Acta orthopaedica et traumatologica turcica最新文献

Objective: This study aimed to analyze the original articles published in Acta Orthopaedica et Traumatologica Turcica (AOTT) between 2013 and 2022 using bibliometric methods to identify their characteristics and examine the changing trends over the last 10 years.

Methods: The articles were analyzed in terms of publication year, authors, countries, affiliations, citations, study design, subspecialty of orthopedics, sample size, study outcome, presence of statistical methods, time elapsed from submission date to acceptance date, and presence of funding. Periods (2003-2012 and 2013-2022) were compared for trend analysis in the journal. Advanced bibliometric analysis was done using VOSviewer software (version 1.6.19).

Results: A total of 976 articles were included in the analysis. The journal's self-citation rate was 2.94%. Retrospective observational studies remained the most frequently published article design, as observed over 2003-2012 (n=411, 42.1%). No review articles were published in the previous period, while 35 review articles were published in this period. Publications from countries outside Türkiye exhibited a significantly higher number of case reports and reviews (P = .001), whereas articles from Türkiye had a significantly greater number of basic science and cross-sectional studies (P = .007, P=.017, respectively). Trauma (n=207), general orthopedics (n=144), and spine (n=105) were identified as the most prominent subspecialties. Spine surgery and adult reconstruction/arthroplasty publications significantly increased, while hand and microsurgery publications significantly decreased (P < .001). Article types were compared regarding citation counts, revealing that case reports and technical notes had significantly lower citation counts (P = .001). There was a significant increase observed in the number of author affiliations (n=2.57 ± 1.40) (P < .001). Management" (n=83), "fixation" (n=78), and "surgery" (n=65) were the most occurring keywords. There was a significant increase in articles with 1 or 2 authors in the latter 2017-2022 period compared to 2013-2016 (P=.001). A significant increase was observed in publications from private clinics and other clinical facilities (P < .001).

Conclusion: Acta Orthopaedica et Traumatologica Turcica (AOTT) has emerged as one of the leading journals in orthopedics, with a notable increase in international publications in the last decade. Being in the Science Citation Index Expanded (SCI-Expanded) database, increasing impact factor, and having low self-citation rates highlight its high standards and global impact. Acta Orthopaedica et Traumatologica Turcica (AOTT) is a valuable platform for researchers worldwide to share their work and advance orthopedic knowledge.

Level of evidence: N/A.

Objective: Post-lumbar fusion surgery often restricts daily activities due to lumbar stiffness. The validity and reliability of the lumbar stiffness disability index (LSDI) in Türkiye, which measures the impact of lumbar stiffness on functional abilities, have not yet been confirmed. This study aims to test the validity and reliability of the Turkish version of LSDI (Tr-LSDI).

Methods: Sixty-six patients who underwent lumbar fusion surgery were included in this methodological study. The Tr-LSDI was developed using a forward-backward translation. Using the Davis technique and expert feedback, we confirmed the content validity (CV) of the Tr-LSDI. The construct validity of the Tr-LSDI was assessed with exploratory factor analysis (EFA) and convergent validity. Convergent validity was examined by correlation analysis between Tr-LSDI, the Oswestry disability index (ODI) scores, and the number of fusion levels. Internal consistency was determined using Cronbach's alpha coefficients, and test-retest reliability was assessed with the intraclass correlation coefficient (ICC).

Results: Expert evaluation yielded CV indexes > 0.8 for all items. Exploratory factor analysis revealed a one-factor structure for Tr-LSDI, comprising 10 items that accounted for 63.7% of the variance. Factor loadings spanned from 0.371 to 0.926. Notably, the Tr-LSDI score correlated with fusion levels (r=0.386, P=.001) and demonstrated a robust correlation with ODI (r=0.899, P < .001), affirming its convergent validity. The Tr-LSDI displayed excellent internal consistency with a Cronbach's alpha coefficient of 0.934. The ICC was 0.980.

Conclusion: The Tr-LSDI is a validated, reliable tool for measuring lumbar stiffness in Türkiye. Its consistency, validity, and alignment with the original LSDI make it suitable for clinical and research use.

Level of evidence: Level II, Diagnostic Study.

Objective: This study aims to investigate the preferences of orthopedics and traumatology specialists in evaluating the spinopelvic relationship in primary total hip arthroplasty (THA) in Türkiye.

Methods: Members of the Turkish Orthopedics and Traumatology Association (n=2485) were invited to fill out the questionnaire. The survey was created using Google Forms and distributed to participants via WhatsApp and Gmail by sharing the link. A total of 205 orthopedic surgeons responded and completed the questionnaire. The survey included 13 questions about the duration of their experience, the number of THA and spinal instrumentation procedures they performed, the dislocation rates they encountered after surgery, and the radiological assessments they performed for the spinopelvic relationship.

Results: Sixty-three percent of the participants evaluated spinopelvic parameters in patients undergoing THA. Forty-seven percent of surgeons state that in their daily practice, they determine the angle of the acetabular component according to whether the spinal deformity is rigid, flexible, balanced, or unstable. While 88% of the participants stated the rate of encountering dislocation after primary THA as less than 2%, 12% of the participants stated it as more than 2%. It was observed that 40% of the surgeons with a prosthetic dislocation rate of more than 2% evaluated the spinopelvic relationship, while 67% of the surgeons with a dislocation rate of less than 2% evaluated the spinopelvic relationship.

Conclusion: Approximately half of the orthopedic surgeons in Türkiye plan component placement in primary THA cases by considering the spinopelvic relationship. In order to increase awareness about the spinopelvic relationship, it would be beneficial to give more space to this subject in training programs and conferences.

Level of evidence: N/A.

Objective: This study aimed to develop the Turkish version of the Brief Michigan Hand Outcomes Questionnaire (B-MHQ) and to demonstrate its reliability and validity for evaluating hand function in the Turkish population with hand/wrist disorders.

Methods: This study was conducted in accordance with Beaton et al.'s Guidelines for the Process of Cross-Cultural Adaptation of SelfReport Measures. A total of 54 patients with various hand and wrist problems were included in the study. The B-MHQ and Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) were used to evaluate hand function, and the visual analog scale (VAS) was used for the assessment of pain, which were completed by the subjects at baseline and 7 days later.

Results: The Turkish version of the B-MHQ showed good internal consistency, as evidenced by Cronbach alpha coefficients ranging from 0.895 to 0.876, and excellent test-retest reliability with an intraclass correlation coefficient of 0.968. In addition, B-MHQ was strongly correlated with Q-DASH (r=-0.878) and moderately correlated with VAS (r=-0.445).

Conclusion: The Turkish version of the B-MHQ seems to be a reliable and valid tool for assessing hand function in Turkish-speaking patients with hand disorders.

Level of evidence: Level III, Diagnostic Study.

Vertebral arterial injury (VAI) remains a fatal complication of C1-C2 posterior screw fixation. Herein, we report asymptomatic bilateral VAI that was caused by screws following C1-C2 posterior fixation. A 34-year-old woman with cerebral palsy experienced quadriplegia after a fall. Cervical computed tomography (CT) showed increased ADI, with os odontoideum, for which C1 pedicle screw and C2 pedicle-lamina screw fixation were performed. Cervical magnetic resonance imaging (MRI) conducted for postoperative weakness in shoulder elevation demonstrated a well-decompressed spinal cord. However, neck CT angiography revealed bilateral vertebral artery (VA) violations by the C1 pedicle screw that induced occlusion of the V2 and V3 segments of both VA, with intact V4 segments. Diffusionweighted imaging showed no evidence of infarction. Cerebral angiography showed reconstitution of posterior circulation via the left fetal posterior communicating artery. Steroid treatment-induced improvement in shoulder elevation to the preoperative level, and no neurological deterioration has been detected for 3 years postoperatively. Prevention of VAI is one of the most important objectives when performing posterior cervical screw fixation. The screw should be inserted considering the rotation of C1 and C2. Notably, variations in cerebral circulation, which enable collateral blood flow to the posterior circulation, can lead to different sequelae in patients with iatrogenic VAI.

Objective: This study aimed to compare the clinical and functional outcomes of patients with large posterosuperior rotator cuff tears between those with intact rotator cables (crescent-shaped tears) and those with repaired rotator cables (U-, V-, or L-shaped tears).

Methods: Eighty-two patients with a mean age of 64.05 ± 9.06 years who underwent arthroscopic repair due to large posterosuperior rotator cuff tears were evaluated with a follow-up period of 32 ± 5.9 months. Forty-two patients with an intact rotator cable and 40 patients with a repaired rotator cable (rotator cable restored with tendon-tendon sutures) were evaluated regarding preoperative and postoperative pain and functional outcomes.

Results: There was no significant difference in the constant score between the rotator cable repaired and the intact group (P=.22). However, when the sub-dimensions of the Constant score were compared separately, the forward flexion was significantly higher in the group with the intact rotator cable (P=.002). When the postoperative visual analog scale (VAS) scores were compared, lower scores were observed in the group with the repaired rotator cable (P < .001).

Conclusion: In large posterosuperior rotator cuff tears, patients with a repaired rotator cables experienced more significant pain relief compared to those with intact rotator cables, although their forward flexion was lower. Therefore, a detailed analysis of the tear type and the rotator cable condition in large posterosuperior rotator cuff tears may help predict postoperative pain and functional outcomes.

Level of evidence: Level III case-control study.

Objective: This study aimed to validate a software application (app) developed by the authors to streamline and enhance the accuracy of disability assessments, specifically for musculoskeletal system disabilities in the upper extremities.

Methods: A software was developed under a TÜB!TAK-funded project to aid in the disability assessment process. This tool, designed for Windows operating systems and developed in Visual Basic (VB.NET), was tested using archive data from 50 patients, focusing on upper extremity physical evaluations. Statistical analysis, including the Shapiro–Wilk and Independent t-test/Mann–Whitney U-tests, was conducted using IBM SPSS Statistics to compare the app-assisted and manual assessment methods regarding time and rating’.

Results: Significant time-saving was observed with the app-assisted method, which was 328.3 seconds faster on average than the manual method. The average rating di"erence between the 2 methods was minor (0.40 points, 0.92% di"erence) and not statistically significant (P=.931). The app-assisted method showed e#ciency in disability assessment with comparable accuracy to the manual methods.

Conclusion: This application was developed for physicians who examine patients with musculoskeletal system disabilities in the upper extremities for the Health Board. Our results show that the application reduces the average evaluation time by 5 minutes while maintaining accuracy comparable to the manual method. It could be a helpful tool for physicians in a clinical setting.

Level of evidence: Level IV, Diagnostic Study.

Objective: Lumbar spinal fusion is a common procedure for treating spinal degenerative diseases. Percutaneous endoscopic lumbar interbody fusion (PELIF) is a minimally invasive technique that has gained popularity. However, the factors influencing fusion success rates after PELIF have not been well-studied.

Methods: This single-center retrospective study reviewed the medical records of 96 patients who underwent single-level PELIF for degenerative pathologies between 2018 and 2020. Fusion was evaluated using thin-slice computed tomography scans at 12 months by 2 independent radiologists and defined as no detectable lucency between bone and graft. Patients were categorized into fusion and non-fusion groups. Data on age, operative time, blood loss, drainage, hospital stay, surgical level, osteoporosis, endplateitis, body mass index, lumbar curvature, and bone morphogenetic protein (BMP) use were collected. Univariate tests (chi-square, Student’s t-test, and analysis of variance) were employed to compare factors between groups. Significant factors were included in a multivariate logistic regression model with fusion as the dependent variable.

Results: The overall fusion success rate was 85.6% (86 fusion and 10 non-fusion). Univariate analysis revealed significant di!erences in age, osteoporosis, hypertension, diabetes, endplateitis, and BMP use between groups. Multivariate analysis identified osteoporosis (odds ratio (OR)=5.44, 95% CI, P < .05) and end-plate osteochondritis (OR=10.449, 95% CI, P < .05) as independent risk factors for non-fusion.

Conclusion: The use of BMP and endplateitis are significant factors that a!ect bone fusion outcomes after the PELIF procedure. These factors should be taken into account in order to improve postoperative bone fusion.

Level of evidence: Level IV, Therapeutic Study

The term "dyskinesia" has often been used interchangeably with "winging," leading to ambiguity in the literature. To address this, the broader term "scapulothoracic abnormal motion (STAM)" was introduced to describe any abnormal position or movement of the scapula on the chest, resulting in pain and dysfunction. Scapulothoracic abnormal motion has a wide range of causes, including musculoskeletal imbalances such as pectoralis minor hyperactivity, neurological impairments such as long thoracic nerve palsy, and genetic conditions like facioscapulohumeral muscular dystrophy (FSHD). This review aims to identify the different causes and classifications of STAM and to propose a detailed treatment algorithm specifically designed to manage these conditions effectively.

This study aimed to investigate the mid-to-long-term surgical outcomes of open reduction and internal fixation (ORIF) using a hybrid locking plate/cable technique for the treatment of Vancouver type B1 and type C periprosthetic femoral fractures (PPFs) in a consecutive group of patients from a single tertiary referral center. Twenty-five patients (25 PPFs; 17 female, 8 male) in whom a Vancouver type B1 or type C PPF was diagnosed and treated by a hybrid locking plate/cable technique from 2005 to 2016 were included in the study. Patients' functional status was categorized into 4 groups based on the Harris Hip Score (HHS) at the final follow-up: 70=poor result; 70-80=fair; 80-90=good, and 90-100=excellent. Intraand postoperative complications were also recorded. PPF union was defined clinically as the patient's ability to bear full weight with or without assistance and radiographically as the presence of a callus bridging the fracture. Subgroup analyses were conducted according to the Vancouver classification and type of fixation regarding the HHS and time to union. The mean age was 57 ± 16.6 (range, 17-82) years at the time of the primary hip replacement and 64 ± 18.7 (range, 24-88) years at the time of PPF. The mean follow-up was 5.6 ± 3.3 (range, 2-14) years from primary procedure to PPF and 6.5 ± 4.1 (range, 3-15) years following PPF. There were 7 type B1 and 18 type C PPFs. At the final follow-up, the mean HHS was 71 ± 7.74 (range, 57-89). According to HHS, functional results were poor in 8 patients, fair in 14 patients, and good in 3 patients. No major intra- or postoperative complications were noted. Fracture union was achieved in all patients without complications at an average of 13 ± 4.9 (range, 6-24) weeks. In subgroup analysis, while no significant differences were observed in the HHS (P=.87 for the Vancouver type, P=.96 for the type of fixation), time to union differed among groups. Time to union was significantly shorter in type B1 than in type C PPFs (P=.006). Time to union was considerably shorter in the uncemented group compared to the cemented one (P=.017). Adding cables to the locking plate can provide adequate stability to preserve fracture alignment and achieve bony union in Vancouver type B1 and C PPFs. Although union can be achieved by ORIF in such patients, a longer union time may be required for PPFs in the setting of a cemented femoral stem or Vancouver type C. Level IV, Therapeutic study.