Acta orthopaedica et traumatologica turcica最新文献

Objective: Accurate pedicle screw placement in severe kyphoscoliosis remains a major challenge due to distorted and rotated spinal anatomy. This study aims to evaluate whether the use of patient-specific 3-dimensional (3D) printed spinal models improves pedicle screw placement accuracy.  Methods: Fourteen patients with severe kyphoscoliosis (Cobb angle >100°) were included in the study. The study group (n = 7) underwent surgery using patient-specific 3D-printed spine models to assist freehand pedicle screw placement, while the control group (n = 7) underwent surgery using the standard freehand technique alone. Pedicle screw accuracy was scored from 0 to 3 on postoperative computed tomography scans. The Mann-Whitney U-test and Cliff's Delta were used for statistical analysis.  Results: Maximum preoperative coronal and sagittal Cobb angles were higher in the control group (mean coronal angle, 106.57 ± 19.76 vs. 128.86 ± 21.42° and mean sagittal angle, 105.00 ± 17.38 vs. 125.00 ± 19.27°) but the statistical difference between the groups was not significant. The mean screw malposition score was significantly lower in the 3D model group (Mean: 0.49 ± 0.93) compared to the control group (Mean: 1.45 ± 1.10) (U = 4802.5, P < .001). Effect size was large (Cliff's Delta = -0.66).  Conclusion: The use of 3D-printed patient-specific spinal models significantly improves the accuracy of pedicle screw placement in severe spinal deformities and should be considered as an adjunct tool in complex deformity surgeries.    Cite this article as: Çetin E, Albayrak A. Patient-specific 3D-printed spinal models improve pedicle screw placement accuracy in severe kyphoscoliosis: a comparative study. Acta Orthop Traumatol Turc., 2026; 60(1), 0593 doi: 10.5152/j.aott.2026.25593.

Objective: The anteroposterior (AP) pelvic X-ray is commonly used for assessing conditions affecting the bony pelvis. The objective of this study was to develop new pelvic X-ray assessment software (CalculOrther) to assess AP pelvic X-rays and evaluate its reliability.  Methods: CalculOrther was developed in 4 stages. Initially, a dataset comprising pelvic X-rays was generated. During the second stage, the convolutional neural network model was trained to identify anatomical landmarks in the pelvic X-ray images. The Hough transform was used to locate the circle and center of the femoral head in the third stage. The border pixels were generated using mathematical morphological processes, and the requisite angles were measured in the fourth stage. Then manual measurements and the software developed were analyzed with Pearson's correlation and intraobserver and interobserver correlation coefficients. Subsequently, the mean error and the root mean square error (RMSE) were acquired.  Results: The Pearson's correlation coefficients varied from 0.84 to 0.99 (P < .001). The interobserver and intraobserver correlation coefficients ranged from 0.77 to 0.99 and from 0.75 to 0.94, respectively. The RMSE ranged from 0.31 to 4.38 and the mean error from 0.05 to 2.86. The mean duration for manual measurements was 230 (177-284) seconds and 215 (160-255) seconds, respectively. The software required an average time of 3.18 (2.95-3.52) seconds to make the same measurements.  Conclusion: Regarding femoroacetabular impingement and hip dysplasia, artificial intelligence can analyze pelvic radiographs and generate equally accurate results within a shorter duration compared to traditional measuring methods.      Cite this article as: Yilmaz A, Selcuk T, Aksoy T, Atilla B. Evaluation of the reliability of novel pelvic X-ray assessment software: CalculOrther. Acta Orthop Traumatol Turc., 2026; 60(1), 0268, doi: 10.5152/j.aott.2026.25268.

Objective: Periacetabular osteotomy (PAO) is a well-established surgical technique that is used to enhance femoral head coverage in patients with developmental dysplasia of the hip (DDH). Although 2-dimensional radiographs remain standard for evaluating acetabular coverage, 3-dimensional (3D) computed tomography (CT)-based measurements using acetabular sector angles (ASAs) provide higher precision. This study aimed to analyze acetabular coverage through ASA parameters and to investigate the long-term clinical outcomes following PAO.

Methods: This retrospective study included 35 hips from 29 patients who underwent PAO for DDH. Radiographic measurements comprised the T.nnis angle, Sharp angle, lateral center-edge angle (LCEA) and anterior center-edge angles (ACEA), anterior center margin angle (ACMA), extrusion index, and hip lateralization index (HLI). The CT-derived variables included acetabular version (AV), anterior ASA (AASA), posterior ASA (PASA), and horizontal ASA (HASA). Clinical outcomes were assessed by using the Harris Hip Score (HHS).

Results: The mean patient age was 19.9 years, with a mean follow-up period of 8.7 years. Significant postoperative improvements were noted in AASA, HASA, T.nnis angle, Sharp angle, extrusion index, AV, LCEA, ACEA, acetabular depth, and HHS (all P < .05). No significant differences were observed in PASA, HLI, or ACMA. The HHS showed a negative correlation with HLI (P < .05) and a positive correlation with postoperative LCEA (P < .01). Patients with postoperative LCEA < 25Åã demonstrated superior functional outcomes compared with those with LCEA ≥ 35Åã (P = .034). Eight patients experienced complications, and 2 patients required conversion to total hip arthroplasty.

Conclusion: The PAO provides durable long-term results in the management of DDH. Incorporating 3D ASA analysis enhances both preoperative planning and postoperative evaluation, contributing to more precise acetabular reorientation and improved clinical assessment   Cite this article as: Güneş Z, Çağlar Ö, et al. Assessment of 3-dimensional acetabular coverage based on acetabular sector angles following periacetabular osteotomy: long-term clinical, radiological, and survivorship outcomes. Acta Orthop Traumatol Turc., 2026; 60(1), 0334, doi: 10.5152/j.aott.2026.25334.

Objective: Local anesthesia with sedoanalgesia and general anesthesia are widely used in percutaneous kyphoplasty (PKP) for vertebral compression fractures (VCF). The aim of this study was to compare erector spinae block (ESP) with conventional local infiltration anesthesia (CLIA) and extrapedicular infiltration anesthesia (EPIA) with respect to analgesic efficacy in patients who underwent elective PKP for VCF.  Methods: A total of 90 American Society of Anesthesiologists (ASA) 1-3 patients were randomly assigned into 3 groups: group CLIA (n = 30), group EPIA (n = 30), and group ESP (n = 30). The same amount of local anesthetic mixture (6 mL lidocaine 1% and 14 mL bupivacaine 0.5%) was used for regional anesthetic techniques in all groups. Fentanyl 0.1 μg/kg and midazolam 0.1 mg/kg were administered intravenously (IV) before prone positioning. Pain was evaluated using the visual analog scale (VAS) and sedation level using the Ramsay Sedation Scale (RSS) during the procedure. Primary outcome measure were VAS and RSS scores. Secondary outcome measures were hemodynamic changes and additional analgesic and sedative consumptions.  Results: Mean baseline VAS scores were similar between groups (5.62 ± .39; P > .05). Intraoperative mean VAS scores were significantly higher in group CLIA compared to EPIA and ESP groups at all timepoints (P < .01). Time-bound changes in VAS scores showed a progressive decrease from baseline until the end of the procedure in EPIA (5.60 ± 1.38 to 1.10 ± 0.85; P < .01) and ESP groups (5.30 ± 1.44 to 1.17 ± 0.95; P < .01), while an increase was detected from baseline to the 20th minute in group CLIA (5.97 ± 1.35 to 7.07 ± 0.94; P < .01) that followed a decrease until the end of the procedure (3.47 ± 0.86; P < .01). The mean RSS scores were similar at baseline and at the end of the procedure in all groups (P > .01), but significantly lower in group CLIA compared to EPIA and ESP groups at the other timepoints (P < .001). Time-bound changes in RSS scores showed a progressive increase from baseline until the 20th minute of the procedure that followed a decrease until the end of the procedure in EPIA (5.60 ± 1.38 to 1.10 ± 0.85; P < .01) and ESP groups (5.30 ± 1.44 to 1.17 ± 0.95; P < .01).  Conclusion: Better anesthetic advantages of ESP and EPIA over CLIA concerning intra-operative analgesia, analgesic and sedative consumption were demonstrated. ESP and EPIA can be used as a suitable anesthetic method in VCF patients undergoing single-level PKP, with stable hemodynamic parameters and analgesia in the intra-operative period.    Cite this article as: Eşkin MB, Özhan MÖ, Şimşek F, Eksert S, Ceylan A, Başak AM. Anesthesia for vertebral compression fractures treated with percutaneous kyphoplasty: comparison of erector spinae plane block, extrapedicular infiltration anesthesia, and conventional local infiltration anesthesia. Acta Orthop Traumatol Turc., 2026; 60(1), 0549, doi: 10.5152/j.aott.2026.25549.

 Objective: This retrospective case series aimed to establish a standardized protocol for the procurement, processing, and surgical application of fresh osteochondral allografts (OCA) in Türkiye and to report the early clinical outcomes of this biological salvage treatment for knee cartilage defects.  Methods: Ten fresh OCA transplantations were performed between July 2019 and June 2024, with a mean follow-up of 26.1 months. Patients were evaluated using the International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), and a 10-cm Visual Analog Scale (VAS) for knee pain. Magnetic resonance imaging was obtained at >12 months postoperatively to assess graft survival.  Results: The mean patient age was 30.3 ± 5.7 years (6 males, 4 females). The mean graft area was 5.1 cm² (range: 2.5-7.5 cm²). The IKDC scores improved from 37.5 to 65.4, KOOS scores from 38 to 69.6, and VAS scores from 6 to 1.6. Magnetic resonance imaging evaluation beyond 12 months showed no evidence of graft failure.  Conclusion: Fresh OCA represents a reliable and effective treatment option for knee cartilage defects. Establishing its availability in Türkiye has the potential to broaden access, enabling more surgeons to adopt the technique and more patients to benefit from this biological salvage procedure.     Cite this article as: Meriç G, Eren O, Kocadal O, Ateş U. Implementation of a fresh osteochondral allograft protocol for the knee: a case series from Türkiye. Acta Orthop Traumatol Turc., 2026, 60(1), 0310,  doi:10.5152/j.aott.2026.25310.

Objective: The aim of this study was to compare the results of patients who underwent biceps tenotomy or tenodesis alongside rotator cuff rupture repair (RCRR), as well as to assess its relationship with alterations in subacromial volume. The hypothesis was that patients undergoing biceps tenodesis would experience greater improvements in outcome scores 2 years after the surgery and larger subacromial volumes as the long head of the biceps tendon maintains its tension.  Methods: This is a retrospective study including patients who underwent an RCRR concomitant with a biceps procedure (88 tenotomy and 63 tenodesis) with a minimum of 2 years of follow-up between January 2015 and December 2022.  Results: Preoperative subacromial volumes of the tenotomy and tenodesis groups were 3.89 cm3 and 3.87 cm3, respectively, which were similar (P = .287). Postoperative subacromial volume was 4.29 cm3 in the tenotomy group and 4.51 cm3 in the tenodesis group (P = .000). Preoperative, postoperative first year and postoperative final follow-up Constant scores were 43.3, 83.1 and 84.8, respectively, in the tenotomy group and 43.7, 86.9 and 89.0, respectively, in the tenodesis group. A statistically significant difference was found between the 2 groups in terms of postoperative Constant scores (P = .000 for both parameters). Volume changes and Constant score changes were significantly correlated (P = .012 and r = 0.513). Although preoperative Visual Analog Scale scores were comparable between the tenodesis and tenotomy groups (P = .076), the tenodesis group demonstrated significantly lower pain scores at both the 1-year follow-up and final evaluation (P = .002 and P = .007, respectively).  Conclusion: In this study, biceps tenodesis was superior to tenotomy in terms of outcome scores. The results also revealed that subacromial volume increases significantly following biceps tenodesis compared to biceps tenotomy and has a moderate relationship with postoperative Constant scores, unlike Visual Analog Scale score.    Cite this article as: Gunes Z, Erdogan E, Aktekin CN. Comparison of subacromial volume and clinical parameters of patients who underwent biceps tenotomy or tenodesis due to long head of biceps tendon pathologies during rotator cuff repair surgery. Acta Orthop Traumatol Turc. 2026; 60(1), 0528, doi: 10.5152/j. aott.2026.25528.

Objective: The Masquelet technique is a 2-stage surgical method used for the reconstruction of critically sized bone defects due to various etiologies. Estrogen is known to have anabolic effects on bone metabolism. In this study, based on literature data, the aim is to systematically evaluate the histological and immunohistochemical effects of adding different doses of estrogen to polymethylmethacrylate cement on induced membrane tissue.  Methods: Twenty-eight male rats were included in the study and divided into 4 groups. Three experimental groups received different doses of estradiol, a subtype of estrogen mixed with bone cement, while a control group received only bone cement. Approximately 10 mm defects were created in single femurs of all rats. Bone cement appropriate for each experimental group was placed in these defects, and bone fixation was performed with mini plates and screws. Tissue samples taken from all animals at the end of the sixth week were evaluated by histological and immunohistochemical methods.  Results: Histological and immunohistochemical evaluations of the induced membranes obtained at the end of the experiment revealed signs of bone formation in all subgroups. A significant increase in bone formation was observed with increasing doses in groups E1, E2, and E3 compared to the control group (P < .05). The histological scores of the study groups were found to increase statistically significantly with increasing estrogen dose (P < .05). Furthermore, immunohistochemical analyses revealed that the immuno-reactive scores for bone morphogenetic protein-4 and insulin-like growth factor-1 expression were significantly higher in the E3 group compared to the other groups (P < .05).  Conclusion: In this study, it was found that enriching the cement content with estrogen during bone cement placement, the first step of the Masquelet technique, improved the quality of the formed membrane. This improvement in membrane quality is promising for increasing treatment efficacy and shortening the treatment duration.    Cite this article as: Çiftçi MU, Purelku M, Özönder F, et al. Dose-dependent effects of estrogen-enriched bone cement on membrane quality in the masquelet technique: experimental rat model. Acta Orthop Traumatol Turc., 2026; 60(1), 0355, doi: 10.5152/j.aott.2026.25355.

Objective: Desmoid tumors are fibroblast-derived rare soft tissue neoplasms with unclear borders that invade the surrounding structures. Despite the non-metastasizing nature, these tumors often relapse due to strong local aggressive behavior. The aim of this study was to analyze the demographic and clinical characteristics of patients with extraabdominal desmoid tumor, who underwent surgery between 2012 and 2022 and to determine the risk factors affecting recurrence.

Methods: Thirty-five patients (14 males, 21 females; mean age 41.2 years (range: 11-80) underwent operation between the years 2012 and 2022 and followed up for a mean of 52 months. The diagnosis was confirmed with biopsy, and the plan for surgery and adjuvant radiotherapy was decided by the multidisciplinary tumor council. Demographic, radiologic, and management data of the patients were collected. Potential effects of surgical margin status, estimated tumor volume (ETV), and radiotherapy on recurrence were investigated. Estimated tumor volume was calculated from dimensions on pathologic specimens.

Results: While wide surgical resection was aimed for all patients, R0 margins were achieved only in 40%, whereas R1 and R2 margins were obtained in 22.9% and 37.1% of these patients respectively. The local recurrence rate was 40%. No significant correlation was observed between surgical margin positivity and the recurrence or progression of the tumor, when patients with R0 margin are sta-tistically compared with the rest (P = .067). On the other hand, when R0 and R1 margins were compared with each other in terms of recurrence or progression, there was a statistically significant difference (P = .006). While the impact of radiotherapy on recurrence or pro-gression could not be determined due to inadequate sample size, the recurrence rate increased significantly with increasing ETV (P = .01).

Conclusion: Extraabdominal desmoid tumors are ill-defined locally aggressive neoplasms with an unpredictable and challenging clinical course. When the disease-free and recurring patients were compared, the recurrence rate increased significantly as the ETV increased. Achieving negative margins is still the benchmark for surgery; however, the risks and benefits of an aggressive surgery should always be reevaluated when there is a high possibility of a complex reconstructive surgery that has the capability to affect the functional outcome adversely.    Cite this article as: Şirin E, Koç E, Yiğit O, Şahbat Y, Sofulu Ö. Challenging aggressive surgical strategies in extraabdominal desmoid tumors: is tumor volume the missing key? Acta Orthop Traumatol Turc., 2026, 60(1), 0103, doi: 10.5152/j.aott.2026.24103.

Objective: To determine the predictive value of the Shock Index (SI), Modified Shock Index (MSI), and Age Shock Index (ASI) for 30-day mortality in elderly patients with hip fractures and to compare these indices with established measures such as the American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR).

Methods: This retrospective cohort study was conducted at a single-center, tertiary care hospital. The study included 2771 patients aged 65 and older who presented with hip fractures between January 1, 2014, and December 31, 2022. The primary outcome measure was 30-day mortality, while the secondary analysis focused on 1-year mortality. Comparisons were made between SI, MSI, ASI, ASA score, CCI, NLR, and PLR using receiver operating characteristic curve analyses to determine their predictive value for mortality.

Results: The mean age was 80.85 ± 7.48, with 63% being female (n = 1747). Modified Shock Index demonstrated the highest predictive performance for 30-day outcomes with a sensitivity of over 70%, a specificity of over 80%, and an area under the curve (AUC) value above 0.8, outperforming the other indices. Neutrophil-to-lymphocyte ratio was also significantly associated with mortality (AUC = 0.779), with a cutoff value of 5.76. For 1-year mortality, MSI showed superior performance (AUC = 0.669-0.673), although the sensitivity and specificity were lower than for 30-day mortality.

Conclusion: Modified Shock Index can aid in identifying high-risk elderly hip fracture patients for short-term mortality and contribute to preoperative planning. Integrating MSI with traditional scoring systems like ASA and CCI may enhance early intervention strategies. Future studies should validate the use of MSI across different populations and orthopedic conditions.   Cite this article as: İğde N, Keskin A, Başkaya N, Yuvacı F. Predictive value of shock indices in 30-day mortality for elderly hip fracture patients: a retrospective cohort study. Acta Orthop Traumatol Turc., 2026, 60 (1), 0225, doi: 10.5252/j.aott.2026.25225.

Objective: The purpose of this study was to define the prevalence of os acromiale on magnetic resonance imaging (MRI) in patients presenting with shoulder pain, to document how often it coexists with rotator cuff tears, and to assess whether focused review detects this variant more reliably than routine radiology reporting.  Methods: A retrospective review was conducted on 3697 shoulder MRI examinations obtained between 2020 and 2025 at a tertiary referral center. All studies were independently evaluated by 2 fellowship-trained shoulder surgeons and 1 musculoskeletal radiologist, focusing specifically on the presence, subtype, and coexistence of os acromiale with rotator cuff pathology. Interobserver reliability was assessed using Cohen's kappa coefficient, and findings were compared with the original radiology reports.  Results: Os acromiale was identified in 26 cases, corresponding to a prevalence of 0.7%. Only 11 cases were mentioned in the original radiology reports. Interobserver agreement between shoulder surgeons was almost perfect (κ = 0.98) and excellent between surgeons and the radiologist (κ = 0.92). Subtypes included 12 preacromion, 13 mesoacromion, and 1 metaacromion. Rotator cuff tears were present in 20 of 26 patients with os acromiale (77%), including isolated supraspinatus tears (n = 9), combined supraspinatus-infraspinatus tears (n = 4), supraspinatus-subscapularis tears (n = 3), massive tears (n = 2), and cuff tear arthropathy (n = 2).  Conclusion: Os acromiale was uncommon in this MRI-based cohort but frequently coexisted with full-thickness rotator cuff tears. Although causality cannot be inferred, this coexistence may carry clinical relevance. Notably, focused evaluation documented more cases than routine radiology reports, underscoring the added value of targeted assessment.       Cite this article as: Birsel O, Yığman GT, Günerbüyük C, Baş A, Chodza M, Eren İ. Prevalence of os acromiale and concomitant rotator cuff tears: a focused assessment of 3697 shoulder magnetic resonance imagings. Acta Orthop Traumatol Turc. 2026; 60(1), 0714P doi: 10.5152/j.aott.2026.25714.