Süleyman Kozlu

This study compares the clinical and radiological outcomes of volar plating alone and combined volar and radial column plating in the management of Arbeitsgemeinschaft für Osteosynthesefragen (AO) type C2–C3 distal radius fractures. This retrospective cohort study included 80 patients with AO type C2–C3 distal radius fractures who were treated with either single volar plating (n = 50) or combined volar and radial column plating (n = 30). The patients were followed up for a minimum of 2 years. Outcome measures included the Patient-Rated Wrist Evaluation score, wrist range of motion, radiological parameters (radial height, inclination, volar tilt, ulnar variance), and pinch strength. Patients treated with dual plating demonstrated significantly better Patient-Rated Wrist Evaluation scores at all follow-up points ( P < .05) as well as improved radial height, inclination, volar tilt, wrist flexion, and grip strength. Pronation values were more favorable in the single-plating group across all follow-up time points, while supination values differed only at the 6-month assessment; overall function and radiological alignment otherwise appeared more favorable in the dual-plating group. In AO type C distal radius fractures with radial styloid involvement or severe comminution, dual plate fixation demonstrated improved functional recovery and maintenance of radiographic alignment. Supplementary radial column fixation may therefore represent an effective treatment strategy for these challenging fracture patterns, warranting further prospective investigation.

BACKGROUND Hip fracture morphology in older adults is influenced not only by bone mineral density but also by biomechanical and functional factors. Knee osteoarthritis (KOA) can alter lower-limb alignment, load distribution, and gait patterns, potentially affecting the type of hip fracture sustained. This study aimed to evaluate the association between radiographic KOA and hip fracture type while accounting for osteoporosis and pre-fracture mobility. MATERIAL AND METHODS This single-center retrospective cohort study included patients aged ≥65 years admitted with low-energy hip fractures between January 2018 and December 2023. Radiographic KOA was assessed using Kellgren-Lawrence classification, defined as grade ≥2. Osteoporosis was evaluated using dual-energy X-ray absorptiometry within 1 year before fracture. Pre-fracture mobility was assessed using the Parker Mobility Score, categorized as high (7-9), moderate (4-6), or low (0-3). Hip fractures were classified as femoral neck or intertrochanteric. Multivariable logistic regression identified predictors of intertrochanteric fracture. RESULTS Ninety-two patients (mean age 79.1±7.8 years; 67.4% female) were included. Intertrochanteric fractures occurred in 55 patients (59.8%). KOA was present in 56 patients (60.9%), and osteoporosis in 64 (69.6%). Intertrochanteric fractures were more common in patients with KOA (71.4% vs 41.7%, P=0.006). Low mobility was also associated with higher rates (79.4% vs 54.8% vs 40.7%, P=0.007). KOA (OR 2.87; 95% CI, 1.18-6.99; P=0.020) and low mobility (OR 3.41; 95% CI, 1.42-8.19; P=0.006) were independent predictors, whereas osteoporosis was not. CONCLUSIONS KOA and reduced mobility were found to be independently associated with intertrochanteric fracture patterns, underscoring the role of biomechanical and functional factors beyond bone density.

Aims: To evaluate the one-year outcomes of conservatively treated isolated greater tuberosity fractures with minimal initial displacement, with particular emphasis on secondary surgical intervention, magnetic resonance imaging (MRI) findings, and the course of bone marrow edema (BME).Methods: This retrospective cohort study included 43 adult patients with isolated greater tuberosity fractures presenting between 2018 and 2023, all of whom had an initial displacement of ≤3 mm and were managed conservatively. Clinical and radiographic data were reviewed with a minimum follow-up of 12 months. The primary outcome was the need for secondary surgical intervention within one year. Secondary outcomes included MRI-detected concomitant soft-tissue pathology, time to BME regression on serial MRI, and final Constant-Murley score.Results: The mean patient age was 52.6±13.4 years, and 26 patients (60.5%) were female. During follow-up, 5 patients (11.6%) required secondary surgical intervention, all of which were arthroscopic procedures. No patient required secondary bony fixation or corrective surgery, and no cases of nonunion, malunion, or secondary displacement were observed. MRI was performed in 18 patients (41.9%) because of persistent symptoms or delayed recovery, and 12 of these patients (66.7%) demonstrated at least one concomitant soft-tissue pathology. All imaged patients who later required secondary surgery had at least one associated soft-tissue lesion. Serial MRI evaluation was available in 11 patients, with a median time to BME regression of 15 weeks (interquartile range, 12-20 weeks). The mean Constant-Murley score at 12 months was 81.4±9.6 and was lower in patients who required secondary surgery.Conclusion: Although minimally displaced greater tuberosity fractures are generally considered to have a benign clinical course, a subset of patients may develop persistent symptoms requiring secondary arthroscopic intervention. In these cases, associated soft-tissue pathology and prolonged bone marrow edema appear to be important determinants of outcome than fracture displacement.

Purpose: Developmental dysplasia of the hip (DDH) requires timely, guideline-concordant decisions to prevent long-term morbidity. ChatGPT-5.0 may support clinicians—especially where pediatric orthopedic expertise is limited, but their reliability across typical and discordant presentations is uncertain. This scenario-based validation study evaluated the accuracy of ChatGPT-5.0’s management recommendations for DDH using 30 structured clinical cases and compared these outputs against AAOS (2022) and AAP (2016) guidelines. Methods: Scenario-based validation using 30 unique cases: 20 concordant (aligned clinical and imaging findings) spanning Graf and acetabular index-based ages, and 10 mismatch scenarios with correct examinations but intentionally erroneous radiology. The primary outcome was guideline-concordant accuracy, categorized as correct, partially correct, undertreatment, overtreatment, or incorrect. Secondary outcomes included the effect of error-aware prompts and multilingual consistency. Results: In concordant scenarios, guided ChatGPT achieved 100% correct, while non-logged-in ChatGPT achieved 95% with one overtreatment. In mismatch scenarios, guided ChatGPT frequently tends toward overtreatment and failing to recommend repeat ultrasound or urgent pediatric orthopedic consultation. Non-logged-in ChatGPT performed better in mismatch cases but similarly under-emphasized remeasurement/consultation. Error-aware prompts did not materially alter recommendations in either environment. Swahili queries produced outputs clinically identical to English responses. Conclusions: ChatGPT-5.0 provides reliable, guideline-concordant guidance for DDH when clinical and radiologic data are concordant, supporting potential use as a decision aid in settings without immediate pediatric orthopedic access. Safe clinical implementation requires human oversight and integration of guideline-based safety checks to prevent mismanagement in ambiguous cases.

Purpose: To compare the effects of postoperative splint immobilization versus early mobilization on 1-year radiological and functional outcomes in pediatric diaphyseal both-bone forearm fractures treated with elastic stable intramedullary nailing (ESIN). Methods: A retrospective analysis was performed on 124 children (6–14 years) who underwent ESIN for closed mid-diaphyseal radius–ulna fractures between January 2018 and December 2023. Patients were divided into splint ( n = 64) and non-splint ( n = 60) groups according to postoperative protocol. Radiological healing was evaluated using the Lane–Sandhu score at 1, 3, 6, and 12 months, and functional outcomes using the Price classification at 3, 6, and 12 months. Results: Baseline characteristics were comparable. At the third month, radiological scores were slightly higher in the splint group, while functional results favored early mobilization, though differences were not statistically significant. By the 6th and 12th months, complete union and excellent functional recovery were achieved in all patients, with no significant intergroup differences ( p > 0.05). Conclusions: Early mobilization following ESIN is feasible and does not delay bone healing or impair function. Routine splinting may be unnecessary, and postoperative care can be tailored to the patient and fracture characteristics. Moreover, our findings demonstrate that when ESIN principles are properly applied, splint use in appropriately selected patients does not lead to any long-term functional deficit, and excellent outcomes can still be expected.

The purpose of the study is to evaluate the effect of medical ozone therapy on fracture healing in rats. 20 male Wistar-Albino rats were randomly divided i

Ejmi Eurasian Journal of Medical Investigation

Background/Objectives: Trigger finger is a common cause of hand pain and functional limitation. Although open A1 pulley release remains the standard surgical treatment, ultrasound-guided percutaneous needle release (UGPR) has emerged as a minimally invasive alternative. This study aimed to compare the clinical effectiveness and safety of UGPR with open surgery. Methods: In this prospective, randomized controlled trial, 146 patients with Green stage 2–4 trigger finger were randomly assigned to UGPR (n = 75) or open release (n = 71). Pain (VAS), functional status (QuickDASH), and symptom severity (Nirschl Phase Rating) were assessed preoperatively and at postoperative day 3, 1, 6, and 12 months. Grip strength was measured with a digital pinchmeter, and ultrasonographic evaluation of A1 pulley and flexor tendon thickness was performed preoperatively and at 12 months. Subgroup analyses were conducted to address the imbalance in thumb distribution. Results: Both groups showed significant postoperative improvements in VAS, QuickDASH, and Nirschl scores (p < 0.05 for intragroup comparisons), with no significant differences between groups at 12 months (p > 0.05). At the one-year follow-up, grip strength was significantly greater in the UGPR group (p = 0.008). Ultrasonographic evaluation revealed greater MCP tendon thickness in UGPR, without clinical impact. Subgroup analyses confirmed comparable functional outcomes in thumb-only and non-thumb cases. Four revisions occurred in the UGPR group (incomplete release, recurrent tenosynovitis, flexor tendon rupture, and neurovascular injury), while none were observed in the open group. Conclusions: UGPR and open release provide comparable long-term outcomes in the treatment of trigger finger. UGPR offers the advantages of being minimally invasive and preserving grip strength, although it carries a small risk of incomplete release and procedure-related complications. Patient preference, surgeon expertise, and digit type should guide treatment selection.

Purpose: Prosthetic joint infection (PJI) is unfortunately a costly process. In this study, we aimed to examine the effect of methicillin resistance on the cost of PJI compared to susceptible patients. Materials and Methods: Patients who underwent primary hip or knee arthroplasty in our center between January 2012 and December 2021 and were diagnosed with staphylococcal PJI were included in this retrospective design study. Expenses incurred during hospitalization were divided into categories. Each expense was converted to dollars ($) at the annual average exchange rate. Results: A total of 55 patients were included in the study. There were 31 and 24 patients in the methicillin-resistant and susceptible groups, respectively. The methicillin-resistant group was significantly older than the susceptible group, other characteristics were similar. The cost in the methicillin-resistant group was $2055.7 ($676.0-$12620.0) and in the susceptible group was $1643.9 ($707.8-$10834.8). There was a statistically significant difference between the two groups in terms of surgical costs, antibiotic costs, blood center costs and radiology costs. Conclusion: According to our study, the treatment cost of methicillin-resistant staphylococcus PJI was 1.3 times higher than that of methicillin-susceptible.