An 84-year-old male patient with no known comorbidity was admitted to the emergency department with complaints of dyspnea and respiratory distress. The patient was referred to the COVID outpatient clinic, laboratory and radiology tests were performed. Thoracic CT scan of the patient showed large peripheral patchy ground glass densities observed in the lower lobes of both lungs. CT imaging findings were evaluated by an experienced radiologist and reported as COVID-19 pneumonia. The patient, who was self-isolated at home for 5 days, presented to the emergency department again on the fifth day with complaints of respiratory distress, fever, bruising with cough, and loss of peripheral pulse in the left lower extremity. Necessary tests were performed on the patient. An above-knee amputation was performed when a diagnosis of limb ischemic necrosis was made and no revascularization attempt was considered by the CVS department. This case study describes the coexistence of sudden lower extremity thrombosis and Covid-19 in our case without a known chronic disease.

Background/Objectives: Trigger finger is a common cause of hand pain and functional limitation. Although open A1 pulley release remains the standard surgical treatment, ultrasound-guided percutaneous needle release (UGPR) has emerged as a minimally invasive alternative. This study aimed to compare the clinical effectiveness and safety of UGPR with open surgery. Methods: In this prospective, randomized controlled trial, 146 patients with Green stage 2–4 trigger finger were randomly assigned to UGPR (n = 75) or open release (n = 71). Pain (VAS), functional status (QuickDASH), and symptom severity (Nirschl Phase Rating) were assessed preoperatively and at postoperative day 3, 1, 6, and 12 months. Grip strength was measured with a digital pinchmeter, and ultrasonographic evaluation of A1 pulley and flexor tendon thickness was performed preoperatively and at 12 months. Subgroup analyses were conducted to address the imbalance in thumb distribution. Results: Both groups showed significant postoperative improvements in VAS, QuickDASH, and Nirschl scores (p < 0.05 for intragroup comparisons), with no significant differences between groups at 12 months (p > 0.05). At the one-year follow-up, grip strength was significantly greater in the UGPR group (p = 0.008). Ultrasonographic evaluation revealed greater MCP tendon thickness in UGPR, without clinical impact. Subgroup analyses confirmed comparable functional outcomes in thumb-only and non-thumb cases. Four revisions occurred in the UGPR group (incomplete release, recurrent tenosynovitis, flexor tendon rupture, and neurovascular injury), while none were observed in the open group. Conclusions: UGPR and open release provide comparable long-term outcomes in the treatment of trigger finger. UGPR offers the advantages of being minimally invasive and preserving grip strength, although it carries a small risk of incomplete release and procedure-related complications. Patient preference, surgeon expertise, and digit type should guide treatment selection.

Background: The purpose of this study is to describe the macroscopic and radiological changes on the fifth finger related to mobile phone use and to evaluate the effect of size and weight of the device and the average time spent using the smartphone on these morphological alterations. Methods: One-hundred and one patient were included in the study. Age, weight, height, education, mobile phone data and digital photographs used in this cross-sectional study were obtained from interviews with the participants in an outpatient orthopedics clinic setting. Digital photographs of the dorsal aspects of both hands were taken with an iPhone X ® (dual 12-megapixel wide camera). The DIP joint angle of the fifth finger was measured on computer software (Image J® version 1.46, National Institute of Health, Bethesda, MD) separately for digital photographs and AP hand X-rays. Results: The proportion of smartphone usage time over 4 hours was significantly higher in patients with complaints than patients without complaints (p<0.05). The mean time of smartphone use over 4 hours was significantly higher in patients with shape discrepancy than in patients without shape discrepancy (p<0.05). Conclusion: Smartphone use of more than 4 hours per day, regardless of size and weight, can cause deformity of the fifth finger, which may disturb the patient even if it does not cause radiologically changes.

Objective: The primary objective of this study is to compare the quality and readability of patient education materials generated by a general-purpose large language model (ChatGPT-5) versus a guideline-based, fine-tuned model (the Gonarthrosis Advisor). The study aims to quantify the performance gains achieved through domain-specific, fine-tuning, and reinforcement learning using osteoarthritis clinical guidelines. Methods: Thirty frequently asked patient questions regarding knee osteoarthritis were compiled from Google’s “People Also Ask” feature and outpatient clinical observations in May 2025. Responses were generated in Turkish by both the Gonarthrosis Advisor and ChatGPT-5 to reflect real-world patient education materials. Content quality was assessed by 2 independent orthopedic surgeons who were blinded to model identity to minimize bias. Both reviewers were co-authors of the article yet did not participate in model construction or data analysis. The assessments utilized the DISCERN instrument, a validated 16-item measure for evaluating the reliability and quality of treatment-related information. Readability was analyzed using the Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease Score (FRES), and Turkish specific indices (Ateşman and Çakır-Demir). For comparability, English-based indices were applied to translated versions of the responses, whereas Turkish indices were applied to the original texts. All responses were anonymized and randomized prior to evaluation. Model identifiers were removed, and each response was presented in a standardized format to ensure blinding of reviewers. Inter-rater reliability was measured using Cronbach’s α. Normality assumptions were tested, and Wilcoxon signed-rank tests were used for statistical comparisons. As no human subjects or personal data were involved, ethical approval was not required. Results: Mean DISCERN scores corresponded to the “good” category (66.4) for the Gonarthrosis Advisor and the ‘moderate’ category (54.2) for ChatGPT-5, according to established cut-off thresholds. The Gonarthrosis Advisor achieved significantly higher DISCERN scores than ChatGPT-5 (66.4 ± 4.8 vs. 54.2 ± 5.6; P < .001) with high inter-rater reliability (Cronbach’s α = 0.86). Readability metrics favored the Gonarthrosis Advisor across all indices: lower FKGL (7.8 ± 0.7 vs. 9.6 ± 0.9) and higher FRES (54.3 ± 3.4 vs. 46.7 ± 3.7), Ateşman (92.0 ± 4.2 vs. 84.3 ± 4.9), and Çakır-Demir (111.7 ± 5.1 vs. 106.9 ± 5.4) scores (all P <.001). Conclusion: Fine-tuning large language models with guideline-based content and reinforcement learning improves the quality, neutrality, and accessibility of artificial intelligence–generated patient education materials, offering a scalable tool to enhance health literacy and support shared decision-making in knee osteoarthritis care. Cite this article as: Öner SK, Demirkiran ND, Canlı EA, Bilir A. Gonarthrosis Advisor vs ChatGPT-5: quality and readability of AI–generated patient education for knee osteoarthritis. Acta Orthop Traumatol Turc., 2026, 60(2), 0618, doi: 10.5152/j.aott.2026.25618.

Protez eklem enfeksiyonları kalça ve diz artroplastisi sonrası sık görülen bir komplikasyon olup Pasteurella cinsi bakterilere bağlı olarak nadir de olsa karşımıza çıkmaktadır. Özellikle bağışıklığı baskılanmış ve hayvanlarla yakın teması bireylerde ortaya çıkan bu enfeksiyonlar hakkında literatürde yeterli düzeyde çalışma yoktur. Bu derleme çalışmasında, Pasteurella cinsi bakterilere bağlı gelişen protez eklem enfeksiyonları konusunda literatürün derlemesini ve uygulanan tedaviler ile tedavi sonuçlarının gözden geçirilmesi amaçlandı.