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Lumbar spinal stenosis (LSS) frequently coexists with degenerative spondylolisthesis (DS) in the elderly population, and the standard treatment commonly involves decompression with fusion. However, fusion procedures are associated with increased morbidity and may not always be necessary, particularly in Grade I DS. Full-endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) has gained attention as a motion-preserving alternative, yet its impact on postoperative stability remains insufficiently studied. Primary objective was to evaluate 12-month improvements in patient-reported outcomes (leg-pain VAS, ODI) after LE-ULBD; radiographic stability was assessed as a key secondary endpoint. This retrospective cohort study included 32 patients with Meyerding stable Grade I DS and symptomatic LSS who underwent single-level lumbar LE-ULBD between January 2023 and October 2024. Pre- and 12-month postoperative radiographs were analyzed for segmental instability, defined as sagittal translation > 4 mm or angular motion > 10°. Clinical outcomes were assessed using Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Macnab’s criteria. Subgroup analysis was performed based on slip progression. Mean vertebral slip percentage showed no significant change postoperatively (13.4% ± 3.1 vs. 13.8% ± 3.4; p  = 0.27). Only one patient (3.1%) developed new radiographic instability. VAS improved from 7.1 ± 1.2 to 1.4 ± 0.8 and ODI from 64.3% ± 9.1 to 18.5% ± 4.7 ( p  < 0.001 for both). According to Macnab’s criteria, 90.6% of patients reported Excellent or Good outcomes. Slip progression was observed in 9 patients (28.1%), but this was not associated with inferior clinical results. Complications occurred in 2/32 (6.3%) one incidental durotomy and one epidural hematoma with reoperation in 1/32 (3.1%); new radiographic instability in 1/32 (3.1%). LE-ULBD appears to be a safe and effective treatment option for selected patients with Grade I DS and LSS, achieving significant symptomatic relief while preserving segmental stability in the majority of cases. These findings support its consideration as an alternative to fusion in carefully selected individuals. LE-ULBD short-term (12-month) radiographic stability and clinically meaningful improvement in patients with stable grade-I degenerative spondylolisthesis; longer-term follow-up is required to determine durability and late instability risk.

Periprosthetic joint infections caused by Brucella melitensis are rare and present significant diagnostic and therapeutic challenges, especially in endemic regions such as Anatolia. The indolent nature of Brucella infections often results in subclinical presentations, complicating early detection and management. This case series highlights the importance of recognizing Brucella melitensis as a potential pathogen in periprosthetic joint infection and explores the treatment options for this condition. Herein, we present five cases of Brucella melitensis-associated periprosthetic joint infections involving three hip replacements and two knee replacements. Diagnoses were confirmed through advanced diagnostic techniques, including prolonged cultures and serological testing, as routine methods often yielded negative results. Two patients underwent one-stage revision arthroplasty, two underwent two-stage revision arthroplasty, and one patient was managed conservatively with targeted antibiotics due to the absence of prosthetic loosening. All patients showed excellent functional recovery and infection eradication at follow-up, with normalized inflammatory markers and no evidence of recurrence. This case series emphasizes the importance of clinical suspicion and the use of advanced diagnostics in endemic areas for timely recognition of Brucella-associated periprosthetic joint infections. One-stage revision arthroplasty combined with prolonged antibiotic therapy demonstrated favorable outcomes and may serve as an effective treatment strategy.

Objective Neural tube defects are the most common congenital disorders after cardiac anomalies. Lumbar kyphosis deformity is observed in 8–15% of these patients. This deformity severely limits the daily lives of these patients. In our study, we aimed to correct the kyphosis angle of the patients with lumbar kyphosis associated with myelomeningocele (MMC) and allow them to continue their growth without limiting their lung capacity by applying kyphectomy and sliding growing rod technique. Patients and methods In this study, we retrospectively evaluated 24 patients with congenital lumbar kyphosis deformity associated with MMC, aged between 4 and 9 years, and who applied to Umraniye Training and Research Hospital between the dates of 2018 and 2021. We evaluated preoperative and postoperative kyphosis angles, correction rates, bleeding during operations, operation time, level of instrumentation, number of the resected vertebrae, initial levels of the posterior defects, duration of hospital stays, annual lengthening, and weight of the patients. Results Mean age was 5.04 (between 4 and 9). Mean preoperative and early postoperative kyphosis angles were 129.8° (87–175°) and 0.79° (− 20–24°), respectively. The kyphotic deformity correction rate was 99.1%. A difference was found regarding kyphosis measurements between preoperative and early period values ( p  < 0.05). The annual height lengthening of patients was calculated as 0.74 cm/year and 0.77 cm/year between T1–T12 and T1–S1, respectively. Mean preoperative level of hemoglobin (Hgb) was 11.95, postoperative Hgb value was 10.02, and the decrease was significant ( p  < 0.05). In terms of complications, 50% (12) had broken/loosen screws, 50% (12) had undergone debridement surgery, 37.5% (9) had vacuum-assisted closure therapy, and 33.3% (8) had to get all of their implants removed. Conclusion We believe that our sliding growing rod technique is a new and updated surgical method that can be applied in these patient groups, facilitating the life, rehabilitation process, and daily care of MMC patients with lumbar kyphosis. This technique seems to be a safe and reliable method which preserves lung capacity and allows lengthening.

OBJECTIVE: The purpose of the present study was to evaluate the mid-term implant survivorship, modes of failure, radiographic results, and clinical outcomes of current cementless total hip arthroplasty (THA) treatment designs for steroid-induced avascular necrosis (AVN). METHODS: A time span of 5 years between January 2012 and November 2017 was scanned to accommodate 5 years of follow-up and a total of 15 patients (18 hips), who had undergone implantation of ultra-high molecular weight polyethylene (UHMWPE) and newly designed other head and liner components, were included in the study. Only patients operated for steroid-induced AVN were included in the study. Patients with alcohol-induced, idiopathic, and traumatic AVN were excluded from the study. The primary outcomes were the assessments of Harris Hip Score (HHS) and the presence of loosening, osteolysis, polyethylene wear or a reoperation (with or without revision of components). The fixation of cementless femoral components was assessed according to Engh criteria. RESULTS: The study group consisted of 18 hips from 15 patients. The mean age was 47.6[+ or -]8.1 (29-55) years. A cementless femoral stem and acetabular cup were used for all patients. Septic loosening was detected in all components of one patient (5.6%). The mean HHS score was 83.3[+ or -]7.2 (60-92) for all patients. Of the 18 hips, 83% (15 hips), 5.6% (1 hip), 5.6% (1 hip), and 5.6% (1 hip) had good, poor, fair, and excellent HHS scores. Ceramic or polyethylene liner wear was not detected in any of the patients. The Engh Grading Scale revealed a \"bone ingrowth\" in 16 (89%) hips, \"suspected in-growth\" in 1 (5.6%) hip and \"suboptimum but stable\" femoral fixation in a patient with septic loosening (5.6%) just before revision surgery. There was no significant correlation between femoral stem design and Engh score (p=0.842). CONCLUSION: Modern total hip arthroplasty systems, including ceramic on ceramic or ceramic on polyethylene headliner options with cementless femoral stem, offer promising mid-term survivorship and positive clinical outcomes for steroid-induced AVN treatment. However, studies including long-term follow-ups with larger sample size are needed to obtain more precise data. Keywords: Avascular necrosis; liner wear; steroid use; survival; total hip arthroplasty.

[LANGUAGE= \"English\"] INTRODUCTION: We aimed to evaluate the effectiveness of modified Aberdeen Weight-Bearing Test (Knee) (AWT-K) and KSS (Knee Society Score) comparing their correlations with the Tegner Lysholm (TL) score in patellar instability patients.METHODS: Patients treated for patellar dislocation were divided into two groups. The first group consisted of patients operated on for patellar instability and the second group patients followed by conservative means. Duration of follow-up, age, gender, Caton-Deschamps index, and type of surgical interventions were recorded. Since the TL scoring system was previously validated in the follow-up of patellar instability treatment, the compatibility of KSS and modified AWT-K scoring systems with the TL scoring system was evaluated and their effectiveness in the follow-up of patellar instability was examined.RESULTS: A moderate correlation was found between TL and total KSS scores.However, when the relationship between KSS subgroups ES, SS, OKS, FAS and TL is examined; a weak and moderate correlation was found between the TL scoring system and OKS, SS, and FAS. When weak and non-correlated ES and SS were excluded, there was a strong correlation between TL score and mtKSS.There was a low correlation between TL scores and AWT-K 60-second average load difference and there was a low correlation between FA and AWT-K 60-second mean load difference and ratios.DISCUSSION AND CONCLUSION: The weak correlation of the AWT-K test for weight-bearing on the knee with findings of KSS and the TL scoring system reveals that may not be an adequate follow-up instrument for patients with patellar instability in short-term follow ups.[LANGUAGE= \"Turkish\"] GİRİŞ ve AMAÇ: Patellar instabilite hastalarında modifiye Aberdeen Weight-Bearing Testi (Diz) (AWT-K) ve KSS (Knee Society Score) ile Tegner Lysholm (TL) skoru arasındaki korelasyonun etkinliğini değerlendirmeyi amaçladık.YÖNTEM ve GEREÇLER: Patella çıkığı nedeniyle tedavi edilen hastalar iki gruba ayrıldı. Birinci grup patellar instabilite nedeni ile opere edilen hastalardan, ikinci grup ise konservatif yöntemlerle takip edilen hastalardan oluşturdu. İzlem süresi, yaş, cinsiyet, Caton-Deschamps indeksi ve uygulanan cerrahi girişimlerin tipi kaydedildi. TL skorlama sistemi daha önce patellar instabilite tedavisi takibinde valide edildiğinden, KSS ve modifiye AWT-K skorlama sistemlerinin TL skorlama sistemi ile uyumu değerlendirilerek patellar instabilite takibindeki etkinliği incelenmiştir.BULGULAR: TL ile toplam KSS puanları arasında orta düzeyde bir korelasyon bulundu. Ancak KSS alt grupları ES, SS, OKS, FAS ve TL arasındaki ilişki incelendiğinde; TL puanlama sistemi ile OKS, SS ve FAS arasında zayıf ve orta düzeyde bir korelasyon bulundu. Zayıf ve korelasyonsuz ES ve SS hariç tutulduğunda, TL puanı ile mtKSS arasında güçlü bir korelasyon vardı. TL puanları ile AWT-K 60 saniye ortalama yük farkı arasında düşük bir korelasyon vardı ve FA ile AWT-K 60 saniye ortalama yük farkı ve oranları arasında düşük bir korelasyon vardı.TARTIŞMA ve SONUÇ: AWT-K testinin diz üzerine yük bindirme ile KSS bulguları ve TL skorlama sistemi arasındaki zayıf korelasyonu, patella instabilitesi olan hastalarda kısa dönem takiplerde yeterli bir takip aracı olmayabileceğini ortaya koymaktadır.

Background/Objectives: Osteochondral lesions are common after acute patellar dislocation, particularly in young, active individuals. Although fixation of osteochondral fragments is a preferred treatment to restore joint congruence and prevent cartilage degeneration, the prognostic effect of lesion localization and size on postoperative outcomes remains unclear. Methods: This retrospective clinical study included 75 patients (mean age 23.8 ± 6.1 years) who underwent osteochondral fixation after patellar dislocation between 2018 and 2024. Lesions were classified by location—medial patellar facet, lateral facet, trochlear groove/lateral femoral condyle, or multiple regions—and measured on preoperative MRI for size and depth. Functional outcomes were assessed using Kujala, Lysholm, Tegner, and VAS pain scores preoperatively and 12 months postoperatively. Associations between lesion characteristics and postoperative results were analyzed using t-tests, ANOVA, and Pearson correlation. Results: Lesions were most frequently located on the medial patellar facet (42.7%), followed by the trochlear groove/lateral femoral condyle (34.7%). Larger and deeper lesions were more common in trochlear or multiple-site involvement (p = 0.002 and p = 0.031, respectively). At final follow-up, all functional scores improved significantly (Kujala: 62.4 ± 11.3 to 86.7 ± 9.1; Lysholm: 64.1 ± 12.0 to 88.2 ± 8.3; VAS: 6.2 ± 1.3 to 2.1 ± 1.1; all p < 0.001). Patients with smaller lesions (<100 mm2) and medial facet involvement achieved higher Kujala scores (p = 0.020) and lower postoperative pain (p = 0.001). The overall return-to-sport rate was 78.7%, and postoperative complications occurred in 10.7% of cases, mainly recurrent dislocation or implant irritation. Conclusions: Lesion localization and size significantly affect postoperative outcomes after osteochondral fixation for patellar dislocation. Medial facet and smaller lesions are associated with better pain relief and functional recovery, whereas large or trochlear lesions carry a less favorable prognosis. Morphological assessment of lesion characteristics should therefore guide surgical planning, fixation strategy, and postoperative rehabilitation to optimize clinical outcomes.

[LANGUAGE= \"English\"] BACKGROUND: Lateral condyle fractures are the second most common peri-elbow fractures in children aged 6-10 years, following supracondylar fractures. In treating these fractures, either open or closed reduction fixation can be performed. However, it is not yet completely clear which type of fracture should be treated and how. The Song classification has been increasingly used by orthopedic surgeons for these fractures in recent years. A review of the literature reveals few studies comparing closed reduction and percutaneous pinning (CRPP) and open reduction and internal fixation (ORIF) in lateral condyle fractures (LCFs) with displacements of 2 mm or more. Based on this, we compared Song stage 4 and 5 fractures operated with open or closed reduction methods in our clinic in terms of radiological and clinical aspects.METHODS: Patients who underwent surgery in our clinic for Song type 4 and 5 lateral condyle fractures between 2011 and 2016 were included in the study. After obtaining approval from our ethics committee (ID: 00171379117), we retrospectively evaluated the medical records of the patients. Between 2011 and 2016, 213 patients underwent surgery for LCF in our hospital, 24 patients were lost to follow-up, and 78 patients had other types of Song fractures. Our study evaluated 111 patients, who were divided into two groups: the CRPP group and the ORIF group.RESULTS: A total of 111 patients were included in our study, with 52 undergoing CRPP and 59 undergoing ORIF. There was no difference between the groups in terms of age, gender, side of injury, mechanism of trauma, and follow-up time (p=0.962, p=0.198, p=0.706, p=0.526, p=1.000, p=0.708, respectively). There was also no significant difference in the displacement amounts between the patients (p=0.233). In the postoperative radiological comparison, a lateral spur was observed in 12 patients (23%) in the CRPP group and 28 patients (47.5%) in the ORIF group. Hardacre's criteria were evaluated as excellent in 46 (88.4%) of the patients who underwent CRPP and 50 (84.7%) of the patients who underwent ORIF. No significant result was found between both groups (p=0.769). There was no difference in complications between the groups (p=1.000).CONCLUSION: This study demonstrates that in pediatric patients with lateral condyle fractures displaced by 2 mm or more, the choice between open or closed reduction has minimal impact on medium and long-term outcomes. Since there are not many studies on this subject in the literature, we believe that our results will provide valuable guidance for treatment decisions.[LANGUAGE= \"Turkish\"] AMAÇ: Lateral kondil kırıkları özellikle 6-10 yaş arası çocuklarda suprakondiler kırıklardan sonra en sık görülen dirsek çevresi kırıklardır. Bu kırıkların tedavisinde açık ya da kapalı redüksiyonla tespit yapılabilmektedir. Hangi kırık tipinin nasıl tedavi edileceği henüz tam olarak netlik kazanmamıştır. Ortopedik cerrahlar tarafından Song sınıflaması son yıllarda bu kırıklar için daha sık kullanılmaya başlanmıştır. Literatürü incelediğimizde 2 mm ve üzeri deplasmanı olan LKK'lerde KRPP ve ARİF'i karşılaştıran az sayıda çalışma olduğunu görüyoruz.Buradan yola çıkarak kliniğimizde açık veya kapalı redüksiyon yöntemleriyle ameliyat edilen Song evre 4,5 kırıklarını radyolojik ve klinik açıdan karşılaştırdık.GEREÇ VE YÖNTEM: Çalışmaya 2011-2016 yılları arasında Song tip 4,5 lateral kondil kırığı nedeniyle kliniğimiz tarafından ameliyat edilen hastalar dahil edildi. Etik kurul onayı alındıktan sonra hastaların tıbbi kayıtları retrospektif olarak değerlendirildi (ID: 00171379117). Hastanemizde 2011-2016 yılları arasında 213 hasta LKK nedeniyle ameliyat edilmiş, 24 hasta takip dışı bırakılmış ve 78 hasta diğer Song tiplerine sahip hastalardan oluşmuştur. Çalışmamız 111 hasta üzerinde değerlendirildi ve hastalar 2 gruba ayrıldı: KRPP ve ARİF grubu.BULGULAR: Çalışmaya toplam 111 hasta alındı, 52 hastaya KRPP ve 59 hastaya ARİF uygulandı. Gruplar arasında yaş, cinsiyet, taraf, travma mekanizması ve takip süresi açısından fark yoktu (sırasıyla, p=0.962, p=0.198, p=0.706, p=0.526, p=1.000, p=0.708). Hastaların deplasman miktarları arasında anlamlı bir fark yoktu (p=0.233). Ameliyat sonrası radyolojik karşılaştırmada, KRPP uygulanan 12 hastada (%23) ve ARİF uygulanan 28 hastada (%47.5) lateral spur gözlendi. Hardacre kriterleri KRPP uygulanan hastaların 46'sında (%88.4) ve ARİF uygulanan hastaların 50'sinde (%84.7) mükemmel olarak değerlendirildi. Her iki grup arasında anlamlı bir sonuç bulunmadı (p=0.769). Gruplar arasında komplikasyon açısından fark yoktu (p=1.000).SONUÇ: Çalışma bize deplasmanı 2 mm ve üzerinde olan çocuk hastalarda açık ya da kapalı redüksiyon yapılmasının orta ve uzun dönemde pek fark olmadığını sunmaktadır. Literatürde bu konuda çok fazla çalışma bulunmaması nedeniyle sonuçlarımızın tedaviyi yönlendirmede etkili olacağı kanaatindeyiz.

Periprosthetic joint infections caused by Brucella melitensis are rare and present significant diagnostic and therapeutic challenges, especially in endemic regions such as Anatolia. The indolent nature of Brucella infections often results in subclinical presentations, complicating early detection and management. This case series highlights the importance of recognizing Brucella melitensis as a potential pathogen in periprosthetic joint infection and explores the treatment options for this condition. Herein, we present five cases of Brucella melitensis -associated periprosthetic joint infections involving three hip replacements and two knee replacements. Diagnoses were confirmed through advanced diagnostic techniques, including prolonged cultures and serological testing, as routine methods often yielded negative results. Two patients underwent one-stage revision arthroplasty, two underwent two-stage revision arthroplasty, and one patient was managed conservatively with targeted antibiotics due to the absence of prosthetic loosening. All patients showed excellent functional recovery and infection eradication at follow-up, with normalized inflammatory markers and no evidence of recurrence. This case series emphasizes the importance of clinical suspicion and the use of advanced diagnostics in endemic areas for timely recognition of Brucella -associated periprosthetic joint infections. One-stage revision arthroplasty combined with prolonged antibiotic therapy demonstrated favorable outcomes and may serve as an effective treatment strategy.

BACKGROUND: Both-bone forearm fractures (BBFx) are common, high-energy injuries that significantly disrupt the anatomical and functional integrity of the forearm. While plate-screw osteosynthesis (PSO) has long been the standard treatment, intramedullary nailing (IMN) and hybrid methods combining both approaches have gained attention due to their potential advantages in minimally invasive procedures and functional outcomes. This study aims to compare the surgical and clinical outcomes of four different treatment strategies for BBFx. METHODS: A retrospective review was conducted on 191 adult patients who underwent surgical treatment for combined radius and ulna fractures between 2012 and 2022. Patients were divided into four groups: PSO for both radius and ulna (Group A), IMN for both bones (Group B), IMN for radius, and PSO for ulna (Group C), and PSO for radius and IMN for ulna (Group D). Surgical outcomes including union time, fluoroscopy exposure, surgical duration, and functional recovery were analyzed. RESULTS: Group B demonstrated significantly shorter surgical times (75.4 minutes) and faster fracture union (10.1 weeks) compared to Group A, which had a mean union time of 13.2 weeks. Fluoroscopy exposure was significantly lower in Group A, while Groups C and D showed intermediate results. Functional outcomes, including range of motion, grip strength, pinch strength, and QuickDASH (Quick Disabilities of the Arm, Shoulder, and Hand) scores, did not differ significantly between groups. The complication rate was lowest in Groups C and D (2.5%) and highest in Group B (6.5%), with complications such as infection and nonunion observed. CONCLUSION: While PSO remains the gold standard for BBFx, hybrid methods combining PSO and IMN provide a promising alternative, offering shorter surgical times, faster union, and reduced fluoroscopy exposure. The hybrid technique may become a preferred approach due to these advantages, although further prospective studies are required to confirm these findings. Keywords: Both-bone forearm fracture; plate-screw osteosynthesis; intramedullary nailing; hybrid fixation; trauma. AMAC: On kol cift kemiginin birlikte kirilmasi (OCKK), on kolun anatomik ve fonksiyonel butunlugunu ciddi sekilde bozan, yuksek enerjili travmalar sonucu gelisen yaygin kiriklardir. Bu kiriklarin tedavisinde uzun suredir plak-vida osteosentezi (PVO) standart yontem olarak kullanilmakta olup; son yillarda intrameduller civileme (IMC) ve her iki yontemi birlestiren hibrit teknikler, minimal invaziv cerrahi avantajlari ve fonksiyonel sonuclari acisindan dikkat cekmektedir. Bu calismanin amaci, OCKK tedavisinde uygulanan dort farkli cerrahi yontemin cerrahi ve klinik sonuclarini karsilastirmaktir. GEREC VE YONTEM: 2012 ile 2022 yillari arasinda radius ve ulna kirigi nedeniyle cerrahi tedavi uygulanmis 191 eriskin hasta retrospektif olarak incelendi. Hastalar dort gruba ayrildi: her iki kemige PVO uygulananlar (Grup A), her iki kemige IMC uygulananlar (Grup B), radiusa IMC ve ulnaya PVO uygulananlar (Grup C), radiusa PSVO ve ulnaya IMC uygulananlar (Grup D). Kaynama suresi, floroskopi maruziyeti, cerrahi suresi ve fonksiyonel iyilesme gibi cerrahi sonuclar degerlendirildi. BULGULAR: Grup B'de cerrahi sure (75.4 dakika) ve kaynama suresi (10.1 hafta) anlamli sekilde daha kisa olup, Grup A'da ortalama kaynama suresi 13.2 hafta olarak izlendi. Floroskopi maruziyeti ise Grup A'da anlamli sekilde daha dusuktu. Gruplar C ve D, bu parametrelerde ara degerler gosterdi. Fonksiyonel sonuclar (eklem hareket acikligi, el kavrama gucu, parmak uclari arasindaki sikma gucu ve QuickDASH skorlari) acisindan gruplar arasinda anlamli fark bulunmadi. Komplikasyon orani Grup C ve D'de en dusuk (%2.5), Grup B'de ise en yuksek (%6.5) olarak izlendi; komplikasyonlar arasinda enfeksiyon ve kaynamama yer aldi. SONUC: PVO halen OCKK tedavisinde altin standart olarak kabul edilse de, PvO ve IMC yontemlerinin birlikte kullanildigi hibrit teknikler; daha kisa cerrahi sure, daha hizli kaynama ve dusuk floroskopi maruziyeti gibi avantajlar sunarak umut verici bir alternatif olusturmaktadir. Bu avantajlara ragmen, bulgularin dogrulanmasi icin ileriye donuk calismalara ihtiyac vardir. Anahtar sozcukler: Hibrit fiksasyon; intrameduller civileme; on kol cift kemik kirigi; plak-vida osteosentezi; travma.