Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.

Background/Objectives: Over the past 25 years, reconstructive techniques and patient management advancements have significantly improved outcomes in mangled lower extremity injuries. Functional results of limb salvage have been demonstrated to surpass those of primary amputations. Developments such as local fasciocutaneous flaps, vacuum-assisted closure, and hyperbaric oxygen therapy have enhanced the reconstructive ladder. Despite progress, the utility of the Mangled Extremity Severity Score (MESS) and Gustilo–Anderson classification remains debated, particularly in their prognostic value for limb salvage decisions. In the study, we aimed to evaluate the outcomes of optimizing mangled lower extremity reconstruction in 93 patients, focusing on their functional scores retrospectively. Methods: This retrospective study analyzed 93 patients treated for mangled lower extremities between January 2015 and October 2022. Patients were assessed for age, gender, injury location, MESSs, Gustilo–Anderson classifications, surgical methods, and functional outcomes using the Lower Extremity Functional Scale (LEFS). Surgical interventions included internal and external fixation, skin grafts, local flaps, muscle flaps, and free tissue transfer. LEFS scores were categorized into disability levels for functional evaluation. Correlations were drawn between LEFS and variables such as MESS, Gustilo–Anderson types, and nerve injuries. Results: Among the 93 patients, 16 had MESSs ≥ 7, and 77 had MESSs < 7. Reconstruction methods included local fasciocutaneous and muscle flaps (37 patients), free tissue transfer (29 patients), and skin grafting with vacuum-assisted closure (27 patients). Smoking was associated with delayed union and increased infection rates. LEFS scores were significantly lower in patients with MESSs ≥ 7, Gustilo grade 3C fractures, and tibial nerve injuries. Flap failures and a higher number of surgeries (>3) also correlated with poorer functional outcomes. The average soft tissue healing time was 18 days, and bone union time was 17 weeks. Conclusions: Lower extremity reconstruction demands precise surgical planning and execution, prioritizing functional restoration. MESSs and Gustilo–Anderson classifications provide practical frameworks but have limitations in predicting long-term functionality. Factors such as joint involvement, nerve injuries, and flap selection significantly influence outcomes. Smoking and delayed healing remain critical challenges. While free flaps are essential for complex defects, more straightforward methods yield better outcomes in suitable cases. LEFS emerged as a reliable tool.

Dünya genelinde en önde gelen ölüm ve sakatlık sebepleri arasında yer alması sebebiyle halk sağlığını tehdit eden travma ile Ortopedi ve Travmatoloji ailesi olarak ön saflarda mücadele etmekteyiz. Bu alanda bugün ki mesleki uygulamalarımız ve yaklaşımlarımıza ulaşmamızda bizlere öncü olan büyüklerimizin tecrübelerine duyduğumuz minnet sonsuzdur. Tüm bu bilgi birikimine bir nebze katkıda bulunmuş olmak en büyük hedefimizdir. Ortopedi ve Travmatoloji uzmanlık eğitiminde yol gösterici olmasını istediğimiz bu eser; bilgilerimizin ve deneyimlerimizin güncel literatür ışığında bir derlemesidir.

Background: Failed first metatarsophalangeal (MTP) joint surgery with bone loss is a challenging revision problem. This study aimed to evaluate the radiographic and clinical outcomes of iliac crest bone-block arthrodesis in this setting. Methods: This retrospective cohort included 72 patients who underwent revision first MTP arthrodesis with tricortical iliac crest autograft between 2018 and 2022. All patients had at least 2 years of clinical and radiographic follow-up, and 83.3% had at least 3 years of follow-up. Fusion rates, complications, and changes in visual analog scale (VAS) and 36-Item Short Form Health Survey (SF-36) scores were recorded; the influence of age, comorbidities, and graft length was explored. Results: The median time from the index procedure to revision was 24 months, and the median graft length 11 mm. Primary radiographic union was achieved in 67 of 72 patients (93.1%); after secondary grafting in 3 additional patients, final radiographic union was 70 of 72 (97.2%), with persistent nonunion in 2 patients (2.8%); 44.4% had at least 1 complication and 6.9% required further surgery. Median VAS improved from 8 (7.8-9.0) preoperatively to 0 (0-1.0) at 24 months, and SF-36 improved from 55 (50-62) to 88 (82-90). Exploratory analyses suggested that systemic comorbidities and longer graft length were associated with less favorable pain and functional outcomes. Conclusion: Iliac crest bone-block arthrodesis may be an acceptable salvage option after failed first MTP joint surgery with bone loss, achieving a high radiographic union rate and meaningful clinical improvement; however, postoperative complications were frequent, and outcomes were less favorable in patients with systemic comorbidities or larger structural defects. Level of Evidence: Level IV, non-comparative retrospective cohort

BackgroundHallux valgus interphalangeus is a valgus deformity of the distal phalanx at the interphalangeal joint of the great toe. Although frequently observed in adults, particularly in association with hallux valgus, its presence in the pediatric population remains rarely described in the literature. The etiopathogenesis of HVI is multifactorial, with proposed causes including congenital anomalies, physeal arrest, osteochondral trauma, and abnormal tendon insertions. A hallux interphalangeal angle (HVIA) exceeding 10° is typically considered pathological.PurposeThis study aims to present two pediatric cases of idiopathic hallux valgus interphalangeus - one of which represents the first reported case of bilateral adolescent hallux valgus interphalangeus - and to provide a comprehensive review of the literature to define diagnostic criteria, outline radiological measurement standards, and evaluate current treatment modalities for hallux valgus interphalangeus across all age groups.MethodsA systematic literature review was conducted using the PubMed/MEDLINE database up to January 2025, identifying 59 articles, of which 37 were included based on strict eligibility criteria. Studies were categorized into four thematic groups: radiologic assessment, adult clinical studies, pediatric cases, and individual case reports.ResultsRecent literature underscores the importance of accurate radiographic assessment using standardized angles, such as the hallux interphalangeal angle, proximal phalangeal articular angle, and proximal distal phalangeal articular angle, with hallux valgus interphalangeus being observed even in asymptomatic patients. Conservative treatment remains the initial approach; however, surgical correction - most commonly via Akin osteotomy - is indicated in symptomatic or progressive cases. In pediatric patients, growth plate preservation is essential, and procedures such as epiphysiodesis or physeal-guided correction may be considered in selected cases.