Mesut Uluöz

Background: Bunionette deformity is commonly treated with distal or diaphyseal osteotomy, but concerns remain regarding correction loss, implant irritation, and metatarsal shortening. This study evaluated outcomes of mini-open fifth metatarsal osteotomy stabilized with intramedullary rigid fixation in symptomatic Coughlin type II and III deformity. Methods: This single-center retrospective observational study included 32 consecutive patients treated between February 2018 and February 2023. Radiographic outcomes included the fourth-to-fifth intermetatarsal angle (IMA), fifth metatarsophalangeal angle (MPA), maintenance of correction, and fifth metatarsal shortening. Clinical outcomes included the American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analog scale (VAS) pain score, and complications. An exploratory subgroup analysis compared isolated correction with combined procedures. Results: The mean follow-up was 31.5 ± 6.8 months. The mean AOFAS score improved from 52.5 ± 4.2 to 93.4 ± 3.4, and the mean VAS score decreased from 7.8 ± 0.9 to 1.2 ± 0.6 (both p < 0.001). The mean MPA improved from 19.4° ± 3.6° to 2.3° ± 1.1°, and the mean IMA improved from 14.0° ± 1.4° to 4.5° ± 2.5° (both p < 0.001). Minor but statistically significant correction loss occurred between early postoperative and final follow-up radiographs. Mean fifth metatarsal shortening was 1.3 ± 0.8 mm. One patient required implant removal for hardware irritation. No nonunion, transfer metatarsalgia, or wound complications were observed. Conclusions: Mini-open fifth metatarsal osteotomy with intramedullary rigid fixation was associated with pain relief, functional improvement, maintained radiographic correction, limited shortening, and a low observed complication rate in this series.

Background/Objectives: Selection of the upper instrumented vertebra (UIV) in Lenke type 1 adolescent idiopathic scoliosis (AIS) influences postoperative proximal balance; however, the long-term clinical relevance of radiographic differences remains uncertain. This study evaluated long-term radiological and clinical outcomes in a homogeneous Lenke type 1 AIS cohort undergoing posterior spinal fusion with UIV selection at T2 or T4. Methods: During the study period, 120 consecutive Lenke type 1 AIS patients underwent posterior spinal fusion. Twelve patients who developed major postoperative complications were excluded, resulting in a final cohort of 108 patients (T2: n = 61; T4: n = 47). Patients requiring posterior column osteotomies were excluded to maintain surgical homogeneity. Radiological parameters, including coronal and sagittal alignment, proximal balance measures, and curve flexibility, were assessed preoperatively, postoperatively, and at a minimum follow-up of five years. Clinical outcomes were evaluated using validated Turkish versions of the Pediatric Quality of Life Inventory (PedsQL) and the Scoliosis Research Society—22 revised questionnaire (SRS-22r). Longitudinal within-group changes were analyzed. Results: Substantial correction of the main thoracic curve was achieved postoperatively and maintained at long-term follow-up within each cohort (p < 0.001). Preoperative bending radiographs demonstrated preserved curve flexibility, indicating that postoperative alignment differences were not attributable to baseline rigidity. Proximal coronal and shoulder balance parameters improved over time within each cohort, with residual differences observed according to UIV selection. Psychosocial domains of the PedsQL and SRS-22r improved significantly over time within each cohort. In contrast, PedsQL physical functioning scores declined significantly at long-term follow-up (p < 0.001), consistent with fusion-related stiffness rather than global clinical deterioration. No clinically meaningful divergence in patient-reported outcome trajectories was observed according to the UIV strategy. Conclusions: In Lenke type 1 AIS, UIV selection influences long-term proximal balance-related radiological parameters but does not confer a clinically meaningful advantage in patient-reported outcomes. Both T2 and T4 strategies provide durable deformity correction and sustained multidimensional recovery when guided by individualized criteria. Prospective multicenter investigations are warranted to further clarify the clinical relevance of proximal balance metrics.

Background: Hallux valgus affects footwear tolerance, body image, and social participation, particularly among white-collar women who adhere to formal dress codes. While clinical outcomes of hallux valgus surgery are well described, little is known about how women in office-based occupations experience postoperative recovery. This study explored the lived experiences of women at least 12 months after surgical correction of mild-to-moderate hallux valgus using distal first-metatarsal osteotomy with adjustable intramedullary T-plate fixation. Methods: A qualitative interpretivist approach was employed. Semi-structured interviews were conducted with purposively selected Turkish-speaking white-collar women who underwent surgery between January 2021 and January 2024. All had ≥12 months of follow-up. Interviews were transcribed verbatim and analyzed using reflexive thematic analysis guided by Consolidated Criteria for Reporting Qualitative Research (COREQ) principles. Trustworthiness was supported through member checking, an audit trail, negative case analysis, and peer debriefing. Data saturation was reached at 27 interviews. Results: Twenty-seven women (mean age 43.04 ± 4.66 years) participated. Six themes emerged: (1) expectations and motivations; (2) postoperative physical experience; (3) aesthetic perception; (4) psychological responses; (5) social and domestic support; and (6) footwear identity and adaptation. Participants described meaningful gains in comfort, confidence, and mobility. The ability to choose footwear freely, rather than endure pain, was central to their sense of recovery. Improvements in self-image and ease in professional and social settings were also emphasized. Conclusions: Across six interrelated themes, white-collar women described postoperative recovery as a multidimensional process encompassing footwear autonomy, body image, occupational confidence, physical experience, psychological responses, and social support. These findings highlight the importance of incorporating footwear expectations and workplace needs into preoperative counselling and postoperative care.

Objective: The aim of the study was to compare postoperative pain, functional recovery, knee stability and complication profiles between the all-inside technique and the conventional full tibial tunnel technique for anterior cruciate ligament (ACL) reconstruction. Methods: This retrospective comparative cohort study included 104 patients who underwent primary ACL reconstruction between 2018 and 2020. Surgical technique allocation was non-randomized. Patients were divided into two groups based on the surgical technique employed; the conventional full tibial tunnel group (n = 58) and all-inside group (n = 46). Hamstring tendon autografts were used in all cases, and the procedures were performed by the same surgical team to ensure consistency. Clinical outcomes were evaluated using the Visual Analog Scale (VAS) for pain, Lysholm knee score and International Knee Documentation Committee (IKDC) score. Knee stability was assessed with the Lachman and pivot-shift test. Additionally, postoperative complications and revision rates were recorded. Results: The study included 104 patients, with 58 treated using the conventional technique and 46 using the all-inside technique. Baseline characteristics, trauma mechanisms, and follow-up duration were comparable between groups (p > 0.05). Four patients in each group underwent revision surgery and excluded from the final analysis. Revision rates were comparable between groups (6.9% vs. 8.6%) and were considered descriptively when interpreting outcomes. The preoperative VAS, Lysholm and IKDC scores were comparable between groups. At 3 months, the all-inside group demonstrated significantly lower VAS pain scores and higher Lysholm and IKDC scores (with moderate-to-large effect sizes) (all p < 0.01). No significant differences were observed at the 12-month or final follow-up. Postoperative knee stability was comparable between groups, whereas anterior knee pain was significantly less frequent in the all-inside group (p < 0.001). Moreover, patients treated with the all-inside technique returned to sports significantly earlier than those treated with the conventional technique (13.25 ± 2.70 vs. 16.40 ± 5.85 months, p < 0.001; Cohen’s d = 0.66). However, the proportion of patients who returned to their preinjury sports level was comparable between the two groups (81.0% vs. 83.3%, p = 0.78). Conclusions: The all-inside ACL reconstruction technique was associated with superior early pain relief and short-term functional outcomes compared with the conventional technique, while achieving comparable knee stability and mid-term clinical results. These advantages occur without increasing complications or revision rates. These findings support the all-inside technique as patient-centered, optimizing early recovery without sacrificing mid-term clinical durability. These findings should be interpreted in the context of the non-randomized retrospective study design.

Aim: Pediatric femoral neck fractures are extremely rare but carry a high risk of complications such as avascular necrosis (AVN), nonunion, and coxa vara. This study aimed to evaluate clinical and radiological outcomes and to identify prognostic factors associated with adverse events. Materials and Methods: A retrospective cohort of 87 patients (aged 1–16 years) with femoral neck fractures treated at a tertiary trauma center between January 2017 and July 2022 was analyzed. Demographic, clinical, radiological, and operative data were reviewed. Surgical delay was categorized as ≤24 hours or >24 hours, and reduction quality was graded. Outcomes included union time, AVN, nonunion, coxa vara, and revision surgery. Group comparisons were made using appropriate parametric or non-parametric tests for continuous variables and Chi-square or Fisher’s exact tests for categorical variables. Results: The mean age was 9.5 years, and 66.7% of patients were male. Most fractures were Delbet type II or III. Definitive fixation within 24 hours was achieved in 82.8% of cases. The overall complication rate was 17.2%, including nonunion (6.9%), coxa vara (3.4%), and AVN (3.4%). Surgical delay beyond 24 hours was significantly associated with nonunion (p = 0.03), while poor reduction quality correlated with coxa vara (p = 0.04). Two patients (2.3%) required revision surgery due to implant failure. Conclusion: Surgical delay and poor reduction quality were the strongest predictors of adverse outcomes. Early fixation within 24 hours and meticulous anatomical reduction are essential to minimize complications in this rare but high-stakes pediatric injury.

Introduction: In our study, we aimed to evaluate the effect of platelet-rich plasma (PRP) obtained from autologous blood on rabbit intra-tunnel tendon bone healing using biomechanical and histologic parameters. Methods: The hind legs of 31 New Zealand albino rabbits were used in the study. After the extensor digitorum longus tendon of both hind legs was removed from the proximal attachment site, the same leg was placed in a bone tunnel opened in the tibia. In the P “platelet” group, PRP was injected into the tunneled part of the tendon, while in the K “control” group, the tunneled part of the tendon. In addition, each group was divided into two groups “six and twelve weeks old”. After sacrification, the bone-tendon junction, which was removed together with the tibia and tendon, was pulled in a pulling device at a speed of 5mm/second. The machine recorded the maximal endurance force (ULF). Using these values, stiffness and energy absorption were calculated. Three specimens each from the sixth and twelfth groups were examined histologically. Results: At 6.-12. weeks, all biomechanical parameters were higher than in the control group and the increase was significant in all three parameters at twelfth week and in two of the parameters (ULF, stiffness) at sixth week (p<0.05) Conclusions: As a conclusion of the study, it was determined by biomechanical and histological examinations that PRP application positively enhanced healing in the intra-tunnel healing model created in the New Zealand albino rabbit. PRP application can be successfully used to accelerate tendon-bone healing.