Furkan Erdoğan

Rod migration is a rare but potentially serious late complication of spinal instrumentation. A case of long-distance rod migration to the groin following anterior lumbar fusion for adolescent idiopathic scoliosis is presented. A 43-year-old female, who had undergone selective anterior lumbar fusion 20 years earlier, presented with progressive lumbar pain. Initial radiographs demonstrated screw loosening and rod dislodgment. Before the planned revision surgery, the patient re-presented with pain localized to the hip and groin. Imaging revealed distal migration of the rod toward the anterior aspect of the hip joint. The patient underwent surgical removal of the migrated rod via an anterior hip (Smith–Petersen) approach. Intraoperatively, the rod was identified adjacent to the femoral nerve and was carefully removed without neurovascular injury. Postoperatively, symptoms improved, and staged treatment consisting of removal of the remaining instrumentation followed by correction of the residual deformity was planned. Rod migration is frequently associated with pseudoarthrosis, inadequate biological fusion, and persistent segmental motion. These factors may facilitate progressive implant migration along anatomical pathways such as the psoas muscle. Clinical presentation is typically nonspecific, leading to potential diagnostic delays. This case highlights the importance of considering implant-related complications in patients with atypical pain and a history of spinal instrumentation. Early recognition is essential to prevent implant progression and potentially serious neurovascular complications. Cite this article as: Albayrak B, Tabur F, Erdoğan F, H, Coşkun S. An unexpected journey: migration of a scoliosis rod to the groin. Acta Orthop Traumatol Turc. 2026; 60(4), 01011, doi: 10.5152/j.aott.2026.261011.

Background/Objectives: Patellar chondromalacia (PC) is a clinical condition characterized by early cartilage degeneration in the patellofemoral joint. This study aimed to investigate the relationship between the lateral-to-medial femoral condyle length ratio (LFCL/MFCL) measured on standard anteroposterior (AP) knee radiographs and the presence of PC. Methods: A retrospective analysis was conducted on patients who presented with anterior knee pain between 2020 and 2024. PC was diagnosed using magnetic resonance imaging (MRI). The LFCL/MFCL ratio was measured on plain radiographs. Additional morphological condylar parameters were evaluated on MRI. Symptom severity was assessed using the Kujala score. Statistical analyses included t-tests, correlation analysis, logistic regression, and receiver operating characteristic (ROC) curve analysis. Results: A total of 100 patients (50 with PC, 50 controls) were included. The LFCL/MFCL ratio was significantly higher in the PC group compared to controls (1.24 ± 0.19 vs. 1.08 ± 0.15, p = 0.002). A negative correlation was found between the LFCL/MFCL ratio and Kujala score (r = −0.322, p = 0.029). Other MRI-based parameters did not show statistically significant differences. In logistic regression, the LFCL/MFCL ratio was identified as an independent predictor of PC (p = 0.01). ROC analysis yielded an AUC of 0.743 (95% CI: 0.643–0.842). Conclusions: The LFCL/MFCL ratio, which can be easily measured on plain radiographs, may serve as a simple, cost-effective, and reproducible parameter to aid in the diagnosis of patellar chondromalacia. Further prospective studies with larger sample sizes are needed to validate this finding.

Hip fractures represent a major public health concern due to their increasing incidence in the aging population and their association with significant morbidity and mortality. Comorbidities are known to complicate both the surgical management and rehabilitation process, yet their specific impact on outcomes remains variable across studies. This study aimed to determine the prevalence and distribution of comorbidities in patients who presented with hip fractures and underwent surgical treatment, to evaluate perioperative and postoperative risk factors retrospectively, and to compare these findings with the existing literature. A retrospective descriptive analysis was conducted on 589 patients aged ≥ 60 years who were surgically treated for hip fractures between 2013 and 2024 at a tertiary university hospital. Demographic characteristics, surgical protocols, anesthesia types, revision rates, infection, dislocation, mobilization outcomes, hospital stay, intensive care admissions, and mortality were systematically analyzed in relation to comorbidity profiles and the number of comorbidities. Statistical analyses included chi-square, Fisher’s exact test, Mann-Whitney U, and Kruskal-Wallis tests, with p < 0.05 considered significant. Hypertension (59.1%), diabetes mellitus (33.6%), coronary artery disease (21.4%), and Alzheimer’s disease (21.4%) were the most frequent comorbidities. Revision surgery was significantly associated with diabetes mellitus and congestive heart failure. Diabetes mellitus, coronary artery disease, and chronic renal failure were strong predictors of postoperative infection. While the mean hospital stay was significantly prolonged in patients with ≥ 3 comorbidities, mortality was significantly associated only with oncological diseases and chronic renal failure. Contrary to expectations, no significant association was found between overall mortality and the number of comorbidities. Comorbidities, particularly diabetes mellitus, congestive heart failure, oncological diseases, and chronic renal failure, substantially influence surgical outcomes, postoperative complications, and hospitalization in hip fracture patients. However, the number of comorbidities alone was not a predictor of mortality, highlighting the importance of the type rather than the quantity of comorbid conditions. These findings underscore the need for individualized perioperative planning and comprehensive patient counseling to reduce risks and improve postoperative outcomes.

Background/Objectives: To evaluate the clinical and MRI characteristics of benign solitary schwannomas of the extremities, compare pre- and postoperative neurological symptoms, and identify preoperative and intraoperative risk factors for postoperative complications. Methods: A retrospective review was conducted on 47 patients with histopathologically confirmed benign solitary schwannomas of the extremities who underwent surgical excision. Demographic data, MRI characteristics (tumor volume, perilesional edema, and degenerative changes such as cystic components or intratumoral hemorrhage), fascicular relationship, and use of tru-cut biopsy were recorded. Pre- and postoperative neurological symptoms were compared. Univariate logistic regression analysis was performed to identify factors associated with postoperative complications. Results: The mean age was 38.6 ± 15 years, and the mean follow-up period was 109.8 ± 65.1 months. Lesions were predominantly located in the upper extremity (65.9%), with a mean volume of 9.6 ± 4.8 cm³; perilesional edema and/or degenerative changes were present in 53.1% of cases. Postoperative complications occurred in 19.1% of patients, with intrafascicular involvement being a significant predictor (OR = 5.4, p = 0.037) and a positive preoperative Tinel’s sign showing a trend toward significance (OR = 4.2, p = 0.084). Tumor volume, perilesional edema, degenerative changes, tru-cut biopsy, and anatomical location were not significantly associated with complications. At final follow-up, pain remission was 82.1%, and paresthesia improvement was 63.6%. Conclusions: Intrafascicular involvement was associated with postoperative complications in univariate analysis, whereas preoperative MRI characteristics, biopsy, and Tinel’s sign showed no predictive value for postoperative risk.

Aims: This study aims to evaluate the clinical, radiological, and histological findings of patients who were treated for osteoid osteoma and discusses the diagnostic stages and surgical results of patients treated for osteoid osteoma.

Introduction: This study compared clinical and radiological outcomes of partial and total capitate shortening osteotomies in Lichtman stage 2–3A Kienböck’s disease. Methods: Fifty-one patients were retrospectively analysed. Functional outcomes included pain scores, grip and pinch strength and range of wrist motion. Radiological assessment comprised carpal height ratio, lunate dimensions, capitolunate and scapholunate angles, and lunate revascularization on magnetic resonance imaging. Osteoarthritic changes were identified from follow-up radiographs. Results: Both procedures significantly improved pain, grip, pinch strength and range of motion from the baseline. Between-group comparisons revealed similar clinical and radiological outcomes, except for greater grip strength improvement in the partial osteotomy group. Osteoarthritic progression occurred in four patients per group, without significant differences. MRI findings demonstrated comparable lunate revascularization and disease stabilization. Conclusion: Partial and total capitate shortening osteotomies are effective for Lichtman stage 2–3A Kienböck’s disease, with grip strength improvement more pronounced in the partial capitate shortening group, while other outcomes were comparable. Level of evidence: III

Background and Objectives: Undifferentiated pleomorphic sarcoma (UPS) is a rare but aggressive soft tissue tumor. Achieving a tumor-free surgical margin is believed to be crucial for reducing local recurrence; however, the effect of margin thickness on recurrence and survival remains a matter of controversy. This study aimed to assess the association between histopathological margin status and outcomes, including local recurrence, disease-free survival (DFS), and overall survival (OS), in patients with UPS. Materials and Methods: We retrospectively analyzed 69 patients with histologically confirmed UPS, identified from a tertiary university hospital tumor database between January 2010 and December 2023. Patients were grouped by histopathological margin status as follows: >1 mm, ≤1 mm, or positive. Recurrence and survival outcomes were analyzed using Kaplan–Meier estimates, Cox regression, and multivariate logistic regression. Patients who underwent reoperation were also evaluated separately. Results: Minimum follow-up was 24 months (mean: 52.2 months). Local recurrence occurred in 21 patients, 20 of whom underwent reoperation. Positive margins were significantly associated with higher recurrence risk compared to the >1 mm group (OR: 17.6; 95% CI: 2.88–107.61; p = 0.0019). Although recurrence odds were lower in the ≤1 mm group than in the positive group, this was not statistically significant compared to the >1 mm group (OR: 0.52; 95% CI: 0.076–3.50; p = 0.498). In reoperated patients, surgical margin status was significantly associated with local recurrence (p = 0.0044), and overall survival tended to be longer in those with margins > 1 mm (67.3 ± 47.7 months) or ≤1 mm (50 ± 28.2 months) compared to positive margins (23.3 ± 17.3 months). A moderate negative correlation was observed between age and DFS (p < 0.001, r = –0.495). Conclusions: This study highlights the prognostic value of surgical margin status in patients undergoing reoperation for local recurrence. In this unique subgroup, margin status was significantly associated with recurrence risk, and patients with negative margins had improved overall survival compared to those with positive margins.

Objectives: Knee osteoarthritis (OA) is a common cause of pain and disability, and conventional conservative treatments often provide only limited and temporary relief. Platelet‐rich plasma (PRP) injections have emerged as a promising biological therapy; however, patient response is highly variable, and biomechanical factors such as lower extremity malalignment may influence treatment outcomes. This study aimed to evaluate the effect of the lower extremity mechanical axis angle (MAA) on the clinical efficacy of PRP injection therapy in improving knee function and pain in patients with OA. Methods: A total of 210 patients with knee OA who consented to PRP treatment between January 1, 2018, and January 1, 2023, were enrolled. Patients were stratified into three groups according to baseline varus angle: Group 1, 0°–5° ( n = 70); Group 2, 6°–10° ( n = 70); and Group 3, 11°–15° ( n = 70). Clinical evaluations were performed at baseline and at 1, 3, 6, 12, and 24 months post‐treatment using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Kujala Patellofemoral Score, knee joint range of motion (ROM), MAA measurement, and a Visual Analogue Scale (VAS) for pain. Results: All groups demonstrated significant improvements in pain and functional scores over the 24‐month follow‐up compared to baseline ( p < 0.001), with the most notable gains observed at 3 and 6 months. At 3, 6, and 12 months, Group 1 achieved significantly better VAS and KOOS Pain subscale scores than Group 3 ( p < 0.05). Both Groups 1 and 2 had higher KOOS Total scores than Group 3 at these time points ( p < 0.05). Spearman correlation analysis revealed moderate negative associations between baseline MAA and changes from baseline to 6 months in VAS ( ρ = −0.58), KOOS Total ( ρ = −0.54), and Kujala scores ( ρ = −0.53) (all p < 0.001). Statistical analyses were conducted using ANOVA or Kruskal–Wallis tests as appropriate, and effect sizes (Cohen's d) with 95% confidence intervals were calculated. Conclusion: PRP injection therapy yields significant improvements in pain and functional outcomes in patients with knee OA. However, increased MAA is associated with reduced clinical benefit, indicating that baseline lower extremity alignment should be considered in treatment planning.

The aim of this article is to provide a comprehensive approach to hydatid cyst, a zoonotic disease caused by Echinococcus granulosus. The parasite maintains its life cycle primarily in dogs and sheep; human infection occurs through excessive contact with these animals or the consumption of food or water contaminated with their feces. In isolated muscular cyst cases, negative serological test results are possible, requiring careful attention during diagnosis. Cystic lesions in endemic regions and typical imaging features should raise suspicion. Avoiding invasive procedures is vital to prevent the spread of the parasite. The association between classical imaging findings and endemic regions suggests that any cystic lesion may be a potential indicator of this disease. In this article, two sporadic cases of primary hydatid cysts are presented-one located in the sacral paravertebral region and the other in the gluteus maximus muscle.

Background: This study aimed to evaluate the impact of surgical margin status, tumor size, and adjuvant radiotherapy on local control, overall survival, and postoperative complications in patients undergoing surgery for sacral chordoma. Methods: This retrospective analysis included 18 patients who underwent surgical treatment for primary sacral chordoma between 2002 and 2019. The variables assessed included patient demographics, tumor size and volume, surgical margin status, adjuvant radiotherapy, local recurrence, overall survival, and postoperative complications. Survival analysis was performed using the Kaplan–Meier method, and appropriate parametric or non-parametric tests were used for group comparisons. Results: The cohort’s mean age was 62.6 ± 7.9 years, with a mean follow-up of 8.8 ± 4.1 years and an average tumor volume of 235 cm³. Negative surgical margins (R0) were achieved in 44% of patients. Local recurrence occurred in 50% of R0 cases and 83% of R2 cases. Negative surgical margins (R0) were associated with significantly lower local recurrence rates compared to R1 and R2 resections (Fisher’s exact test, p = 0.043), and showed a trend toward improved overall survival (p = 0.077). Overall survival was significantly lower in patients with tumors measuring ≥ 5 cm (p = 0.031). Adjuvant radiotherapy did not significantly reduce local recurrence (p = 0.245); however, an increase in complication rates was observed, although this association did not reach statistical significance (p = 0.108). Bladder dysfunction was significantly more frequent in patients undergoing S1–S2 resections (p = 0.036). Conclusions: Achieving negative surgical margins improves local control and may prolong survival. Larger tumors (≥5 cm) were associated with worse prognosis. While adjuvant RT may be considered in selected high-risk cases, its efficacy in preventing recurrence is unclear and may increase complication rates.