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Background Knee dislocation is a rare but severe orthopedic emergency with a substantial risk of limb-threatening complications. This retrospective national database cohort study aimed to describe the epidemiology of traumatic knee dislocations and identify risk factors for vascular and neurological injuries. Methods A total of 164 patients diagnosed with knee dislocation between 2016 and 2023 were included in this retrospective study. Data were obtained from the Ministry of Health system, and diagnoses were confirmed. Demographics, injury mechanisms, associated fractures, and complications were evaluated using International Classification of Diseases (ICD) codes. Logistic regression was used to identify independent risk factors. Results The study population consisted primarily of males (81.7%) with an average age of 31.74 years. Vascular injuries occurred in 19.5% of patients, most commonly involving the popliteal artery. Neurological injury was present in 20.1%. In patients with open injuries, infection, vascular injury, amputation, debridement, and soft tissue defect repair were found to be significantly higher. Despite these findings, open injury was not an independent predictor of vascular injury in multivariate analysis. Charlson Comorbidity Index (CCI) > 0 independently predicted the need for vascular procedures. Younger age was associated with neurological injury. Intensive Care Unit (ICU) admission was associated with systemic injuries. The overall amputation rate was 1.2%. Conclusion Traumatic knee dislocations frequently involve serious neurovascular complications. While open injuries were associated with a more complicated clinical course, only CCI independently predicted the need for vascular intervention. Early recognition of patients with comorbidities and significant concomitant injuries may improve outcomes. Level of evidence Level IV.

Diagnosing femoroacetabular impingement (FAI) is challenging and surgical indications for hip arthroscopy are still evolving. This study analyzes the two years leading up to surgery in a large cohort of patients with FAI. We hypothesized that patients with FAI experience diagnostic challenges causing delayed treatment. We assessed the 2-year diagnostic journeys of patients prior to hip arthroscopy by analyzing recurring hip-related hospital visits, magnetic resonance imaging (MRI), the geographical distribution, and healthcare settings of these visits related to hip pain using data from a nationwide database. Medical records in the national e-health database were reviewed to identify patients who underwent hip arthroscopy between January 2017 and May 2023. Patients aged 18–65 years with a minimum of 2 years of prior medical records were included. The number of clinic visits and MRI scans in the 2 years prior to hip arthroscopic FAI surgery were analyzed with distributions of age and sex. 1754 patients who were confirmed to have complete procedure notes were included in the study. Only 30 of the 81 provinces of Türkiye had hip arthroscopy entries (37.0%). The majority of patients presented at university hospitals on their first visit (35.3%), and 1544 patients (88%) underwent MRI prior to surgery. The median number of clinic visits was 9 (SD: 7.7) and that of MRI scans was 2 (range: 1–7) per patient. Patients under 40 years had a higher mean of orthopedic surgery clinic visits (M: 8.8, SD: 5.1) than those over 40 years (M: 8.1, SD: 6.0) ( p  = 0.01). There was no significant difference between men and women in mean orthopedic clinic visits (8.5 vs. 8.4, respectively). The findings suggest that patients with FAI undergo a considerable number of physician visits (median of 9) and MRI scans (median of 2) in the 2 years preceding hip arthroscopy in Türkiye. These results may indicate diagnostic challenges, delays in determining the need for surgery, and potential reluctance to undergo hip arthroscopy. Addressing these issues would require implementing strategies to reduce the time from symptom onset to treatment initiation and alleviate the financial burden associated with delayed diagnosis.

Purpose The posterior cruciate ligament (PCL) is a vital knee stabilizer. While PCL injuries are rare, high-energy traumas can lead to total ruptures, with accompanying injuries requiring surgery. This study aims to investigate the demographics, concomitant injuries, and postoperative complications of patients who underwent PCL reconstruction due to high-energy trauma in a large patient sample. Methods Patients who underwent PCL reconstruction from 2016 to 2022 were retrospectively evaluated using data from a nationwide personal health recording system. Patient demographics, injury mechanisms, associated fractures, soft tissue injuries, and postoperative complications were collected from patient notes, clinical visits, and surgical notes. Individuals with a PCL injury following high-energy trauma (car accident, falls from height, motorcycle accident) with a minimum follow-up of 1 year were included in the study. Results The study included 416 patients with a mean age of 32.4 years. Isolated PCL injuries (n = 97, 23.3%) were observed less frequently than multiple-ligament injuries (n = 319, 76.7%). Most cases were treated with single-stage surgery (86.8%), while staged surgeries were performed in a minority of cases (13.2%). There was no relationship between trauma mechanisms and multiple-ligament involvement, accompanying injuries, or postoperative complications. Surgeries following car accidents were more likely to occur as staged surgeries ( p  = 0.014). Additionally, the complication rates for staged surgeries and younger patients (≤ 18 years) were significantly higher ( p  = 0.009). Conclusion High-energy trauma-induced PCL injuries are often associated with severe concurrent knee injuries with multiple ligament involvement. PCL reconstructions following car accidents are more likely to be staged. These findings highlight the importance of careful consideration in managing these cases to minimize complications, particularly in younger age groups. Level of evidence Level III.

Background The primary objective of this study was to examine the incidence of fractures among individuals aged 20–64 years over a 7-year timeframe by utilising an electronic recording system that is integrated with a substantial portion of the Turkish population. Methods De-identified health records were acquired from the nationwide personal health recording system. Four age groups were established: 20–34, 35–44, 45–54, and 55–64 years. Incidence rates were further analysed according to sex and age group. Results A total of 3,286,991 fractures were recorded in the 7-year time period, with male patients accounting for 62.1% of those cases. The overall fracture incidence rate in the Turkish adult population was 1029/100,000. The incidence rate was 727.44/100,000 for women and 1158.86/100,000 for men ( p  < 0.001). The age group with the highest number of fractures was 20–34 years with 1337.012 (37.3%) fractures. Wrist fractures (17.46%), finger fractures (14.4%), and foot fractures (11.85%) accounted for 43.7% of all fractures. In women, the incidence of fractures, excluding those of the hand and wrist, increased significantly as the age groups increased ( p  < 0.05). Conclusion Wrist, finger, and foot fractures were found to be the most common fractures among individuals aged 20–64 years. Fracture incidence was highest in men and in the age group of 20–34 years, encompassing individuals who are more active in work and sports.

Abstract Background: Diagnosing femoroacetabular impingement (FAI) is challenging and surgical indications for hip arthroscopy are still evolving. No studies have investigated the diagnostic challenges of FAI in a large cohort. Objectives: We hypothesized that patients with FAI experience diagnostic challenges and low referral numbers to hip preservation centers causing delayed treatment. We assessed the 2-year diagnostic journeys of patients prior to hip arthroscopy by analyzing recurring hospital visits, magnetic resonance imaging (MRI), and the geographical distribution and healthcare settings of these visits using data from a nationwide database. Study Design & Methods: Medical records in the national e-health database were reviewed to identify patients who underwent hip arthroscopy between January 2017 and May 2023. Patients aged 14-65 years with a minimum of 2 years of prior medical records were included. Numbers of clinic visits and MRI scans in the 2 years prior to definitive hip arthroscopic FAI surgery were analyzed with distributions of age and sex. Results: Among 5015 records with hip arthroscopy surgical codes, 1754 patients who were confirmed to have complete procedure notes were included in the study. Only 30 of the 81 provinces of Türkiye had hip arthroscopy entries (37.0%). The majority of patients presented at university hospitals on their first visit (35.3%), and 1544 patients (88%) underwent MRI prior to surgery. The median number of clinic visits was 9 (SD: 7.7) and that of MRI scans was 2 (range: 1-17) per patient. Patients under 40 years had a higher mean of orthopedic surgery clinic visits (M: 8.8, SD: 5.1) than those over 40 years (M: 8.1, SD: 6.0) (p=0.01). There was no significant difference between men and women in mean orthopedic clinic visits (8.5 vs. 8.4, respectively). Conclusions: Patients with FAI required a mean of 9 physician visits and 2 MRI scans in the 2 years prior to hip arthroscopy in Türkiye. These results are suggestive of diagnostic challenges, difficulties in indicating surgery, and avoidance of hip arthroscopy. Further strategies are needed to decrease the symptom-to-treatment time and financial burden caused by delayed diagnosis by increasing awareness of FAI.

Background The suprascapular and axillary nerves can be subject to entrapment due to both their anatomical courses and their anatomical relationships with surrounding anatomical structures around shoulder. These entrapments were previously considered as a diagnosis of exclusion. However, today these pathologies can be diagnosed as primary. The most common complaints of patients are pain and sometimes weakness. The clinician’s suspicion is very important in making diagnosis. The patient’s history, duration of symptoms, and information such as the movements in which the complaints increase should be questioned carefully and in detail. In physical examination, symmetrical evaluation of both shoulders can provide important information. In addition, cervical and brachial plexus pathologies should be kept in mind. According to the suprascapular and axillary nerve innervations, muscle atrophy should be evaluated during inspection. Range of motion and neurological examination around shoulder should be performed. Since these entrapments can be seen together with rotator cuff tears and labrum pathologies etc., these additional pathologies should also be targeted during evaluation. The evaluation should be expanded with imaging methods such as plain radiographs, ultrasonography, computed tomography, magnetic resonance imaging, electrodiagnostic studies and local anaesthetic injections to the entrapment area. There is no definitive method to diagnose these pathologies. As a result of all these evaluations, a diagnosis can be made. There is no consensus on treatment. In isolated entrapment cases where there are no additional surgical pathologies such as space-occupying lesions, non-operative treatment is primarily recommended. It is generally recommended to try non-operative treatment for at least six months. Surgical treatment is recommended in cases where non-operative treatment fails or in cases where there are additional pathologies requiring surgery or in cases where there is extrinsic compression such as sapce-occupying lesions. In the decision and choice of surgical treatment, it is very important to determine the aetiology precisely. Surgical treatment can be performed open and arthroscopically. Various additional arthroscopic portals and techniques have been described. However, there is no clear consensus on the superiority of these treatments over each other. Although physical therapy is recommended after surgical treatment, there is no consensus on this issue in the literature. Aim This review aims to summarize the diagnosis and management of suprascapular and axillary nerve entrapments in athletes, focusing on clinical presentation, diagnostic methods, treatment options, and current controversies.

Purpose Complex rigid foot deformities include three-plane deformities and usually presents with poor soft tissue coverage. In the last decades, gradual correction with computer-assisted fixator became an appropriate option for the treatment rigid foot deformities. This study aims to report our experience about treatment of complex foot deformities using Smart Correction fixator system®. Methods We retrospectively analyzed 13 complex rigid foot deformities of ten consecutive patients treated with Smart Correction fixator system® from 2016 to 2020. Primary outcomes were classified as good, fair, and poor according to previously determined criteria. The outcomes were also assessed with The Manchester-Oxford Foot Questionnaire (MOXFQ). Non-parametric analysis (Wilcoxon test) for continuous variables and the Fisher’s exact test for categorical variables were used. Results Plantigrade foot was achieved in all patients after correction program. Supramalleolar osteotomy was applied in nine feet, midfoot osteotomy was applied in two feet, hindfoot osteotomy was required in one foot, and only soft tissue distraction performed in two feet. Two patients had recurrent deformity managed by further acute corrections. The mean MOXFQ scores improved from 72.7 preoperatively to 24.8 at last follow-up. Conclusions Present study shows that SCF the reliable option for the treatment of complex foot deformities, which also facilitates three-plane correction and concomitant lengthening with gradual soft tissue balance.

Objectives: Anterior cruciate ligament (ACL) tears are prevalent among the pediatric population, often leading to knee instability, reduced activity levels, and early onset of osteoarthritis. The incidence of ACL reconstruction (ACLR) in children and adolescents has risen significantly over the last decade. While various intrinsic and extrinsic factors have been implicated in increasing the risk of ACL tears, the role of patellofemoral parameters has not been comprehensively evaluated in a large cohort. This study investigates the association between patellofemoral abnormalities and the incidence of ACL tears in a pediatric cohort. We hypothesize that children with patellofemoral abnormalities have a higher rate of ACL tears compared to those with normal patellofemoral anatomy. Methods: A retrospective analysis of 443 pediatric patients who underwent ACLR from 2016 to 2022, using data from the ‘e-Nabiz’ digital personal health record system was conducted. Patellofemoral parameters, including trochlear dysplasia, TT-TG distance, sulcus angle, and Caton-Deschamps Index, were evaluated from imaging studies. A control group of 443 age- and sex-matched individuals from the normal population was used for comparison. A random matched sample of 50 patients (25 ACLR, 25 Controls) was used to determine interrater reliability between two examiners. The agreement between raters in terms of numerical variables was evaluated with the Spearman correlation coefficient, and Intraclass correlation coefficient (ICC). To compare differences between groups, either a two-sided Mann-Whitney U test was applied for continuous variables, while Yates correction for continuity chi-square were employed for categorical variables. The cut-off points for TT-TG and Sulcus angle were determined by Receiver Operating Characteristic Curve (ROC) analysis. Cut-off values ​​were calculated with the Youden Index. Univariate analysis and multiple binary logistic regression were performed to identify risk factors for anterior cruciate ligament rupture.All statistical analyses were evaluated at p < 0.05. Results: A total of 886 skeletally immature patients (443 ACLR – 443 Control) who underwent ACLR were included in the study. The ICC values for the agreement between observers in terms of numerical variables are above 0.80, indicating excellent reliability. Accordingly, there was a good agreement beyond chance for the Dejour classification between observer-1 and observer-2, who made the evaluation (κW=0.914), Table 1-Figure 3. The TT-TG distance in the ACLR group was significantly higher than in the control group (median 10 mm, SD: 9 – 12.3 mm vs 9.9 mm, SD: 9.2 – 10.5 mm, p = 0.002). The mean sulcus angle was significantly greater in the ACLR group compared to the control group ( median 141 (132 – 152) vs. 135 (130-140), p < 0.001). For the Caton-Deschamps index, there was no significant difference between the ACLR group and the control group for the CDI (1.07 ± 0.1 for both groups, p = 0.778), The prevalence of trochlear dysplasia was significantly higher in the ACLR group (148 cases, 91,9%) compared to the control group (13 cases, 8,1%), p-value of <0.001, Table 2. The cut-off points for TT-TG and Sulcus angle were determined by ROC and Youden index were 11.75 mm and 142.5 degrees, respectively. Indicating that values over the cut-off are associated with an increased risk for ACL rupture, Table 3. The model created to define the factors associated with ACL tear showed that, the risk of ACL tear is 4.951 times higher in individuals with a TT-TG value above 11.75 compared to those with a value below 11.75. The risk of anterior cruciate ligament tear is 3.271 times higher in individuals with a sulcus value greater than 142.5 compared to those with a value below 142.5. The risk of ACL tear is 5.375 times higher in individuals with trochlear dysplasia values compared to those without dysplasia, Table 4. Based on the Hosmer-Lemeshow test result, the model is determined to have a good fit to the data. To assess the goodness of fit of the established model, a correct classification rate of 72.10% and an AUC value of 0.73 were obtained, Figure 4 and 5. Conclusions: Patellofemoral abnormalities, including increased TT-TG distance, greater sulcus angle, and prevalence of trochlear dysplasia, are significantly associated with pediatric ACL tears. These findings suggest that assessing patellofemoral parameters could be crucial in predicting and potentially preventing ACL injuries in children. Future preventive strategies should consider these parameters to reduce the risk of ACL tears in the pediatric population.

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: The accessory anterolateral talar facet (AALTF) is a recognized anatomical variant of the talocalcaneal articulation that has gained increasing clinical attention due to its association with talocalcaneal impingement and sinus tarsi syndrome. The AALTF presents varying prevalence across studies, ranging from 3.6% in general MRI populations to over 30% in symptomatic patients. Its clinical significance lies in its potential role in mechanical stress, causing foot pain and restricted subtalar joint motion, particularly when associated with tarsal coalition. Comprehensive studies involving larger cohorts with detailed clinical and radiological assessments remain limited. This study aims to evaluate a large cohort of patients with AALTF and concurrent pathologies and assessing clinical outcomes. Methods: This retrospective study evaluated patients diagnosed with AALTF who underwent surgical resection between 2016 and 2023. Data were collected from preoperative and postoperative assessments, including Patient Reported Outcomes Measurement Information System (PROMIS), Visual Analog Scale (VAS) scores, Foot Function Index (FFI), American Orthopaedic Foot & Ankle Society (AOFAS) scores, and Oxford Ankle Scores. Patients were evaluated preoperatively, at 6 months, 12 months, and the latest follow-up. Preoperative imaging included assessments of the angle of Gissane and sinus tarsi fat obliteration, with concurrent tarsal coalition assessed as confounding factor. Statistical analysis was performed using Wilcoxon signed-rank tests to compare preoperative and postoperative outcomes. Results: Seventeen feet from 13 patients (mean age: 15.6 years, range: 12–23) underwent AALTF resection with a mean follow-up of 16.9 months (range: 12–24). The AOFAS score improved from 53.8 ± 15.7 preoperatively to 78.6 ± 9.4 at 6 months (p =0.001) and 82.3 ± 12.6 at the latest follow-up. The Oxford score decreased from 39.1 ± 21.2 preoperatively to 15.1 ± 10.4 at 6 months (p =0.001) and 10.8 ± 10.3 at the latest follow-up. FFI decreased from 22.6 ± 16.0 to 10.3 ± 11.5 (p < 0.001). PROMIS scores increased from 63.4 ± 9.0 to 86.2 ± 11.8. VAS improved from 6.1 ± 1.3 to 3.1 ± 1.1 at 6 months (p =0.001). The angle of Gissane decreased from 131.4° to 125.7° (p =0.004). Conclusion: Surgical resection of AALTF leads to significant improvements in pain relief and foot function. PROMIS, VAS, and AOFAS scores demonstrated substantial postoperative benefits, and radiological correlations supported the clinical findings. The results confirm that addressing AALTF, particularly in cases with concurrent tarsal coalitions, is effective in improving patient outcomes. Further prospective studies are recommended to validate these findings and improve surgical strategies.