Acta orthopaedica et traumatologica turcica最新文献

Objective: This study aims to undertake a comprehensive review of malpractice litigation cases involving limb amputation surgery, with a subsequent evaluation of the cases accepted as malpractice. Methods: The retrospective, descriptive study evaluated cases of alleged medical malpractice involving extremity amputations sent to the Medical Council. When medical error decisions were made by the board, the full range of allegations was subjected to evaluation, including issues related to consent, diagnosis, and treatment errors. A review was conducted of all closed legal cases pertaining to medical malpractice in the field of extremity amputation. A comprehensive dataset was collated, encompassing detailed information on each case. This included age, sex, and the anatomical location of the amputation (lower or upper extremity). Additionally, the amputation mechanism, the duration of hospitalization, and the time interval between surgery and the initiation of legal proceedings were investigated. Results: The study encompassed 290 medical litigations with a mean age of 39.6 ± 20 years. Of the participants, 213 (73.4%) were male, and 77 (26.6%) were female. Amputation surgery was conducted on the lower extremity in 191 patients (65.9%), the upper extremity in 97 patients (33.4%), and both upper and lower extremities in 2 patients (0.7%). The reasons for amputation surgery were classified as secondary to disease in 143 patients (49.3%) and traumatic injury in 147 patients (50.7%). Fifty-nine cases were accepted as medical malpractice. No significant di!erences were found between cases with and without medical malpractice, or among age groups, genders, extremities, lengths of hospital stays, levels of amputation, whether cases were secondary to trauma or disease. Conclusion: It is evident that there is a higher prevalence of malpractice in cases of traumatic injury; therefore, clinicians should exercise greater caution and diligence in the management of these cases. Level of Evidence: Level IV, Prognostic study.

Objective: This study aimed to evaluate the association between preoperative anticoagulant use and time to surgery, hospital length of stay, and 30-day postoperative complications in elderly patients with proximal femur fractures. Methods: This study included 572 patients with low-energy proximal femur fractures who required surgical treatment. Patients were categorized into two groups based on anticoagulation therapy use. The following data was collected and compered between the groups: time from hospitalization to surgery, hospital length of stay, percent changes in hemoglobin and other post-operative complications: death, cardiac complications, sepsis, deep venous thrombosis, pneumonia, urinary tract infection, surgical site infection, pressure ulcers, acute kidney injury and delirium. Multivariate regression analysis was performed to analyze possible confounders. Results: The median age of study participants was 83 years. 78.2% being female. Anticoagulation therapy was used by 19.9% of patients, predominantly non-vitamin K oral anticoagulants. Patients receiving anticoagulants experienced significantly longer hospital stays (median 9 vs. 7 days; P < .05) and surgical delays (median 3 vs. 2 days; P < .0001) compared to those without anticoagulation. Complication rates and hemoglobin level changes did not di!er significantly among the groups (P > .05). Multivariate analysis identified age, time to surgery, and hospital length of stay as independent predictors of 30-day postoperative complications, with age and hospital stay also significantly associated with 30-day mortality. Conclusion: Anticoagulation therapy did not directly increase 30-day postoperative complications or mortality but was associated with surgical delays and prolonged hospital stays, which negatively impacted outcomes. Delayed surgery and extended hospitalization emerged as key risk factors. These findings underscore the clinical importance of minimizing surgical delays in anticoagulated patients to improve postoperative outcomes. Level of Evidence: Level II, Prognostic study.

Objective: This study aimed to evaluate orthopedic residency training in Türkiye by analyzing the structure of clinical education, levels of faculty engagement, availability of mentorship, and residents' self-perceived competence. It further examined the influence of mentorship and faculty involvement on surgical training, academic career interest, and subspecialty decisions. Methods: A cross-sectional survey was conducted among orthopedic residents across Türkiye between February 6-18, 2025. A total of 849 residents participated, covering all provinces with orthopedic training centers. Data on institutional characteristics, educational methods, surgical exposure, mentorship, and residents' self-assessed competencies were collected using an online questionnaire. The mean age of participants was 29.1 years (range: 23-35), and 95.2% were male. The mean residency year was 2.7. The primary outcomes included surgical exposure, self-assessed competence, academic interest, and mentorship impact. Results: Among participants, 8.13% reported no theoretical education, with peer-based learning (52.1%) being the dominant method. Faculty-led instruction was limited (24.6%). A mentor figure was present in 68.8% and was significantly associated with higher selfassessed competence in theoretical knowledge, surgical skills, and complication management (P < .0001). Mentored residents had greater academic interest (41.1% vs. 33.2%, P=.011) and clearer subspecialty goals (27.9% vs. 18.9%, P=.017). Only 45.7% of the fifth-year residents rated themselves as highly competent. Higher monthly operating room days and case volumes were significantly correlated with greater self-perceived competence (P=.0001). Conclusion: This study reveals substantial disparities in surgical training, faculty engagement, and mentorship across orthopedic residency programs in Türkiye. Structured mentorship initiatives, improved surgical exposure, and faculty-driven education are essential to enhance residents' professional development and preparedness for independent practice.

Objective: This study aimed to evaluate the utility of preoperative spinopelvic analysis in reducing dislocation risk and to assess changes in spinopelvic mobility following total hip arthroplasty (THA). Methods: This cohort was assessed between 2018 and 2021, including 123 patients (123 hips) who underwent THA via the posterolateral approach. Group 1 (63 hips, 61 patients) underwent spinopelvic analysis with standing and sitting radiographs preoperatively and at 1- and 2-year follow-up, while Group 2 (62 hips, 62 patients) did not. Patients with Crowe type III-IV dysplasia, neurological or cognitive disorders, or acute trauma were excluded. Sacral slope (SS), spinopelvic tilt (sPT), and pelvic femoral angle were assessed. Intergroup comparisons were performed to evaluate the dislocation rates and changes in spinopelvic mobility. Results: One dislocation occurred in Group 1 and 3 in Group 2. In Group 1, significant changes were observed in sitting SS (preoperative to year 1: P < .001; year 2: P=.003) and sitting sPT (year 1: P=.004; year 2: P=.043), while standing measurements remained stable (SS: P=.762-.470; sPT: P=.683-.600). Mean sitting hip flexion also increased significantly (P < .001). Among 26 patients with hypermobility, 18 demonstrated normalization at 1 year, and 2 additional patients normalized at 2 years. In 1 patient with hypomobility, adjustment of acetabular anteversion based on spinopelvic findings successfully prevented dislocation. Conclusion: Preoperative spinopelvic analysis enabled the identification of mobility abnormalities and allowed for targeted surgical adjustments that may reduce dislocation risk. Notably, dislocations could potentially have been avoided with prior spinopelvic evaluation, underscoring its clinical relevance in preoperative planning. Postoperatively, SS increased exclusively in the sitting position, while remaining unchanged in standing position, reinforcing the necessity of seated imaging for comprehensive assessment. Level of Evidence: Level II, Cohort Study.

Objective: The purpose of this study is to investigate the intrarater and interrater reliability of handheld dynamometer (HHD) measurements in assessing isometric muscle strength of the shoulder abductors and to compare these results with those obtained using a fixed dynamometer (FD). Methods: The study involved 25 voluntary participants, all over the age of 18, asymptomatic (with no injuries in the upper extremity), and not engaged in overhead sports. The participants were evaluated twice by 2 di!erent testers who were experienced in orthopedic rehabilitation, at 90 degrees of shoulder abduction in the scapular plane. On the first measurement day, Tester 1 performed measurements using both HHD and FD, while on the second measurement day, both testers used only the HHD. A 3- to 7-day interval separated the 2 measurement sessions. Paired-samples t-tests were used to evaluate the systematic bias between the testers. Spearman's rank correlation coe"cient, intraclass correlation coe"cient, standard error of measurement, and minimal detectable change were calculated. The statistical significance level was accepted as P < .05. Results: Data from 22 participants (15 women, 7 men; mean age: 23.00 ± 3.19 years) were analyzed, as 3 individuals did not attend the final assessment. A strong correlation (r=0.772) was found between Tester 1's HHD measurements and FD, while a similarly strong correlation (r=0.748) was observed for Tester 2's HHD measurements. Excellent intrarater reliability (intraclass correlation coe"cient [ICC]=0.941) was found between Tester 1's measurements, and excellent interrater reliability (ICC=0.889) was found between testers. Conclusion: Handheld dynamometer has demonstrated excellent interrater and intrarater reliability and high validity for assessing shoulder abductor muscle strength in research and clinical use. Since the muscle strength of testers using the HHD may influence the results, the FD may be a more appropriate option when the study population is stronger than the testers. Studies involving di!erent clinical populations and testers with varying experience levels are needed to improve the relevance of the results. Level of Evidence: Level III, Diagnostic Study.

Objective: This study aims to evaluate the proximity between the anterior horn of the lateral meniscus (AHLM) and the tibial tunnel on postoperative magnetic resonance imaging (MRI) in patients who underwent remnant-preserving anterior cruciate ligament reconstruction (RP-ACLR), in order to assess the potential risk of AHLM injury. Methods: Eighty patients who underwent RP-ACLR between 2014 and 2020 were retrospectively analysed using postoperative MRIs. A 4-layer hamstring graft was used in all cases, and the mean diameter of the tibial tunnel was 8.17 ± 0.67 mm (range: 7-10 mm). The nearest distances between the AHLM and the tibial tunnel were measured in the coronal and axial planes on postoperative MRIs. Pearson and Spearman correlation tests were used for the correlation analyses. Calculations were made for the intraclass and interclass correlation coe!cients (ICC). Results: In the axial plane, the tibial tunnel was tangential to the AHLM in 4 patients (5%) and in the coronal plane in 3 patients (3.8%), with the nearest distance measured as 0 mm. No contour irregularity of the lateral meniscus was observed in any patient; meniscal morphology and signal characteristics were preserved, and no complex tears, deformations, or extrusions were detected on MRI. Statistical analyses demonstrated excellent intraobserver (ICC: 0.97-0.98) and interobserver (ICC: 0.99) reliability of the measurement method. Additionally, no statistically significant correlation was found between the measured distances and Lysholm scores. Conclusion: This study demonstrated that, although the tibial tunnel in RP-ACLR is in close proximity to the AHLM, injury to the AHLM can be avoided by carefully adjusting the trajectory of the guide wire to ensure it exits through the centre of the remnant tissue. Level of Evidence: Level IV, Therapeutic Study.

Objective: This study aimed to evaluate how single-leg weight-bearing and double-leg weight-bearing radiographs a!ect knee osteoarthritis assessment and treatment planning. Methods: Fifty orthopedic physicians were asked to assess the knee radiographs of 10 female patients (mean age: 68 ± 6.6 years) presenting with knee pain. The radiographs were obtained in both double-leg and single-leg weight-bearing positions. Physicians were asked to determine the appropriate treatment plan (conservative management, unicondylar knee replacement, or total knee replacement). If they opted for surgical intervention, they were further asked to specify which prosthetic material they required to be available during surgery (a unicondylar knee prosthesis, both unicondylar and total knee prostheses, a total knee prosthesis, both total and revision knee prostheses). Treatment plans based on double-leg and single-leg weight-bearing radiographs were compared. Results: Conservative management was more frequently selected based on double-leg weight-bearing radiographs (P < .001). In contrast, the requirement for additional surgical materials was significantly higher for single-leg weight-bearing radiographs (P < .001). Specifically, 53.6% of physicians preferred having both total and revision knee prostheses available based on double-leg weight-bearing images, compared to 64.2% for single-leg images. Moreover, 31.2% of physicians upstaged their treatment plans after reviewing single-leg radiographs. Additionally, 13% of physicians opted for a total knee prosthesis based on double-leg weight-bearing images, whereas this proportion increased to 29% with single-leg weight-bearing images. Conclusion: Single-leg weight-bearing radiographs prompted more invasive treatment decisions, highlighting their clinical utility in detecting pathology that may influence surgical planning. Level of Evidence: Level IV, Diagnostic Study.

Objective: This study aimed to investigate and compare the e!ects of naproxen (a nonselective nonsteroidal anti-inflammatory drug [NSAID]), celecoxib (a cyclooxygenase (COX)-2 selective NSAID), and acetaminophen (an analgesic with minimal anti-inflammatory activity) on tendon and tendon-bone healing following surgically induced supraspinatus tendon repair in a rat model. Methods: In this experimental study, 56 adult male Wistar Albino rats (mean weight, 300 g) were randomized into 4 groups (n=14 per group): control (1% methylcellulose vehicle), naproxen, celecoxib, and acetaminophen. A standardized full-thickness tear of the supraspinatus tendon was surgically created, and repair was performed using transosseous suture fixation through a humeral bone tunnel. Postoperative treatments were administered via oral gavage for 14 days. Tendon healing was assessed at 28 days through histological evaluation using modified Bonar scoring (n=6 per group) and biomechanical testing via uniaxial tensile assays (n=8 per group). Primary outcome measures included Bonar scores, maximum tensile strength, displacement, and sti!ness. Results: The acetaminophen and control groups demonstrated superior maximum strength and sti!ness compared to the NSAID-treated groups; however, these di!erences did not achieve statistical significance (maximum strength: P=.28; sti!ness: P=.40). Histological analyses revealed significantly enhanced tendon-bone healing in the acetaminophen and control groups relative to the celecoxib and naproxen groups (P=.01). Conclusion: The early postoperative administration of COX-2 selective and nonselective NSAIDs may compromise early tendon-bone healing compared to acetaminophen. Although biomechanical di!erences were not statistically significant at 28 days, histological findings underscore the potential impact of analgesic selection on early postoperative tendon healing. Level of Evidence: N/A.

Objective: The present study aimed to evaluate the clinical success of computed tomography (CT)-guided radiofrequency ablation (RFA) in the treatment of proximal femoral located intra-articular osteoid osteoma (IAOO). Methods: This retrospective study included consecutive patients with clinical and CT imaging features suggestive of IAOO who were treated using a standardized CT-guided RFA technique between January 2020 and September 2024. The clinical, demographic, and radiological characteristics of the patients were documented. The e!cacy and results of the RFA treatment were evaluated. Results: Based on the inclusion criteria, 20 patients were included in the study. The mean follow-up period was 29.2 months (range: 6-48 months). The median procedure time was 43 minutes. No immediate or late major or minor complications were recorded. Technical success was achieved in 100% of the cases. In 3 of 20 patients, pain symptoms recurred within the first month, so RFA was performed again, and full clinical success was achieved. The preoperative mean Visual Analogue Scale (VAS) score was 7.4 (range: 5-10). The postoperative first month mean VAS score was 1.2 (range: 0-2). Conclusion: Computed tomography-guided RFA is a highly safe and e"ective technique that can be considered as the first choice for treating symptoms associated with proximal femoral IAOO. Performing all manipulations under CT guidance at all stages of the procedure, accessing the nidus through extra-articular normal bone, and centralizing the nidus with the RFA probe facilitates the safety of the technique and prevents damage to the articular cartilage. Ü Level of Evidence: Level IV, Therapeutic Study.