Cumhur Deniz Davulcu

Objective: Axillary artery injury during total shoulder arthroplasty (TSA) is rare but potentially limb-threatening. This report describes an intraoperative arterial injury attributed to retractor placement and highlights its multidisciplinary management and clinical outcome. Methods: A 76-year-old woman with left shoulder pain, restricted range of motion, glenohumeral arthritis, and chondromatous changes underwent TSA. The clinical presentation, intraoperative findings, vascular repair, postoperative management, and 1-year outcome were evaluated. Results: During humeral head resection, significant bleeding in the axillary region became pulsatile after the retractors were removed. Cardiovascular surgeons identified a focal, pinpoint arterial injury considered to be associated with retractor placement. Primary suture repair achieved complete hemostasis without the need for arterial ligation, grafting, or other vascular reconstruction. The planned arthroplasty was subsequently completed during the same surgical session. Postoperative upper-extremity perfusion remained intact. Following rehabilitation, no vascular sequelae were observed, and the patient maintained a satisfactory shoulder range of motion at the 1-year follow-up. Discussion: Early recognition of the injury and immediate involvement of cardiovascular surgery prevented potentially severe hemorrhagic and ischemic complications. This case demonstrates that retractors may endanger the axillary artery during surgical exposure and humeral head resection, even during an otherwise routine TSA. Conclusion: Meticulous retractor placement, detailed knowledge of regional vascular anatomy, and prompt assessment of unexpected bleeding are essential during shoulder arthroplasty. Immediate multidisciplinary intervention and primary vascular repair can preserve limb perfusion and allow safe completion of the planned procedure. Cite this article as: Celayir A, Doğan R, Davulcu CD, Aydın N. Axillary artery injury attributed to retractor placement during shoulder arthroplasty: a case report on management and outcomes. Cerrahpaşa Med J 2026, 50, 0131, doi: 10.5152/cjm.2026.26131.

Objective: Artificial intelligence (AI) is increasingly used in orthopedic decision-making, offering potential benefits in diagnostic accuracy and treatment planning. This study evaluates the alignment between AI-generated and clinician-based treatment recommendations for distal radius fractures. Methods: A retrospective analysis was conducted on 53 patients with distal radius fractures. Radiographs were reviewed by clinicians and by the ChatGPT-4O AI model, which was provided with standardized surgical indication criteria. Artificial intelligence–generated treatment decisions (surgical vs. conservative) were compared to clinical decisions to assess concordance. Results: Clinicians recommended surgical treatment in 9 cases (17%) and conservative treatment in 44 cases (83%). ChatGPT-4O agreed with the clinical decision in 35 cases (66%). Discrepancies occurred in 18 cases (34%), mostly involving borderline indications, where clinical context and judgment were essential. Conclusion: While AI demonstrated reasonable alignment with expert decisions, its limitations in cases requiring nuanced interpretation were evident. The findings highlight the need for cautious integration of AI as a decision-support tool not a replacement for clinical expertise. Artificial intelligence, exemplified by ChatGPT-4O, can support orthopedic decision-making but must be used under clinical supervision. Ongoing refinement and validation are essential for safe and effective clinical integration. Cite this article as: Celayir A, Doğan R, Davulcu CD, Aydın N. Integrating artificial intelligence in orthopedic decision-making: A comparative analysis of distal radius fracture management. Cerrahpaşa Med J 2026, 50, 0061, doi:10.5152/cjm.2026.25061.

Aim Geriatric hip fragility fractures represent a significant challenge in orthopedic practice due to high morbidity and functional impairment. The choice between arthroplasty and osteosynthesis remains a critical decision influenced by patient factors, fracture characteristics, and expected outcomes. This study aimed to compare the clinical outcomes of arthroplasty and osteosynthesis in elderly patients with hip fragility fractures, identifying the most effective treatment approach. Methods A retrospective cohort study was conducted, including 130 patients treated at a tertiary center between 2016 and 2023. Patients were divided into two groups: 65 underwent arthroplasty (55 hemiarthroplasty, 10 total hip arthroplasty) and 65 osteosynthesis with proximal femoral nails. Intraoperative metrics (surgical duration, blood loss), postoperative parameters (mobilization time, hospital stay, complications), functional outcomes (Harris Hip Score [HHS], Visual Analog Scale [VAS]), and radiological outcomes were evaluated. Results The arthroplasty group demonstrated significantly shorter surgical duration (78.3 ± 12.4 vs. 92.7 ± 15.8 minutes; p < 0.001), earlier mobilization (1.1 ± 0.8 vs. 2.4 ± 1.2 days; p < 0.001), and reduced hospital stays (4.8 ± 1.4 vs. 6.2 ± 1.7 days; p < 0.001). Postoperative complications were lower in the arthroplasty group (9%) compared to osteosynthesis (15%; p = 0.03). Functional recovery at 12 months favored arthroplasty, with higher HHS (89.3 ± 4.6 vs. 83.7 ± 6.3; p < 0.001) and lower VAS pain scores (1.8 ± 0.5 vs. 2.9 ± 0.8; p < 0.001). Radiological assessments confirmed satisfactory fracture healing in 91% of osteosynthesis cases and implant stability in 97% of arthroplasty cases. Multivariate analysis identified arthroplasty as an independent predictor of shorter hospital stay (p = 0.02) and lower complication rates (p = 0.01). Conclusion Arthroplasty offers superior clinical outcomes in terms of faster recovery, fewer complications, and better functional scores compared to osteosynthesis for geriatric hip fragility fractures. These findings support arthroplasty as the preferred treatment in suitable elderly hip fracture patients, with further prospective studies recommended to strengthen the evidence base.

Immobilization with a Short Leg Cast in Acute Peroneus Brevis Tendon Tears - Article abstract #948836

Objective: This study aimed to identify the risk factors contributing to re-amputation, survival rates, and mortality determinants in patients who underwent unilateral lower extremity amputation due to diabetes mellitus (DM) or peripheral artery disease (PAD). Methods: This retrospective study included 93 patients who underwent amputation due to DM (62) or PAD (31). Data regarding the etiology and level of amputation, comorbidities, ASA scores, postoperative intensive care unit (ICU) admission, ICU length of stay, re-amputation rates, factors necessitating re-amputation, wound culture results, time to re-operation, survival status, and duration were analyzed. Results: PAD patients were older (P = .019), had fewer comorbidities than DM patients (P < .001), and predominantly underwent transfemoral amputation (TFA) (64.5%). The re-amputation rate was 32.6%, with a median interval of 6 weeks, driven by wound healing complications (64.5%). The median survival duration was 6 months (range 1–29 months). PAD-TFA patients had the highest re-amputation rates and the lowest 1-year survival. Independent mortality predictors included advanced age (P = .003), ASA-4 status (P = .018), and hypoalbuminemia (P = .032). Re-amputation did not independently affect survival (P = .213) but significantly reduced prosthetic fitting rates (P = .005). Conclusion: Patients undergoing amputation for chronic lower extremity circulatory issues should be closely monitored for wound problems, particularly during the first 6 weeks postoperatively. PAD-TFA patients represent the highest-risk subgroup. The poor prognostic factors for survival include advanced age, ASA-4 status, and hypoalbuminemia. Furthermore, the significantly older age of PAD patients highlights the importance of addressing diabetes as a critical health concern across all age groups.Cite this article as: Davulcu CD, Afacan MY. Identification of risk factors and survival in patients undergoing re-amputation after extremity amputation. Cerrahpaşa Med J. 2025, 49, 0003, doi: 10.5152/cjm.2025.25003.

The Impact of TRIMANO Adjustable Arm Holder on Proximal Humerus Fracture Management: Enhancing Surgery Duration, Surgical Efficiency, and Patient Outcomes - Medical Journal of Bakirkoy