Nevzat Gönder

Purpose: Parents increasingly consult large language model (LLM) chatbots about pediatric flexible flatfoot, a common condition that rarely requires treatment and in which the clinical task is chiefly communication. We compared four LLMs on the quality, readability, and reproducibility of parent-oriented answers. Methods: This was a cross-sectional, comparative content analysis of AI-generated text. No patients, clinical records, or human participants were involved; the units of analysis were parent-oriented questions and the chatbot responses they generated. Twenty parent-oriented questions were submitted in triplicate to ChatGPT, Claude, DeepSeek, and Gemini in independent, memory-disabled sessions (240 responses). Two blinded pediatric orthopedic surgeons scored responses (Mika grade, four-point Likert, and a hallucination taxonomy; PEMAT-P, DISCERN, and QUEST on pooled material). Readability used five indices. Between-model differences were tested with Friedman and Dunn–Bonferroni post-hoc tests; agreement and reproducibility used intraclass correlation coefficients (ICC). Results: All five readability indices differed between models (P < 0.001); none reached the recommended sixth-grade level. DeepSeek was most accessible (FRES 66.3) and ChatGPT least (FRES 17.7). On pooled-material instruments (inter-rater ICC 0.63–0.74), Claude scored highest for understandability (91.6%) and actionability (88.3%). Per-response clinical-quality measures were closely clustered, showed poor inter-rater agreement (ICC −0.01 to +0.07), and did not discriminate. Readability reproducibility across identical queries was moderate (FRES ICC 0.49–0.72). Conclusions: Clinical-quality scales did not reliably distinguish the four LLMs, whereas readability differed substantially; none met recommended readability standards, and output was only moderately reproducible. Model choice should be guided by readability and actionability, under clinician oversight. Significance of Study: For a condition managed mainly through parent education, LLM selection should rest on readability and actionability rather than presumed clinical accuracy, with output used under clinician oversight. Level of Evidence: V (cross-sectional comparative content analysis of AI-generated text; no human participants).

Background: The definitive diagnosis of cartilaginous tumors remains challenging because imaging and biopsy findings may not reliably distinguish low-grade from high-grade lesions. Consequently, the final diagnosis is often established only after surgical excision and histopathological examination. Inflammatory biomarkers derived from routine peripheral blood tests have emerged as potential adjunctive tools for tumor characterization, but their role in cartilaginous tumors remains unclear. Questions/Purposes: (1) Are preoperative inflammatory markers different between low-grade and high-grade cartilaginous tumors? (2) Which inflammatory markers are associated with high-grade (versus low-grade) cartilaginous tumors? (3) What is the diagnostic performance of the pan-immune inflammation value (PIV) in predicting high-grade cartilaginous tumors? Patients and Methods: We retrospectively reviewed 67 patients who underwent surgery for cartilaginous tumors between January 2022 and July 2025 and received definitive histopathological diagnoses. Patients were divided into two groups according to tumor grade. Group A consisted of enchondroma (n = 9), atypical cartilaginous tumor (ACT) (n = 13), and Grade 1 chondrosarcoma (n = 14), whereas Group B consisted of Grade 2 (n = 19) and Grade 3 chondrosarcoma (n = 12). Preoperative peripheral blood inflammatory markers, including white blood cell count (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), mean platelet volume (MPV), red blood cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and pan-immune inflammation value (PIV), were compared between groups. Receiver operating characteristic (ROC) analysis was performed to evaluate the diagnostic performance of significant biomarkers. Results: Baseline demographic and clinical characteristics were comparable between groups. Patients with high-grade chondrosarcoma (Group B) demonstrated higher CRP (6.35 ± 5.25 versus 4.02 ± 3.33; p = 0.030), PLR (198.08 ± 98.83 versus 139.11 ± 73.76; p = 0.016), SII (728.33 ± 177.26 versus 526.50 ± 126.17; p = 0.001), SIRI (2.01 ± 0.72 versus 1.40 ± 0.62; p = 0.001), and PIV (629.68 ± 125.19 versus 295.00 ± 111.48; p = 0.001) compared with Group A. ROC analysis showed that PIV had the highest diagnostic accuracy, with a cutoff value greater than 461.5 yielding a sensitivity of 96.8% and a specificity of 97.2% for identifying high-grade malignancy (p < 0.001). Conclusions: Preoperative inflammatory markers, particularly SII, SIRI, and PIV, were associated with high-grade cartilaginous tumors; differences in CRP and PLR did not survive correction for multiple comparisons. Among these markers, PIV demonstrated excellent discriminatory ability for distinguishing high-grade from low-grade cartilaginous tumors. These findings suggest that PIV may serve as a readily available and low-cost adjunctive biomarker in the preoperative evaluation of cartilaginous tumors. Further prospective studies are warranted to validate its clinical utility and determine its role alongside established radiological and histopathological assessment methods. Level of Evidence: Level III, diagnostic study (retrospective comparative cohort study).

Background/Objectives: Meniscal tears frequently occur during athletic activities and are often associated with anterior cruciate ligament injuries. The purpose of this study was to compare the posterior tibial slope (PTS) in young adults undergoing arthroscopic surgery for isolated meniscal tears with that of a control group, and to investigate its association with meniscal tears. Methods: This retrospective, single-centre, controlled study included 190 patients aged 18–30 years who presented with unilateral knee pain and underwent knee magnetic resonance imaging (MRI) between 2015 and 2022. Patients with an isolated medial meniscal tear (Group A, n = 67) or an isolated lateral meniscal tear (Group B, n = 31), confirmed on MRI and directly with arthroscopy, were compared with a symptomatic control group who presented with knee pain but had no meniscal or anterior cruciate ligament (ACL) tear on MRI (Group C, n = 92). Medial and lateral PTS angles were measured on pre-existing standing lateral knee radiographs. Interobserver and intraobserver reliability were quantified using intraclass correlation coefficients (ICCs). Group comparisons, receiver operating characteristic (ROC) analysis with the Youden index, and multivariable binary logistic regression adjusted for age, sex and side were performed. Results: Both medial and lateral PTS angles were significantly higher in Groups A and B than in the control group (p < 0.05). ROC analysis identified a cut-off of 9.2° for the medial PTS in the medial-tear group (AUC: 0.756, 95% CI: 0.68–0.83; sensitivity: 64.18%, specificity: 80.43%) and 9.9° for the lateral PTS in the lateral-tear group (AUC: 0.709, 95% CI: 0.60–0.82; sensitivity: 58.06%, specificity: 81.52%). The association persisted after adjustment for age, sex and side (medial slope in medial tears adjusted OR: 1.36 per 1°, 95% CI: 1.19–1.55, p < 0.001; lateral slope in lateral tears adjusted OR: 1.25 per 1°, 95% CI: 1.08–1.44, p = 0.003). Conclusions: In this retrospective cohort of young adults, an increased posterior tibial slope was associated with isolated meniscal tears. A medial PTS greater than 9.2° and a lateral PTS greater than 9.9° were associated with medial and lateral meniscal tears, respectively. Given the modest sensitivity and the observational design, PTS should be regarded as a supportive morphological marker rather than a stand-alone diagnostic metric, and a causal relationship cannot be inferred based on the results of this study. Because discrimination was only fair (AUC 0.693–0.756) and sensitivity limited (54.8–64.2%), these cut-offs are not clinically applicable decision thresholds and should be used only in conjunction with clinical assessment and MRI.

Aims: Wrist arthroplasty has become an important surgical option for end-stage wrist arthritis; however, the global research landscape in this field has not yet been comprehensively characterized. This bibliometric study aimed to examine publication growth, the principal contributors, collaboration patterns, and thematic groupings within the wrist arthroplasty literature from 1980 to April 2026.Methods: A structured search was performed in the Web of Science (WoS) Core Collection. Articles and review articles on wrist arthroplasty published from 1980 through April 2026 were retrieved and evaluated. Bibliometric measures, including publication volume, citations, h-index, leading journals, countries, and authors, were compiled. Co-authorship and keyword co-occurrence networks were mapped with VOSviewer.Results: In total, 183 publications were included, yielding 3,912 citations overall, an average of 21.4 citations per item, and an h-index of 37. Yearly output increased clearly over time and reached its highest point in 2025 with 18 publications. The Journal of Hand Surgery-American Volume published the most papers (n=33). Keyword mapping showed five major clusters focused on total wrist arthroplasty, rheumatoid arthritis, surgical outcomes, implant design, and comparisons with wrist arthrodesis.Conclusion: Research interest in wrist arthroplasty has increased markedly over the last decade, with especially rapid growth in recent years. Output remains concentrated in North America and Western Europe. Greater multinational collaboration is needed, particularly to clarify long-term implant survivorship, outcomes in non-rheumatoid indications, and future implant development.

Background/Objectives: Post-traumatic hip osteoarthritis (PTHOA) remains the principal long-term complication after operatively treated acetabular fractures. The relative weight of patient-, injury-, and surgeon-dependent variables that drive its development is still debated. We aimed to identify independent predictors of PTHOA after open reduction and internal fixation (ORIF) of acetabular fractures. Methods: We retrospectively reviewed 130 consecutive patients who underwent ORIF for an acetabular fracture at a single tertiary trauma centre between November 2012 and January 2023 and had a minimum follow-up of 24 months. Fractures were classified using the Judet–Letournel system; reduction quality was graded according to Matta. PTHOA was assessed at the latest follow-up using both the Tönnis and Kellgren–Lawrence (KL) systems. Patients were stratified into three groups: no OA, mild OA (Tönnis 1/KL 1–2), and advanced OA (Tönnis 2–3/KL 3–4). Univariable and multivariable analyses identified factors independently associated with advanced OA. Results: The cohort included 106 men (81.5%) and 24 women (18.5%) with a mean age of 40.7 ± 16.3 years and a mean follow-up of 3.4 years. Advanced PTHOA developed in 43 patients (33.1%); 13 (10.0%) underwent THA. On multivariable analysis, prolonged time-to-surgery (>6 days; p = 0.001), associated posterior-wall–transverse fracture (p = 0.038), use of the Kocher–Langenbeck (K-L) approach (p = 0.038), and non-anatomic Matta reduction (p < 0.001) were independently associated with advanced PTHOA. Age ≥ 40 years was significant on univariable analysis (p = 0.002) but not after adjustment. Conclusions: Reduction quality, associated posterior-wall–transverse fracture morphology, surgical timing, and choice of approach are the principal determinants of PTHOA after acetabular ORIF. Early surgery and meticulous anatomic reduction should remain the cornerstones of management.

Background/Objectives: Pes planus and pes cavus are common foot deformities, which may lead to pain, functional limitations, and impairment of foot biomechanics. While calcaneal pitch, talar declination, and Meary angles, commonly used in diagnosis, provide objective information, their lack of a gold standard and the observer’s dependence on manual measurements limit their reliability. Therefore, in this study, these angles obtained from weight-bearing lateral foot radiographs were evaluated according to literature references, and the aim was to determine the model that provides the most accurate prediction in the diagnosis of pes planus using machine learning algorithms. It should be emphasized that, because the diagnostic labels were derived from literature-based thresholds of these same angles, the machine-learning task addressed here is the automated reproduction and standardization of expert, angle-threshold-based classification, rather than an independent clinical diagnosis from raw images. Methods: This retrospective study was conducted using weight-bearing lateral foot radiographs of 697 male patients obtained from the archives of public hospitals in Gaziantep. Calcaneal pitch, Meary angle, and talar declination angles were evaluated in both feet, and the data were labeled as normal, pes planus, and pes cavus. The dataset, consisting of a total of 1394 feet, was divided into training and test groups and analyzed using Random Forest, XGBoost, Logistic Regression, Support Vector Machine (SVM), and K-Nearest Neighbors (KNN) algorithms; the diagnostic performance of the models was compared using measures such as accuracy, F1 score, sensitivity, and specificity. Results: A total of 1394 feet from 697 male patients (mean age 24.8 ± 5.57 years) were analyzed using five machine learning algorithms with calcaneal pitch angle (CPA), Meary angle (MA), and talar declination angle (TDA) as reference labels. Ensemble-based methods showed superior performance, with XGBoost achieving perfect classification (Accuracy = 1.000) under all three labels for the left foot and 0.996–1.000 for the right foot, while Random Forest reached 0.986–1.000 across all experiments. Logistic Regression and SVM yielded moderate accuracies (0.905–0.973), whereas KNN consistently performed the weakest (0.905–0.964), particularly in the pes cavus subgroup. The near-perfect accuracy obtained when the labeling angle was itself included among the predictors reflects, at least in part, the algebraic reconstruction of the threshold rule from a same-source variable rather than genuine diagnostic generalization; results should therefore be interpreted with this in mind. Conclusions: This study demonstrates that machine learning, particularly ensemble methods such as XGBoost and Random Forest, provides high accuracy and consistency in diagnosing foot arch deformities based on radiographic angle measurements. Traditional models, such as Logistic Regression, still hold value in terms of clinical interpretability despite their lower performance. The findings suggest that machine learning-based approaches can offer objective, rapid, and reliable decision support tools for diagnosing pes planus and pes cavus, but external validation studies are necessary for clinical generalizability.

Background/Objectives: Gartland Type III supracondylar humerus fractures (SCHFs) represent the most surgically challenging pediatric elbow injuries, yet controversy persists regarding whether the timing of surgery, specifically after-hours versus working-hours operations, influences clinical and radiological outcomes. This study aimed to compare the functional, cosmetic, and radiological outcomes of Gartland Type III SCHFs managed during working hours versus after hours, with a secondary analysis incorporating the surgical approach (open vs. closed reduction). Methods: A retrospective cohort study was conducted, including 91 pediatric patients who underwent surgical treatment for Gartland Type III SCHFs between January 2020 and June 2025. Patients were stratified into working-hours (n = 48) and after-hours (n = 43) groups. Outcomes were assessed using Flynn’s criteria, radiological parameters, range-of-motion measurements, and complication rates. A secondary subgroup analysis was performed across four groups formed by combining surgical timing and approach. Results: The mean patient age was 70.36 ± 32.97 months with a mean follow-up of 28.07 ± 14.66 months. The time to surgery was significantly shorter in the working-hours group (median 16.0 h; IQR 13.5–20.0) compared with the after-hours group (median 20.0 h; IQR 17.0–27.0) (p = 0.009). No significant differences were observed between the two groups with respect to functional outcomes, cosmetic outcomes, radiological parameters, or overall complication rates (all p > 0.05). However, four-group subgroup analysis revealed a significant difference in Flynn’s functional outcomes (p = 0.019), with the after-hours open reduction subgroup demonstrating a lower rate of excellent results (76.92%) compared with the remaining subgroups (96.88–100%). Conclusions: Working-hours versus after-hours surgical timing alone does not significantly alter clinical or radiological outcomes in Gartland Type III SCHFs. However, the combination of after-hours surgery with open reduction appears to be associated with inferior functional outcomes and a trend toward higher complication rates, suggesting that open reduction for complex fractures should preferably be performed during working hours when optimal theatre conditions and experienced senior surgical teams are readily available.