Dilek Bayraktar

AGREEMENT BETWEEN ADOLESCENTS, PARENTS, AND AN EXPERT IN VISUAL ASSESSMENTS OF ADOLESCENT POSTURE: AN EXPLORATORY PILOT STUDY - The Journal of Turkish Spinal Surgery

Musculoskeletal pain may impair functional performance in university students. Although kinesiophobia, defined as excessive movement-related fear and fear of re-injury, is associated with pain-related disability, its relationship with muscle strength and functional capacity in young adults remains unclear. This study examined the associations between kinesiophobia, lower extremity muscle strength, and functional capacity in university students with chronic musculoskeletal pain. This cross-sectional study included 115 students aged 18–30 years with musculoskeletal pain lasting at least three months. Data were collected at the Department of Therapy and Rehabilitation, Kayseri University, between February 2026 and May 2026. Kinesiophobia was assessed using the Tampa Scale of Kinesiophobia (TSK). Pain intensity and physical activity were evaluated using the Numeric Rating Scale and International Physical Activity Questionnaire–Short Form. Lower extremity strength was measured by handheld dynamometry, and functional capacity was assessed using the Timed Up and Go (TUG), Five Times Sit-to-Stand (5xSTS), and Six-Minute Walk Tests (6MWT). Associations were analyzed using Pearson or Spearman correlation analysis, and hierarchical multiple regression was used to determine whether kinesiophobia independently predicted functional outcomes after adjustment for demographic variables, pain intensity, and physical activity. Higher kinesiophobia was associated with lower muscle strength and poorer functional capacity. TSK scores correlated with knee extensor strength (r = −0.46), TUG (r = 0.44), 5xSTS (r = 0.48), and 6MWT (r = −0.52) (all p < 0.001). Kinesiophobia remained an independent predictor of functional capacity after adjustment for demographic variables, pain intensity, and physical activity (β = −0.41, p < 0.001). Kinesiophobia was independently associated with impaired physical function in university students with chronic musculoskeletal pain. Kinesiophobia should be considered when evaluating functional limitations in this population.

Aims: To examine the association between thyroid dysfunction and bleeding severity, anemia burden, and management outcomes in perimenopausal women with abnormal uterine bleeding (AUB).Methods: In this retrospective cohort study, 742 perimenopausal women aged 40-55 years with AUB were evaluated between January 2014 and December 2024. Thyroid status was categorized as euthyroid, subclinical hypothyroidism, overt hypothyroidism, subclinical hyperthyroidism, or overt hyperthyroidism based on serum thyroid-stimulating hormone and free thyroxine levels. Severe AUB, anemia, and management outcomes (iron therapy, blood transfusion, and procedural interventions) were analyzed using multivariable logistic regression adjusted for demographic and metabolic covariates. Receiver operating characteristic analyses were used to explore the standalone discriminatory performance of thyroid-stimulating hormone for severe AUB and moderate-to-severe anemia.Results: Thyroid dysfunction was identified in 29.4% of participants. Severe AUB and moderate-to-severe anemia were more frequent among women with subclinical and overt hypothyroidism. Thyroid dysfunction was independently associated with severe AUB (aOR 2.21; 95% CI 1.54-3.18), anemia (aOR 1.89; 95% CI 1.33-2.68), and escalation of care (aOR 1.97; 95% CI 1.28-3.02), as well as increased likelihood of iron therapy and blood transfusion. A thyroid-stimulating hormone threshold near 4.0 mIU/L showed moderate discrimination for severe AUB and anemia and should be interpreted as an exploratory risk-enrichment value rather than a definitive diagnostic or treatment cut-off.Conclusion: Thyroid dysfunction, particularly subclinical hypothyroidism, was independently associated with increased bleeding severity, anemia burden, and greater healthcare utilization in perimenopausal AUB. However, given the retrospective observational design, these findings do not establish causality.

Objective: A pelvic X-ray examination might not be accomplished accurately if the images are not acquired properly. In this study, the aim was to develop an automated model using artificial intelligence capable of accurately quantifying the symmetry of the obturator foramen in a pelvic anteroposterior X-ray and determining its suitability for evaluation. Methods: After applying the exclusion criteria, the study included 513 pelvic X-rays. An automated model was developed in the second stage to identify the iliac wings and obturator foramen. After that, calculations were performed to evaluate the obturator foramen’s symmetry using the Dice, Jaccard, and Cosine similarity indices. Finally, the symmetry values determined by the physician and the suggestedsystem were compared statistically. Results: The symmetry values found using the suggested model varied from 0.58 to 0.89. There was no statistically significant di!erence in the symmetry values of the obturator foramen as determined by the automated approach and the observer physician, as indicated by 3 distinct similarity indices (P=.68, P=.6, and P=.96). Conclusion: The artificial intelligence model successfully evaluated the appropriateness of the pelvic X-ray in terms of obturator foramen symmetry. Cite this article as: Yilmaz A, Selcuk T, Aksoy T, Atilla B. A quantitative analysis of symmetry on standard anteroposterior pelvic X-ray. Acta Orthop Traumatol Turc., 2025;59(2):122-128.

Objectives: Altered body biomechanics during pregnancy can lead to balance impairments and an increased risk of falls. Clinical exercise interventions can help regulate these biomechanical changes. Methods: A total of 101 pregnant participants (exercise group: n = 50; control group: n = 51) were retrospectively analyzed over an 8-week follow-up period. Single-leg balance parameters, including AP sway, ML sway, total body sway, OSD, and center of pressure velocity and acceleration, were assessed considering limb dominance. Measurements were taken at baseline and week 8. Repeated-measures ANOVA was used to analyze time–group interactions, with significance set at p < 0.001. The biomechanical impacts of participant height and body mass on center of pressure dynamics were also considered. Results: The exercise group (EG) demonstrated significant improvements in all balance parameters compared to the control group (CG) (p < 0.001), except for non-dominant anterior-posterior (AP) sway (p = 0.512). In the EG, medio-lateral (ML) and AP sway of the non-dominant limb were minimized, whereas these parameters were significantly increased in the CG. Although both groups exhibited an increased one-leg stance duration (OSD), the improvement was more pronounced in the EG. The controlled improvements observed in the EG suggest a protective effect of exercise on balance, particularly in the dominant limb. Conclusions: Clinical exercise interventions during pregnancy enhance balance parameters, reduce fall risk, and improve functional mobility. These findings suggest that structured exercise programs not only support maternal well-being but also improve reactive balance control. Given the biomechanical changes throughout pregnancy, future studies should examine the center of pressure velocity, acceleration, and the influence of maternal anthropometrics on postural stability to refine exercise recommendations.

Background/Objectives: This study aims to examine the effects of clinical exercise training on foot plantar pressure, the subtalar joint, and the gait cycle during pregnancy. Methods: The study was planned as a randomized, controlled, and single-blind study. Participants’ demographic information, obstetric evaluation, physical activity level, fall history, and pain evaluation were recorded. Foot plantar pressure, the subtalar joint, and the gait cycle were measured through pedobarography at Gait Laboratory. The control group was recommended walking. Clinical exercise training was given to the study group 2 days a week for eight weeks. Evaluations were made on day 0 and the day corresponding to the end of week 8. Results: The study was completed with 50 people in the study group (age: 29.7 ± 3.8 years) and 51 in the control group (age: 29.1 ± 6.1 years). As a result of the parametric and non-parametric tests performed before and after the exercise, it was observed that there was a statistically significant difference between the two groups in weight, BMI, pain score, static plantar pressure, dynamic plantar pressure, subtalar joint flexibility, duration of the walking period, and multistep walking speed (p < 0.01). The two groups had a significant difference only in the dominant midfoot plantar pressure (p > 0.05). Conclusions: According to our research, weight control and pain relief are observed in women who engage in clinical exercise in the second trimester of pregnancy; plantar pressure and subtalar joint flexibility are preserved, the walking period does not increase, and the multistep walking speed can be maintained after eight weeks.

Objective: One of the reasons for foot pain is the changes in the structure of the medial longitudinal arch. Assessment of medial longitudinal arch height is often made with foot radiographs and pedobarographic measurements. The relationship between these methods in the presence of foot sole pain has not been examined yet. This study aims to investigate the relationship among these measurement methods in adults with foot sole pain. Materials and Methods: 60 adults with foot sole pain were included in this study. The talohorizontal, talocalcaneal, talo1.metatarsal, and calcaneal inclination angles were measured in the lateral weight bearing foot radiographs. The arch index was calculated in static, dynamic pedobarographic measurements. The agreement of radiological and pedographic measurements among themselves and with each other was determined. Results: The mean age of 60 participants was 45.32 ±13.64. Agreement among foot classifications of radiologic measurements was poor Gwet’s agreement coefficient =-0.198 with a 95% confidence interval (-0.315,-0.080); percent agreement = 0.167 with a 95% confidence interval (0.099,0.234) and Kappa =-0.047 with a 95% confidence interval (-0.083,-0.01) were found. The agreement between pedobarographic classifications was fair Gwet’s agreement coefficient =0.486 with a 95% confidence interval (0.355,0.617); percent agreement =0.65 with 95% confidence interval (0.563,0.737) and Kappa=0.453 with a 95% confidence interval (0.324,0.583) were found. Among radiological measurements, the calcaneal inclination angle showed the highest coefficients of agreement with pedobarographic measurements. The extent of its agreement was fair. Conclusion: Pedobarography is a simple, reliable, inexpensive, and noninvasive method. The calcaneal inclination angle which is used in radiological imaging can give an idea about the height of the medial longitudinal arch.

Objective: This study aimed to determine the frequency of low back pain after calcaneal fractures treated with open reduction internal fixation (ORIF) and the risk factors that cause this condition. Methods: Thirty-one patients (27 males and 4 females) who underwent surgery for a unilateral calcaneal fracture between 2016 and 2020 and had no complaints of low back pain before fracture surgery were included in the study. The patients were divided into 2 groups: those who developed low back pain after the operation and those who did not. Patients were evaluated with the Life Quality Short Form SF-36, the Oswestry Disability Index (ODI), and American Orthopedic Foot-Ankle Association Score (AOFAS). Sanders’ fracture type, joint range of motion (ROM) measurements of injured and uninjured limbs, maximal isometric muscle strength measurements, balance on 1 leg with pedobarographic measurements, and walking time were evaluated. The obtained data were compared among the 2 groups. Results: Low back pain was observed in 71% of the patients and was detected after an average of 6 months from the operation. In ODI, 59.1% of the patients reported that low back pain limited their lives slightly. Patients with low back pain have lower AOFAS scores and worse SF-36 physical functionality than those without low back pain (P < .001, P=.016). Balance time on 1 foot in pedobarographic measurements, foot in ROM, ankle in ankle active, passive plantar flexion, inversion, active hip, passive internal, external rotation, muscle is the foot eversion force. In these measurements, the values of the injured side are intact. It was statistically significantly lower than the other side (interaction P < .1). Conclusion: Low back pain may occur after unilateral calcaneal fractures treated by ORIF. This may be caused by decreased angles of ankle dorsi and plantar flexion, foot inversion, hip abduction, and internal and external rotation. In the rehabilitation program, not only the ankle region but also the hip joint of the affected side should be included, and the kinetic chain that describes the interaction mechanism of the human body should not be forgotten. Level of Evidence: Level IV, Prognostic Study. Cite this article as: Bayraktar D, Özgürbüz C, Öztürk AM, Aktuğlu SK, Özkayın N. An investigation into the frequency and risk factors of low back pain following surgical treatment of isolated calcaneal fractures. Acta Orthop Traumatol Turc., 2024;58(1):45-56.

Objective: The aim of our study is to examine the injury profiles of ballet dancers. Materials and Methods: Dancers of The State Opera and Ballet Directorate who volunteered for the study applied to Ege University Faculty of Medicine, Department of Sports Medicine. Age, gender, height, body weight, education level and physical activities other than dance were recorded. Body fat ratio analysis was performed with the with dual-energy X-ray absorptiometry (DEXA) (iDXA, GE Lunar, Madison, Wisconsin, USA). All the training program of the dancers was questioned in detail. The number of dance injuries diagnosed in the last year was recorded. The relationship between injury incidence and other physical parameters was examined. Results: Forty-four dancers who met the inclusion criteria were evaluated. Thirty-five participants reported being injured at least once in the past 12 months. The most injured areas were reported as lumbar, ankle, neck, shoulder and knee. Nearly 60% of the participants reported that they train more than two hours a day. There was a statistically significant relationship between pain, fatigue, and previous injury with injury profile (p0.05). Conclusion: While pain, fatigue, and incomplete healing of the previous injury are related with the injury profile, strengthening exercise, running and participating other sports activities do not have any impact.