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Purpose In this study, postoperative changes in the posterior tibial slope angle and clinical outcomes following open-wedge high tibial osteotomy were evaluated. Methods This study included 39 knees (18 left, 21 right) of 35 patients (three male, 32 female; median age, 53 years; age range 37–64 years) with symptomatic isolated medial joint osteoarthritis who underwent open-wedge high tibial osteotomy and fixation with a Puddu plate. The patients were clinically assessed according to the Lysholm knee score, a visual analogue pain scale, and a patient satisfaction questionnaire. Radiological assessment was made according to the changes in the posterior tibial slope angle and the correlation between these changes and clinical signs. The median follow-up period was 11 years (range 7–14 years). Results Significant improvements were observed in the preoperative and postoperative clinical scores of the Lysholm knee scale, visual analogue pain scale, and patient satisfaction questionnaire ( p  < 0.05). Radiological assessment showed that the posterior tibial slope angle was significantly higher during the postoperative and follow-up periods ( p   0.05). There was no correlation between the postoperative Lysholm scores and the increase in the posterior tibial slope angle ( p   =  n.s.). Conclusions We conclude that both the conventional Puddu plate design and its anteromedial plate placement are what increase the tibial slope after an opening-wedge proximal tibial osteotomy. Therefore, current new plate design may help preserve the posterior tibial slope angle. Level of evidence IV.

Background/objectives This study aimed to compare the clinical outcomes of parallel and orthogonal plating in the surgical treatment of AO/OTA type 13-C distal humerus fractures in patients over 50 years of age and to evaluate the predictive role of local bone quality, measured using Hounsfield Unit (HU), on these outcomes. Methods In this retrospective study, 80 patients over the age of 50 who underwent surgery for AO/OTA type 13-C distal humerus fractures between 2012 and 2022 were analyzed. Patients were categorized into two groups according to the plating technique: parallel( n  = 33) or orthogonal( n  = 47). Functional and radiological outcomes were compared, including elbow range of motion, Mayo Elbow Performance Score (MEPS), QuickDASH, time to union, complication and reoperation rates, and presence of post-traumatic osteoarthritis. Bone quality was stratified based on HU measurements obtained from preoperative CT scans, specifically from the largest intact slice of the capitellum and trochlea in the sagittal view and from the axial slice just above the proximal fracture line, using a threshold value of 124.5 HU corresponding to the median HU value of the patient cohort. MEPS and QuickDASH were evaluated at the 12-month postoperative follow-up. Results Orthogonal plating was associated with longer union times ( p  < 0.001), higher complication rates ( p  = 0.008), and greater incidence of post-traumatic arthrosis ( p  = 0.027) compared to parallel plating. Subgroup analysis revealed that in patients with HU ≤ 124.5, orthogonal plating was linked to significantly increased nonunion risk ( p  = 0.03) and longer union times ( p  < 0.001), whereas parallel plating yielded more consistent results regardless of bone quality. Nonunion was significantly higher in the HU ≤ 124.5 subgroup ( p  = 0.031), and particularly more frequent in orthogonal plating within this group ( p  = 0.04). Conclusion While both plating techniques provided comparable functional outcomes, orthogonal plating was associated with higher complication and nonunion rates, especially in patients with poor bone quality. This may be attributed to the reduced mechanical stability of orthogonal constructs in osteoporotic bone, which may compromise fixation strength and lead to higher failure rates. HU assessment from routine CT scans may aid in preoperative decision-making to optimize surgical outcomes.

Objective: Spinopelvic parameters were identified and the association between sagittal spinopelvic alignment and lumbar disc diseases have been reported in several studies. The purpose of this study was to evaluate the spinopelvic parameters such as lumbar lordosis (LL) and sacral slope (SS) in normal healthy lumbar spine versus degenerative disc disease group. Methods: We retrospectively identified 140 patients suffered from back pain with/without radiculopathy between 2016-2017 in this study. Of these 70 patients had normal disc morphology and they constituted called control group, and the other 70 patients had lumbar degenerative disc disease and they constituted called disease patient group. All patients’ LL, and SS angles were measured on T2 weighted sagittal magnetic resonance imaging and degenerated disc levels were noted. We also recorded LL-SS ratio which was calculated by dividing of LL by SS value in both groups. We compared these parameters between two groups. Results: In disease patient group there was a positive correlation (r=0.947, p<0.0001) between the LL and SS angles. The mean LL was 45.14±11.01 and the mean SS angle was 35.91±7.67 degrees and there was weak negative correlation between degenerated disc level and SS angle (r=-0.243, p=0.042). LL-SS ratio was 1.25±0.1. In control group, there was a positive correlation (r=0.927, p<0.0001) between the LL and SS angles. The mean LL was 49.46±9.07 and the mean SS was 38.45±6.91 degrees. LL-SS ratio was 1.28±0.93. There were significant differences in LL, SS and LL-SS ratio between groups (p=0.013, p=0.041, and p=0.025, respectively). Conclusion: LL, SS angles and LL-SS ratio which are easily measured at in neurosurgery, orthopaedics and physical therapy practice, may be the predictor of disc degeneration.

Aim: To examine whether the application of intra-articular lavage during arthroscopic joint fracture surgery can disturb fracture union and cartilage healing. Metods: Twenty New Zealand rabbits were then randomly divided into 3 groups; these groups consisted of 2 surgical groups including eight rabbits and a control group consisting of 4 rabbits. After both rear limbs exposed with a medial parapatellar incision, medial femoral condyle was fractured. Four groups were created by doing anatomic reduction or non-anatomic reduction and making irrigation or no irrigation. (Group 1: Fixed by creating a gap and no Irrigation; Group 2: Fixed by creating a gap and irrigation; Group 3: Fixed with complete reduction and no irrigation; Group 4: Fixed with complete reduction and irrigation) X-rays of both knees of all rabbits were taken at the end of the second week and at the end of the eighth week. The operated knees were collected for histopathological analysis. Results: Radiological data show a significant difference in the level of ossification between the groups in the 2nd week; however, this difference was lost in the 8th week. Histopathologically, at the end of week 8, it was observed that the subchondral bone tissue was incompletely renewed in all the groups. The cartilage tissue of the joint surface was not fully formed and renewed and that it did not completely coalesce with the old cartilage tissue in all of the groups. Compared with the other groups, the group that fracture was anatomically reducted with no irrigation (Group 1), the cartilaginous tissue layer formed was thicker while the surface of the tissue was flatter. Conclusion: There were no adverse effects of intra-articular lavage on fracture union and cartilage healing in an in vivo environment. Nonetheless, the findings of this study should be confirmed with a larger sample size.

Sir, Digital photography is an extensively used tool for documentation of the clinical presentation of patients and medical and surgical procedures, and it is important from both scientific and medicolegal point of view. Best photographs are captured by professional photographers in standard conditions. The staff can hold the stick with both hands and lessen the tremor. [...]we think that selfie stick can be a helpful accessory to take intraoperative pictures without endangering sterile surgical site...

The influence of anatomical or nonanatomical femoral tunnel position on tunnel widening and clinical outcomes in patients undergoing anterior cruciate ligament (ACL) reconstruction is not fully understood. This retrospective study examined the influence of tunnel width and placement on anterior knee stability and clinical outcomes after ACL reconstruction using the AperFix System (Cayenne Medical Inc, Scottsdale, Arizona), a direct expandable fixation technique with autologous hamstring grafts. The records of 80 patients (79 men and 1 woman) who underwent ACL reconstruction were evaluated. In 38 patients, anatomical femoral tunnel placement was performed via an accessory medial portal (anteromedial group); in the remaining 42 patients, the femoral tunnel was positioned nonanatomically using a transtibial technique (transtibial group). Mean follow-up was 40.7 months (range, 27–60 months). Postoperative knee kinetics were measured, and clinical outcomes were assessed using International Knee Documentation Committee, Lysholm, and Tegner scores. Femoral tunnel widening was measured by comparing postoperative radiographs with final follow-up radiographs. Femoral tunnel width was significantly greater ( P <.001) and anterior knee translation was significantly higher ( P =.01) in the transtibial group. Lysholm and Tegner scores were not significantly different ( P >.05) between the 2 groups. These findings suggest that femoral tunnel widening is associated with increased anterior joint laxity when a direct fixation technique is used for ACL reconstruction, particularly in nonanatomically positioned femoral tunnels. Anatomical femoral tunnel placement provides better anterior stability and less tunnel widening than transtibial tunnel placement; however, these benefits did not produce a detectable advantage in clinical outcomes measures. [ Orthopedics. 2017; 40(3):e532–e537.]

Wide-awake anesthesia is a type of local anesthesia consisting of a combined application of lidocaine, epinephrine, and bicarbonate and has a wide potential in hand surgery as it offers the advantage of being applied without sedation and without using a tourniquet. In light of recent studies, its use has increased with the disappearance of the belief among surgeons that epinephrine can cause circulatory disturbance in fingers. Patients with finger pathologies who were operated upon at the Baltalimani Bone Diseases Teaching and Research Hospital between January 2015 and February 2016 were divided into two groups according to anesthesia type: wide-awake anesthesia and axillary block anesthesia, with 52 patients in each group. Start time of surgery, length of hospital stay, anesthesia cost, and patient satisfaction were compared. For the evaluation of patient satisfaction, the patients were postoperatively asked whether they would accept the same anesthesia method if they had to have the same experience. Each group was further divided into two subgroups: bone interventions (phalangeal fracture, bone biopsy, implant removal, and interphalangeal joint arthrodesis) and soft tissue interventions (digital nerve repair, fingertip local skin flap, flap division, releasing stiff joint, ligament repair, and debridment). Each subgroup included 26 patients. Sufficient anesthesia to cover the whole duration of surgery was achieved in both the groups. Regarding the question \"If you were experiencing the same experience, would you accept the same anesthesia again?\" 26 and 33 patients responded positively, 16 and 7 patients repsonded negatively, and 10 and 12 patients remained neutral in the axillary block and wide-awake anesthesia groups, respectively. According to the Social Security Institution data, the average anesthesia cost was 316.1 TL in the axillary block anesthesia group and 25.3 TL in the wide-awake anesthesia group; the average length of hospital stay was 32.9 h in the former and 13.6 h in the latter. Start time of surgery was 34 minutes in axillary block anesthesia and 5.3 minutes in wide-awake anesthesia. We found that compared with axillary block anesthesia, the length of hospital stay was 19.3 h less and anesthesia cost was 290.8 TL less with wide-awake anesthesia; furthermore, the start time of surgery decreased by 29.7 min with the latter. Moreover, patient satisfaction rate was better in the wide-awake anesthesia group. No bleeding, patient incompatibility, and other complications that might interfere with the surgery were detected .

Non-traumatic vertebral compression fractures are increasingly common due to longer life expectancies. Age-related bone mass loss significantly contributes to these fractures. Typically asymptomatic for extended periods, early detection of non-traumatic vertebral compression fractures can reduce associated health issues and enable more effective treatment. Deep learning methods have shown high accuracy and sensitivity in detecting, classifying, diagnosing, and segmenting various pathological conditions in healthcare. Recently, these methods have been applied more frequently in the detection of non-traumatic vertebral compression fractures and vertebral body segmentation research. This study introduces a unique dataset to apply deep learning techniques, using raw computed tomography (CT) images of patients. The dataset was compiled from retrospective CT images taken at Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Radiology. It includes 197 individuals, with 100 diagnosed with non-traumatic vertebral compression fractures and 97 without. Radiological diagnoses of non-traumatic vertebral compression fractures were added based on CT reports. The dataset comprises a total of 118,200 cross-sectional images in DICOM format, which were enhanced using the Wiener filter. The U-Net network was used to segment 6,301 vertebrae, achieving a 100% dice overlap index score. Additionally, 593 features of vertebral fractures confirmed by reports were extracted using the radiomics method, and 537 features were selected via the logarithmic lambda method. The convolutional neural network (CNN) classification model was employed, achieving an accuracy of 86.7%. The classification results were evaluated through ROC-AUC, loss, and accuracy graphs.

Background: Osteosarcoma is a rare but aggressive bone malignancy. Despite advances in multimodal therapy, survival remains suboptimal, highlighting the need for prognostic markers to guide treatment. Methods: This study included 162 osteosarcoma patients who received neoadjuvant chemotherapy followed by surgery between January 2009 and March 2024. Patients received either double (cisplatin + doxorubicin) or triple (MAP or PEI) chemotherapy. Survival analyses were conducted using Kaplan–Meier curves, log-rank tests, and Cox proportional hazards models. Results: The median age was 20 years (IQR: 18–29), and 53.1% were male. Patients who received triple chemotherapy regimens demonstrated significantly longer overall survival (OS) compared to those on doublet regimens. High tumor necrosis rates (>90%) and negative surgical margins were strongly associated with improved OS, while metastatic disease at diagnosis, elevated alkaline phosphatase (ALP), and male gender were linked to poorer survival. Multivariate analysis identified adjuvant therapy, age under 18, high necrosis rate, negative margins, and normal ALP as significant OS predictors. Conclusions: Triple-agent chemotherapy, necrosis rate ≥90 and negative surgical margins are strongly associated with prolonged survival in osteosarcoma. The key prognostic indicators such as ALP levels, surgical margins and age at diagnosis should guide personalized treatment strategies to improve outcomes in curable patients.