Muhammed Kazez

Aims: Pes planovalgus (PPV) deformity is a common deformity in ambulatory patients with cerebral palsy (CP), and progressive cases may require surgery. This study aimed to evaluate short- to mid-term radiological and functional outcomes following individualized combined surgical treatment in ambulatory CP patients. Methods: Twenty-five ambulatory patients with CP who underwent surgical treatment for PPV were retrospectively reviewed. Demographic characteristics, surgical procedures, radiological parameters, and American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scores were assessed. Preoperative and postoperative values were compared using paired t-tests or Wilcoxon signed-rank tests. Surgical strategy was individualized based on deformity severity, flexibility and associated muscle tendon imbalance. Results: The mean age was 15.16±3.80 years (range, 9-25 years), and the mean follow-up duration was 1.67±0.77 years. The most common surgical approach was achilloplasty combined with midfoot or calcaneal osteotomy (72%). Significant postoperative improvements were observed in calcaneal pitch (p=0.006), Kite angle (p=0.015), lateral talocalcaneal angle (p=0.022), Gissane angle (p=0.039), and Simons angle (p=0.007). The AOFAS Ankle-Hindfoot score significantly improved from 40.88±12.88 to 83.52±8.34 (p

Background: The optimal coronal mechanical alignment after medial opening-wedge high tibial osteotomy (MOWHTO) remains controversial. This study aimed to evaluate the association between postoperative hip–knee–ankle angle (HKA) and early- to mid-term clinical outcomes and to explore whether this relationship showed evidence of nonlinearity within the observed valgus range. Methods: This single-center retrospective cohort study included 188 patients who underwent MOWHTO with a 10- or 12.5-mm osteotomy opening. The primary exposure was HKA measured at 6 weeks postoperatively, and the final follow-up International Knee Documentation Committee (IKDC) score was designated as the primary clinical outcome. Lysholm and visual analog scale (VAS) scores were evaluated as secondary outcomes. Associations between postoperative HKA and clinical outcomes were assessed using multivariable linear regression with HC3 heteroskedasticity-robust standard errors, while potential nonlinear relationships were explored by incorporating a quadratic HKA term. Results: The mean age was 52.64 ± 4.74 years, the mean follow-up was 25.48 ± 6.80 months, and the mean HKA at 6-weeks postoperatively was 2.88 ± 1.21° of valgus. IKDC and Lysholm scores significantly improved, whereas VAS scores decreased (all p < 0.001). In multivariable analyses, each 1° increase in postoperative valgus HKA was associated with a 1.49-point-higher final IKDC score (95% CI, 0.04–2.93; p = 0.044) and a 2.61-point-higher final Lysholm score (95% CI, 1.10–4.13; p < 0.001). No statistically significant association was observed with final VAS (β = 0.004; 95% CI, −0.050 to 0.058; p = 0.883). The quadratic HKA term was not statistically significant for any clinical outcome, indicating no statistically detectable nonlinearity within the observed 0.4–4.5° valgus range. The IKDC association was attenuated in an influence sensitivity analysis, whereas the Lysholm association remained significant. Conclusions: Within the restricted postoperative HKA range observed in this cohort (0.4–4.5° of valgus), greater postoperative valgus HKA was associated with higher functional outcome scores, with a more pronounced and consistent association for Lysholm and a more modest association for the primary outcome, IKDC. No association was observed with pain, and no statistically detectable nonlinearity was identified within the observed HKA range. These observational findings do not establish a causal valgus dose–response relationship, a universal optimal postoperative HKA, or the superiority of individualized correction. Prospective studies across broader alignment ranges are needed to define clinically appropriate alignment targets for specific patient subgroups.

This study aimed to translate, culturally adapt, and assess the validity and reliability of the Turkish version of the Hospital for Special Surgery Anterior Cruciate Ligament Postoperative Satisfaction Survey (HSS ACL-SS) in patients who underwent ACL reconstruction. Eighty-six patients who underwent primary ACL reconstruction were included in the study. Patient-reported outcome measures were administered during routine postoperative outpatient follow-up visits. The Turkish HSS ACL-SS, along with the Lysholm score, Tegner activity scale, International Knee Documentation Committee subjective form, and short form-36, were administered. Internal consistency was analyzed using Cronbach alpha, and test–retest reliability was assessed with the intraclass correlation coefficient and Bland–Altman plots. Construct validity was evaluated through principal component analysis with Varimax rotation and Spearman correlation with parallel scales. Floor and ceiling effects were also examined. The Cronbach alpha coefficient for the Turkish HSS ACL-SS was 0.943, indicating excellent internal consistency. The intraclass correlation coefficient was 0.975, demonstrating excellent test–retest reliability. After removing 1 nonadditive item, principal component analysis confirmed a single-factor structure for the final 9-item Turkish HSS ACL-SS, explaining 69.3% of the total variance. Very strong correlations were found with the International Knee Documentation Committee (ρ = 0.815; P < .001), strong correlations with the Lysholm (ρ = 0.681; P < .001), and moderate correlations with the Tegner (ρ = 0.347; P = .001) scores. Only the physical functioning subscale of the short form-36 showed a moderate correlation (ρ = 0.294; P = .006). No significant floor or ceiling effects were observed. The Turkish version of the HSS ACL-SS is a reliable, valid, and culturally adapted instrument for assessing patient satisfaction following ACL reconstruction.

Background/Objectives: Subchondral bone marrow edema (BME) of the knee often causes persistent pain despite conservative treatment, and evidence supporting oral bisphosphonates is limited. We compared conservative treatment alone with conservative treatment plus oral alendronate. Methods: This retrospective cohort study included 82 patients with MRI-confirmed subchondral BME of the knee treated between January 2020 and January 2025. Patients received conservative treatment alone (n = 44) or conservative treatment plus alendronate 70 mg weekly for three months (n = 38). Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were assessed at baseline and three months. Radiological response was assessed on follow-up MRI as the percentage reduction in BME area. Results: Both groups improved significantly at three months. The alendronate group showed greater reductions in VAS (4.0 ± 1.4 vs. 3.2 ± 1.3 points, p = 0.009) and total WOMAC scores (25.5 ± 8.9 vs. 19.8 ± 8.6 points, p = 0.002). Median time to full weight-bearing was shorter with alendronate (7 vs. 9 weeks, p = 0.021), and complete BME regression was more frequent (42.1% vs. 18.2%, Fisher’s exact p = 0.028). After adjustment for Kellgren–Lawrence grade, alendronate was associated with a favorable radiological response (OR = 3.66, 95% CI: 1.18–11.31, p = 0.024). No serious adverse events were recorded. Conclusions: Adding oral alendronate to conservative treatment was associated with greater clinical improvement, earlier full weight-bearing, and a more favorable radiological response at three months. Prospective randomized studies are needed to confirm these findings.

Background and Objectives: Postoperative delirium (POD) is a frequent neuropsychiatric complication following hip fracture surgery in older adults and is associated with prolonged hospitalization, functional decline, and increased mortality. Systemic inflammation is thought to play a central role in its pathogenesis, and the C-reactive protein CRP-to-albumin ratio (CAR) has emerged as a promising inflammatory biomarker. This study aimed to investigate the association between the preoperative CAR and POD and to identify clinical and perioperative factors independently associated with POD. Materials and Methods: This retrospective cohort study included 962 consecutive patients who underwent surgery for hip fractures between January 2022 and December 2025. Patients with femoral neck fractures underwent hemiarthroplasty, whereas those with intertrochanteric fractures were treated with proximal femoral nailing. Cases of postoperative delirium were evaluated following psychiatric consultation requested based on clinical suspicion by the orthopedic team, nursing staff or the patient’s caregiver; the definitive diagnosis was made by consultant psychiatrists according to the DSM-5 diagnostic criteria. Demographic characteristics, perioperative variables, and preoperative laboratory parameters were analyzed. Univariable and prespecified multivariable logistic regression analyses were performed to identify factors independently associated with POD. Model discrimination and calibration were assessed using receiver operating characteristic analysis, bootstrap internal validation, and the Hosmer–Lemeshow goodness-of-fit test. Results: Postoperative delirium developed in 112 of 962 patients (11.6%). Patients who developed POD had significantly higher preoperative CAR values than those without POD (0.76 vs. 0.33, p < 0.001). In the multivariable analysis, male sex (OR 1.567, 95% CI 1.007–2.438; p = 0.046), hemiarthroplasty (OR 1.931, 95% CI 1.213–3.075; p = 0.006), perioperative blood transfusion (OR 1.870, 95% CI 1.178–2.971; p = 0.008), general anesthesia (OR 1.829, 95% CI 1.093–3.061; p = 0.021), higher ASA physical status classification (OR 2.154, 95% CI 1.346–3.446; p = 0.001), longer time from hospital admission to surgery (OR 1.250 per 24 h increase, 95% CI 1.103–1.417; p < 0.001), and a higher log₂-transformed CAR (OR 1.184 per doubling, 95% CI 1.037–1.352; p = 0.013) were independently associated with POD. The final model demonstrated acceptable discrimination (AUC 0.764; optimism-corrected AUC 0.744) and satisfactory calibration (Hosmer–Lemeshow p = 0.242). Conclusions: A higher preoperative C-reactive protein-to-albumin ratio was independently associated with postoperative delirium after hip fracture surgery, even after adjustment for established demographic and perioperative risk factors. Male sex, hemiarthroplasty, general anesthesia, higher ASA physical status classification, perioperative blood transfusion, and delayed surgery were also independently associated with POD. These findings suggest that CAR may be a low-cost and readily available inflammatory biomarker that could be used to develop a preoperative risk classification system for the development of postoperative delirium. However, since routine standardized delirium screening was not performed during the study, cases of hypoactive delirium in particular may not have been adequately identified. For this reason, the findings should be interpreted with caution. Prospective, multicenter studies incorporating standardized delirium screening methods are needed to validate these results and determine the additional predictive value of CAR beyond established clinical risk factors.

Aims: To compare clinical and radiological outcomes, operative parameters, and complication rates between titanium elastic nail (TEN) fixation and plate osteosynthesis in the treatment of fifth metacarpal neck fractures. Methods: This retrospective cohort study included 44 patients with extra-articular fifth metacarpal neck fractures (AO/OTA 77.5.2) treated surgically between January 2020 and March 2025. Twenty-three patients underwent TEN fixation and 21 underwent plate osteosynthesis. Preoperative angulation was measured on initial radiographs. Functional outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) score and metacarpophalangeal (MCP) joint range of motion at 6 months. Radiological union, reduction quality, operative time, fluoroscopy duration, and complications were evaluated. Rotational alignment was assessed clinically.Results: Preoperative angulation was similar between the groups (52±15° vs. 54±16°, p=0.156). Operative time and fluoroscopy duration were significantly lower in the TEN group (32.4±6.8 vs. 51.7±9.5 minutes and 4.2±1.5 vs. 8.6±2.4 seconds, respectively; p0.05). All fractures achieved radiological union with similar time to union (p=0.32). All cases demonstrated good reduction quality (

Objective: Early and accurate diagnosis of septic arthritis is essential to prevent irreversible joint damage and systemic complications. This study aimed to evaluate the diagnostic performance of serum and synovial fluid presepsin and Maresin-1 levels in adult patients with suspected native knee septic arthritis. Methods: This prospective study included 70 adult patients presenting with acute knee monoarthritis who underwent synovial fluid aspiration. Patients were enrolled based on clinical suspicion of septic arthritis and subsequently classified into septic arthritis (n = 25) and control (n = 45) groups according to the Newman criteria. Serum and synovial fluid samples were analyzed for routine inflammatory markers, presepsin, and Maresin-1 levels. Diagnostic performance was assessed using receiver-operating characteristic (ROC) analysis. Results: Serum white blood cell count (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), procalcitonin (PCT), and presepsin levels were significantly higher in the septic arthritis group (WBC: P = .001; ESR: P = .001; CRP: P < .001; PCT: P < .001; presepsin: P = .001). Synovial fluid WBC, lactate dehydrogenase, glucose, and presepsin levels also differed significantly between groups (all P < .001). Serum and synovial Maresin-1 levels did not differ significantly between groups (serum: P = .76; synovial: P = .98). The ROC analysis showed that CRP had the highest diagnostic accuracy (AUC: 0.91), followed by PCT (0.81), synovial presepsin (0.78), ESR (0.74), and serum presepsin (0.73). Conclusion: Synovial presepsin demonstrated moderate diagnostic accuracy in distinguishing native joint septic arthritis from noninfectious effusions and performed better than traditional biomarkers other than CRP. Maresin-1 did not show diagnostic utility in the acute phase. Synovial presepsin may be considered a complementary biomarker in the evaluation of suspected septic arthritis. Cite this article as: Aydın C, Tartar AS, Aydın O, Kazez M. The role of presepsin and maresin-1 levels in blood and synovial fluid in early diagnosis of septic arthritis. Acta Orthop Traumatol Turc., 2026; 60(3), 0523, doi: 10.5152/j.aott.2026.25523.

Age-related differences after fasciotomy for earthquake-related acute compartment syndrome (ACS) remain incompletely defined. This study compared pediatric

Objective: This study aimed to compare clinical outcomes and total treatment costs of 3 fixation strategies—isolated dorsal plating, dorsal plating with a single lag screw, and dorsal plating with dual lag screws—in patients undergoing first metatarsophalangeal (MTP) joint arthrodesis for advanced hallux rigidus. Methods: This retrospective study included 99 patients who underwent primary first MTP joint arthrodesis between 2019 and 2024. Patients were categorized into Group 1 (dorsal plate only; n = 27), Group 2 (plate + 1 lag screw; n = 42), and Group 3 (plate + 2 lag screws; n = 30). Demographic variables, radiographic union, revision rates, functional outcomes (American Orthopaedic Foot and Ankle Society [AOFAS], Visual Analog Scale [VAS], Foot Function Index [FFI]), and total 12-month treatment costs were evaluated. The primary outcome measures were union rate, time to union, revision surgery, functional scores, and cumulative cost. Results: Group 1 demonstrated significantly lower union rates compared with Groups 2 and 3 (88.9% vs. 100% for both; P = .027) and a longer mean time to union (75 days vs. 65.8 and 62 days, respectively; P = .001). Revision surgery was required only in Group 1 (11.1%). The AOFAS scores were significantly higher in the screw-augmented groups (P = .013), while VAS and FFI scores showed no between-group differences. Cost analysis identified Group 2 as the most cost-effective strategy (9500 ± 1100 TL ≈ $310 ± 36), compared with Group 1 (11 200 ± 1400 TL ≈ $365 ± 46, P = .021) and Group 3 (11 600 ± 1300 TL ≈ $378 ± 42, P = .038). Conclusion: Single lag-screw augmentation of dorsal plate fixation provides superior union, fewer revisions, improved functional scores, and the lowest overall 12-month cost. These findings support dorsal plating with a single lag screw as a practical, value-based fixation strategy for advanced hallux rigidus, offering optimal clinical and economic outcomes. Cite this article as: Kazez M, Batur ÖC, Önce G, Kürüm H, Kaya O, Yalın M. Single lag-screw–augmented dorsal plating yields superior union and lower costs in first metatarsophalangeal arthrodesis. Acta Orthop Traumatol Turc., 2026; 60(2), 0417, doi: 10.5152/j.aott.2025.25417.