Muhlik Akyurek

Background: The purpose of this study was to assess whether coronoid fragment size, expressed as coronoid height loss, is associated with functional outcomes in terrible triad injuries treated using a selective coronoid fixation algorithm based on intraoperative elbow stability. Methods: This retrospective cohort study included adult patients with terrible triad injuries treated between 2016 and 2022. All patients underwent preoperative computed tomography evaluation with standardized measurement of coronoid height loss and fracture classification using Mason and Regan–Morrey/O’Driscoll systems. Radial head fixation or arthroplasty and lateral ulnar collateral ligament repair were routinely performed. Coronoid fixation was applied selectively, guided by intraoperative fluoroscopic stability assessment. Patients requiring secondary procedures for stiffness or radial head avascular necrosis were excluded from the final functional analysis, a potential source of attrition bias since these represent treatment failures rather than random missing observations. Functional outcomes at a minimum 24-month follow-up included elbow range of motion, Mayo Elbow Performance Score, and Quick Disabilities of the Arm, Shoulder and Hand score. Results: Functional outcomes were analyzed in 26 patients with coronoid fixation and 23 patients without fixation. Although coronoid height loss was higher in the fixation group, no significant differences were observed in range of motion or clinical outcome scores. Univariable and adjusted regression analyses did not demonstrate a significant association between coronoid height loss and range of motion or functional outcome scores. Findings were unchanged when coronoid fracture classification, determined independently of the continuous height-loss measurement, was used as the exposure variable. Conclusions: In this retrospective cohort, coronoid height loss was not significantly associated with functional outcomes in terrible triad injuries treated using a selective fixation algorithm. These findings suggest that intraoperative stability assessment may help guide coronoid fixation decisions; however, they should not be interpreted as proving that fragment size has no clinical relevance.

The purpose of this study was to evaluate whether standardized robotic-specific patient information was associated with sustained reduction in preoperative anxiety in patients undergoing robotic-assisted TKA, and whether the reduction in anxiety was associated with improved postoperative outcomes and clinically meaningful recovery. This retrospective cohort study evaluated 106 patients who underwent primary unilateral robotic-assisted TKA. Anxiety was assessed using the Hospital Anxiety and Depression Scale–Anxiety subscale(HADS-A) at baseline, immediately after robotic-specific patient information, and preoperatively. Perceived reassurance was measured using a 5-item Likert-type module. Postoperative outcomes included Visual Analog Scale(VAS) pain, Oxford Knee Score(OKS), and Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC) scores at 6 weeks and 12 months. Multivariable regression analyses adjusted for baseline scores and relevant covariates were performed. Clinically meaningful recovery was evaluated using established minimal clinically important difference(MCID) and patient acceptable symptom state(PASS) thresholds. Mean anxiety scores decreased significantly from baseline to post-information and preoperative assessments(12.7 to 11.0 to 9.7; P < .001). Higher perceived reassurance was strongly associated with greater anxiety reduction(ρ = 0.92; P < .001). Greater anxiety reduction remained independently associated with improved postoperative outcomes, including higher OKS at 12 months(adjusted β = 2.00; 95% CI 1.56–2.43; P < .001), lower WOMAC scores(adjusted β = −3.03; 95% CI −3.90 to −2.17; P < .001), and lower VAS pain(adjusted β = −0.22; 95% CI −0.35 to −0.09; P < .001). Greater anxiety reduction also was associated with achievement of MCID and PASS thresholds at 12 months(P < .001). Standardized robotic-specific patient information was associated with sustained preoperative anxiety reduction and greater anxiety reduction was in turn associated with better postoperative pain, function, and clinically meaningful recovery after robotic-assisted total knee arthroplasty.

This study aims to compare the biomechanical performance of three different surgical fixation techniques in the treatment of proximal humerus fractures with medial metaphyseal defects. A total of 24 synthetic humerus bone models were used and equally divided into three groups (n = 8 per group). A standardized unstable proximal humerus fracture model with a medial metaphyseal cortical defect extending to the surgical neck was created using a three-dimensional (3D)-printed osteotomy guide. Group 1 received fixation with a lateral anatomical locking plate. Group 2 was treated with a combination of a lateral anatomical plate and a medial buttress plate (dual plating). Group 3 underwent fixation with an intramedullary nail (IMN); in this group, four specimens had distal locking with an endopin (Group 3a), and the other four with static screws (Group 3b). All specimens were subjected to axial loading until failure. Forces at the onset of failure and complete failure were recorded, and fracture patterns were documented. In Groups 1 and 2, transverse fractures consistently occurred at the level of the most distal screw of the lateral plate. In Group 3, failure was observed either proximally or distally at the nail tip, including butterfly fragment formation and metaphyseal collapse. Group 2 exhibited the highest resistance to axial loading, followed by Group 1 and Group 3, with statistically significant differences between all groups (p = 0.043, p = 0.0003, p < 0.00001). No significant difference was found between subgroups 3a and 3b (p > 0.05). Our study results indicate that double plating provides the greatest axial stability in proximal humerus fractures with medial metaphyseal defects, supporting its use in fracture patterns with medial column deficiency. However, as fixation choice should be guided by patient-specific factors and surgical feasibility, these findings should be interpreted in the context of experimental conditions and loading limitations.

Background/Objectives: Variations in drill orientation during femoral and tibial tunnel creation can alter intra-articular tunnel aperture morphology in anterior cruciate ligament (ACL) reconstruction. Enlarged or irregular apertures may affect graft–tunnel conformity and graft mechanics. This study aimed to assess the relationship between intra-articular femoral and tibial tunnel aperture areas, postoperative clinical outcomes, and graft rerupture. This study specifically focuses on MRI-based measurement of intra-articular tunnel aperture area, a morphological parameter that has not been routinely evaluated in previous ACL reconstruction studies and differs conceptually from tunnel diameter or drilling angles. Methods: This retrospective case–control study included patients who underwent primary ACL reconstruction with an 8 mm hamstring autograft using the anteromedial portal technique. All patients completed a minimum 2-year follow-up and postoperative MRI. Femoral and tibial intra-articular aperture areas were measured on MRI Clinical outcomes (Lysholm scores and KOOSs) in patients with intact grafts. Patients were categorized into intact-graft and rerupture groups. Correlation analyses were used to evaluate associations between aperture areas and clinical outcomes. Logistic regression identified predictors of rerupture. Results: A total of 152 patients met the inclusion criteria, including 13 with graft rerupture. In the intact-graft group, mean femoral and tibial aperture areas were 127.34 ± 8.92 mm² and 138.33 ± 7.08 mm², respectively. Both aperture areas demonstrated significant negative correlations with Lysholm scores and KOOSs. Patients with rerupture had significantly larger femoral (145.26 ± 4.22 mm²) and tibial (158.02 ± 2.88 mm²) aperture areas (p < 0.001 for both). Logistic regression identified tibial aperture area as a significant predictor of rerupture. Conclusions: Larger intra-articular tunnel aperture areas were associated with inferior functional outcomes, and increased tibial aperture area correlated significantly with graft rerupture. Aperture morphology may represent an important factor influencing graft integrity and postoperative recovery after ACL reconstruction.

Background: Subcoracoid cysts (ScCs) are often associated with rotator cuff tears, but their relationship with rotator cuff retears remains unclear. Purpose: To investigate the correlation between ScCs and retears in patients having undergone arthroscopic rotator cuff repair. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective analysis was conducted on patients who underwent arthroscopic rotator cuff repair from November 2016 to March 2022. Patients with Patte stage 1 or 2 tears were included. Preoperative magnetic resonance imaging (MRI) assessed subscapularis and supraspinatus tendons, biceps pulley, and ScC volume. Postoperative MRI evaluated the same parameters as preoperative MRI, with the addition of rotator cuff retear assessment. On the basis of preoperative MRI, patients were classified into group A (with cyst) and group B (without cyst). According to postoperative MRI, groups were further divided into A1 (without retear), A2 (with retear), B1 (without retear) and B2 (with retear). Postoperative decrease in ScC volume (ScC delta), Sugaya classification, and Constant score were compared. Results: The study included 109 patients: 69 in group A (A1 = 40, A2 = 29) and 40 in group B (B1 = 35, B2 = 5). The retear rate was significantly higher in group A (34.8%) than in group B (12.5%) ( P = .02). In group A, the median (minimum-maximum) ScC delta value was significantly greater in group A1 (2422 mm ³ [257 to 7503 mm ³ ]) compared with group A2 (625 mm ³ [–1060 to 1978 mm ³ ]), indicating no recurrence of the ScC ( P = .03). Postoperative Constant shoulder scores were higher in the no retear groups (group A1, 79.3 ± 8.2; group A2, 66.2 ± 13.4; group B1, 83.2 ± 8.5; group B2, 61.4 ± 5.9) ( P < .001). Conclusion: For the patients with ScCs detected on preoperative MRI scans, preserved tendon integrity after rotator cuff repair was associated with a reduction in ScC volume. This reduction was evident on postoperative MRI scans when compared with preoperative measurements. Conversely, compromised tendon integrity did not lead to a significant reduction in ScC volume after surgery, potentially suggesting cyst reformation. Therefore, the postoperative identification of an ScC may indirectly indicate rotator cuff retear.

Amaç: Tıp pratiğinde konsültasyon, tıbbın tüm dallarında vazgeçilmez bir uygulamadır. Özellikle patolojide, yakın zamana kadar genellikle yüz yüze yapılmıştır; ancak yakın zamandaki COVID-19 salgını, fiziksel mesafe önlemleri, karantinalar ve evden çalışma düzenlemelerini zorunlu kıldı. Biz de hastanemizde kapanmanın ve sonrasının yoğun olduğu dönemde Zoom® video konferansı kullanarak konsültasyonu benimsemek zorunda kaldık. Bu çalışma ile İstanbul Medeniyet Üniversitesi Göztepe Eğitim ve Araştırma Hastanesi’ndeki deneyimimizi aktarmak istedik. Gereç ve Yöntemler: Mart 2020 ile Ocak 2021 tarihleri arasında ortopedik onkoloji biriminden alınan 100 kemik ve yumuşak doku tümörü, hastanenin patoloğu ve konsültan patolog tarafından Zoom® video konferansı aracılığıyla gözden geçirildi. Bulgular: Hastaların yaş ortalaması 32 idi. 51'i erkek, 49'u kadındı. 70 vaka kemik lezyonu, 30 vaka ise yumuşak doku lezyonları idi. Spesmenlerin 36'sı rezeksiyon materyali, 42'si küretaj materyali ve 22'si tru-cut biyopsi materyaliydi. Vaka başına incelenen kesit sayısı 1 ila 28 arasında değişmekteydi. Sonuç: Dinamik olmayan robotik olmayan telemikroskopinin en önemli avantajı, danışman, ev sahibi patolog ve diğer katılımcılar arasında aynı anda gerçekleşen etkileşimdir; bu etkileşim, etkili bir şekilde öğretim aracı olarak hizmet etmektedir.

Background/aim: Impacted valgus proximal humerus fracture has been known to be challenging in terms of treatment and outcomes since it was defined. Moreover, it is a type of fracture that is difficult to treat. In addition, exact limits have not yet been determined regarding which parameters affect patients? functional and reported outcomes. The purpose of this study was to compare the radiological results of patients with impacted valgus proximal humerus fractures treated conservatively and surgically and to evaluate the effect of these radiological parameters on functional outcomes. Materials and methods: A total of 79 patients who were treated between 2015 and 2021 with a diagnosis of impacted valgus fracture were evaluated retrospectively. Patients treated conservatively (Group 1) and surgically (Group 2) were evaluated in terms of radiological measurements (tubercle displacement (TD), cephalodiaphyseal angle (CDA), medial hinge (MH), cephaloglenoid angle (CGA), medial hinge impaction (MHI), American Shoulder and Elbow Surgeons Shoulder Score (ASES), Constant Shoulder Score, and functional outcomes (range of motion). The effect of radiological parameters on clinical outcomes was analyzed by a correlation test. Results: In the postoperative period, the ASES and Constant scores of the patients in Group 2 were significantly higher than those of the patients in Group 1. Additionally, Group 2 had better results in terms of passive extension, active internal rotation, and active/passive external rotation. Patients in both groups exhibited improvements in radiological parameters, and the correlation test showed that MH and MHI were mostly related to ASES and Constant scores. Conclusion: The monitoring and treatment of impacted valgus proximal humerus fractures remain controversial. Although radiological parameters are a guide for orthopedic surgeons, the limits have not been clearly defined. In this study, in addition to all parameters, the effect of MH and MHI on functional results was emphasized.

Unstable femoral neck fractures with medial calcar defects are difficult to manage. The optimal fixation methods for these fractures have been a subject of ongoing debate among orthopedic surgeons. In this study, three different fixation techniques for vertical, medial defected femoral neck fractures were compared. In this study, a biomechanical analysis was conducted to compare three fixation methods: cannulated screws (Group 1), cannulated screws combined with a medial buttress plate (Group 2), and intramedullary nails (Group 3). Synthetic composite bone models representing vertical collum femoris fractures with medial calcar defects were used. Each group consisted of seven specimens, and, to maintain consistency, a single surgeon performed the surgical procedure. Biomechanical testing involved subjecting the specimens to axial loading until failure, and the load to failure, stiffness, and displacement values were recorded. Normality was tested using the Shapiro–Wilk test. One-way ANOVA and Tukey’s HSD post hoc test were used for comparisons. The difference in the load to failure values was statistically significant among the groups, with Group 2 exhibiting the highest load to failure value, followed by Group 3 and Group 1. Stiffness values were significantly higher in Group 2 than in the other groups. Displacement values were not significantly different between the groups. Fracture and displacement patterns at the point of failure varied across the groups. The results of this study indicate that fixation with a medial buttress plate in combination with cannulated screws provides additional biomechanical stability for vertical femoral neck fractures with medial calcar defects. Intramedullary nail fixation also demonstrated durable stability in these fractures. These findings can be used to better understand current management strategies for these challenging fractures to promote the identification of better evidence-based recommendations.

Bone marrow edema (BME) is a self-limiting syndrome that can be caused by many pathological conditions. The most frequently seen symptom of BME is pain. Hyperbaric oxygen therapy (HBOT) is an available treatment. This study aims to present the clinical results of quantitatively evaluating the use of HBOT. We evaluated all BME patients 18 to 65 years old without osteoarthritis, inflammatory rheumatological disease, or malignancy diagnosed through magnetic resonance imaging. All were treated with acetylsalicylic acid (100 mg daily) and bisphosphonates (70 mg alendronate once a week) and were instructed to avoid weight-bearing activities. Some of the patients also received HBOT. We divided the patients into 2 groups: 1 group took HBOT; the other did not. We used the Wilcoxon test to compare groups. HBOT is an effective treatment option for BME. We quantitatively measured faster healing when HBOT was used for BME of the knee. There were no significant side effects.

Background and Objectives: Tenosynovial giant cell tumors (TSGCTs) are benign soft tissue tumors that are divided into localized- and diffuse-type tumors, according to the World Health Organization classification of soft tissue tumours. The diffuse-type TSGCT sometimes behave aggressively and poses treatment challenges especially in patients with neurovascular involvement. Symptomatic patients who are not good candidates for surgery due to high morbidity risk may benefit from medical therapy. Objectives: Drugs that target programmed death ligand 1 (PD-L1) are among a new generation of medical therapy options, which, recently, have been explored and have displayed promising results in various cancer types; therefore, we aimed to investigate the PD-L1 status of TSGCTs as a possible therapeutic target. Materials and Methods: We assessed the PD-L1 status of 20 patients (15 men and 5 women, median age = 39 years) that had been diagnosed with TSGCTs in a single institution, between 2018 and 2020. The patients had localized- (n = 7) and diffuse-type (n = 13) TSGCTs. Formalin-fixed paraffin-embedded (FFPE) blocks were retrospectively retrieved from the pathology department. An immunohistochemical analysis was performed in sections of 3 micron thickness from these blocks. Results: Seventy-five percent of our patients with TSGCTs were immunopositive to PD-L1 staining. Conclusions: Taking into consideration the high positivity rate of PD-L1 staining in TSGCTs, PD-L1 blockage may be used as a valuable medical treatment for TSGCTs; however, further studies are needed.