Acta orthopaedica et traumatologica turcica最新文献

Objective: The structure and function of the Metatarsal Transverse Arch (MTA) remain underexplored. It was hypothesized that, during the push-off phase of gait, the MTA does not form a single arch between the first and fifth metatarsals; rather, it consists of 2 separate arches-one spanning the first to the third metatarsals and the other spanning the third to the fifth metatarsals-that function like the hulls of a trimaran boat. This study aims to investigate the biomechanical role of the MTA during this critical phase. Methods: Dynamic pedobarographic measurements were utilized from 1250 adults (847 females, 403 males). Maximum pressures on all metatarsal heads during the push-off phase were recorded, and MTA arches were calculated using the SAP2000 program. Statistical significance was set at P < .05. Results: The mean pressure on the third metatarsal was 160.0 (minimum: 9.0, maximum: 1799.0) for the left foot and 142.0 (minimum: 0.0, maximum: 1753.0) for the right foot. The maximum pressure in both feet occurred at the third metatarsal head (left: 67.0%, right: 54.6%). There was no statistically significant difference between genders regarding the maximum load on the metatarsal heads. Conclusion: This study reinterprets the biomechanical behavior of the forefoot and MTA during the push-off phase, potentially aiding in the understanding of forefoot pathologies. Future research on children and adolescents could further illuminate forefoot biomechanics. Level of Evidence: Level III.

Objective: This study aimed to identify the factors influencing the decisions of orthopedic and plastic surgery residents in Türkiye regarding their pursuit of a subspecialty in hand surgery, as well as to evaluate the challenges faced during hand surgery training. Methods: A national survey was conducted among residents in orthopedic and trauma surgery (n=92), plastic surgery (n=84), and hand surgery (n=12). The survey, developed from literature reviews and previous studies, was distributed online, and responses were collected via Google Forms. Orthopedic and plastic surgery residents responded using a 4-point Likert scale, while hand surgery residents answered multiple-choice questions. The collected data were analyzed to determine factors influencing career choices, training adequacy, and the challenges faced by residents. Results: The analysis revealed a negative correlation between the high volume of emergency hand surgery cases and residents' inclination toward the subspecialty (r=-0.217, P < .05). Theoretical training was significantly linked to enhanced hand surgery knowledge and skills (r=0.213, P < .05), whereas the lack of adequate training infrastructure negatively affected residents' experience (r=0.390, P < .05). Financial concerns and heavy workloads were identified as major challenges, with 33.3% of hand surgery subspecialty residents considering quitting their program. The study also highlighted a lack of continuity in training, insufficient exposure to elective hand surgery cases, and limited access to international educational opportunities. Conclusion: The findings indicate a need to enhance both the theoretical and practical aspects of hand surgery training in Türkiye. By addressing financial and workload-related concerns, improving clinical exposure, and expanding access to microsurgical tools and training resources, it may be possible to increase interest in the subspecialty and ensure a sustainable workforce of hand surgeons in the future. Level of Evidence: N/A.

Objective: This study aimed to investigate the relationship between post-traumatic pain levels in patients with hand-wrist injuries and symptoms of depression, activity participation, and quality of life. Methods: The study included 44 patients who presented to the Physical Therapy and Traumatic Hand Injury Outpatient Clinic with various diagnoses of traumatic hand injuries. Eligible patients had sustained traumatic hand injuries up to 10 cm proximal to the wrist, had no prior diagnosis of depression, and presented to the clinic for the first time between postoperative days 3 and 10. Pain severity was assessed using the Visual Analog Scale (VAS), activity participation was evaluated with the Quick Disability of the Arm, Shoulder, and Hand Questionnaire (Q-DASH), health-related quality of life was measured with the European Quality of Life Five Dimension Five Level Scale (EQ-5D-3L), and depression symptoms were assessed using the Beck's Depression Inventory (BDI). Results: All patients included in the study had at least one injured structure. The majority of the patients were male and worked in blue-collar occupations. The depressive symptoms were classified as moderately severe (BDI score ≥ 17). Among the injured structures, tendon injuries were the most common, and post-traumatic injuries were the most frequently observed type. Visual Analog Scale scores were significantly higher in tendon-fracture and tendon-nerve injuries compared to tendon injuries alone (P=.038 and P < .001, respectively). Quick Disability of the Arm, Shoulder, and Hand Questionnaire scores were significantly higher in tendon-nerve injuries than in tendon injuries (P < .001). Beck's Depression Inventory scores were significantly higher in tendon-nerve injuries than in bone and tendon injuries (P=.006 and P < .001, respectively). European Quality of Life Five Dimension Five Level Scale index scores were significantly lower in tendon-nerve injuries compared to bone and tendon injuries (P=.002 and P < .001, respectively). Correlation analysis revealed that VAS, QuickDASH, and BDI scores were not correlated with age. However, there was a strong positive correlation between VAS and QuickDASH scores, VAS and BDI scores, and QuickDASH and BDI scores. Conclusion: The findings suggest that pain management and psychological support interventions should be integrated into the rehabilitation process for patients with traumatic hand injuries. Addressing both pain and depressive symptoms during recovery may help minimize their negative impact on quality of life and improve activity participation. Level of Evidence: Level IV, Prognostic Study.

Objective: This study aimed to evaluate the impact of spinal anesthesia (SA) compared to general anesthesia (GA) on clinical outcomes in patients undergoing direct anterior approach total hip arthroplasty (DAA-THA) at a single institution. Methods: This prospective observational study was conducted at a single institution between 2014 and 2017. A total of 437 patients who underwent primary elective DAA-THA were included. Among them, 363 patients received SA, and 74 patients received GA. Demographic characteristics (age, sex), comorbidities, American Society of Anesthesiologists (ASA) scores, and preoperative hematocrit levels were recorded. The mean age was 59.4 years (range, 26-82 years), and 67.3% of the patients were female. The primary outcome measures included complication rates, estimated blood loss (EBL), changes in hematocrit, length of hospital stay (LOS), duration of surgery, acetabular and femoral component orientation, and stem subsidence. Results: No significant differences were found between the GA and SA groups regarding median EBL (0.9 L vs. 0.9 L, P=.675), hematocrit change (-8.12% vs. -7.70%, P=.727), mean duration of surgery (103 min vs. 105 min, P=.999), and LOS (3.5 days vs. 3.6 days, P=.462). Radiological outcomes, including femoral stem varus/valgus alignment (0.2° vs. 0.3°, P=.877), stem subsidence (0.9 mm vs. 1.0 mm, P=.111), and acetabular component abduction angles (42° vs. 43°, P=.475), were also comparable. The overall complication rates were 8% in the GA group and 5% in the SA group (P=.400). Conclusion: Both general and spinal anesthesia can be safely utilized in DAA-THA, providing comparable clinical and radiological outcomes. The choice of anesthesia did not significantly affect surgical time, blood loss, or complication rates. These findings are clinically relevant for optimizing anesthesia strategies in DAA-THA, offering flexibility for both surgeons and anesthesiologists without compromising patient outcomes. Level of Evidence: Level II, Therapeutic Study.

Objective: This study aimed to investigate the effects of traumatic brain injury (TBI) on vascular response and fracture healing during recovery. Methods: In this experimental animal study, a total of 63 male Wistar albino rats (200-250 g) were randomly assigned to 3 groups: TBI with tibia fracture (TBI+Fx, n=21), tibia fracture only (Fx only, n=21), and a control group (n=21). Traumatic brain injury was induced in the motor cortex using a controlled impact device, followed by the tibia fracture. The severity of TBI was assessed using rotarod tests. Blood samples were collected on days 1, 7, and 21 post-fracture, while brain and tibia samples were taken on day 21 following decapitation. Levels of antidiuretic hormone (ADH) and angiotensin 1-7 (Ang 1-7) were quantified using Enzyme-linked immunosorbent assays (ELISA). Fracture healing was assessed through micro-CT and histopathological analysis. Aortic segments were evaluated for contractile response and relaxation in isolated organ baths. Results: Micro-CT analysis revealed significantly greater bone volume (BV) (P=.02) and trabecular number (P=.038) in the TBI+Fx group. Histopathological healing scores were also significantly higher in the TBI+Fx group compared to the Fx only group (P=.019). Potassium chloride (KCl) induced contractile responses were greater in the Fx only group than in the TBI+Fx group (P < .05). Acetylcholine (ACh) induced relaxation was diminished in both Fx and TBI+Fx groups compared to controls (P < .01), whereas sodium nitroprusside (SNP)-induced relaxation was significantly greater in the TBI+Fx group than in the Fx only and control groups (P < .05). On day 21, arginine vasopressin (AVP) levels were significantly higher in the Fx only group compared to the TBI+Fx group (P=.034), with no significant differences observed on days 1 and 7. Plasma Ang 1-7 levels were significantly elevated in the Fx only group on day 21 compared to the TBI+Fx group (P < .05). Conclusion: Traumatic brain injury was associated with accelerated fracture healing, as evidenced by increased BV, trabecular thickness, and histopathological healing scores. Additionally, TBI appeared to modulate vascular function, possibly via mechanisms involving nitric oxide and calcium signaling. These findings suggest that neuroendocrine changes following TBI may enhance fracture healing, offering potential clinical insights for managing polytrauma patients. Level of Evidence: N/A.

Giant cell-rich osteosarcoma (GCRO) is a rare variant of osteosarcoma with unusual radiological and histopathological features that make its diagnosis challenging. The most critical and unusual feature of GCRO is that it has a purely osteolytic appearance. Therefore, GCRO cases are frequently subject to delayed diagnosis or incorrect treatment owing to misdiagnosis. This negatively affects the prognosis of these patients. In this study, 3 young adult cases are presented. The first case describes a young female patient who underwent repeated curettages due to a misdiagnosis of a giant-cell bone tumor, and the second case describes a delay in diagnosis in a young male patient who was misdiagnosed with an aneurysmal bone cyst. The final case report describes a young woman who was diagnosed early, treated promptly, and had a good prognosis. One of the poor prognosis cases in this report was treated with amputation, and the other was alive with multiple metastases. Misdiagnosis or delayed diagnosis leads to a poor prognosis in such cases. To make a diagnosis, it is necessary to have knowledge and to be suspicious of the radiological features of this rare variant. Giant cell-rich osteosarcoma should be among the differential diagnosis options when dealing with pure metaphysiodiaphyseal osteolytic bone lesions in young adults. To avoid misdiagnosis or delay, it is necessary to have knowledge and to be suspicious of this rare variant. Level of Evidence: Level IV, Therapeutic study.

Objective: Acromioclavicular (AC) joint instability remains a challenging clinical problem, particularly in chronic cases where both vertical and horizontal stability must be restored. Traditional techniques have limitations in addressing multidirectional instability and minimizing implant-related complications. The aim of this study was to evaluate the clinical and radiological outcomes of a combined coracoclavicular (CC) ligament and transacromial capsule reconstruction technique in patients with chronic AC joint instability. Methods: A retrospective study was performed on 40 patients who underwent AC joint reconstruction at a single center from 2019 to 2023. Radiological outcomes (clavicle-coracoid distance) were evaluated preoperatively, immediately postoperatively, and at the last follow-up (6 months). Functional results were assessed using the Constant, American Shoulder and Elbow Surgeons score (ASES), and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Data were analyzed using SPSS v28.0. T-tests and repeated measures of Analysis of Variance (ANOVA) were employed to compare outcomes, with significance set at P < .05. Results: The preoperative mean CC distance was 20.3 ± 3.4 mm. Early postoperative measurements showed a significant reduction in CC distance, with a mean of 9.5 ± 1.5 mm in the capsule reconstruction group compared to 10.5 ± 1.6 mm in the non-reconstruction group (P=.053). At the 6-month follow-up, the late postoperative CC distance was maintained at 10.1 ± 1.6 mm in the reconstruction group, while it increased to 14.4 ± 2.0 mm in the non-reconstruction group (P < .001). The mean ASES score was 87.1 ± 8.1. The mean Constant score was 86.2 ± 7.6. Pain levels, evaluated using the Visual Analog Scale (VAS), decreased from a mean of 5.8 ± 1.2 preoperatively to 2.1 ± 1.0 postoperatively, indicating significant pain relief and improved functionality. No hardware failure or infection was noted. About 12.5% of patients experienced short-term anterior knee pain. Conclusion: The results of this study demonstrate that combined CC ligament and transacromial capsule reconstruction improves radiographic outcomes by maintaining the clavicle-coracoid distance and enhances functional scores (ASES and Constant) in patients with chronic AC joint instability. Addressing both vertical and horizontal instability appears to contribute to better short-term clinical recovery. Further studies with larger sample sizes and longer follow-up are needed to confirm these findings. Level of evidence: Level III (Retrospective Comparative Study).

Objective: The aim of this study is to compare the clinical and functional results of single-radius (SR) and multi-radius (MR) femoral components in total knee arthroplasty (TKA). Methods: A total of 74 patients who underwent TKA surgery by a single surgeon between 2018 and 2021 were included in the study. The patients were then divided into 2 groups according to their femoral component design: group SR (38 patients) and group MR (36 patients). Except for gender and follow-up duration (P < .05), no significant difference was observed in age, American Society of Anesthesiologists scores, and BMI (P > .05). Knee range of motion, visual analogue scale (VAS), and combined KSS (Knee Society Score) were evaluated at the preoperative and final controls of the patients. In addition, frequency of anterior knee pain (AKP), AKP scale, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Hospital for Special Surgery (HSS) score, and the Forgotten Joint Score-12 (FJS12) were evaluated at the final follow-up. Results: There was no difference between the 2 groups in terms of postoperative range of motion (ROM), VAS, combined KSS, and HSS (P > .05). The frequency of AKP in patients with SR was found to be statistically lower than those with MR (P=.021; P < .05). The AKP scale was found to be statistically significantly lower in patients with prosthetic type MR compared to patients with SR (P=.04; P < .05). Singleradius patients had significantly better FJS-12 (P=.014; P < .05) and WOMAC scores (P=.003; P < .05). Conclusion: The results of this research showed that good clinical and functional results are obtained with TKA regardless of the femoral component design. Single-radius prostheses show better results than MR prostheses in terms of the frequency and severity of AKP. While there is no difference between femoral designs in terms of TKA-specific functional results such as KSS and HSS, the WOMAC score, which measures disease-related functions, provides better clinical results in SR designs. Additionally, SR designs show significantly better results in functional scores indicating patient satisfaction, such as FJS-12.

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.

Objective: A pelvic X-ray examination might not be accomplished accurately if the images are not acquired properly. In this study, the aim was to develop an automated model using artificial intelligence capable of accurately quantifying the symmetry of the obturator foramen in a pelvic anteroposterior X-ray and determining its suitability for evaluation. Methods: After applying the exclusion criteria, the study included 513 pelvic X-rays. An automated model was developed in the second stage to identify the iliac wings and obturator foramen. After that, calculations were performed to evaluate the obturator foramen's symmetry using the Dice, Jaccard, and Cosine similarity indices. Finally, the symmetry values determined by the physician and the suggested system were compared statistically. Results: The symmetry values found using the suggested model varied from 0.58 to 0.89. There was no statistically significant difference in the symmetry values of the obturator foramen as determined by the automated approach and the observer physician, as indicated by 3 distinct similarity indices (P=.68, P=.6, and P=.96). Conclusion: The artificial intelligence model successfully evaluated the appropriateness of the pelvic X-ray in terms of obturator foramen symmetry. Level of Evidence: Level III, Diagnostic Study.