Ramadan Özmanevra

Posterior tibial slope (PTS) is a key determinant of sagittal knee mechanics, cruciate ligament loading, and flexion-extension behavior after total knee arthroplasty (TKA). Accurate reproduction of the intended PTS is therefore an important objective in contemporary TKA, particularly when patient-specific alignment targets are used. The aim of this study was to evaluate the radiographic agreement among planned, robot-validated, and postoperative PTS values in ROSA-assisted TKA using standardized true lateral radiographs and blinded repeated measurements, and to determine the reliability of postoperative radiographic measurements. This retrospective observational radiological study, reported in accordance with the STrengthening the Reporting of OBservational studies in Epidemiology statement, included knees that underwent robotic-assisted primary TKA using the ROSA system and had complete intraoperative robotic records and adequate postoperative true lateral radiographs. Postoperative true lateral radiographs were obtained at 6-week follow-up. Planned PTS values were obtained from the robotic planning interface, and final robot-validated PTS values were recorded intraoperatively after tibial preparation. Postoperative PTS was measured on standardized true lateral radiographs by 2 independent blinded orthopedic surgeons, each performing repeated measurements at a 2-week interval. Agreement was assessed using paired comparisons, mean absolute differences, outlier analysis, and Bland–Altman evaluation. A total of 73 knees from 64 patients were initially reviewed, and 72 knees with complete paired measurements were included in the final analysis. There was no statistically significant difference between planned and robot-validated PTS values. The mean absolute difference between planned and robot-validated PTS was 0.57°, and 80.6% of knees were within ±1° of the planned target, while all knees were within ±2° and ±3°. Similarly, no statistically significant difference was observed between robot-validated and postoperative mean radiographic PTS values. Radiographic measurement reliability was excellent, with ICC(3,1) = 0.983 (95% confidence interval = 0.976–0.989) and ICC(3, k ) = 0.996 (95% confidence interval = 0.994–0.997). ROSA-assisted TKA demonstrated close radiographic agreement among planned, robot-validated, and postoperative PTS values, with low absolute deviations and excellent measurement reliability. Because this study lacked a comparator group and did not assess clinical outcomes, these findings should be interpreted as evidence of radiographic reproducibility rather than evidence of superiority over conventional instrumentation or proof of clinical benefit.

Comparison of Performance Parameters of Professional Football Players with Unilateral Anterior Cruciate Ligament Reconstruction to the Contralateral Extremity - Cyprus Journal of Medical Sciences

Background: This study aims to compare the clinical outcomes of coracoclavicular fixation using the endobutton (EB) technique versus tendon grafts (TGs) and examine the impact of early surgical intervention on functional outcomes in patients with acute Rockwood type III, IV, and V acromioclavicular joint dislocations. Methods: This retrospective study encompasses 35 patients with acute Rockwood type III, IV, and V acromioclavicular joint dislocations who underwent coracoclavicular fixation surgery employing either the EB or hamstring TG techniques between January 2016 and January 2020. Patients were classified into 2 groups: the EB group and the TG group. Clinical outcomes were measured using the Visual Analog Scale (VAS), Disabilities of the Arm, Shoulder, and Hand questionnaire, and Constant score preoperatively and postoperatively. Results: The Constant-subjective and Meler scores of the EB group were significantly higher than those of the TG group. Postoperative EB group VAS scores were significantly lower than those of the TG group (P = .029). Furthermore, the Constant-objective scores of patients who underwent surgery within 3 weeks were significantly higher (P = .010). Additionally, the VAS scores of patients whose surgery occurred within 3 weeks were significantly lower than those of patients who had surgery after 3 weeks (P = .048). Conclusion: Early surgical treatment of acromioclavicular joint separation leads to higher Constant scores. Moreover, irrespective of the surgical technique, patients who underwent surgery within the first 3 weeks post-injury had lower VAS scores. Level of evidence: Level III, retrospective.

Background: Distal tibial fractures remains a significant challenge in orthopedic trauma surgery. As the fracture level approaches the joint, alternative fixation options instead of intramedullary nailing (IMN) come to the fore. The present study aimed to assess the biomechanical stability of IMN at different distal tibial fracture levels and the number of locking screws required. Methods: Using a total of 21 sawbone models, 3 different tibial fracture levels (3, 4.5, and 6 cm proximally to the talocrural joint) were created and the fractures were fixed using 2, 3, or 4 distal locking screws. A single compression force at a speed of 30 mm/min with a maximum force of 800 Newton and a cyclic compression force of 60 cycles at a speed of 60 mm/min was applied to all tibia models. The applied weight and displacements from the fracture lines were recorded and evaluated. Results: There was no statistically significant difference in fixation with 2 distal locking screws in groups 1, 2, and 3 (single test P =.9689) (cyclic test P =.8050). Therefore, if 2 distal screws are used, the fracture level does not affect the strength of fixation. In fractures located 6 cm proximal to the talocrural joint, all 4 holes of the nail can be used to insert screws, which provides a stronger fixation. When 2 screws are used, a statistically weaker fixation is obtained than with 3 or 4 screws. However, there is no significant difference between using 3 or 4 screws. Conclusion: Our findings support the use of IMN with 2 distal locking screws as a viable option for the management of distal tibial fractures. We found that it provides sufficient fixation regardless of the fracture level, suggesting that there is no need to choose an alternative fixation technique due to concerns of inadequate fixation as the fracture line moves distally. In cases where more stable fixation is desired, an additional locking screw can be used, but the potential increase in procedure and fluoroscopy time should be considered.

Background: The purpose of this study is to describe the macroscopic and radiological changes on the fifth finger related to mobile phone use and to evaluate the effect of size and weight of the device and the average time spent using the smartphone on these morphological alterations. Methods: One-hundred and one patient were included in the study. Age, weight, height, education, mobile phone data and digital photographs used in this cross-sectional study were obtained from interviews with the participants in an outpatient orthopedics clinic setting. Digital photographs of the dorsal aspects of both hands were taken with an iPhone X ® (dual 12-megapixel wide camera). The DIP joint angle of the fifth finger was measured on computer software (Image J® version 1.46, National Institute of Health, Bethesda, MD) separately for digital photographs and AP hand X-rays. Results: The proportion of smartphone usage time over 4 hours was significantly higher in patients with complaints than patients without complaints (p<0.05). The mean time of smartphone use over 4 hours was significantly higher in patients with shape discrepancy than in patients without shape discrepancy (p<0.05). Conclusion: Smartphone use of more than 4 hours per day, regardless of size and weight, can cause deformity of the fifth finger, which may disturb the patient even if it does not cause radiologically changes.

Robotik cerrahi, tıp alanında hata payını en aza indirmek ve olası komplikasyonları önlemek amacıyla geliştirilen, ortopedide implant konumlandırma, mekanik eksen restorasyonu ve bağ dengesini sağlama gibi kritik avantajlar sunan yenilikçi bir teknolojidir. İlk olarak 1986'da Robodoc ile başlayan süreç; günümüzde pasif, aktif, interaktif ve tele-operated olarak sınıflandırılan Mako, Navio, Rosa Knee ve iBlock gibi gelişmiş robotik sistemlerin geliştirilmesiyle devam etmektedir. Literatür incelendiğinde, robotik yardımlı total diz artroplastisinin (RATDP) ameliyat öncesi veya esnası planlamalarla kemik kesilerini ve implant yerleşim başarısını artırdığı, tibia komponent yerleşimindeki açısal kusurları azalttığı ve BT tarama maliyetleri dahil edildiğinde bilateral vakalarda konvansiyonel yönteme göre daha düşük 90 günlük operasyon maliyetleri sunduğu gösterilmiştir. Buna karşın, ameliyat sürelerinin daha uzun olması ve sistemlerin yüksek başlangıç yatırım maliyetleri ile cerrahi ekibin öğrenme eğrisi gibi faktörler bu teknolojinin dezavantajları arasında yer almaktadır. Sonuç olarak, yüksek operasyon maliyetleri ve teknik karmaşıklığa rağmen, robotik sistemler ortopedik cerrahide cerrahın başarı oranını artıran ve gelecekte uzaktan cerrahi gibi uygulamalara zemin hazırlayan kalıcı ve gelişimini sürdüren bir destek elemanı konumundadır. Robotic surgery is an innovative technology developed to minimize the margin of error and prevent potential complications in the medical field, offering critical advantages in orthopedics such as implant positioning, mechanical axis restoration, and soft tissue balancing. The process, which initially began in 1986 with Robodoc, continues today with the development of advanced robotic systems like Mako, Navio, Rosa Knee, and iBlock, which are classified as passive, active, interactive, and tele-operated. Literature reviews indicate that robotic-assisted total knee arthroplasty (RATDP) increases the success rate of bone resections and implant placement through pre- or intraoperative planning, reduces angular alignment defects in tibial component positioning, and offers lower 90-day episode-of-care costs in bilateral cases compared to the conventional method when CT scan costs are included. Conversely, factors such as longer operative times, high initial investment costs of the systems, and the learning curve of the surgical team remain among the disadvantages of this technology. In conclusion, despite high operational costs and technical complexities, robotic systems stand as a permanent and evolving supportive tool in orthopedic surgery that enhances the success rate of the surgeon and paves the way for future applications like remote telesurgery.

Akademisyen Yayınevi yöneticileri, yaklaşık 30 yıllık yayın tecrübesini, kendi tüzel kişiliklerine aktararak uzun zamandan beri, ticarî faaliyetlerini sürdürmektedir. Anılan süre içinde, başta sağlık ve sosyal bilimler, kültürel ve sanatsal konular dahil 2000 kitabı yayımlamanın gururu içindedir. Uluslararası yayınevi olmanın alt yapısını tamamlayan Akademisyen, Türkçe ve yabancı dillerde yayın yapmanın yanında, küresel bir marka yaratmanın peşindedir. Bilimsel ve düşünsel çalışmaların kalıcı belgeleri sayılan kitaplar, bilgi kayıt ortamı olarak yüzlerce yılın tanıklarıdır. Matbaanın icadıyla varoluşunu sağlam temellere oturtan kitabın geleceği, her ne kadar yeni buluşların yörüngesine taşınmış olsa da, daha uzun süre hayatımızda yer edineceği muhakkaktır.