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Background/Objectives: Artificial intelligence (AI) may support rotator cuff MRI interpretation; however, its performance relative to clinicians at different experience levels remains uncertain. We compared a locked YOLO11m-based model with prespecified orthopaedic physician panels using arthroscopy as the reference standard. Methods: This retrospective single-centre study included a separate 300-patient model-development dataset and an arthroscopy-referenced reader cohort of 258 patients (60 intact cuffs, 86 partial-thickness tears, and 112 full-thickness tears). Twelve blinded physicians were assigned to four three-reader experience panels, and panel diagnoses were defined by a two-of-three majority. Paired accuracy comparisons used exact McNemar tests with Holm adjustment. Results: AI achieved 0.841 overall accuracy (95% CI, 0.792–0.881). The senior-specialist panel had numerically higher accuracy (0.911), but the difference from AI was not statistically significant after adjustment (Holm p = 0.060); the junior-specialist panel also did not differ from AI (0.822; Holm p = 0.649). AI showed higher paired accuracy than the senior-resident (0.729; Holm p = 0.005) and junior-resident panels (0.671; Holm p < 0.001). Partial-thickness tears had the lowest AI sensitivity (0.709). Conclusions: In this restricted-cine, three-category benchmark, AI outperformed both resident panels, whereas neither specialist panel comparison reached the adjusted significance threshold. These findings do not establish equivalence to specialists or benefit from AI-assisted reading.

COMPUTED TOMOGRAPHY-BASED EVALUATION OF SACROCOCCYGEAL MORPHOLOGY IN ADULT PATIENTS WITH CHRONIC COCCYDYNIA: A RETROSPECTIVE STUDY - The Journal of Turkish Spinal Surgery

Rotator cuff (RC) tears are a prevalent source of shoulder pain that restrict everyday activities and diminish quality of life. While MRI reveals structural damage in the tendon, it is uncertain if RC illness is also indicated in the body's circulating metabolites. The establishment of systemic signals may guide the future creation of blood‐based biomarker panels; however, existing evidence is currently insufficient. This exploratory, hypothesis‐generating case–control study investigated serum metabolites via proton nuclear magnetic resonance ( ¹ H‐NMR) in persons with full‐thickness RC injuries and age‐ and sex‐matched healthy controls (50 cases, 50 controls). Spectra underwent meticulous quality assessments, and predetermined statistical analyses were conducted with management of false discoveries. We also examined how well different metabolites discriminated RC tears from controls and explored which metabolic pathways were most represented. Numerous metabolites exhibited variations between the groups. Concentrations of N‐carbamoyl‐β‐alanine, taurine, erythritol, and N‐acetylaspartate were elevated in RC tears, but levels of 3‐methylhistidine and proline were diminished. Pathway enrichment revealed pyrimidine metabolism, bile‐acid biosynthesis, taurine/hypotaurine metabolism, β‐alanine metabolism, and histidine metabolism, indicating coordinated perturbations at the pathway level rather than isolated alterations. These data must be regarded as preliminary and hypothesis‐generating, lacking the establishment of causation or immediate clinical applicability. Although preliminary, these findings are scientifically significant because they suggest that full‐thickness RC tears may be associated with a coordinated systemic metabolic signature rather than only a focal tendon abnormality. This systems‐level perspective adds to the current understanding of RC pathology by generating biologically plausible hypotheses related to tissue remodeling, oxidative stress adaptation, and energy metabolism. Prospective longitudinal investigations with targeted quantification, external validation, and integration with imaging and clinical outcomes are required before clinical translation.

Background: Medial epicondyle fractures account for a substantial proportion of pediatric elbow injuries, but the determinants of functional outcome after operative fixation remain incompletely defined. This study sought to describe functional and radiographic outcomes after open reduction and internal fixation (ORIF) of pediatric medial epicondyle fractures and to identify clinical, injury-related, and treatment-related parameters associated with these outcomes. Methods: We retrospectively reviewed consecutive patients 16 years or younger who underwent ORIF for isolated medial epicondyle fractures between 2018 and 2024, with ≥12 months of follow-up. Fixation was performed with either Kirschner wires (KW) or a cannulated lag screw (LS) with washer. Outcomes at final review included Mayo Elbow Performance Score (MEPS), elbow flexion–extension range of motion (ROM), and forearm rotation range (ROR). Fragment incarceration, preoperative ulnar nerve involvement, complications, and time to radiographic union were recorded. Univariate analyses and multivariable linear regression were used to identify factors associated with MEPS, ROM, and ROR. Results: Thirty-nine patients were included (KW, n = 22; LS, n = 17; mean age = 12.4 y). The mean time for radiographic union was 5.4 weeks. At final follow-up, mean MEPS was 91.9, ROM 133.9 degrees, and ROR 156.8 degrees. Fragment incarceration occurred in 11 patients (28%), and preoperative ulnar nerve involvement in 4 (10%). In multivariable analysis, fragment incarceration was independently associated with lower MEPS and reduced ROM, whereas KW fixation was associated with a small absolute difference of approximately 3 to 4 MEPS points on the 0 to 100 scale compared with LS. No variable significantly predicted ROR. Conclusions: Both K-wire and cannulated lag screw with washer fixation achieved early union and generally excellent function after pediatric medial epicondyle fractures. Within this cohort, fragment incarceration appeared more strongly related to residual functional loss than implant type, supporting individualized implant selection and suggesting that careful attention to reduction, fixation stability, and a protocol-driven early mobilization program may be particularly important when incarceration is present. Level of Evidence: Level III, retrospective cohort study.

Aim: This study aimed to compare the functional outcomes of comminuted (AO/OTA C3) patellar fractures treated with tension band wiring technique to those of simple two-part fractures (AO/OTA C1) treated with the same method. Methods: Patients who underwent surgery for patellar fractures between 2017 and 2023 were retrospectively analyzed. A total of 83 patients met the inclusion criteria (C1: n=45; C3: n=38). All patients underwent open reduction and internal fixation with the tension band wiring technique. Functional outcomes were evaluated using the Böstman score. Statistical analysis was performed with SPSS 20.0 software. Results: There was no statistically significant difference between the groups in terms of age, sex, side, follow-up duration, or implant removal rates (p>0.05). The mean Böstman score was significantly higher in the C1 group (23.33±5.07) compared to the C3 group (19.58±6.48; p=0.005), indicating better functional outcomes in the simpler fracture type. Conclusion: The tension band wiring technique yields satisfactory results in simple two-part patellar fractures. However, it may be insufficient for comminuted fractures, suggesting a need for evaluating alternative surgical fixation techniques for such cases.

Background: Proximal femoral nailing (PFN) is a preferred treatment for intertrochanteric femoral fractures in elderly patients due to its minimally invasive nature and early mobilisation benefits. However, mechanical complications such as implant failure, cutout, and reduction collapse remain significant challenges. This study introduces the targeted surgical score (TSS), a novel scoring system designed to predict and mitigate mechanical complications by evaluating modifiable surgical factors. Methods: A retrospective analysis of 586 patients aged 65 and older treated with PFN between 2015 and 2022 was conducted. Data on demographic characteristics, fracture classifications, and surgical parameters were collected. Radiographic assessments included tip-apex distance (TAD) and lag screw positioning for implant placement quality, medial and anterior cortical support (MCS and ACS), and fracture alignment in both AP and lateral planes for reduction quality. Each parameter was scored, resulting in a cumulative TSS ranging from 0 to 8. Logistic regression and ROC curve analysis were performed to evaluate the predictive capacity of TSS. Results: The average TSS was 4.06 ± 2.22 in the complication group and 6.14 ± 1.56 in the non-complication group (p < 0.001). A one-point increase in TSS was associated with a 44.9% reduction in complication risk (OR 0.551; p < 0.001). Independent risk factors included lag screw placement (non-central superior quadrants), inadequate cortical support in AP and lateral planes (MCS and ACS), and TAD (≥ 25 mm). The TSS demonstrated relatively good discriminative ability with an AUC of 0.768. Conclusion: TSS may aid in predicting and mitigating mechanical complications while potentially guiding surgical applications in PFN, but further prospective multicentre validation is required. While certain parameters of TSS could be considered intraoperatively, its full implementation may be more practical for postoperative risk assessment.

This study aimed to evaluate the early effects of N-acetylcysteine, which has antioxidant, inflame-modulatory, and cytoprotective properties, on tendon healing. Thirty-five male Wistar Hannover rats were divided into five groups: first-week treatment (Group 1T), first-week control (Group 1C), third-week treatment (Group 3T), third-week control (Group 3C), and native tendons (Group N). Bilateral Achilles tenotomy was performed on all rats except Group N. After tenotomy, 150 mg/kg N-acetylcysteine was administered daily intraperitoneally to treatment groups, while isotonic saline was given to the control groups. Tendons were evaluated histopathologically, immunohistochemically, and biomechanically after sacrifice in the first and third weeks. No significant differences were observed in the first week (p > 0.05). Movin and Bonar scores (lower scores reflect improved histologic healing) were significantly lower in Group 3T than in Group 3C (p = 0.002). Collagen type-I/type-III ratios were higher in Group 3T compared to Group 3C (p = 0.001). Fmax (N) values were similar across Group 3T, Group 3C, and Group N (p = 0.772). However, cross-sectional areas (mm²) were significantly smaller in Group 3T than in Group 3C (p = 0.001), with the smallest areas observed in native tendons. Thus, tensile strength (MPa, load per unit area) and toughness (J/10³ mm³, energy absorbed per unit volume) were significantly higher in Group 3T than in Group 3C (p = 0.001). N-acetylcysteine supplied some improved results on early markers of tendon healing. Although our findings support the potential of NAC as a therapeutic adjunct in tendon injuries, further studies are needed to evaluate the long-term effects and underlying mechanisms.

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.