand surgery subspecialty training: a nationwide survey of orthopedic, plastic, and hand surgery residents in Türkiye.
Okkan M, Çaltıner İ, Saygılı AT … +2 more , Yıldıran G, Bağır M
Acta Orthop Traumatol Turc · 2025 May · PMID 40536062 · Full text
Objective: This study aimed to identify the factors influencing the decisions of orthopedic and plastic surgery residents in Türkiye regarding their pursuit of a subspecialty in hand surgery, as well as to evaluate the c...
Objective: This study aimed to identify the factors influencing the decisions of orthopedic and plastic surgery residents in Türkiye regarding their pursuit of a subspecialty in hand surgery, as well as to evaluate the challenges faced during hand surgery training. Methods: A national survey was conducted among residents in orthopedic and trauma surgery (n=92), plastic surgery (n=84), and hand surgery (n=12). The survey, developed from literature reviews and previous studies, was distributed online, and responses were collected via Google Forms. Orthopedic and plastic surgery residents responded using a 4-point Likert scale, while hand surgery residents answered multiple-choice questions. The collected data were analyzed to determine factors influencing career choices, training adequacy, and the challenges faced by residents. Results: The analysis revealed a negative correlation between the high volume of emergency hand surgery cases and residents' inclination toward the subspecialty (r=-0.217, P < .05). Theoretical training was significantly linked to enhanced hand surgery knowledge and skills (r=0.213, P < .05), whereas the lack of adequate training infrastructure negatively affected residents' experience (r=0.390, P < .05). Financial concerns and heavy workloads were identified as major challenges, with 33.3% of hand surgery subspecialty residents considering quitting their program. The study also highlighted a lack of continuity in training, insufficient exposure to elective hand surgery cases, and limited access to international educational opportunities. Conclusion: The findings indicate a need to enhance both the theoretical and practical aspects of hand surgery training in Türkiye. By addressing financial and workload-related concerns, improving clinical exposure, and expanding access to microsurgical tools and training resources, it may be possible to increase interest in the subspecialty and ensure a sustainable workforce of hand surgeons in the future. Level of Evidence: N/A.
Effects of traumatic brain injury on vascular response and fracture healing: an experimental study in a rat model.
Mehmet Y, Ahmet Nadir A, Bolukbası Hatip FF … +4 more , Altunay ZM, Mete GA, Bilgen M, Demirkan F
Acta Orthop Traumatol Turc · 2025 May · PMID 40535310 · Full text
Objective: This study aimed to investigate the effects of traumatic brain injury (TBI) on vascular response and fracture healing during recovery. Methods: In this experimental animal study, a total of 63 male Wistar albi...
Objective: This study aimed to investigate the effects of traumatic brain injury (TBI) on vascular response and fracture healing during recovery. Methods: In this experimental animal study, a total of 63 male Wistar albino rats (200-250 g) were randomly assigned to 3 groups: TBI with tibia fracture (TBI+Fx, n=21), tibia fracture only (Fx only, n=21), and a control group (n=21). Traumatic brain injury was induced in the motor cortex using a controlled impact device, followed by the tibia fracture. The severity of TBI was assessed using rotarod tests. Blood samples were collected on days 1, 7, and 21 post-fracture, while brain and tibia samples were taken on day 21 following decapitation. Levels of antidiuretic hormone (ADH) and angiotensin 1-7 (Ang 1-7) were quantified using Enzyme-linked immunosorbent assays (ELISA). Fracture healing was assessed through micro-CT and histopathological analysis. Aortic segments were evaluated for contractile response and relaxation in isolated organ baths. Results: Micro-CT analysis revealed significantly greater bone volume (BV) (P=.02) and trabecular number (P=.038) in the TBI+Fx group. Histopathological healing scores were also significantly higher in the TBI+Fx group compared to the Fx only group (P=.019). Potassium chloride (KCl) induced contractile responses were greater in the Fx only group than in the TBI+Fx group (P < .05). Acetylcholine (ACh) induced relaxation was diminished in both Fx and TBI+Fx groups compared to controls (P < .01), whereas sodium nitroprusside (SNP)-induced relaxation was significantly greater in the TBI+Fx group than in the Fx only and control groups (P < .05). On day 21, arginine vasopressin (AVP) levels were significantly higher in the Fx only group compared to the TBI+Fx group (P=.034), with no significant differences observed on days 1 and 7. Plasma Ang 1-7 levels were significantly elevated in the Fx only group on day 21 compared to the TBI+Fx group (P < .05). Conclusion: Traumatic brain injury was associated with accelerated fracture healing, as evidenced by increased BV, trabecular thickness, and histopathological healing scores. Additionally, TBI appeared to modulate vascular function, possibly via mechanisms involving nitric oxide and calcium signaling. These findings suggest that neuroendocrine changes following TBI may enhance fracture healing, offering potential clinical insights for managing polytrauma patients. Level of Evidence: N/A.
A rare case of a mature intramedullary cystic teratoma in an adult female: A case report and literature review.
Zhang Q, Liu X, Li H
Acta Orthop Traumatol Turc · 2025 Apr · PMID 40357903 · Full text
A 51-year-old female with a 10-year history of progressive low back pain presented with a 9 × 15 mm circular tumor adjacent to L1 on preoperative magnetic resonance imaging. The lesion was successfully removed by T12-L2...
A 51-year-old female with a 10-year history of progressive low back pain presented with a 9 × 15 mm circular tumor adjacent to L1 on preoperative magnetic resonance imaging. The lesion was successfully removed by T12-L2 laminectomy and nail-rod fixation. Histopathological examination diagnosedmature intramedullary cystic teratoma. At 6-month follow-up, right lower limb numbness and pain were reduced.
A quantitative analysis of symmetry on standard anteroposterior pelvic X-ray.
Yilmaz A, Selcuk T, Aksoy T … +1 more , Atilla B
Acta Orthop Traumatol Turc · 2025 Apr · PMID 40357874 · Full text
Objective: A pelvic X-ray examination might not be accomplished accurately if the images are not acquired properly. In this study, the aim was to develop an automated model using artificial intelligence capable of accura...
Objective: A pelvic X-ray examination might not be accomplished accurately if the images are not acquired properly. In this study, the aim was to develop an automated model using artificial intelligence capable of accurately quantifying the symmetry of the obturator foramen in a pelvic anteroposterior X-ray and determining its suitability for evaluation. Methods: After applying the exclusion criteria, the study included 513 pelvic X-rays. An automated model was developed in the second stage to identify the iliac wings and obturator foramen. After that, calculations were performed to evaluate the obturator foramen's symmetry using the Dice, Jaccard, and Cosine similarity indices. Finally, the symmetry values determined by the physician and the suggested system were compared statistically. Results: The symmetry values found using the suggested model varied from 0.58 to 0.89. There was no statistically significant difference in the symmetry values of the obturator foramen as determined by the automated approach and the observer physician, as indicated by 3 distinct similarity indices (P=.68, P=.6, and P=.96). Conclusion: The artificial intelligence model successfully evaluated the appropriateness of the pelvic X-ray in terms of obturator foramen symmetry. Level of Evidence: Level III, Diagnostic Study.
Presence of sacralized lumbar vertebra predisposes to adjacent level lumbar disc degeneration: A cross-sectional study.
Bayram S, Altin YF, Kahraman A … +3 more , Yağci TF, Korkmaz M, Akgül T
Acta Orthop Traumatol Turc · 2025 Apr · PMID 40357873 · Full text
Objective: This study aimed to examine the relationship between lumbosacral transitional vertebra (LSTV), classified by Castellvi's system, and lumbar disc degeneration, graded using Pfirrmann's classification, based on...
Objective: This study aimed to examine the relationship between lumbosacral transitional vertebra (LSTV), classified by Castellvi's system, and lumbar disc degeneration, graded using Pfirrmann's classification, based on radiological assessment. Methods: This retrospective study analyzed 2516 patients (1548 females and 968 males) with a mean age of 51.83 ± 15.6 years with chronic low back pain who underwent lumbosacral magnetic resonance imaging and computed tomography scans at a single center between January 2018 and January 2021. Pfirrmann grading was used to assess L4-L5 intervertebral disc degeneration, and Castellvi classification determined the anatomical type of LSTV. Correlation analysis was performed to evaluate the association between LSTV presence and disc degeneration. Additionally, a proportional-odds ordinal logistic regression model was used to examine the relationship between Pfirrmann grade and patient-specific factors (age, gender, and LSTV presence). Results: According to Pfirrmann classification, 113 patients were grade I, 402 were grade II, 877 were grade III, 861 were grade IV, and 263 were grade V. A total of 771 patients (30.6%) did not have LSTV, while the remaining 1745 patients (69.4%) had LSTV. A statistically significant association was found between LSTV presence and Pfirrmann grade (P < .001, r=.200). Patients with LSTV had 0.75 times higher probability (95% CI: 0.58-0.90, P < .001) of exhibiting a higher Pfirrmann grade compared to those without LSTV. However, no significant correlation was observed between LSTV subtypes classified by Castellvi and Pfirrmann grade (P=.379). Additionally, age was significantly correlated with Pfirrmann classification, LSTV presence, and Castellvi classification (P < .001). Female patients had 1.34 times higher likelihood (95% CI: 1.19-1.49, P < .001) of exhibiting a higher Pfirrmann grade compared to male patients. Conclusions: This study highlights the significant association between LSTV and advanced disc degeneration, establishing LSTV as a potential risk factor for progressive spinal changes. It emphasizes the importance of early detection and targeted management, particularly for older adults and females who are more susceptible to severe degenerative changes. Level of Evidence: Level III, Prognostic Study.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe