Hip fractures in the elderly have a significant impact, both in terms of human suffering and healthcare costs. Little is known about preoperative markers that may predict mortality following geriatric hip fracture surgery. This study aimed to investigate potential risk factors, including the C-reactive protein to albumin ratio (CAR), for mortality in elderly patients undergoing surgery for hip fracture. A total of 180 elderly patients with hip fractures were included in this cross-sectional study. The patients were divided into two groups: the survival group and the deceased group. Serum levels of C-reactive protein (CRP) and albumin, as well as the CAR, were compared between the two groups to determine whether CAR is a predictor of mortality in elderly patients undergoing hip fracture surgery. The Mini Nutritional Assessment-Short Form was used to evaluate the nutrition status of the patients. The mean age of the 180 participants was 78 years, and 53.3% were female. A statistically significant difference was observed between the two groups in terms of the duration of hospital and intensive care unit stay (p0.15, CAR could predict mortality after geriatric hip fracture surgery with a sensitivity of 74% and a specificity of 53%. The area under the ROC curve (AUC) for CAR was 0.67 (95% confidence interval [CI]: 0.57-0.76, p<0.001). CAR and the time between fracture and surgery were found to be independent predictors of mortality (p=0.003, odds ratio [OR]=1.37 and p=0.044, OR=1.33, respectively). An elevated preoperative CAR is associated with a significantly increased risk of mortality in elderly patients undergoing hip fracture surgery. Additionally, a shorter time to surgery was associated with lower mortality in these patients.

Background and Objectives: The incidence of hip fractures in people of advanced ages is increasing due to our aging society. Patient positioning for the intertrochanteric fractures of the femur can be performed in various ways. The aim of this study is to clinically and radiologically compare the use of the supine hemilithotomy position, the lateral decubitus position, and the traction table when performing proximal femoral nail (PFN) surgery for femoral intertrochanteric fractures in the geriatric age group. Materials and Methods: A total of 170 elderly patients with femoral intertrochanteric fractures were included in this cross-sectional study. The patients were divided into three groups (the supine hemilithotomy group, the lateral decubitus group, and the fracture table group). For the postoperative period, complications, length of stay in the intensive care unit, and length of stay in hospital were examined, while in postoperative radiographs, tip–apex distances (TADs), collodiaphyseal angles (CDAs), and Cleveland–Bosworth quadrants were examined to evaluate the placement of the lag screw in the femoral head. The quality of fracture reduction was evaluated according to the modified Baumgaertner criteria. Results: The mean age of the patients was 77.8 ± 8.8; 57.6% of patients were female. According to the modified Baumgaertner criteria, it was determined that patients with ‘poor’ reduction quality had an approximately ten times higher risk of cut-out than those with ‘good’ reduction quality (OR = 10.111, p = 0.002, 95% confidence interval; 2.313–44.207). The operative time for patients in the fracture table group was longer than that of the other groups Additionally, the CDA in the supine hemilithotomy position group was longer. Conclusions: Although PFN surgery using the traction table is longer in terms of surgical time compared to surgery performed in the lateral decubitus position and the supine hemilitotomy position, it is advantageous in terms of better TAD and CDA values and lower complication rates.

Background: Large language models (LLMs) have shown increasing relevance in clinically supervised decision-support frameworks; however, their performance in orthopedic sports injury scenarios remains unclear. This study aimed to comparatively evaluate the diagnostic, treatment, and rehabilitation recommendations generated by GPT-4o and GPT-5 using standardized clinical scenarios assessed by orthopedic specialists. Methods: Fifteen sports injury–based clinical scenarios were developed and validated by orthopedic specialists with subspecialty expertise in sports traumatology. Each scenario was scored for clinical realism, adequacy of physical examination findings, and adequacy of radiological information using a 7-point Likert scale adapted from AGREE II domains. Both GPT-4o and GPT-5 were prompted using standardized zero-shot instructions, with each scenario submitted three times to assess internal consistency. Two blinded orthopedic specialists evaluated content-level consistency, and five independent orthopedic specialists scored the expert-rated clinical adequacy of AI-generated responses on a 0–5 scale. Inter-rater reliability was assessed using the intraclass correlation coefficient (ICC) and Cohen’s kappa. Results: Specialists rated the clinical scenarios favorably, with 69–72% agreement across domains and ICC values indicating good reliability for clinical realism (ICC = 0.725) and moderate reliability for physical examination (ICC = 0.634) and radiological adequacy (ICC = 0.512). GPT-4o produced consistent outputs in 93.3% of cases, with one scenario showing clinically relevant inconsistency (κ = 0.82). Comparative expert evaluation demonstrated significantly higher scores for GPT-5 (median = 4.60) than GPT-4o (median = 4.00) ( p = 0.007). Inter-rater reliability for AI response scoring was high for both models (ICC = 0.888 for GPT-4o; ICC = 0.895 for GPT-5). Conclusion: GPT-4o and GPT-5 generated responses with generally high expert-rated clinical adequacy and strong consistency in standardized sports injury–related clinical scenarios, with GPT-5 achieving higher scores in expert evaluations. By providing a structured, specialty-specific expert assessment under controlled conditions, this study adds comparative insight into how contemporary large language models are perceived in orthopedic sports injury contexts, without implying objective diagnostic accuracy or autonomous clinical decision-making.

Background and objectives: Supracondylar humerus fractures are common in children and can be surgically treated. However, the general surgical procedures involving reduction and fixation might lead to reduction loss, failure to direct the Kirschner (K)-wire toward the desired position, prolonged surgery, or chondral damage. This study aimed to show that temporary fixation of closed reduction with a fabric adhesive bandage in pediatric supracondylar humerus fractures could maintain reduction so that surgical treatment can be easily performed by a single physician. Materials and Methods: Forty-six patients with Gartland type 3 supracondylar humerus fractures who underwent surgical treatment between May 2017 and June 2018 were retrospectively evaluated. Fluoroscopy-guided reduction and fixation were performed from the distal third of the forearm to the proximal third of the humerus using a fabric adhesive bandage. Two crossed pins were applied on the fracture line by first inserting a lateral-entry K-wire and then inserting another K-wire close to the anterior aspect of the medial epicondyle and diverging from the ulnar nerve tunnel. A tourniquet was not applied in any patient and no patients required open reduction. Results: The study included 32 boys (69.6%) and 14 girls (30.4%) (mean age, 7.1; range, 2–16 years). The mean hospital stay and follow-up duration were 4.3 ± 3.9 days and 48.1 ± 14.3 weeks, respectively. Heterotopic ossification was detected in one patient, and ulnar nerve neuropraxia was detected in another patient. Functional (according to Flynn criteria) and cosmetic outcomes were excellent in 95.6%, moderate in 2.2%, and poor in 2.2% of patients. The mean duration of fixation of the closed reduction with a fabric adhesive bandage was 8.1 ± 3.9 min, and the mean duration of pinning was 7.9 ± 1.4 min. Conclusions: Temporary preoperative fixation of supracondylar humerus fractures that require surgical treatment with a fabric adhesive bandage may be significantly convenient in practice.

BACKGROUND: This study presents a new fluoroscopy-controlled approach in patients with chronic traumatic coccydynia by applying ganglion impar block using the needle-inside-needle technique from the intercoccygeal region without the administration of contrast material. With this approach, the cost and possible side effects of using contrast material can be prevented. In addition, we examined the long-term effect of this method.METHODS: The study was designed retrospectively. The marked area was entered with a 21-gauge needle syringe, and 3 cc of 2% lidocaine was administered subcutaneously by local infiltration. A 25-gauge 90 mm spinal needle was inserted into the guide 21-gauge 50 mm needle tip. The location of the needle tip was controlled under fluoroscopy, and 2 mL of 0.5% bupivacaine and 1 mL of be-tamethasone acetate were mixed and administered.RESULTS: A total of 26 patients with chronic traumatic coccydinia participated in the study between 2018 and 2020. The average procedure time was approximately 3.19 min. The mean time of pain relief of more than 50% was 1.25 +/- 1.22 (1st min-72 h) min. The mean Numerical pain rating scale scores were 2.38 +/- 2.26 at 1 h, 2.50 +/- 2.30 at 6 h, 2.50 +/- 2.21 at 24 h, 3.73 +/- 2.20 at 1 month, 4.46 +/- 2.14 at 6 months 1 and 5.23 +/- 2.52 at 1 year.CONCLUSION: Our study shows that as an alternative in patients with chronic traumatic coccydynia, the long-term results of the needle-inside-needle method from the intercoccygeal region without contrast material are safe and feasible.