Resul Bircan

Background: This study evaluated the clinical and radiological outcomes of surgically treated intraosseous lipomas by analyzing a series of 21 patients.Methods: Patients who underwent surgical treatment for intraosseous lipoma at our clinic between January 2002 and January 2022 were retrospectively reviewed. Demographic data, tumor location, affected extremity, surgical technique (curettage, curettage with grafting, curettage with grafting and internal fixation), Milgram classification stage, use of internal fixation, preoperative and postoperative Visual Analog Scale (VAS) scores in symptomatic patients, follow-up duration, and recurrence status were recorded.Results: The study included 21 patients (13 males, 8 females) with a mean age of 42.9 years (range: 23–65). The mean follow-up period was 34.9 months (range: 12–75). Intraosseous lipoma most frequently involved the lower extremities (81%), with the calcaneus being the most commonly affected bone (62%). Persistent pain was the primary presenting symptom in 66% of patients. According to Milgram’s classification, 33% of patients were stage 1, 14% stage 2, and 52% stage 3. Curettage alone was performed in 24% of patients, while 76% underwent curettage with grafting; only one patient required additional internal fixation. No postoperative pathological fractures, recurrences, or malignant transformation were observed. One patient developed a wound-related complication. Postoperative VAS scores showed a significant pain reduction in symptomatic patients.Conclusion: Surgical treatment of intraosseous lipoma provides effective pain relief with low complication and recurrence. Surgical intervention appears particularly beneficial for Milgram stage 3 lesions associated with persistent pain or an increased risk of pathological fracture.

Background: Fifth metacarpal neck fractures are common hand injuries, and various surgical techniques have been described for their management. However, the comparative effectiveness and cost implications of these techniques remain controversial.Methods: This retrospective study included 30 patients treated between 2023 and 2024. Patients were divided into two equal groups: K-wire fixation (n=15) and plate–screw fixation (n=15). Outcomes included QuickDASH (qDASH), grip strength measured with a dynamometer, and metacarpophalangeal (MCP) joint range of motion (ROM) recorded as active and passive. Grip strength was analyzed within-patient as operated hand versus contralateral healthy hand. Direct implant-related cost was obtained from the hospital billing system.Results: All fractures achieved radiographic union. One wound infection and one loss of reduction requiring revision occurred in the plate–screw group; no complications were observed in the K-wire group. Functional outcomes were comparable between groups: qDASH 4.69±3.03 vs 5.60±3.21 (p=0.479). Operated-hand grip strength was 41.1±7.7 kg vs 38.0±8.7 kg (p=0.253), and contralateral healthy-hand grip strength was 40.0±8.9 kg vs 38.0±8.1 kg (p=0.506). Active and passive MCP flexion and extension were similar between groups (p=0.471, p=0.607, p=0.823, and p=0.495). Implant-related cost was markedly lower with K-wire fixation (52.0±12.6 TL vs 9,941.3±827.9 TL; p

Objective: This study aimed to evaluate the clinical benefit of arthroscopic acromioplasty in patients with isolated subacromial impingement syndrome (SIS) and to determine whether coracoacromial ligament (CAL) degeneration severity and acromion morphologic type can predict postoperative outcomes. Methods: This retrospective comparative study included patients with isolated SIS who failed conservative treatment and underwent arthroscopic acromioplasty between December 2012 and December 2018 at a single institution. Patients with at least 2 years of follow-up were included. The study group comprised 125 patients (48 males, 77 females) with a mean age of 50.33 ± 8.02 years and a mean follow-up of 36.70 ± 11.93 months. Acromion morphologic type (types 1, 2, and 3) and CAL degeneration grade (minor fraying and major fraying) were determined from digital archives, and clinical outcomes were compared across these subgroups. Clinical outcomes were assessed using the University of California Los Angeles (UCLA) score, visual analog scale (VAS), and modified Constant–Murley score. Results: Significant postoperative improvement was observed in the overall cohort for both VAS and UCLA scores compared with preoperative values (P < .001 for both). There were no significant differences in postoperative outcomes between the minor and major CAL fraying groups (UCLA, P = .533; VAS, P = .730; Constant, P = .494). Likewise, acromion type was not associated with significant differences in postoperative outcomes (UCLA, P = .798; VAS, P = .170; Constant, P = .465). A subgroup comparison showed a significantly greater UCLA improvement in patients with major CAL fraying and type 3 acromion than in those with minor CAL fraying and type 2 acromion (P = .018). Conclusion: Arthroscopic acromioplasty was associated with significant clinical improvement in patients with isolated SIS; however, CAL degeneration severity and acromion morphologic type were not reliable overall predictors of postoperative outcomes. Clinically, these findings suggest that CAL degeneration grade and acromion type alone should not be used to select patients for acromioplasty in isolated SIS. Cite this article as: Bircan R, Kaya İ, Odluyurt M, Vural A, Can MM, Kanatli U. Predictive value of acromion morphology and coracoacromial ligament degeneration after arthroscopic acromioplasty for isolated subacromial impingement syndrome. Acta Orthop Traumatol Turc. 2026; 60(5), 0029, doi: 10.5152/j. aott.2026.24029.

Background/Objectives: Optimizing surgical visualization via controlled hypotension and managing postoperative pain remain challenging in arthroscopic Bankart repair. While interscalene brachial plexus block (ISBPB) is effective, pharmacological adjuncts may further improve hemodynamics and prolong analgesia. The aim of this study was to assess the impact of intraoperative intravenous dexmedetomidine on visual clarity, hemodynamics, and postoperative pain during arthroscopic Bankart repair. Methods: This retrospective, single-center cohort study evaluated 63 patients undergoing isolated anterior Bankart repair under ISBPB. The dexmedetomidine group (Group D, n = 33) received an intravenous dexmedetomidine loading dose (1 mcg/kg) and maintenance infusion (0.5 mcg/kg/h) alongside ISBPB. A historical control group (Group C, n = 30) received ISBPB alone. Secondary outcomes included serial intraoperative hemodynamics, blinded surgeon-rated surgical visualization, and pain scores, while the primary outcome was postoperative analgesia duration. Results: Baseline characteristics were comparable between groups. Group D yielded significantly higher surgeon satisfaction for visual clarity (p < 0.001). Intraoperatively, Group D showed a significantly lower diastolic blood pressure at the 50 min mark after correction for multiple comparisons. Postoperatively, Group D exhibited significantly lower 24 h visual analog scale (VAS) pain scores (p < 0.001) and a significantly prolonged duration of analgesia (7.45 vs. 4.16 h; p = 0.001). Overall patient satisfaction and Pain Catastrophizing Scale scores did not differ significantly between cohorts. Conclusions: In this retrospective cohort, adjunctive intravenous dexmedetomidine added to ISBPB was associated with improved surgeon-rated visualization, lower postoperative pain scores, and prolonged analgesia, without an increase in adverse events. Due to the retrospective design and historical control group, these findings should be interpreted as associations; prospective randomized trials are required to confirm them.

Objective: This study aimed to examine the frequency of long head of the biceps tendon (LHBT) pathologies in anterosuperior rotator cuff tears (RCT) involving the LHBT pulley system and investigate the relationship between RCT types and LHBT pathology subtypes.Methods: A retrospective review was conducted of 555 shoulder arthroscopies performed for rotator cuff tears between 2017 and 2023. Patients were classified into 3 groups: isolated subscapularis (SSC) tears (n=74), isolated supraspinatus (SSP) tears (n=177), and combined SSC+SSP tears (n=304). The severity of the subscapularis tear was graded using the Lafosse classification. The LHBT pathologies were categorized as tendinitis, subluxation, dislocation, partial rupture, and full-thickness rupture.Results: The LHBT pathology was present in 86.1% of cases. The most common pathologies were tendinitis (44.7%), complete rupture (13.5%), partial rupture (12.1%), subluxation (8.5%), and dislocation (7.4%). The SSC+SSP group had the highest LHBT pathology rate (99.0%) compared to isolated SSC (70.3%) and SSP (70.6%) groups (P < .001). The SSC+SSP group had a 36.04 times higher risk of LHBT pathology than the SSP group (P < .001). Dislocation and complete rupture were most frequent in the SSC+SSP group (P < .001). The LHBT pathology prevalence increased with Lafosse grade (P < .001), and higher grades were strongly associated with dislocation and rupture.Conclusion: Anterosuperior rotator cuff tears are strongly associated with LHBT pathologies, and the severity of LHBT pathologies increases in parallel with the Lafosse grade. Combined SSC+SSP tears significantly increase the risk of LHBT pathology, particularly dislocation and complete rupture, highlighting the need for thorough LHBT evaluation in anterosuperior RCT cases.Level of Evidence: Level III, Prognostic Study.Cite this article as: Kaya I, Yaş S, Bircan R, Ahmadov A, Sarikaya B, Kanatli U. Combined subscapularis and supraspinatus tears markedly increase the risk of long head of the biceps tendon pathology. Acta Orthop Traumatol Turc., 2026, 60(2), 0483, doi: 10.5152/j.aott.2026.25483.

Developmental dysplasia of the hip (DDH) is a congenital disorder influenced by genetic and epigenetic factors. This study aimed to elucidate the molecular pathogenesis of DDH through a comprehensive transcriptomic analysis, identifying differentially expressed genes (DEGs) and long non-coding RNAs (lncRNAs) in hip joint capsules from DDH patients and healthy controls. RNA sequencing data from 12 samples (6 DDH, 6 controls) were retrieved from the NCBI database. Functional annotation was performed using Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses via the DAVID tool. A protein–protein interaction (PPI) network of DEGs was constructed using STRING with medium confidence settings. Among 78,930 transcripts, 4.3% were significantly differentially expressed, according to DESeq2 analysis. A total of 3425 DEGs were identified (FDR < 0.05, |log2 FC| > 2), including 1008 upregulated and 2417 downregulated transcripts in DDH samples. Additionally, 1656 lncRNAs were detected among the DEGs. These findings enhance our understanding of the genetic and epigenetic landscape of DDH and highlight the involvement of key biological pathways such as cell cycle regulation and Wnt signaling. This study provides a foundation for future molecular research into the pathogenesis of DDH.

Aim: This study compared the malposition rates of fixed and adjustable suspensory button implants used for femoral fixation of the graft during anterior cruciate ligament (ACL) reconstruction and examined the effectiveness of intraoperative imaging in managing these complications. Methods: This retrospective study evaluated 187 patients who underwent arthroscopic ACL reconstruction. The patients included in the study were categorized into two groups according to the type of femoral suspensory button (FSB) implant used: fixed suspensory button (FxSB) and adjustable suspensory button (ASB). Button malpositions were determined and recorded with intraoperative images in cases where fluoroscopy was used and postoperative X-ray radiographs in cases where fluoroscopy was not used. Malposition rates were compared between the two groups, and risk analysis was performed. Results: The FxSB implant was used in 89 patients, and the ASB implant was used in 98 patients. Malposition was detected in 24 patients (12.8%). When the FxSB and ASB implant groups were analyzed separately, the number and rate of malpositions were 5 (5.6%) and 19 (19.3%), respectively (p=.0123). Regression analysis showed that the risk of malposition was 3.5 times higher in the ASB implant group than in the FxSB implant group (M: 3.57 (p=.0017) 95% CI (1.36-10.1)). Conclusion: This study found that ASB implants used in ACL reconstruction resulted in a higher rate of button malposition than FxSB implants. In addition, intraoperative fluoroscopy was found to be a useful method to detect malpositions in all FSB implants and allow for proper button positioning with intraoperative interventions.

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.

Background: Accurate differentiation of spinal multiple myeloma (MM) and osteolytic metastatic bone tumor (OMBT) can be challenging. Usually, imaging methods, laboratory tests, and biopsy are performed for the correct diagnosis. In this study, we aimed to differentiate CT images from patients with MM and OMBT using CNN models. Materials and Methods: 3707 CT images of 91 patients (1886 OMBT images and 1821 MM images; 46 males and 45 females; mean age: 61.2 years) obtained between January 2015 and January 2023 were reviewed. 2667 images were randomly selected for the training set, 740 for the validation set, and 300 for the test set. A transfer learning approach was used based on DenseNet121, DenseNet169, EfficientNetB0, MobileNet, MobileNetV2, VGG16, and Xception CNN architectures. The performance of the models was evaluated. Results: When the sensitivity, specificity, positive predictive value, negative predictive value, accuracy, F1 score, and kappa measurements of the models in the MM and OMBT differentiation are evaluated, the most successful ones are MobileNetV2, MobileNet, and VGG16, with accuracy of 88%, 86.33%, and 86%, respectively. Conclusions: Our study showed that CNN-based artificial intelligence models can differentiate MM and OMBT on CT images.