Fatih Durgut

Background: Hallux valgus (HV) is a three-dimensional deformity, and preoperative assessment of sesamoid position and first metatarsal rotation is important for surgical planning. Weight-bearing computed tomography (WBCT) enables three-dimensional assessment but was unavailable at our institution during the study period. Therefore, this study was a retrospective, exploratory, descriptive radiographic study of a modified weight-bearing metatarso-sesamoid (MS) projection, rather than a diagnostic-accuracy, comparative, or feasibility study. Methods: Between 2022 and 2024, 18 patients (16 female, 2 male; mean age 46 years, range 25–75 years) with 22 feet scheduled for HV surgery were included. Preoperative weight-bearing AP, lateral, and modified MS radiographs were evaluated. The alpha angle, sesamoid rotation angle (SRA), AOFAS tibial sesamoid grade, and the pronation/subluxation (P/S) pattern were recorded on the modified MS view. Because the alpha angle and P/S classification were originally defined on axial CT, we applied them to plain radiography as an exploratory approach. We did not validate them against a CT reference standard. Intraobserver and interobserver measurement agreement on the same existing radiographs was assessed through repeated blinded measurements by the primary observer after four weeks and through independent evaluations by a second blinded observer. We quantified reliability using ICC(2,1), unweighted kappa, and linearly weighted kappa, with 95% CIs. Technical acquisition performance was recorded. Results: On AP radiographs, IMA1–2 showed 2 mild, 15 moderate, and 5 severe deformities; HVA showed 1 normal, 11 mild, and 10 moderate cases; and Agrawal lateral sesamoid (LS) severity showed 1 mild, 20 moderate, and 1 severe case. On the modified MS view, the alpha angle ranged from 6° to 30° (mean ± SD 15.6 ± 6.6°), and the SRA from 6° to 45° (18.2 ± 8.3°). Using the CT-derived thresholds as descriptive reference labels only, alpha values were at or below 15.8° in 13 feet and above 15.8° in 9 feet, and SRA values were within the 7–18° reference range in 11 feet. AOFAS tibial sesamoid grade was 0 in 6 feet, 1 in 11, and 2 in 5. P/S patterns were P−/S− in 9 feet, P−/S+ in 4, P+/S− in 4, and P+/S+ in 5. Intraobserver ICCs were 0.996 (95% CI 0.991–0.998) for the alpha angle and 0.998 (0.994–0.999) for the SRA; interobserver ICCs were 0.988 (0.972–0.994) and 0.975 (0.947–0.981), respectively. Interobserver agreement was substantial for the P/S pattern (κ = 0.746, 95% CI 0.476–0.937) and excellent for the AOFAS grade (linear weighted κ = 0.878, 95% CI 0.663–1.000); intraobserver agreement was κ = 1.000 for both. The modified MS view provided a diagnostic image on the first acquisition in 15 of 18 patients; 3 patients required a single repeat acquisition, which was adequate in every case, and no procedure-related discomfort or intolerance was recorded. Acquisition time and radiation exposure were not recorded. Conclusions: Weight-bearing CT remains the reference standard for three-dimensional assessment. In this small cohort study, the modified MS projection could be obtained in every patient and showed high intraobserver and interobserver measurement agreement when the same existing radiographs were assessed. These findings describe measurement agreement on the same existing radiographs and the acquisition experience. Because no WBCT reference standard was available, the study cannot determine which projection reflects the underlying anatomy and provides no evidence of diagnostic accuracy, superiority over AP radiography, or clinical benefit. Standardized prospective studies with direct WBCT validation are required.

Background: Proximal extra-articular tibial fractures present considerable biomechanical and technical challenges due to the short proximal fragment, the wide metaphyseal canal, and the deforming forces acting around the knee. These factors predispose isolated intramedullary (IM) nailing to malalignment, prompting the use of adjunct reduction aids such as Poller screws or supplemental plates. This study aimed to compare the mechanical behavior of IM nailing alone with that augmented by Poller screws or a monocortical plate in a standardized proximal tibia fracture model. Methods: Fifteen synthetic tibiae with an AO/OTA 41-A2.3 extra-articular proximal fracture model were randomized into three groups ( n = 5 each): IM nailing alone, IM nailing plus two Poller screws, and IM nailing plus a four-hole medial monocortical plate. All specimens were instrumented with a 10 × 340-mm titanium nail and two proximal and two distal locking screws. Mechanical testing included axial compression to 800 N, axial loading to failure, and torsion at a rate of 25°/min. Displacement, stiffness, maximum load, and torque parameters were compared across groups. Results: Under 800 N axial load, the plate-augmented group showed the lowest displacement and highest stiffness (2.40 ± 0.22 mm; 332.4 ± 21.7 N/mm), followed by the Poller screw group (2.48 ± 0.25 mm; 321.6 ± 19.4 N/mm) and the IM-only group (3.45 ± 0.31 mm; 231.8 ± 18.9 N/mm) ( p < 0.001). In axial load-to-failure testing, the plate group reached the machine limit (4500 N), while the Poller screw and IM-only groups demonstrated lower capacities (4318 ± 210 N and 3906 ± 265 N, respectively; p = 0.012). Torsional stiffness was likewise highest with plate augmentation (0.30 ± 0.04 Nm/°) and lowest in the IM-only constructs ( p = 0.021). Conclusion: Both Poller screw and monocortical plate augmentation improved the initial mechanical stability of IM-nailed proximal tibial constructs, with the plate configuration yielding the highest stiffness values. However, the absolute displacement differences under physiologic axial loads were modest, and the primary clinical role of these adjuncts is reduction control rather than pure stiffness enhancement. Accordingly, the choice between Poller screws and supplemental plating should be individualized based on the fracture pattern, soft-tissue considerations, implant availability, and the surgeon’s experience.

Aim: Tibial fractures are the most common fractures in the lower extremity. Intramedullary nailing is a widely used surgical technique for the treatment of tibial fractures. The aim of this retrospective study is to analyse the clinical and radiological outcomes of suprapatellar tibial nailing performed in a single centre.Methods: The study was conducted at a single center between January 2020 and June 2022. Patients treated for tibial fractures at the age of 18 years or older, having acute tibia fractures amenable to suprapatellar nailing, and having available preoperative and postoperative radiographs and clinical follow-up data. Included in this study. Clinical outcomes were assessed by examining range of motion of the knee joint, Visual Analog Score for pain and Lysnholm scale for knee joint functions. Radiological outcomes, including fracture healing, alignment, were also evaluated using postoperative radiographs. Complications, such as malalignment, non-union, infection, and knee stiffness, were recorded.Results: 12 patients were included in this study. Mean age was 35,25 and 9 were male. Mean follow up time was 20 mounth. All the fractures healed during the last examination. The mean VAS Score was 1.33 and. Lysholm’s score was 92,5. There were no malunion according to the x ray examinations. Range of motion of the knee was between 120 degrees flexion and 180 degrees extension. The maximum shift was 9 degrees.Conclusion: According to the findings of this current study suggest that suprapatellar tibial nailing technique is a viable option for treatment of tibial shaft fractures. This approach is associated with lower rates of anterior knee pain as reported in the literature, alongside excellent union rates and clinical functional scores.

Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.

Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.

Pott's disease may accompany psoas abscesses, but bilateral psoas abscess is rarely encountered. Computerised Tomography (CT) is the gold standard for the diagnosis of psoas abscesses. Treatment of psoas abscess usually involves drainage of abscess and antibiotic therapy. CT and USG-guided catheters are often utilised for abscess drainage. In cases where neurological symptoms are observed, open surgery may be required. Pott’s disease accompanied by bilateral psoas abscess was detected in a 21-year-old male patient who was admitted to the clinic with complaints of low back pain and weakness in his left leg at the Selcuk University, Turkey, in 2018. The reason for the development of neurological deficit only on the left side was the compression of the nerve roots by the abscess tissue. The patient underwent debridement and anterior instrumentation with an anterior approach. In the postoperative follow-up it was observed that the patient's complaints were relieved. ---Continue

Injuries from stingray fish are among the most common fish stings, and their frequency is increasing with the increase in global tourism. It most commonly causes injuries to the extremities and causes morbidity if not treated appropriately. Less commonly, life-threatening injuries can be observed due to injuries in the thorax and abdomen and damage to large vessels and vital organs. In addition to severe pain, tissue necrosis, and secondary infection after injury, systemic symptoms may occur. Since these injuries can occur in both fresh and salt water, it is possible to encounter such a case at any time. Flat spines are sharp, with backward barbs or serrations that make them difficult to extract once they penetrate tissue. After first aid, surgical extraction of the stingray spine with minimal damage is essential in addition to local and systemic treatments. In the literature, there are studies on envenomation and other systemic findings after stingray spine injuries, but few publications are available on the stingray spine extracted technique after injury. This case report presents a new and helpful technique for stingray spine extraction. Cite this article as: Akar MS, Ulus SA, Durgut F, Yiğit Ş. A technical trick for extracting a stingray spine from hand: a case report. Acta Orthop Traumatol Turc. 2022;56(5):347-349.