Kamil Balaban

Objective: To compare the clinical accuracy, information quality and readability of chatbot responses to common patient questions about lower extremity amputation. Methods: Twenty frequently asked patient questions were submitted once to each of ChatGPT, Gemini and DeepSeek in separate sessions. Two reviewers, blinded to chatbot identity, independently assessed responses using a four-category clinical accuracy scale and the DISCERN instrument. Readability was quantified as the mean grade level across the Flesch-Kincaid Grade Level, Gunning Fog, Coleman-Liau, and Simple Measure of Gobbledygook indices. Comparisons used Friedman tests and Holm-adjusted Wilcoxon signed-rank tests. Results: Sixty responses were analysed. Mean (±standard deviation) clinical accuracy scores were 2.20 ± 0.57, 1.55 ± 0.65 and 1.20 ± 0.38 for ChatGPT, Gemini and DeepSeek, respectively (lower scores indicate greater accuracy). Gemini and DeepSeek received lower scores than ChatGPT (adjusted p=0.012 and p=0.002, respectively), whereas the Gemini–DeepSeek difference was not significant (p=0.090). Mean DISCERN scores were 50.05 ± 5.78, 53.33 ± 5.43 and 58.23 ± 3.39, respectively, with significant differences in all pairwise comparisons. Mean reading grades were 12.93 ± 1.28, 13.17 ± 1.36 and 11.74 ± 1.15, respectively; DeepSeek had lower grades than both comparators (both adjusted p<0.001). Conclusion: DeepSeek responses received higher information quality scores and had lower reading grade levels, although clinical accuracy did not differ significantly between DeepSeek and Gemini. All three chatbots exceeded commonly recommended reading levels for patient education. Clinician review and language adaptation are warranted before chatbot-generated information is used to supplement individualised counselling on amputation and rehabilitation.

Tourniquet-related nerve injury is an uncommon but clinically important complication of extremity surgery. Postoperative radial nerve palsy after humeral shaft fixation is usually attributed to fracture-related injury or surgical manipulation, particularly when a posterior approach is used. We present a case of transient radial-dominant neuropathy following the use of a sterile exsanguination tourniquet during the posterior plating of a distal humeral shaft fracture. A 27-year-old male construction worker with an AO/OTA (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association) 12A1 spiral fracture of the distal humeral shaft underwent open reduction and internal fixation through a posterior triceps-splitting approach. A sterile exsanguination tourniquet was applied distal to the axilla and proximal to the incision and fracture line for 70 minutes. The radial nerve was identified, looped, and protected intraoperatively. The patient had a normal preoperative neurological examination but developed early postoperative wrist drop, dorsal hand numbness, and palmar-digital paresthesia. Four-week nerve conduction studies demonstrated severe proximal radial neuropathy with milder proximal median nerve involvement and relative preservation of ulnar motor conduction. At four months, repeat studies showed marked electrophysiological recovery, and the patient achieved complete clinical recovery by one year. The radial-dominant but median-associated proximal conduction pattern, together with the location of tourniquet application and recovery profile, was compatible with a compressive neurapraxic mechanism rather than isolated surgical radial nerve trauma alone. Sterile exsanguination tourniquet-related neuropathy should be considered in the differential diagnosis of postoperative radial nerve palsy after humeral shaft fixation, especially when neurological findings extend beyond an isolated radial nerve distribution.

Background: Tibiotalocalcaneal (TTC) nailing has become an increasingly preferred option for the treatment of complex ankle pathologies and fragility fractures, particularly in geriatric patients. Despite its growing clinical use, limited data are available regarding how different nail designs impact joint surface integrity during intraoperative preparation. This cadaveric study aimed to compare the articular surface destruction caused by straight and valgus-curved TTC nails. Methods: 20 fresh-frozen cadaveric lower limbs (mean age 70.1 ± 4.1 years) were randomized to receive either a straight or a valgus-curved TTC nail (n = 10 per group). All procedures were performed by a single experienced orthopedic surgeon without formal joint debridement. After reaming, four joint surfaces—calcaneal posterior facet (CPF), talar posterior facet (TPF), talar dome (TD), and tibial plafond (TP)—were dissected and digitally analyzed using ImageJ software to measure total and reamed areas. Joint destruction (%) and articular reaming (%) were calculated and compared between groups. Results: Valgus-curved nails resulted in significantly greater joint destruction in CPF (12% vs. 6%, p = 0.018) and TPF (15% vs. 8%, p = 0.007) compared to straight nails. Articular reaming was also higher in the valgus-curved nails for both CPF (56% vs. 31%, p = 0.012) and TPF (79% vs. 43%, p = 0.004). No significant differences were found in TD or TP for either parameter (all p > 0.05). Conclusion: Reaming for valgus-curved TTC nails yielded greater destruction of subtalar joint surfaces than straight nails, but the amount remained below 15%. These findings emphasize the impact of nail design on reaming-induced articular surface destruction during intraoperative preparation and provide quantitative anatomic data on the extent of joint surface involvement.

Background: Patients are increasingly turning to online resources and artificial intelligence (AI)-based tools to obtain information about orthopedic conditions and surgical options. Large language models, such as ChatGPT, are becoming prominent in patient education; however, their reliability and readability remain uncertain. This study evaluated the quality and readability of responses generated by ChatGPT-4o and ChatGPT-5 to frequently asked patient questions regarding hallux rigidus fusion surgery. Methods: Twenty commonly asked patient questions were compiled and presented to ChatGPT-4o and ChatGPT-5. Readability was assessed using the Flesch–Kincaid Grade Level, Gunning Fog, Coleman–Liau, and Simple Measure of Gobbledygook indices. Quality was evaluated with the DISCERN tool, response accuracy scores, and Journal of the American Medical Association (JAMA) criteria. Interrater agreement was measured using the Intraclass Correlation Coefficient (ICC). Results: ChatGPT-4o generated longer responses (802 vs. 242 words; p<0.001) with slightly higher readability grade levels (10.81 vs. 10.37; p=0.031). Accuracy (2.00 vs. 1.85; p=0.323) and DISCERN scores (49.35 vs. 48.93; p=0.747) showed no significant differences. All responses received a JAMA score of 0 due to the absence of citations, authorship, or transparency indicators. Interrater reliability indicated moderate to good agreement (ICC: 0.68–0.80). Conclusion: ChatGPT-4o and ChatGPT-5 provide generally satisfactory yet non-comprehensive, limited-quality information at a level above tenth-grade regarding hallux rigidus fusion surgery. Although linguistically coherent, responses lack evidence-based detail and individualized guidance. These models may supplement, but cannot replace, expert orthopedic counseling. Ensuring physician oversight and integrating validated, updated clinical content remain essential for safe implementation of AI-generated patient information.

Intertrochanteric femur fractures often require cephalomedullary nailing, yet many centers, particularly those in resource-limited settings, lack traction tables. This technical note introduces a novel positioning method that enables safe and reproducible intramedullary fixation on a standard radiolucent operating table with a central post, a configuration for which practical guidance is limited in the literature. The technique uses caudal table translation, 15-20° ipsilateral sacral elevation, and 40-50° contralateral limb lowering to achieve adequate anteroposterior and lateral fluoroscopic visualization without specialized equipment. This approach is intended for orthopedic surgeons working in hospitals with restricted infrastructure, offering improved ergonomics, reliable imaging, and efficient workflow. Potential challenges, including limited leg support, fluoroscopic overlap, and contamination risk during under-table imaging, can be minimized with appropriate preparation. The method provides a practical alternative for centers without traction tables and expands operative feasibility in equipment-constrained environments.

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.