This study investigates the automated detection of enchondromas, benign cartilage tumors, from x‐ray images using deep learning techniques. Enchondromas pose diagnostic challenges due to their potential for malignant transformation and overlapping radiographic features with other conditions. Leveraging a data set comprising 1645 x‐ray images from 1173 patients, a deep‐learning model implemented with Detectron2 achieved an accuracy of 0.9899 in detecting enchondromas. The study employed rigorous validation processes and compared its findings with the existing literature, highlighting the superior performance of the deep learning approach. Results indicate the potential of machine learning in improving diagnostic accuracy and reducing healthcare costs associated with advanced imaging modalities. The study underscores the significance of early and accurate detection of enchondromas for effective patient management and suggests avenues for further research in musculoskeletal tumor detection.

Background and Objectives: The primary objective of surgeons treating bone and soft tissue sarcomas (STS) is to achieve optimal local tumor control, ensuring a tumor-free margin and preventing local recurrence. However, the impact of surgical resection margin status on extremity STSs remains an area that requires further exploration. Therefore, this study aims to investigate the effects of surgical resection margin status on both local recurrence and overall survival rates. Materials and Methods: One hundred and eighty-five patients who underwent surgical resection with a diagnosis of soft tissue sarcoma were studied. The study recorded patient demographics, tumor characteristics, surgical margin distance (in millimeters), and disease-related outcomes. Results: The minimum follow-up period was 24 months (24–168). The mean time to local recurrence after resection was 103.2 months (95% CI 91.73 to 114.64). The mean local recurrence-free survival was found to be 7.23 months in patients with positive surgical margins, 87.42 months in patients with ≤1 mm, and 139.80 months in patients with >1 mm (p < 0.001). Patients with surgical margins ≤1 mm were more likely to have local recurrence than patients with >1 mm (0.41 [0.21–0.81], p = 0.010). The mean overall survival was 106.72 months (95% CI 95.98 to 117.46). Positive surgical margins were associated with decreased overall survival (3.58 [1.46–8.80], p = 0.005). There was a statistically significant difference between the histologic grade in terms of local recurrence (4.50 [95% CI 2.57 to 7.88]; p < 0.001) and overall survival (3.12 [95% CI 1.52 to 6.41]; p = 0.002). Conclusions: Achieving a negative surgical margin distance of more than 1 mm appears to be correlated with a reduced risk of local recurrence. Positive surgical margins are a risk factor that detrimentally impacts overall patient survival. However, determining the appropriate margin distance for all patients poses a significant challenge.

Background and Objective: Tenosynovial giant cell tumors (TGCTs) are benign but potentially aggressive soft-tissue tumors, most commonly affecting the hand and frequently associated with local recurrence despite surgical treatment. While positive surgical margins are recognized as the strongest predictor of recurrence, the preoperative identification of factors influencing margin status remains underexplored. This study analyzed the risk factors associated with surgical margin positivity and local recurrence in patients treated for localized hand TGCTs, contributing to more accurate preoperative risk stratification. Materials and Methods: A retrospective analysis was conducted on 44 patients diagnosed with localized TGCTs of the hand and treated surgically at a tertiary regional hospital between 2009 and 2023. Demographic characteristics, tumor size and location, anatomical relationships (bone, joint, and neurovascular proximity), Al Qattan classification, and surgical outcomes were recorded. Binary logistic regression was used to evaluate the impact of these variables on surgical margin status and recurrence. Postoperative satisfaction was assessed using a four-choice questionnaire. Results: The mean patient age was 47.5 years, with 68.2% being female. The most common tumor site was the second finger (31.8%), and 20.5% of patients had positive surgical margins. Recurrence occurred in four patients (9.1%). Bone invasion, interphalangeal joint proximity, neurovascular involvement, and Al Qattan type 2 tumors were statistically significant risk factors for both surgical margin positivity and recurrence. Lesions with periosteal involvement, however, did not significantly impact recurrence risk. Among patients with positive margins, 44.4% developed recurrence. Conclusions: Complete surgical excision with clean margins remains the cornerstone of TGCT management. This study uniquely identifies preoperative predictors of margin positivity—key contributors to recurrence—highlighting the importance of meticulous surgical planning in high-risk cases. Close postoperative follow-up is essential, particularly for patients with positive margins, to detect and manage recurrence promptly.

The terrible triad of the elbow consists of radial head fracture and coronoid process fracture in addition to posterior dislocation of the elbow. It indicates high-risk complications such as instability, malunion, nonunion, and proximal radioulnar synostosis. We describe a rare case that was admitted to the emergency service with a terrible triad of the elbow with additional capitellum fracture, lateral collateral ligament (LCL) injury, and ipsilateral humeral shaft fracture. We treated the patient urgently by performing osteosynthesis of the humeral shaft fracture, radial head fracture, coronoid fracture, capitellum fractures, and repair of the LCL rupture. The terrible triad of the elbow also can be accompanied by adjacent column fractures, including the humeral shaft. In such complex cases, preoperative planning should be done well, and the entire anatomy should be demonstrated with additional imaging. Optimal treatment of all the fractured bones and ligaments is critical for early rehabilitation. The main aim of surgery is to acquire desired results by starting an early rehabilitation, including joint movement.

Open (incisional) biopsies have long been accepted as the gold standard in diagnosing bone and soft tissue tumors. However, the main disadvantage of this method is that it can lead to increased contamination, hematoma, infection, and pathological fracture. Compared to open biopsies, percutaneous core needle biopsies are less invasive, do not require hospitalization, have low costs and low complication rates, and there is no need for wound healing in cases that require radiotherapy. This study evaluated the diagnostic accuracy and reliability of percutaneous core needle biopsy. The study included the results of 250 percutaneous core needle biopsies of 244 patients who presented at the tertiary university hospital between September 2012 - September 2022 and were diagnosed with a bone or soft tissue tumor using the percutaneous core needle biopsy method and then underwent surgical excision in the Orthopaedics and Traumatology Clinic. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy rates were calculated for the percutaneous core needle biopsy method according to the compatibility of the results. A fluoroscopy-guided percutaneous Jamshidi needle biopsy performed by an orthopedist for lesions originating from the bone has a diagnostic accuracy of 96%. CT-guided percutaneous Jamshidi needle biopsy performed by a radiologist for lesions originating from the bone has a diagnostic accuracy of 88.9%. Percutaneous Tru-cut needle biopsy performed by an orthopedist without imaging guidance for lesions originating from soft tissue has a diagnostic accuracy of 92%. USGguided percutaneous Tru-cut needle biopsy performed by a radiologist for lesions originating from soft tissue has a diagnostic accuracy of 96,7% (p<0.001). The diagnostic accuracy of open biopsies ranges from 91% to 99% in the literature. Additionally, the diagnostic accuracy of core needle biopsies in recent studies ranges from 76% to 99%. Compared to the literature, our study has shown that biopsies performed by orthopedic specialists have a high diagnostic power (96% for bone-derived lesions; 92% for soft tissue-derived lesions). Percutaneous core needle biopsy is highly effective and reliable in diagnosing bone and soft tissue tumors. Managing patients by a team using a multidisciplinary approach will increase diagnostic success. core needle biopsy, percutaneous, diagnostic accuracy, radiology guided biopsy, bone and soft tissue tumors.

Aim: Frozen shoulder, characterized by synovial inflammation and joint capsule fibrosis, impacts shoulder mobility and comfort. With the rise of online health information seekers, assessing the credibility of YouTube videos on frozen shoulder is crucial. This study aims to explore potential differences between physician and non-physician contributors by assessing the quality of Youtube videos using the DISCERN and JAMA scoring systems. Methods: The first 50 YouTube videos found by searching with the word "Frozen shoulder" were examined; Short, repetitive titles and non-English content were not included in the study. Videos were categorized by content type, uploader, and key metrics of the videos were recorded. Two observers independently scored the videos using DISCERN and JAMA systems.Statistical analysis was performed, including Mann-Whitney tests and Spearman correlation.. Results: While 45 of the 50 videos contained real images, 5 were animations. Physiotherapists were the most contributing group (40%), and 60% of the videos contained general information about frozen shoulder. Considering the average DISCERN and JAMA scores, videos were mostly rated poor in quality. No statistically significant differences were found between the videos uploaded by physicians and non-physicians. Observer agreement was excellent. Conclusion:Internet users searching for information about frozen shoulder face difficulties in distinguishing reliable content. Healthcare professionals should share videos with accurate information and direct patients to reliable online resources..