Acta orthopaedica et traumatologica turcica最新文献

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.

Three-dimensional printing has rapidly evolved into an important technology in orthopedic surgery, enabling the creation of patient-spe cific instruments, implants, and anatomical models. As printing has become more affordable and accessible, point-of-care manufacturing has increasingly allowed clinicians to design and produce surgical aids directly within clinical units. This development, combined with advances in computed tomography (CT)-based imaging and segmentation software, has significantly expanded the use of patient-specific surgical guides (PSGs), particularly in foot and ankle surgery, where complex multiplanar deformities, poor soft-tissue, and limited visu alization often create technical challenges. Patient-specific surgical guides are generated from thin-slice CT data and allow surgeons to accurately transfer preoperative planning to the operative field. Their use has been reported across a wide range of procedures, including deformity correction, joint fusion, ankle arthroplasty, etc. Across these applications, studies consistently demonstrate improved osteot omy accuracy, enhanced deformity correction, reduced operative time, lower fluoroscopy exposure, and greater reproducibility between surgeons. The increasing adoption of weight-bearing CT has further strengthened the accuracy of preoperative planning by capturing true functional alignment. Despite these advantages, several limitations persist, including increased preoperative imaging requirements, higher initial costs, and dependency on manufacturing logistics. Most published studies remain level III-IV, with limited long-term data on clinical outcomes and cost-effectiveness. Nevertheless, as technological capabilities improve and workflows become more efficient, PSGs are poised to become an integral component of personalized foot and ankle surgery, with the potential to enhance both surgical precision and patient outcomes.   Cite this article as: Kavak S, Ozturk B, Ogut T, DiGiovanni CW, Esfahani SA, Karaismailoglu B. Application of patient-specific surgical guides in foot and ankle surgery. Acta Orthop Traumatol Turc., 2025;59(6):340-348.

Objective: Giant cell tumor of the bone (GCTB) is a locally aggressive benign tumor with unpredictable recurrence patterns. While intraos seous recurrences are well-documented, soft tissue recurrence (STR) remains underrecognized. This study aimed to identify risk factors, radiographic features, and histopathological characteristics associated with STR of GCTB.

Methods: This retrospective study included 69 patients treated for GCTB between 1996 and 2022. Demographic data, tumor location, surgical method, recurrence history, and adjuvant treatments were extracted from medical records. Radiologic assessments were performed using a picture archiving and communication system, and lesions were graded by Campanacci classification.  analysis was performed using chi-square, Fisher's exact, and Mann-Whitney U-tests.

Results: The initial surgical approach was curettage in 55 patients (79.7%), resection in 14 (20.3%). Recurrence occurred in 24 patients (34.8%), and STR was identified in 7 (10.1%). Most STRs were located near the distal femur. Among these, 4 had prior intraosseous recur rence, and 5 had Campanacci grade 3 lesions. No statistically significant association was found between STR and variables including age, sex, tumor volume, Campanacci grade, tumor location, denosumab, or local adjuvant use. H3F3A analysis was performed in 6 out of 7 patients with STR, and positivity was detected in 3 of them. Pulmonary metastasis was documented in 8 patients overall, including 3 of 7 with STR (42.9%) compared with 5 of 62 without STR (8.1%), representing a significant difference.

Conclusion: Soft tissue recurrence in GCTB may occur independently or following intraosseous recurrence and is frequently observed in high-grade lesions. Although not statistically significant, the findings suggest a possible association between tumor aggressiveness and STR. Histological features remain consistent with osseous lesions, but the diagnostic value of H3F3A expression in STRs warrants fur ther investigation. Importantly, STR represents a distinct recurrence pattern and may be associated with an increased risk of pulmonary metastasis, underscoring the need for vigilant long-term follow-up and systematic surveillance.   Cite this article as: Mirioğlu A, Dalkır KA, Ölke HC, et al. Soft tissue recurrence in giant cell tumor of bone: risk factors and radiological and histopathological features. Acta Orthop Traumatol Turc.,  2025;59(6):470-476.

Objective: This study aimed to investigate the relationship between spinopelvic parameters and radiographic foot axes and to examine whether these associations differ across age groups.

Methods: This retrospective radiographic study analyzed imaging from patients treated at a university medical center for degenerative or traumatic conditions. Cases with weight-bearing, 2-view foot radiographs and standing lumbar spine radiographs, including the femoral heads, were included. Spinopelvic parameters (lumbar lordosis, pelvic tilt, sacral slope, and pelvic incidence) and radiographic foot axes (including hallux valgus angle, tibiotalar angle, and metatarsal declination angle) were measured, and correlation analyses were per formed with age-based subgroup comparisons.

Results: A total of 46 Caucasian patients (33 females, 13 males) were included (mean age 55.6 ± 18.5 years). Lumbar lordosis showed a significant negative correlation with hallux valgus angle (r = -0.29, P = .015). Sacral slope was negatively correlated with the hallux valgus angle (r = -0.42, P < .001). Pelvic tilt correlated positively with tibiotalar angle (r = 0.34, P = .004) and metatarsal declination angle (r = 0.25, P = .042). Age-stratified analyses demonstrated age-related differences in correlation patterns.

Conclusion: Spinopelvic alignment demonstrates measurable associations with radiographic foot alignment, supporting the concept of the spine-pelvis-lower-limb unit as a biomechanically integrated system. Clinically, these findings suggest that integrated, chain oriented assessment and management strategies (considering both spinal and foot alignment, particularly with aging) may be relevant when evalu ating patients with coexisting spine and foot disorders.   Cite this article as: Roch FE, Kletschka F, Jäckle K, et al. Age-dependent associations between spinopelvic alignment and foot axes: A retrospective radiographic study. Acta Orthop Traumatol Turc., 2025;59(6):379-386.

Objective: There is still no optimal suture material or configuration for flexor tendon repair. Barbed sutures provide an alternative for flexor tendon repair with unidirectional clefts that effectively resist sliding. Increasing the suture purchase results in an expected increase in the tensile force. This study investigated the relationship between suture purchase length and repair strength in flexor tendon. This addresses the question of whether it is possible to achieve sufficient tensile strength compared to a 2-strand polypropylene suture by simply increasing the barbed suture course inside the tendon.

Methods: The study involved 24 sheep flexor digitorum tendons, which were divided into 4 subgroups, each comprising 6 tendons. Group P1 utilized polypropylene sutures 1 cm from the incision, while group P2 used it 2 cm away. Group B1 utilized a barbed suture positioned 1 cm from the incision, while group B2 employed a barbed suture 2 cm from the incision. The outcome measures included testing for 2-mm Gap Resistance (2mm-GR) and maximum tensile strength (MTS) using an Instron® 3345K7023 tensile testing device (Norwood, MA, USA).

Results: A 2 cm suture purchase length increased by the mean 2mm-GR by 6.9 N for polypropylene and 12.6 N for barbed sutures. Group B2 showed the highest 2mm-GR (20.7 N). Groups P2 and B2 had significantly higher 2mm-GR than groups P1 and B1 (P < .05). The MTS did not differ significantly between the groups (P = .743). Suture breakage occurred in 92% of cases, with knot failure observed in 8%.

Conclusion: Extending the purchase length of the barbed suture within the tendon significantly enhances the MTS and 2mm-GR. With further refinement, barbed sutures have the potential to become a favorable option for tendon repair, possibly facilitating early and effec tive postoperative rehabilitation.   Cite this article as: Cırdı YU, Günay AE, Ekici M, Şekerci ÖT, Ozturk Rİ, Gürsoy S. Increases in suture purchase of same magnitude lead to a higher gap resistance force for barbed sutures used in flexor tendon repair. Acta Orthop Traumatol Turc., 2025;59(6):434-438.

Objective: This study aimed to evaluate the reported efficacy of electrical bone stimulation (EBS) in promoting union in foot and ankle fractures and arthrodesis by synthesizing the available literature.

Methods: A literature review was conducted using PubMed/Medline, EMBASE, ScienceDirect, Web of Science, and CINAHL. Study type, patient demographics, interventions, and outcomes were extracted. The Methodological Index for Non-Randomized Studies assessment tool was used for methodological quality assessment and for evaluating outcomes regarding union rates.

Results: Fourteen studies involving 1253 patients met inclusion criteria from a total of 668 screened articles. These studies involved 1253 patients treated with EBS for foot and ankle fracture and fusion surgeries. The majority of investigations reported increased success unionization and reduced time to union using EBS methods including direct current, capacitated coupling, pulsed electromagnetic field (PEMF), low-intensity pulsed ultrasound (LIPUS), and combined magnetic field.

Conclusion: Although existing evidence suggests that EBS may enhance union rates, there is no consensus regarding the most effective stimulation modality due to limited comparative data. Emerging modalities such as PEMF and LIPUS demonstrate promising results; however, well-designed comparative studies are needed to clarify their relative efficacy and safety profiles.   Cite this article as: Schluter R, McLeod H, Ebrahimi A, et al. The effect of electrical bone stimulation on bone union in foot and ankle injuries: A scoping review. Acta Orthop Traumatol Turc., 2025;59(6):349-360.

Objective: This study aimed to evaluate whether sagittal plane range of motion (ROM) and isokinetic muscle strength of the ankle are affected following surgical treatment of patients with Myerson type B Lisfranc injuries.

Methods: This retrospective controlled study included 14 patients who underwent open reduction and internal fixation for Myersontype B Lisfranc injuries and 14 age- and sex-matched healthy  controls. Ankle dorsiflexion and plantarflexion ROM were measured, and isokinetic strength was assessed bilaterally at 30°/s and 120°/s. Clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Score and the Foot and Ankle Outcome Score (FAOS). Radiographic assessments were performed at final follow-up.

Results: At a mean follow-up of 77 months, the mean FAOS was 83.5 ± 15.6. According to the AOFAS classification, 21% of patients were rated as excellent, 43% good, 14% fair, and 21% unsatisfactory. Dorsiflexion ROM was significantly lower on the affected side compared to both the contralateral limb (5.57° ± 3.94 vs. 18.36° ± 3.08, P = .003) and the control group (22.57° ± 4.22, P < .001). While plantarflexion ROM did not significantly differ, isokinetic strength was significantly reduced in most parameters, particularly in dorsiflexion.

Conclusion: Patients with surgically treated Myerson type B Lisfranc injuries exhibit persistent deficits in ankle dorsiflexion ROM and in isokinetic strength and endurance of both dorsiflexion and plantarflexion, despite favorable clinical scores and radiographic outcomes. These findings highlight the importance of incorporating objective functional assessments in the long-term follow-up of these patients.   Cite this article as: Demirel M, Karaçam Mİ, Ayan MO, Şahinkaya T, Utlu DK, Polat G. Reduced ankle strength and dorsiflexion joint motion after surgical treatment of Myerson type B Lisfranc injuries: A controlled study. Acta Orthop Traumatol Turc., 2025;59(6):405-414.

Objective: The aim of this study was to evaluate the epidemiological features, anatomical distribution, and treatment methods of bone and soft tissue tumors in the foot and ankle region.

Methods: This retrospective study included 193 cases evaluated at the musculoskeletal tumor board of the institution between January 2014 and December 2024. Patients' demographic data (84 males, 109 females; mean age, 37.8 years), lesion type, anatomical location, histopathological subtype, and treatment modalities were recorded. Tumors were classified according to the 2020 World Health Organization classification of bone and soft tissue tumors.

Results: Of the 193 cases, 128 (66.3%) were true tumors and 65 (33.7%) were tumor-like lesions. Among the tumors, 70 (54.7%) were bone tumors, 54 (42.2%) were soft tissue tumors, and 4 (3.1%) were metastases. Benign lesions accounted for 79.7%, malignant for 14.0%, and intermediate for 6.3% of all tumors. Tumors were most frequently located in the forefoot (44%), followed by the ankle (29%). Intraosseous lipoma was the most common benign bone tumor, giant cell tumor of the tendon sheath the most common benign soft tissue tumor, and ganglion cyst the most frequent tumor-like lesion. Excisional biopsy was the main treatment, whereas amputation was mainly performed for malignant tumors.

Conclusion: Foot and ankle tumors are rare but clinically significant as misdiagnosis or delayed diagnosis can lead to poor outcomes. Although most are benign, malignant cases, especially in the ankle region, require aggressive management. Awareness of their regional distribution and histopathological spectrum is essential for early recognition, accurate diagnosis, and appropriate treatment planning.   Cite this article as: Yıldırım S, Çiftdemir M, Salih O, Ustabaşıoğlu FE, Üstün F, Usta U. Retrospective clinicopathological analysis of 193 cases of bone and soft tissue tumors in the foot and ankle. Acta Orthop Traumatol Turc., 2025;59(6):485-492.