Acta orthopaedica et traumatologica turcica最新文献

Objective: This study aimed to comparatively evaluate the clinical knowledge generation performance of 3 widely used large language model (LLM)-based chatbots (ChatGPT, Claude, and Perplexity) in the context of septic arthritis.

Methods: This cross-sectional comparative study was based on 24 scenario-based clinical questions developed in accordance with the SANJO guideline (Management of Septic Arthritis in Native Joints) of the European Bone and Joint Infection Society. Responses generated by ChatGPT (OpenAI GPT-4), Claude 2 (Anthropic), and Perplexity AI were independently assessed by 2 senior experts: 1 in orthopedic surgery and the other in infectious diseases. Each response was evaluated across 6 domains: scientific accuracy, content depth, termino logical consistency, clinical applicability, brevity, and reference support, using a 5-point Likert scale.

Results: All 3 LLM-based chatbots achieved perfect scores in accuracy and terminological consistency (P = 1.000), and no significant dif ference was observed in clinical applicability (P = .912). Perplexity scored significantly lower in content depth compared to both ChatGPT (P = .001) and Claude (P = .041), whereas ChatGPT and Claude did not differ significantly (P = .807). ChatGPT produced significantly more unnecessary elaboration than Claude (P = .009) and Perplexity (P < .001), while Claude and Perplexity were comparable (P = .115). For reference support, Perplexity scored significantly higher than both ChatGPT (P < .001) and Claude (P < .001), with no difference between the latter 2 (P = 1.000). Overall, Perplexity achieved the highest total score (P < .001), followed by ChatGPT and Claude. Interrater agree ment was substantial (κ = 0.72).

Conclusion: The LLM-based chat platforms demonstrated overall high performance, but their strengths differed across evaluation domains. While ChatGPT and Claude provided more comprehensive and detailed responses, Perplexity offered stronger reference sup port. These findings suggest that context-specific selection of LLMs is essential, as the optimal choice may vary depending on whether detailed explanation or robust referencing is prioritized.   Cite this article as: Bayrak HC, Karagöz B, Bayrak Ö. Comparative evaluation of large language model-based chatbots in a septic arthritis scenario: ChatGPT, Claude, and Perplexity. Acta Orthop Traumatol Turc., 2025;59(6):415-420.

The atlantoaxial segment of the cervical spine is unique for its distinctive anatomical features. Given the variation in the anatomy of this region, surgeons must possess a profound knowledge of its anatomy to be able to combine multiple surgical approaches tailored to the specific anatomical variants of the patient's condition. Insertion of C1 lateral mass screws can be technically demanding, particularly in cases where dissection leads to iatrogenic injury of the C1/C2 venous sinus and causes significant bleeding or in patients with dysplastic C1 anatomy or vertebral artery anomalies. Gallie's fusion necessitates an intact posterior arch and C2 spinous process for the wire place ment. However, this technique carries a risk of C2 spinous process fracture, which may compromise the overall stability of the construct. Magerl's transarticular screw technique is an option, but it requires the reduction of the C1/C2 subluxation before the screws can be placed. In this report, a novel surgical technique that combines transarticular screws with a transverse rod and Gallie's wire fixation utilized in 2 cases of atlantoaxial subluxation is illustrated. This technique will be an alternative option of C1-C2 fixation, which mitigates the surgical difficulties of the existing techniques while enhancing the stability of the construct.   Cite this article as: Chandirasegaran S, Praveen G, Chan C.Y.W, Kwan M.K. A novel atlantoaxial subluxation fixation technique combining transarticular screws with transverse rod and Gallie's wires: A report of two cases. Acta Orthop Traumatol Turc., 2025;59(6):493-496.

Objective: This study aimed to compare the functional outcomes and complications of cemented versus cementless femoral stem fixation in end-stage chronic kidney disease (CKD) patients with traumatic femoral neck fractures (FNF).

Methods: This retrospective cohort study included 43 hips of 42 patients with end-stage chronic kidney disease (mean age 77.7 years; range, 55-89; 42.9% female) who underwent hemiarthroplasty for traumatic femoral neck fractures at a regional trauma center between 2010 and 2022. Patients were divided into two groups according to the fixation method: cemented hemiarthroplasty (n = 23) and cement less hemiarthroplasty (n = 20). Functional outcomes were assessed using the Harris Hip Score (HHS), and complications including throm boembolic events, surgical site infection, periprosthetic fracture, prosthesis dislocation, osteolysis, reoperation, and mortality were evaluated.

Results: The mean follow-up duration was 45.1 months. At final follow-up, the mean HHS was significantly higher in the cementless group compared with the cemented group (72.1 vs. 68.3, P = .011). Osteolysis occurred more frequently in the cemented group (30.4% vs. 0%, P = .008). No statistically significant differences were observed between the groups regarding thromboembolic events (0% vs. 5.0%, P = .284), surgical site infection (4.3% vs. 10.0%, P = .473), periprosthetic fracture (4.3% vs. 0%, P = .351), prosthesis dislocation (8.7% vs. 5.0%, P = .639), reoperation rates (13.0% vs. 15.0%, P = .855), or overall mortality (69.6% vs. 60.0%, P = .517).

Conclusion: In end-stage CKD patients with traumatic FNFs, cementless hemiarthroplasty was associated with fewer cases of osteolysis and better functional outcomes compared with cemented fixation. These findings highlight the potential biomechanical advantage of cementless fixation in prolonging prosthesis survival and support its consideration as the preferred option in patients with end-stage CKD.   Cite this article as: Abul MS, Yılmaz H, Sevim ÖF, Hekim Ö, Kayaalp ME, Eceviz E. Cemented versus cementless hemiarthroplasty in end-stage chronic kidney disease: A retrospective comparative study of femoral neck fracture outcomes. Acta Orthop Traumatol Turc., 2025;59(6):458-462.

Objective: This study aimed to evaluate the effects of different anterior and posterior wedge opening distances on medial and lateral pos terior tibial slope (PTS) angles during medial open wedge high tibial osteotomy (MOWHTO) using an in vitro sheep tibia model.

Methods: This in vitro study was conducted on 24 tibial bones from 2-year-old female domestic sheep. The samples were divided into 2 groups (n = 12 each) based on wedge configuration. Group 1 underwent osteotomy with a posterior opening of 6 mm and an anterior of 2 mm to reduce slope, while Group 2 received a 2 mm posterior and 6 mm anterior gap to increase slope. The medial and lateral PTS angles were measured separately using true lateral radiographs before and after osteotomy. Rotational changes were evaluated on computed tomography. Nine tibiae were excluded due to lateral hinge fractures; thus, the final analysis included 7 samples in Group 1 and 8 in Group 2.

Results: In Group 1, the lateral PTS decreased significantly more than the medial PTS (6.28° ± 2.5 vs. 1.49° ± 1.9, P = .03). In Group 2, medial and lateral PTS changes were similar (5.28° ± 2.8 vs. 5.76° ± 2.9, P = .79). Computed tomography images revealed that the hinge was intact in the anterolateral cortex in Group 1 (Fig 5a) and in the lateral cortex in Group 2. Rotational assessment showed external rotation of the proximal fragment in Group 1 (2.05° ± 1.38) and internal rotation in Group 2 (Fig 5b) (2.88° ± 1.62), with no significant difference between groups (P = .33).

Conclusion: In MOWHTO, applying a larger posterior opening than anterior results in greater lateral PTS reduction compared to the medial side, particularly when the hinge is located in the anterolateral cortex. These findings highlight the importance of wedge configura tion and hinge integrity in controlling sagittal plane alignment.   Cite this article as: Yahyaoğlu A, Ergün S, Eceviz E. Effect of asymmetric anterior and posterior wedge openings on medial and lateral posterior tibial slope in medial open wedge high tibial osteotomy: An in vitro study on sheep tibias. Acta Orthop Traumatol Turc., 2025;59(6):421-427.

This case report describes a rare avulsion fracture of the calcaneus involving the plantar fascia insertion in an adolescent patient following a sports-related injury. The patient presented with acute heel pain, and imaging confirmed a significant avulsion at the plantar fascia's calcaneal attachment. Unlike the more common Achilles tendon-related avulsion injuries, this case illustrates a less frequently recognized injury pattern in the pediatric population. Management was conservative, consisting of rest, immobilization, and a structured rehabilitation program. The patient achieved full recovery, returning to normal activities without residual symptoms. This case underscores the importance of considering plantar fascia avulsion fractures in adolescent patients with heel pain, particularly in the context of athletic trauma.

The role of fasciotomy in the treatment of lower extremity crush injuries remains controversial. Late fasciotomy wounds are known to be associated with sepsis and amputation. This report presents the results of a limb-saving treatment procedure for a patient with crushinduced leg compartment syndrome who had undergone fasciotomy before admission. A 36-year-old male patient, trapped under rubble for 37 hours, presented with purulent-necrotic drainage from the fasciotomy site of his right leg. Two radical muscle debridements were performed to excise all necrotic muscles. No signs of sepsis developed postoperatively, and renal function normalized with the aid of hemodialysis. At the 1-year follow-up, the patient was able to walk with the assistance of a walker. Semmes-Weinstein monofilament testing showed a positive response to a 4.31-mm monofilament over the plantar aspect of the first metatarsal head; however, no sensation was detected in the dorsal aspect of the foot. This case highlights that radical muscle debridement may be considered a limb-preserving surgical option in patients with crush-induced leg compartment syndrome, as it can prevent sepsis, improve renal and metabolic function, and potentially obviate the need for amputation.

Objective: Cerebral palsy (CP) is a prevalent neurological disorder a!ecting 2-3 per 1000 live births globally. A common orthopedic consequence in CP is hip dislocation, with an incidence ranging from 15% to 30%. This study aimed to assess physiotherapists' (PTs) awareness and knowledge of hip dislocation in CP and identify knowledge gaps in this field. Methods: A cross-sectional survey was administered to PT working in healthcare institutions across Türkiye. The online anonymous survey, hosted on Google Forms, received responses from 128 PTs. It included questions related to the diagnosis, treatment approaches, and clinical experience concerning hip dislocation/subluxation. The survey consisted of 3 types of questions: demographic questions, yes/no knowledge questions, and opinion-suggestion questions. Results: The majority of PTs participating in this study work with pediatric patients. Physiotherapists had basic knowledge about hip dislocation although we observed significant gaps in areas related to routine screening programs and advanced treatment modalities. PTs incorrectly answered 3 out of 8 knowledge-based questions. The majority emphasized the importance of early diagnosis and treatment and expressed a need for more education and awareness programs. Conclusion: Physiotherapist provided important opinion-suggestion insights. The findings indicate a need for improved education and training for PT concerning hip dislocation in children with CP. We believe that the most appropriate screening method for Türkiye is to establish a screening program with a multidisciplinary structure formed between pediatric orthopedists, physical medicine and rehabilitation specialists (PM&R), PT, and family physicians (FPs). Level of Evidence: N/A.

Objective: This study aimed to evaluate the clinical and functional outcomes of patients who underwent simultaneous arthroscopic capsular release for adhesive capsulitis and rotator cu! repair. Methods: A retrospective analysis was performed on patients treated between 2014 and 2023 who underwent arthroscopic global capsular release combined with rotator cu! repair. Preoperative and postoperative outcomes, including range of motion (ROM), Visual Analogue Scale (VAS) scores, and Constant scores, were assessed with a minimum follow-up of six months. Results: Among 69 patients undergoing capsular release, 29 patients (20 females, 9 males; mean age: 56 years) received concurrent rotator cu! repair. The mean follow-up period was 14 months. Most tears involved the supraspinatus (25 full-thickness, 4 partial bursal-side). Complications were minimal, with only two diabetic patients displaying persistent ROM limitations and there were no re-tear in followup period. Statistically significant di!erences seen in ROM, VAS and Constant scores, VAS decreased from 7.1 to 1.2, Constant score improved from 37.5 to 72.3 (P < .05). Conclusion: Simultaneous arthroscopic management of adhesive capsulitis and rotator cu! tears provides favorable clinical and functional outcomes with lower complication rates compared to current literature, supporting its value as an e!ective treatment option. However, the limited sample size and relatively short follow-up should be considered when interpreting these results. Level of Evidence: Level IV, Therapeutic study.

Objective: This study aimed to evaluate button-related injuries, which are increasingly common in the textile and apparel manufacturing sector, to contribute to diagnosis and treatment and to raise awareness among employers and workers. Methods: This retrospective study included 23 patients with button-related injuries. The study evaluated patient demographics, the department they presented to, the level of hand injury, accompanying pathologies (osseous, neurological, vascular, and tendinous injuries), tetanus immunization status, occupational health and safety training status, awareness of workplace physicians, prior awareness of such injuries, history of occupational accidents, and long-term outcomes. Statistical analyses were performed using SPSS v21. Descriptive data were summarized as frequency (%) or mean ± SD, and the Shapiro-Wilk test was used to assess normality. Results: Among the 23 patients (14 males, 9 females), 16 sustained injuries to the distal phalanx and pulp level, while 7 had injuries at the middle phalanx level. At presentation, 4 patients exhibited hypoesthesia on the a!ected side of the finger, and 9 patients had reduced blood flow. Two patients had accompanying phalanx fractures. No tendinous pathologies were observed in any of the patients. All patients underwent surgical intervention. Seven patients developed nail deformities in the follow-up. Conclusion: Timely intervention and appropriate treatment after an injury are crucial for limb salvage and functionality. In long-term follow-ups, most patients healed without major complications; however, some the patients developed nail deformities. Level of Evidence: Level IV, Therapeutic Study.