Acta Orthopaedica Et Traumatologica Turcica[JOURNAL]
Sun
200 papers
Role of Piezo2/P2X7/MG pathway in synaptic plasticity and analgesic effects of massage therapy in cervical spondylotic radiculopathy: A preclinical study in animal models.
Jiang X, Yang S, Duan X … +8 more , Liao K, Li S, Qiu Z, Tan J, Xie L, Xiao Y, Yang J, Zhou K
Acta Orthop Traumatol Turc · 2025 Apr · PMID 40357846 · Full text
Objective: This study aimed to investigate the synaptic plasticity of the spinal dorsal horn regulated by the Piezo2/P2X7/MG signaling pathway and elucidate its role in the analgesic effects of massage in Cervical Spondy...
Objective: This study aimed to investigate the synaptic plasticity of the spinal dorsal horn regulated by the Piezo2/P2X7/MG signaling pathway and elucidate its role in the analgesic effects of massage in Cervical Spondylotic Radiculopathy (CSR), with the goal of identifying potential therapeutic targets for effective treatment. Methods: This experimental animal study included 40 Sprague-Dawley rats (180 ± 20 g), randomly divided into four groups (control, model, sham-operated, and massage; n=10 per group) after a one-week acclimation period. The CSR model was established by spinal canal insertion. Blood and spinal cord tissues were collected post-intervention. Mechanical pain threshold (MPT), 50% paw withdrawal threshold (50% PWT), immunofluorescence, Western blot, and qRT-PCR assays were employed to evaluate synaptic plasticity and pathway expression. Results: The massage group demonstrated significantly higher MPT and 50% PWT values compared to the model group post-intervention (P < 0.05). Downregulation of the Piezo2/P2X7/MG signaling pathway was observed in the massage group, correlating with a reduction in CSR progression, while upregulation in the model group promoted CSR (P < 0.05). Conclusion: The Piezo2/P2X7/MG signaling pathway regulates the synaptic plasticity of the spinal dorsal horn in CSR. These findings suggest that massage therapy can effectively alleviate CSR-associated pain by modulating this pathway, offering a potential noninvasive therapeutic approach.
The dose-dependent effect of tranexamic acid on epidural fibrosis after laminectomy: an experimental study on rats.
Baris A, Circi E, Ozmen E … +3 more , Ozmen HI, Yuksel S, Beytemur O
Acta Orthop Traumatol Turc · 2025 Apr · PMID 40357816 · Full text
Objective: This study aimed to evaluate the dose-dependent efficacy of tranexamic acid (TXA) in preventing epidural fibrosis in a rat laminectomy model and explore its potential as a therapeutic intervention for postoper...
Objective: This study aimed to evaluate the dose-dependent efficacy of tranexamic acid (TXA) in preventing epidural fibrosis in a rat laminectomy model and explore its potential as a therapeutic intervention for postoperative fibrosis in spinal surgery. Methods: In this experimental animal study, 32 female Wistar-Albino rats were randomized into four groups (control, 10 mg/kg TXA, 30 mg/kg TXA, and 100 mg/kg TXA; n=8 per group). Following a standardized laminectomy procedure, TXA was administered intravenously as a loading dose through the tail vein prior to surgery. The rats were sacrificed at the 4th-week post-surgery, the lumbar vertebrae were excised en bloc, and epidural fibrosis, inflammatory cell density, and fibroblast density were assessed histologically. Results: High-dose TXA (100 mg/kg) significantly reduced epidural fibrosis compared to the control (p=0.004), 10 mg/kg (p=0.002), and 30 mg/kg TXA groups (p=0.03). While the 30 mg/kg group showed lower epidural fibrosis grades compared to the control, the difference was not statistically significant. No significant differences were observed in inflammatory or fibroblast densities across groups. Conclusion: High-dose TXA (100 mg/kg) effectively reduced epidural fibrosis in a dose-dependent manner, demonstrating potential as a systemic therapeutic option to improve postoperative outcomes in spinal surgery.
Dose-independent adverse effects of corticosteroid injections on rotator cuff healing in a rat model.
Şahin H, Akalın Y, Çevik N … +3 more , Avci Ö, Sağlıcak H, Öztürk A
Acta Orthop Traumatol Turc · 2025 Apr · PMID 40357630 · Full text
Objective: The aim of this experimental study in a rat model was to investigate the biomechanical and histological effects of subacromial corticosteroid injections on the healing of the tendon-bone junction after repair...
Objective: The aim of this experimental study in a rat model was to investigate the biomechanical and histological effects of subacromial corticosteroid injections on the healing of the tendon-bone junction after repair in the rotator cuff tear model. Methods: A total of 48 rats were divided into 3 groups: the control group, the single-dose steroid group, and the 4-dose steroid group. The supraspinatus tendon was completely dissected from the footprint attachment site and repaired. Saline was injected into the subacromial area in the control group, while 0.6 mL-4.8 mg/kg of single-dose methylprednisolone was applied to the single-dose group, and the same dose was applied 4 times at 1-week intervals to the 4-dose steroid group. All animals were allowed unrestricted movement during this period, and all animals were sacrificed by cervical dislocation 4 weeks after the last dose in the 4-dose steroid group. Cell shape and the number of apoptotic cells were assessed histopathologically, and the fracture load, maximum stress, and energy absorption were assessed biomechanically. Results: There were no significant differences in terms of cell shape between the groups. There was a significant difference in the mean number of apoptotic cells in the control group and in the single-dose and 4-dose steroid groups (P=.028). There was a 36% reduction in the mean number of apoptotic cells in the steroid groups compared to the control group. In the biomechanical evaluation, no differences were found between the groups in terms of maximum tension or breaking load (n.s.). A significant difference was found when the 3 groups were compared in terms of energy absorption (P=.001). There was a significant difference in energy absorption between the control group and the steroid-treated groups, but there was also a significant difference between the single-dose group and the 4-dose group (P=.038). Conclusion: The administration of corticosteroids was found to have a negative effect on healing at the tendon-bone junction, but this effect did not vary with the number of steroid injections. From a biomechanical perspective, it was observed that the energy absorption at the surgical repair site was lower with corticosteroid administration, and this negative effect increased with the increasing number of injections.
Glenoid-version-measurement methods on magnetic resonance imaging: accuracy and reliability analysis.
Karademir G, Tunalı O, Atalar AC
Acta Orthop Traumatol Turc · 2025 Apr · PMID 40357582 · Full text
Objective: Glenoid-version-measurement methods were initially defined for computed tomography (CT) but are now used for magnetic resonance imaging (MRI). However, their accuracy and reliability on MRI have not been thoro...
Objective: Glenoid-version-measurement methods were initially defined for computed tomography (CT) but are now used for magnetic resonance imaging (MRI). However, their accuracy and reliability on MRI have not been thoroughly investigated. The aim was to determine the accuracy of these methods on MRI and compare their reliability, hypothesizing that MRI could provide accurate measurements similar to CT using all 3 methods, with the Matsumura method having the highest reliability. Methods: Glenoid-version measurements of 40 patients (14 female, 26 males; mean age 46.5 ± 17.9 years) with glenohumeral instability were performed using the Friedman, Poon and Ting, and Matsumura methods on MRI. These measurements were compared to those on 3-dimensional corrected slices of CT scans to evaluate accuracy. Reliability was assessed by 2 observers who repeated MRI measurements after 2 months. Results: All methods demonstrated favorable accuracy. The Friedman and Matsumura methods exhibited good interobserver reliability [intraclass correlation coefficient (ICC)=0.78 (0.58-0.88) and 0.89 (0.79-0.94)], while the Poon and Ting method showed moderate reliability [ICC=0.71 (0.44-0.84)]. Intraobserver reliability was excellent for the Matsumura method [Observer 1 ICC=0.96 (0.93-0.98), Observer 2 ICC=0.86 (0.95-0.99)], good for Friedman [Observer 1 ICC=0.77 (0.57-0.88), Observer 2 ICC=0.82 (0.67-0.91)], and moderate to good for Poon and Ting [Observer 1 ICC=0.68 (0.39-0.83), Observer 2 ICC=0.82 (0.65-0.9)]. Conclusion: All 3 methods can be used confidently for MRI measurements, matching the accuracy of CT scans. The Friedman and Matsumura methods demonstrated higher interobserver and intraobserver reliabilities. Level of evidence: Level III, diagnostic study.
Efficacy of hyaluronic acid and conditioned serum in acute rotator cuff tear repair: A rat model study.
Önel Y, Şahin E, Akpolat Ferah M … +3 more , Sezgin A, Mammadov İ, Bilgin B
Acta Orthop Traumatol Turc · 2025 Apr · PMID 40356568 · Full text
Objective: This study aimed to compare the e!ects of local hyaluronic acid (HA) and autologous conditioned serum (ACS) on the repair of acute rotator cu! (RC) tears and their impact on functional outcomes, specifically o...
Objective: This study aimed to compare the e!ects of local hyaluronic acid (HA) and autologous conditioned serum (ACS) on the repair of acute rotator cu! (RC) tears and their impact on functional outcomes, specifically on running performance. Methods: In this study, 25 male Wistar Albino rats, aged 16 weeks and weighing 350-400 g, were used. The rats were divided into 4 groups (n = 6 per group). Group A was the sham group, and the 3 treatment groups were as follows: group B (primary repair), group C (primary repair + ACS), and group D (primary repair + HA). A standardized procedure was used to create an acute tear-and-repair model of the RC in each treatment group. The rats in group B received no injections. Group C received ACS 24, 48, and 72 h after surgery. Patients in group D received a single dose of HA at the operative site. After a 4-week follow-up period, the rats were subjected to an exercise protocol using a computer-monitored motorized treadmill. For each treadmill run, shocks were recorded as one penalty point using a computer (one point per shock). Subsequently, the rats were sacrificed and bone-tendon healing in each group was assessed histopathologically. Results: Group A had the lowest penalty points in the final run and the highest penalty points. The best performance among the surgical groups was observed in group D. Groups C and D received fewer penalty points than group B. Group D received fewer penalty points than group C; however, there was no significant di!erence between them in pairwise comparisons (P = .132). When the statistical analysis of histological parameters was conducted, excluding the sham group, the least inflammation was observed in group D. Pairwise analysis between groups D and B revealed significantly fewer inflammatory cells in group D (P = .026). After pairwise analysis between groups, no significant di!erences were found in terms of fibroblastic proliferation, neovascularization, or fibrosis. Conclusion: This study has shown that HA application in an acute RC tear repair model significantly reduced inflammation, acceler- ated tendon healing, and markedly improved running performance by reducing pain. Additionally, immunohistochemical evaluations revealed that following HA application, collagen fibers were reorganized, forming a regular and tight connective tissue structure.
Biomechanical comparison of rotator cuff repair techniques in osteoporotic conditions: testing a novel technique.
Eskara H, Keskin A, Tatar Y … +3 more , Gercek N, Imren Y, Dedeoglu SS
Acta Orthop Traumatol Turc · 2025 Apr · PMID 40356567 · Full text
Objective: This study aimed to compare the biomechanical characteristics of conventional transosseous equivalent (TOE) techniques with those of the novel free independent double-row medial fixation method, using rigid po...
Objective: This study aimed to compare the biomechanical characteristics of conventional transosseous equivalent (TOE) techniques with those of the novel free independent double-row medial fixation method, using rigid polyurethane (PU) foam blocks to simulate osteoporotic humerus bone. Methods: In this biomechanical study, 4 groups were tested using rigid PU foam blocks with osteoporotic properties and bovine infraspinatus tendons to simulate the rotator cuff. Groups 1 and 2 employed conventional TOE techniques: medial row knotted repair and knotless repair, respectively. Groups 3 and 4 utilized the "free independent double-row medial fixation method," differing in the order of suture tying. Several biomechanical characteristic and pressure parameters were measured. Results: Groups 3 (0.16 ± 0.04 MPa) and 4 (0.17 ± 0.05 MPa) achieved significantly higher initial contact pressure compared to standard TOE techniques (P=.039). While contact area (Group 3: 102.4 ± 55.0 mm², Group 4: 110.4 ± 37.2 mm²) and ultimate failure force (Group 3: 212.0 ± 26.5 N, Group 4: 214.7 ± 30.2 N) were relatively higher, the differences were not statistically significant (P=.135 and P=.3, respectively). The overall failure types included medial anchor pullout (40%) and suture/tendon stripping (32.5%), with no significant differences among groups (P=.260). Conclusion: With superior contact pressure and comparable ultimate failure and contact area measurements, the novel independent double-row medial fixation technique may be a viable alternative to conventional TOE techniques for enhancing medial row stability in osteoporotic conditions. Level of Evidence: N/A.
Does biceps tenodesis screw with forked eyelet decrease the risk of Popeye deformity when compared to traditional closed eyelet screws?
Caliskan E, Buyukdoğan K, Eren I … +3 more , Birsel O, Aslan L, Demirhan M
Acta Orthop Traumatol Turc · 2025 Apr · PMID 40356546 · Full text
Objective: While many biomechanical studies have compared various biotenodesis materials for biceps tenodesis, there is a lack of research comparing different types of interference screws. This study aimed to compare the...
Objective: While many biomechanical studies have compared various biotenodesis materials for biceps tenodesis, there is a lack of research comparing different types of interference screws. This study aimed to compare the impact of a polyether ether ketone (PEEK) forked eyelet tenodesis screw with the traditional PEEK closed eyelet whipstitching technique. The focus was on evaluating the occurrence of Popeye deformity, which is an objective predictor of a successful arthroscopic suprapectoral long head of biceps tenodesis. Methods: A retrospective analysis was conducted on patients who underwent arthroscopic rotator cuff repair and biceps tenodesis performed by a single surgeon between January 2010 and 2020 at a single center. The follow-up period was at least 1 year. Exclusion criteria included previous shoulder surgery and osteoarthritis. Patients were divided into 2 groups based on the type of tenodesis anchor used: forked eyelet tenodesis screw versus closed eyelet tenodesis screw. The occurrence of Popeye deformity was compared between the 2 groups. Results: A total of 82 patients who underwent arthroscopic rotator cuff repair and biceps tenodesis were evaluated, with a mean follow-up of 24.5 ± 4 months. The patients operated on using forked eyelet tenodesis screw were labeled as Group I (n=72) and those with traditional PEEK closed eyelet screw as Group II (n=10). There were no significant differences between the groups in terms of age (Group I: 59.4 ± 5, Group II: 58.4 ± 4, P=.896), gender (both groups predominantly male, P=.886), and body mass index (Group I: 26.7 ± 2, Group II: 27 ± 3; P=.896). The overall rate of popeye deformity in all patients was 8% (n=7). No significant difference in popeye deformity occurrence was observed between the 2 groups (Group I: 6/72 (8.3%), Group II: 1/10 (10%); P=.998). Conclusion: The incidence of Popeye deformity after arthroscopic biceps tenodesis in patients undergoing concomitant rotator cuff repair is low. The choice of fixation anchor, whether a forked eyelet or closed eyelet PEEK anchor, does not significantly influence the occurrence of Popeye deformity. Level of Evidence: Level III, Therapeutic study.
Clinical outcomes of distraction (gap) arthroplasty as an alternative to arthrodesis for septic hand arthritis with osteomyelitis.
Lipatov K, Asatryan A, Melkonyan G … +4 more , Kazantcev A, Solov'eva E, Gorbacheva I, Voinov M
Acta Orthop Traumatol Turc · 2025 Mar · PMID 40338018 · Full text
OBJECTIVE: Septic arthritis of the hand often leads to sti!ness or even complete loss of joint function. Septic arthritis with osteomyelitis is especially severe. In this case, most experts recognize the need to perform...
OBJECTIVE: Septic arthritis of the hand often leads to sti!ness or even complete loss of joint function. Septic arthritis with osteomyelitis is especially severe. In this case, most experts recognize the need to perform arthrodesis. This study is devoted to another way of solving this problem. METHODS: The results of treatment of 240 patients (255 joints) treated for septic arthritis of the hand were retrospectively analyzed. In most cases, septic arthritis with osteomyelitis was noted-145 (56.9%). All patients were operated on. After resection of osteochondral structures, in most cases, the developed method named distraction (gap) arthroplasty was used. Mid-term results were assessed within 7 months (interquartile range [IQR]: 4-9). Finger function was assessed using the total active motion (TAM) system. RESULTS: With the development of osteomyelitis, the delay in treatment was longer than in patients without osteomyelitis: 13 days (IQR: 4-22). Tendon destruction, which prevents the restoration of joint function, was observed in 12 (4.7%) cases. After rehabilitation, the maximum median TAM was in patients after arthritis with osteomyelitis of the metacarpophalangeal (MCP) joint-68.1% (IQR: 50.1-86.2), 65.3% (IQR: 49.4-75.4), 60.8% (IQR: 58.7-72.4), and 63.8% (IQR: 51.7-71.9) after arthritis with osteomyelitis of the proximal interphalangeal (PIP) joint, distal interphalangeal (DIP) joint, and thumb interphalangeal (IP) joint, respectively. CONCLUSION: Septic arthritis of the hand is a severe disease that is often accompanied by the development of osteomyelitis, the spread of a purulent process to the paraarticular soft tissues, and sometimes the destruction of the tendons. It often leads to the need for arthrodesis or amputation of the finger. As an alternative to this, a treatment method named "distraction (gap) arthroplasty" after resection of the a!ected structures of the joint can be considered. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.
Clinical efficacy of Endobutton combined with mini-plate in the treatment of Neer IIB (IIC) type distal clavicle fracture.
Lin B, Dong Y, Wei L … +3 more , Du Y, Huang W, Zhang X
Acta Orthop Traumatol Turc · 2025 Mar · PMID 40338011 · Full text
OBJECTIVE: This study aimed to investigate the clinical outcomes of employing Endobutton with a mini-plate for managing Neer IIB (IIC) type distal clavicle fractures. METHODS: A retrospective case-control approach was ut...
OBJECTIVE: This study aimed to investigate the clinical outcomes of employing Endobutton with a mini-plate for managing Neer IIB (IIC) type distal clavicle fractures. METHODS: A retrospective case-control approach was utilized, examining clinical data from 62 patients with Neer IIB (IIC) type distal clavicle fractures treated at our institution from January 2018 to December 2022. Patients were divided into 2 groups: 32 treated with an Endobutton and a mini-plate (study group) and 30 with a clavicular hook steel plate (control group). Surgical metrics such as duration, incision length, and hospital stay were documented. Follow-up assessments included fracture healing, postoperative complications, and the necessity for secondary internal fixation removal. Preoperative and postoperative coracoclavicular distances (CCD) were recorded at various intervals. Pain and shoulder joint functionality were evaluated using the Visual Analog Scale (VAS) and Constant-Murley score. RESULTS: All patients successfully underwent surgery and were followed up. The follow-up period for the study group was 12-23 months (18.7 ± 2.7), and for the control group, it was 12-22 months (15.8 ± 1.6). The surgery duration was significantly shorter in the control group [(65.12 ± 9.88) minutes] compared to the study group [(82.58 ± 7.36) minutes, P < 0.05]. In comparison, the incision length in the control group was longer than that in the study group [(69.58 ± 6.43) mm vs. 58.24 ± 4.83 mm, P < .05]. There were no significant di!erences in hospital stay and fracture healing time between the 2 groups (P > .05). In the control group, all patients required secondary removal of internal fixation, while in the study group, only 1 patient needed it. Complications such as subacromial bone erosion, distal clavicle osteolysis, subacromial impingement with shoulder pain, and skin irritation were observed in the control group, while only skin irritation due to thinness was noted in the study group, with statistically significant di!erences between the groups (P < .05). Postoperative CCD improved significantly in both groups. At the final follow-up, the increase in CCD was greater in the control group (1.819 ± 0.97 mm) compared to the study group (0.274 ± 0.18 mm, P < .05). The study group showed better VAS scores at 6months (1.22 ± 0.96) and the last follow-up [(1.22 ± 0.96), (0.68 ± 0.57) points] compared to the control group [(2.97 ± 0.86), (1.98 ± 0.84) points, P < .05]. The Constant-Murley functional scores were also better in the study group [(81.67 ± 5.54), (90.45 ± 3.42) points] than in the control group [(91.45 ± 3.44), (94.21 ± 1.43) points, P < .05]. CONCLUSION: The use of an Endobutton combined with a mini-plate for Neer IIB (IIC) type distal clavicle fractures offers significant advantages, including improved recovery of shoulder joint function, fewer postoperative complications, and reduced need for secondary internal fixation removal. This approach is a viable treatment option for Neer IIB (IIC) type distal clavicle fractures. LEVEL OF EVIDENCE: Level III, Therapeutic study.
Agreement between physical examination and dynamic sonography in infants with developmental dysplasia of the hip.
Imerci A, Thacker M, Bowen R
Acta Orthop Traumatol Turc · 2025 Mar · PMID 40338010 · Full text
OBJECTIVE:: For years, physical examination (PE) findings (e.g., Barlow, Ortolani tests, and abduction limitation) have been used as the primary screening method in the early diagnosis of developmental dysplasia of the h...
OBJECTIVE:: For years, physical examination (PE) findings (e.g., Barlow, Ortolani tests, and abduction limitation) have been used as the primary screening method in the early diagnosis of developmental dysplasia of the hip (DDH). There are a limited number of studies in the literature that evaluate the agreement of PE findings and dynamic sonographic evaluation. Our aim was to evaluate the correlation between dynamic sonographic hip types and physical examination findings in infants with DDH. METHODS:: A total of 281 infants (562 hips) with DDH younger than 6 months who were given Pavlik harness treatment were included in the study. Socio-demographic characteristics (e.g., age, gender, and race) of the infants were recorded. The concordance between the PE findings and sonographic findings of the patients at the first admission was evaluated. The agreement analysis between the dynamic sonography evaluations and the PE results was demonstrated by Cohen’s kappa (k) coefficient and Kendall’s coefficient (W) of concordance. RESULTS:: Of the 55 hips evaluated as normal in PE, 21 were normal, 25 were found to have dysplasia, and 9 were subluxated/or subluxatable on dynamic sonography. It was observed that 30 (13%) of 219 hips which were dislocated on dynamic sonography were found to be lax on the PE. The overall percentage of agreement between the physical examination and dynamic sonography was 72.4. The Cohen for agreement between the PE and dynamic sonography was 0.541 (CI: 0.479-0.602). The agreement between Ortolani test evaluation with PE and Ortolani test evaluation of patients diagnosed with dislocated hip by dynamic sonography was 70.3% (Cl: 0.34 (0.22-0.46)), while the agreement of Barlow test was 78.5% (CI: 0-0.26). The Kendall’s coefficient of concordance between reducible hip (Ortolani positive) under dynamic sonography and PE was 0.546. Dynamic sonographic evaluation of 238 hips with restricted hip abduction showed that 78 (32.7%) were subluxated at rest and/or subluxated with stress, and the remaining 150 (67.3%) hips were dislocated at rest or dislocated with stress. CONCLUSION:: The agreement between PE and dynamic sonography was fair to moderate. The clinicians should focus on both examinations to reveal essential data for diagnosing and monitoring infants with DDH. LEVEL OF EVIDENCE:: Level IV, Diagnostic Study.
Knowledge and Awareness of Family Physicians as Key Stakeholders Regarding Developmental Dysplasia of the Hip and the Nationwide Screening Program.
Gönen EŞ, Egici MT, Gönen E
Acta Orthop Traumatol Turc · 2025 Mar · PMID 40338009 · Full text
OBJECTIVE: The aim of this study was to examine the knowledge levels and awareness of family physicians about Developmental Dysplasia of the Hip (DDH) and the Nationwide Newborn Hip Screening Program in Turkey. METHODS:...
OBJECTIVE: The aim of this study was to examine the knowledge levels and awareness of family physicians about Developmental Dysplasia of the Hip (DDH) and the Nationwide Newborn Hip Screening Program in Turkey. METHODS: This observational, cross-sectional study was conducted between May and August 2021, involving 401 family physicians working at Family Health Centers (FHC) in Istanbul. A face-to-face survey, developed based on the literature and validated by experts, assessed participants' knowledge, awareness, and practices regarding DDH and the nationwide screening program. The survey consisted of two sections: a Participant Information Form (14 socio-demographic and professional questions) and 30 knowledge-based questions (8 using a Likert scale). RESULTS: Among the 401 family physicians who participated in the study, 109 (27.2%) reported actively managing patients diagnosed with DDH. Over the past year, 20,124 babies were stated to be screened, with 2.98% identified as having pathological ultrasonography results. The overall knowledge and awareness score (for DDH, program details and practices) was 66.59 ± 8.4%, positively associated with following babies with DDH (p=0.042), attending congresses/symposiums (p=0.008), specialty training (p=0.022; r=0.156), receiving in-service training and online education on hip screening program (p=0.002; r=0.167), and screening a higher number of babies (p<0.001). 71.3% of participants recommended double diapering for babies with high risk factors, while 70.3% used provocative tests such as the Barlow-Ortolani. Knowledge awareness scores about the hip screening program were significantly higher in those who followed DDH patients (p<0.001), attended congress and symposiums (p=0.006), screened higher number of babies (r=0.216, p<0.001), had specialty training (p=0.005), female physicians (p=0.012), used multiple training resources (p=0.002), and considered themselves competent in DDH (p<0.001). Awareness of DDH risk factors and treatment remained relatively low (49.2% and 64.1%, respectively). Perception of self-competency scores were significantly higher in family medicine specialists (p=0.020), those with 10+ years of experience (p=0.003), and those managing DDH cases (p<0.001). CONCLUSION: Family physicians in Istanbul demonstrate adequate knowledge and awareness regarding DDH and the nationwide screening program, influenced by factors such as managing DDH cases, postgraduate training, access to educational resources, and participation in professional events. Female physicians have greater knowledge and awareness about the hip screening program. Higher perception of self-competency levels were observed in family medicine specialists, and those with over 10 years of experience or active involvement in DDH care. Addressing gaps in knowledge about risk factors, diagnostic methods, and treatments is critical. Targeted educational initiatives, periodic in-service training, and updated guidelines can enhance DDH management and screening practices, while correcting misconceptions such as the e!ectiveness of double diapering. LEVEL OF EVIDENCE: Level IV, Diagnostic Study.
Efficacy of bone cement volume in unilateral kyphoplasty of thoracolumbar compression fractures: A clinical comparative study.
Benek HB, Ulgen T, Tabanlı A … +3 more , Ak C, Akcay E, Yilmaz H
Acta Orthop Traumatol Turc · 2025 Mar · PMID 40338008 · Full text
OBJECTIVE: To compare the clinical and radiological e!cacy of bone cement volumes injected during unilateral percutaneous balloon kyphoplasty for thoracolumbar vertebral compression fractures. METHODS: In this retrospect...
OBJECTIVE: To compare the clinical and radiological e!cacy of bone cement volumes injected during unilateral percutaneous balloon kyphoplasty for thoracolumbar vertebral compression fractures. METHODS: In this retrospective study, we reviewed data from 96 patients who underwent single-level unilateral kyphoplasty. The patients were categorized into 2 groups based on the cement volume injected: group 1 (cement volume "4 mL, minimum 3 mL; n=48) and group 2 (cement volume >4 mL, maximum 6 mL; n=48). The clinical outcomes, as assessed using the Oswestry Disability Index (ODI) and visual analog scale (VAS) scores, were evaluated preoperatively and then at the final follow-up 1 month postoperatively. The vertebral corpus height at the fracture level was measured at the anterior, middle, and posterior regions through sagittal computed tomography scanning. RESULTS: The mean age of the patients was 64.2 years in group 1 and 63.8 years in group 2. In group 1, the mean anterior vertebral height increased from 19.0 ± 3.3 mm preoperatively to 19.9 ± 3.2 mm postoperatively, whereas in group 2, it increased from 17.9 ± 3.8 mm to 19.6 ± 3.7 mm, respectively. The middle vertebral heights were 15.4 ± 2.5 mm preoperatively and 16.9 ± 2.8 mm postoperatively in group 1 and 16.0 ± 3.6 mm and 17.5 ± 3.2 mm, respectively, in group 2. Both groups exhibited significant improvements in ODI and VAS scores, with no significant di#erence between the groups. A statistically significant increase was recorded within each group for the anterior, middle, and posterior vertebral heights. However, a significantly greater increase was noted in the anterior height in group 2 compared to that in group 1 (P < .05). CONCLUSION: Unilateral kyphoplasty is an e#ective procedure for managing painful vertebral compression fractures. The greatest loss of vertebral height occurred in the middle column, which also exhibited the greatest potential for restoration. Thus, a higher cement volume facilitated greater restoration of the anterior column height. LEVEL OF EVIDENCE: Level III, Therapeutic Study.
A rare case of an isolated scaphoid dislocation neglected for 45 years: A case report and literature review.
İmre E
Acta Orthop Traumatol Turc · 2025 Mar · PMID 40337986 · Full text
Isolated dislocation of the scaphoid bone is an extremely rare injury. If left untreated, results may be catastrophic. This paper presents a late complication of a neglected open scaphoid dislocation injury. A 63-year-ol...
Isolated dislocation of the scaphoid bone is an extremely rare injury. If left untreated, results may be catastrophic. This paper presents a late complication of a neglected open scaphoid dislocation injury. A 63-year-old woman was admitted to the orthopedic outpatient department with symptoms of pain and restricted movement in her left wrist. Her medical history revealed a previous open injury to her left wrist approximately 45 years ago due to being trapped between a cart and a tree. X-ray and computed tomography showed volar dislocation of the scaphoid bone, collapse of the lunate bone, advanced arthritic changes, and cystic alterations in the lunocapitate joint. The decision on surgical treatment was made. Scaphoid excision and radiometacarpal fusion surgery were performed on her left wrist. Isolated scaphoid dislocations are rare injuries. Early recognition and treatment in the acute phase prevent severe complications and yield successful results. Advanced wrist arthritis can be observed in delayed cases. Radiometacarpal fusion is a successful treatment option for advanced cases with complete loss of motion.
Routine histopathological examination of femoral heads and incidental metastatic bone disease in hip arthroplasty.
Birsel O, Aslan L, Eren İ … +2 more , Deveci MA, Şimşek A
Acta Orthop Traumatol Turc · 2025 Mar · PMID 40337985 · Full text
OBJECTIVE: This study aimed to assess the necessity of routine pathological examination of femoral heads in detecting incidental metastatic bone disease in patients undergoing elective and emergency hip arthroplasty. MET...
OBJECTIVE: This study aimed to assess the necessity of routine pathological examination of femoral heads in detecting incidental metastatic bone disease in patients undergoing elective and emergency hip arthroplasty. METHODS: A retrospective review was conducted on medical records, operative notes, and histopathology reports of patients who underwent hip arthroplasty between 2016 and 2024. Patients without pathological evaluation or with known metastases were excluded. The study included patients with hip osteoarthritis undergoing total hip arthroplasty and those with femoral neck fractures undergoing bipolar hemiarthroplasty. Preoperative diagnoses, comorbidities, and operative and histopathological findings were analyzed. RESULTS: The study included 193 patients with femoral neck fractures (mean age: 76.8 years, age range=60 - 98 years) and 257 with osteoarthritis (mean age: 60.4 years, age range= 23 - 88). After excluding 22 femoral neck fracture and 90 osteoarthritis patients, 36 patients in the fracture group and 18 in the osteoarthritis group had a history of malignancy, with 10 and 2 patients, respectively, having known metastases. Incidental metastatic bone disease was identified in four femoral neck fracture patients, while no neoplastic findings were detected in the osteoarthritis group. CONCLUSION: Routine pathological examination of femoral heads is particularly relevant in femoral neck fracture cases, where the risk of detecting metastatic disease is higher. While thorough preoperative assessments and meticulous intraoperative evaluations aid diagnosis, the decision to submit specimens for pathology should be guided by the surgeon's clinical judgment and patient-specific factors. LEVEL OF EVIDENCE: Level III, Diagnostic Study.
Outcomes of scaphocapitate fusion versus proximal row carpectomy in advanced-stage Kienböck's disease.
Gezer MC, Bezirgan U, Yoğun Y … +2 more , Ünsal SŞ, Armangil M
Acta Orthop Traumatol Turc · 2025 Mar · PMID 40337984 · Full text
OBJECTIVE: This study aimed to compare the clinical results and determine functional superiority in patients treated with scaphocapitate fusion (SCF) versus proximal row carpectomy (PRC) for advanced-grade Kienböck disea...
OBJECTIVE: This study aimed to compare the clinical results and determine functional superiority in patients treated with scaphocapitate fusion (SCF) versus proximal row carpectomy (PRC) for advanced-grade Kienböck disease. METHODS: The patients were assessed in terms of demographic data, follow-up duration, disease stage, preoperative and final follow-up values of the disability of arm, shoulder, and hand (DASH) score, patient-rated wrist evaluation (PRWE) score, and visual analog scale (VAS) pain score, together with the key-pinch grip and palmar grip values. The preoperative and postoperative flexion and extension angles and radial and ulnar deviation angles were also recorded and compared. As there were no records of preoperative grip strength values, comparisons were made with the healthy contralateral hand. RESULTS: A total of 26 patients were evaluated, including 10 who underwent PRC surgery and 16 who underwent SCF. Preoperatively, the flexion range was 65.8% in the PRC group and 58.8% in the SCF group, the extension range was 65.8% and 56.7%, radial deviation was 35% and 40.6%, and ulnar deviation was 65% and 61.1%, respectively. Postoperatively, the mean values of these parameters were comparable between the 2 groups. When grip strength was compared with the non-operated hand, it was determined to be 58.8% of the healthy hand in the PRC group and 60.9% in the SCF group. Similarly, pinch strength was 45.5% of the healthy hand in the PRC group and 55.6% in the SCF group. In all patients, a statistically significant reduction was observed in postoperative DASH, PRWE, and VAS scores compared to preoperative values. Specifically, in the PRC group, the postoperative scores were DASH: 22.6, PRWE: 43.6, and VAS: 3.2, while in the SCF group, the corresponding values were DASH: 26.5, PRWE: 38.2, and VAS: 2.9. CONCLUSION: In advanced-grade Kienböck disease, PRC appears to be a more favorable option when preserving joint range of motion is a priority, whereas SCF may provide better outcomes in terms of grip strength. Both techniques seem to o!er comparable pain relief and functional results, suggesting that the choice of procedure should be tailored to the patient's individual needs and priorities. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.
Exploring the role of artificial intelligence in Turkish orthopedic progression exams.
Ayik G, Kolac UC, Aksoy T … +4 more , Yilmaz A, Sili MV, Tokgozoglu M, Huri G
Acta Orthop Traumatol Turc · 2025 Mar · PMID 40337975 · Full text
OBJECTIVE: The aim of this study was to evaluate and compare the performance of the artificial intelligence (AI) models ChatGPT-3.5, ChatGPT-4, and Gemini on the Turkish Specialization Training and Development Examinatio...
OBJECTIVE: The aim of this study was to evaluate and compare the performance of the artificial intelligence (AI) models ChatGPT-3.5, ChatGPT-4, and Gemini on the Turkish Specialization Training and Development Examination (UEGS) to determine their utility in medical education and their potential to improve patient care. METHODS: This retrospective study analyzed responses of ChatGPT-3.5, ChatGPT-4, and Gemini to 1000 true or false questions from UEGS administered over 5 years (2018-2023). Questions, encompassing 9 orthopedic subspecialties, were categorized by 2 independent residents, with discrepancies resolved by a senior author. Artificial intelligence models were restarted for each query to prevent data retention. Performance was evaluated by calculating net scores and comparing them to orthopedic resident scores obtained from the Turkish Orthopedics and Traumatology Education Council (TOTEK) database. Statistical analyses included chi-squared tests, Bonferroni-adjusted Z tests, Cochran's Q test, and receiver operating characteristic (ROC) analysis to determine the optimal question length for AI accuracy. All AI responses were generated independently without retaining prior information. RESULTS: Significant di!erences in AI tool accuracy were observed across di!erent years and subspecialties (P < .001). ChatGPT-4 consistently outperformed other models, achieving the highest overall accuracy (95% in specific subspecialties). Notably, ChatGPT-4 demonstrated superior performance in Basic and General Orthopedics and Foot and Ankle Surgery, while Gemini and ChatGPT-3.5 showed variability in accuracy across topics and years. Receiver operating characteristic analysis revealed a significant relationship between shorter letter counts and higher accuracy for ChatGPT-4 (P=.002). ChatGPT-4 showed significant negative correlations between letter count and accuracy across all years (r="0.099, P=.002), outperformed residents in basic and general orthopedics (P=.015) and trauma (P=.012), unlike other AI models. CONCLUSION: The findings underscore the advancing role of AI in the medical field, with ChatGPT-4 demonstrating significant potential as a tool for medical education and clinical decision-making. Continuous evaluation and refinement of AI technologies are essential to enhance their educational and clinical impact.
The effectiveness of arthroscopic irrigation and debridement in the management of septic arthritis following anterior cruciate ligament reconstruction: A Systematic Review and Meta-Analysis.
Mustamsir E, Aulia Pandu A, Fernando A
Acta Orthop Traumatol Turc · 2025 Mar · PMID 40337953 · Full text
OBJECTIVE: This meta-analysis aimed to evaluate the e!ectiveness of arthroscopic irrigation and debridement in the management of septic arthritis following anterior cruciate ligament reconstruction (ACL-R), with a focus...
OBJECTIVE: This meta-analysis aimed to evaluate the e!ectiveness of arthroscopic irrigation and debridement in the management of septic arthritis following anterior cruciate ligament reconstruction (ACL-R), with a focus on graft retention rates, functional outcomes, and the microbiological profile of infections. METHODS: This meta-analysis adhered to PRISMA guidelines and was registered in PROSPERO (CRD42024562550). PubMed, Cochrane, ProQuest, and ScienceDirect databases were searched for studies published before July 2024 using predefined Medical Subject Headings terms and keywords related to ACL-R infections and arthroscopic irrigation and debridement. Inclusion criteria followed the PICO framework: Population (patients with septic arthritis following ACL-R), intervention (arthroscopic irrigation and debridement), comparator (none), and outcomes (graft retention rate, Lysholm Knee Score, International Knee Documentation Committee [IKD] score, and Tegner Activity Scale [TAS], and microbiology data). The risk of bias was assessed using the Cochrane Risk of Bias in Non-Randomized Studies-of Interventions. Meta-analyses were performed using R Studio, with results presented as pooled proportions or means with 95% confidence intervals (95% CI). RESULTS: A total of 20 studies involving 333 patients were analyzed, with follow-up periods ranging from 18 days to 67 months. The pooled graft retention rate was 92% (95% CI [88-94%]), confirmed by proportional meta-analysis with low heterogeneity (I"=0%, P=2.0948). Functional knee outcomes showed pooled mean scores of 82.41 for Lysholm (95% CI [78.15-86.66], I"=87.3%-92.7%), 79.37 for IKDC (95% CI [74.00-84.75], I"=68.3%-82.2%), and 5.08 for TAS (95% CI [4.87-5.30], I"=0%-52.6%), indicating moderate to satisfactory recovery. Coagulase-negative Staphylococcus (42.34%) and Staphylococcus aureus (23.12%) were the most frequently isolated pathogens, with 9.91% of cases involving antibiotic-resistant strains, including MRSA (4.50%) and MR-CNS (5.41%). Cephalosporin or vancomycin was the most commonly administered first-line antibiotic, often combined with other agents. CONCLUSION: The findings suggest that arthroscopic irrigation and debridement, combined with appropriate antibiotic therapy, are e!ective in managing septic arthritis following ACL-R, achieving a high graft retention rate of 92% and moderate to satisfactory functional outcomes. However, the presence of antibiotic-resistant pathogens and challenges in returning to high-level sports highlight the importance of preventive measures to protect athlete performance and recovery. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.
Letter to the Editor: Clinical Effect of Posterior-Only Approach Debridement, Intervertebral Fusion, and Internal Fixation for Upper Thoracic Tuberculosis.
Ekinci S, Akcali A
Acta Orthop Traumatol Turc · 2025 Mar · PMID 40231814 · Full text
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Colonel Dr. Zeynep Karaosmanğlu: A trailblazer in Turkish orthopedics and traumatology.
Gönen E, Türközü T
Acta Orthop Traumatol Turc · 2025 Mar · PMID 40214632 · Full text
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From the Editor.
Berk H
Acta Orthop Traumatol Turc · 2025 Mar · PMID 40214631 · Full text
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