Acta orthopaedica et traumatologica turcica最新文献

Objective: To evaluate the accuracy, applicability, comprehensiveness, and communication quality of responses generated by ChatGPT and Google Gemini in adolescent idiopathic scoliosis (AIS)-related scenarios, with the aim of assessing their potential utility as tools in patient management. Methods: Six case-based questions reflecting common patient concerns related to adolescent idiopathic scoliosis were developed by orthopedic specialists. Responses generated by ChatGPT and Google Gemini were independently evaluated by 61 orthopedic surgeons using a standardized rubric assessing accuracy, applicability, comprehensiveness, and communication clarity, each rated on a 1-5 Likert scale. Comparative analyses between platforms were performed using the Mann-Whitney U and Wilcoxon signed-rank tests. Additionally, open-ended feedback was collected to explore participants' perspectives on the potential and limitations of AI-based consultations. Results: ChatGPT outperformed Google Gemini in terms of accuracy (P = .013) in postoperative care scenarios. The results for applicability (P = .119), comprehensiveness (P = .619), and communication (P = .240) were not statistically significant. Orthopedic specialists rated both AI models significantly higher than residents in accuracy, applicability, and comprehensiveness. Most evaluators acknowledged the potential of AI to reduce physician workload and support patient guidance; however, concerns were raised regarding reliability, ethical implications, and the current limitations of AI in ensuring patient safety. Conclusion: ChatGPT and Google Gemini demonstrated moderate accuracy and communication quality in adolescent idiopathic scoliosis-related scenarios, with ChatGPT showing a modest advantage. Although both models show promising results as supportive tools for patient education and preliminary consultations, their current limitations in accuracy and comprehensiveness restrict their clinical reliability. Multidisciplinary collaboration is crucial to ensure e!ective applications of AI in orthopedic practice. Level of Evidence: Level III, Diagnostic Study.

Objective: This study aimed to evaluate mid-term outcomes (>52 weeks) of biointegrative implants in foot and ankle surgery by assessing patient-reported outcome measures (PROMs) and comparing them with standard metal implants. Additionally, the study examined radiographic changes in diastasis of the Lisfranc and syndesmosis injuries to determine the e!ectiveness of biointegrative implants for maintaining reduction. Methods: This retrospective case-control study included 178 patients who underwent midfoot, hindfoot, or ankle syndesmosis surgeries at 3 centers within the same institution (91 cases, 87 controls). Of the 91 patients in the case group, 46 were female and 45 were male. The control group consisted of 43 females and 44 males. The mean age was 42.45 ± 18.89 years in the case group and 42.68 ± 18.32 years in the control group. Cases received biointegrative implants; controls received metal or flexible fixation. Procedures included fixation or fusion of the Lisfranc joint, tarsometatarsal joints, intercuneiform, navicular, cuneiforms, and cuboid; hindfoot arthrodesis; and medial malleolus or syndesmosis fixation. Visual analog scale (VAS) pain scores were recorded at preoperative, early postoperative, and at 3, 6, and 12 months. Patient-reported outcome measure scores (Pain Interference [PIF], Pain Intensity [PI], and Physical Function [PF]) were collected at baseline, early postoperative, and "1-month postoperative. Diastasis and fixation integrity were assessed via radiographs and Computed Tomography. Re-operation and complication data were extracted from patient charts. Repeated-measures ANOVA was used for analysis. Results: Both groups showed significant reductions in VAS pain scores from preoperative to postoperative time points (P < .001). Further reductions were observed from the first postoperative visit to 3 and 6 months (P < .02), and from 3 to 12 months (P < .01). However, no significant di!erences were found between groups regarding VAS scores (P = .50). PROMIS scores significantly improved over time in both groups (PF: P < .001, PIF: P < .001, PI: P < .001), with no intergroup di!erences (PF: P = .52, PIF: P = .55, PI: P = .37). No di!erence in diastasis measurements was found between groups (P = .214). Hardware failure occurred in 5 cases and 14 controls; 2 surgical site infections were also observed in the control group. Conclusion: This study is among the first to evaluate mid-term outcomes of biointegrative implants in foot and ankle surgery. Patient-reported outcome measure scores showed significant improvement as early as the early postoperative period. Complication rates were comparable to metal implants. While findings support biointegrative screws as a viable fixation method, long-term and prospective studies are needed to confirm their safety and efficacy. Level of Evidence: Level III, Therapeutic Study.

Objective: Mechanical complications are common after adult spinal deformity (ASD) surgery and can significantly impair outcomes. This study aimed to predict such complications in proportioned and moderately disproportioned patients using a machine learning approach, to inform preoperative planning and enable early preventive care. Methods: Prospectively collected clinical data, including preoperative, intraoperative, and postoperative variables, radiographic param- eters, technical details, and patient-reported outcomes, were obtained from a multi-center ASD surgery database. Parameter tuning of a random forest (RF) classifier was performed using 9-times 3-fold cross-validation over 3 rounds of grid search, with the F-score used as the primary optimization metric. The final RF model was used to derive a clinically interpretable rule set using the inTrees framework. Permutation-based feature importance was assessed for F-score, accuracy, and sensitivity. Results: The model was trained on 295 patients (237 female, 58 male; mean age, 50 ± 19 years) with a minimum 2-year follow-up (mean 53 months, range 24-101). Mechanical complications were observed in 100 patients (34%). A test cohort of 98 patients (33% complication rate) was used for external validation. The RF model achieved 72% accuracy, 91% sensitivity, 64% specificity, and 93% negative predictive value. The derived rule set, comprising 8 rules using 1 to 3 features each, yielded 74% accuracy, 81% sensitivity, 71% specificity, and 83% negative predictive value. The location of the lower instrumented vertebra (LIV) was the most influential predictor. Conclusion: By excluding patients with severe deformities, as defined by the GAP score, this study focused on the more clinically ambiguous group of proportioned and moderately disproportioned patients. To the authors' knowledge, this is the first study to develop predictive tools specifically for this subgroup to assess the risk of mechanical complications following ASD surgery. These tools may assist in early risk stratification and guide preoperative decision-making to reduce postoperative complications and improve patient outcomes. Level of Evidence: Level III, Prognostic Study.

Vascular injuries associated with femoral intertrochanteric fractures are rare but can result in serious complications. A case of iatrogenic injury to the descending branch of the lateral circumflex femoral artery in a patient who underwent surgical fixation of an intertro-chanteric femoral fracture is presented. The injury possibly occurred during the creation of the entry point for nail insertion using a guide pin. Clinical symptoms emerged 10 days postoperatively and were successfully managed with percutaneous embolization, without major complications. This case highlights that pseudoaneurysms can develop as a result of guide pin use during hip nailing procedures. Surgeons can avoid this complication by obtaining lateral and anteroposterior views of the hip. Level of Evidence: IV, Case Report.

Objective: This study aimed to evaluate the clinical outcomes of preserving and repairing the bursal tissue-rather than excising it-during total hip arthroplasty (THA), and to assess the additional e!ect of administering a steroid injection into the repaired bursa. Methods: Patients who underwent total hip arthroplasty (THA) via a posterior approach were retrospectively reviewed and divided into three groups based on the intraoperative bursal tissue management technique. The first group (PB) included patients who received an intraoperative injection of corticosteroid (40 mg methylprednisolone) and local anesthetic (bupivacaine 5 mg/mL) into the pre- served bursa. The second group (BR) consisted of patients who underwent bursal repair without injection. The third group (BE) comprised patients who underwent total excision of the bursa. Clinical outcomes were assessed using the Harris Hip Score (HHS), the Visual Analogue Scale (VAS) for pain during daily activities, and VAS for pain while lying on the ipsilateral hip at 6 and 24 months postoperatively. Results: A total of 41 patients (27 females, 14 males) who underwent THA were included in the study. No statistically significant di!erences were observed between the groups in lateral trochanteric VAS scores during daily activities at both 6 and 24 months postoperatively (P > .05). However, a significant di!erence was found in VAS scores assessed while lying on the operated side at 6 months, favoring the PB group (P < .001). Additionally, Harris Hip Score (HHS) values were significantly higher in the PB group compared to the other groups at both 6 months (P < .001) and 24 months (P = .006). Conclusion: Intraoperative corticosteroid and local anesthetic injection, in addition to bursa repair, may improve early postoperative outcomes and pain relief in patients undergoing THA using the posterior approach, without increasing infection risk.

Objective: The objective of this study is to explore the role and regulatory mechanisms of disulfidoptosis in spinal cord injury (SCI) and to develop a diagnostic model based on this cell death mechanism. Methods: The peripheral blood RNA-seq data from SCI patients sourced from dataset GSE151371 was utilized in the study. Various analytical techniques, including differential gene expression analysis, immune infiltration profiling, consistency clustering, and pathway enrichment analysis, were employed to investigate the impact of disulfidoptosis. Machine learning models were also developed to aid in the diagnosis of SCI based on gene expression profiles related to disulfidoptosis. Results: Gene expression analysis revealed significant upregulation of genes such as GYS1, PDLIM1, NDUFA11, and MYL6, and down-regulation of NUBPL, LRPPRC, and CD2AP in SCI patients, with statistical significance (P < .05). Immune infiltration profiling showed a decrease in CD4+ and CD8+ T cells, contrasted by an increase in gamma delta T cells (P < .05), indicating an altered immune landscape. Furthermore, 2 distinct subgroups were identified through consistency clustering, highlighting significant differences in disulfidoptosis- related gene expression. Pathway enrichment analysis revealed different pathways between clusters, suggesting diverse regulatory mechanisms within SCI subtypes. The diagnostic model evaluation using random forest achieved the highest accuracy with an area under the curve (AUC) of 0.955, demonstrating its potential utility in clinical settings for SCI diagnosis. Conclusion: Disulfidoptosis plays a significant role in the pathophysiology of SCI. This study offers novel insights into its molecular mechanisms and presents a potential foundation for diagnostic modeling.

The management of retained orthopedic hardware during amputation procedures presents significant challenges. A case utilizing a modified Gritti-Stokes through-knee amputation to address a periprosthetic fracture with an exposed intramedullary nail (IMN) in a patient with multiple comorbidities is reported. A 47-year-old male with a history of human immunodeficiency virus, hepatitis C virus, and type 2 diabetes mellitus presented with a left femoral periprosthetic supracondylar fracture. The patient had an existing IMN from a previous femoral shaft fracture 20 years prior, along with a left below-knee amputation. Due to the newly occurred periprosthetic fracture and the patient's immunocompromised status, further amputation was deemed necessary. However, removal of the well-integrated IMN posed significant risks. A modified Gritti-Stokes through-knee amputation was performed, adapting the procedure to use the patella as a biological cap to cover the exposed IMN tip. At 4-month follow-up, the patient demonstrated satisfactory wound healing and stable positioning of the patellar cap. The patient achieved ambulation with an above-knee prosthesis and crutch assistance, reporting high satisfaction and no pain or discomfort. This case highlights the versatility of the Gritti-Stokes procedure in addressing complex scenarios involving retained hardware. By utilizing the patella as a biological cover for the exposed IMN, the risks associated with hardware removal was avoided while achieving a stable, well-healed amputation stump. This modification of the Gritti-Stokes technique offers a viable solution for patients with retained IMNs requiring through-knee amputation, particularly in cases where hardware removal is contraindicated or highly risky.

Early onset scoliosis (EOS) poses significant treatment challenges, often exacerbated by postoperative wound complications. A novel case of hyperinflammatory wound complications in a child with a confirmed NFKB1 mutation is presented, successfully managed with immunomodulation. A 6-year-old boy experienced wound dehiscence and persistent inflammation following rod placement, unresponsive to conventional treatments including surgical debridement and antibiotics. Further evaluation identified an NFKB1 mutation associated with hyperinflammatory states. Targeted treatment with Anakinra, an interleukin (IL)-1 receptor antagonist, resulted in rapid wound healing and normalization of inflammatory markers. Subsequent serial rod expansions, pretreated with Anakinra, were complication-free, and the patient remained stable for 4 years post treatment. This case emphasizes the critical role of genetic predispositions, such as NFKB1 mutations, in postoperative complications. Dysregulated IL-1β activity was effectively managed with targeted immunomodulation, highlighting the importance of recognizing and addressing non-infectious hyperinflammatory processes. Patients presenting with very early wound dehiscence, disproportionate inflammatory responses, and unresponsiveness to infection management may benefit from detailed immunologic evaluation. Rare hyperinflammatory conditions should be considered in the differential diagnosis of challenging postoperative wound healing scenarios.