Introduction: The development of fracture gap during intramedullary nailing in tibial fractures is associated with poor fracture fragment contact and increased time to union and complications. This study aimed to evaluate the effect of the fracture level in the development of the fracture gap and the effect of the fracture gap on pain, radiologic and functional outcomes, and complication rate. Material and method: A total of 45 patients who underwent reamed intramedullary nailing due to closed transverse or short oblique tibial shaft fractures were divided into the proximal fracture group and the distal fracture group. The correlations between the visual analog scale (VAS) score, modified radiograph union score for tibias (RUST), and postoperative 1-year lower extremity functional scale scores, residual fracture gap, and time to union were evaluated. Results: The mean fracture gap amounts in the immediate postoperative anteroposterior and lateral radiographs were 5.6 ± 1.7 and 6.0 ± 1.7 mm in proximal fractures and 0.3 ± 2.4 mm and 0.4 ± 2.3 mm in distal fractures, respectively (p < 0.001 and p < 0.001, respectively). The mean time to union was 21.9 ± 2.9 weeks in the proximal fracture group and 16.7 ± 2.4 weeks in the distal fracture group (p < 0.000). The residual fracture gap amount significantly correlated with the level of fracture (r = 0.811, p < 0.001). Discussion: Tibial shaft fractures proximal to the isthmus level tend to develop significantly larger fracture gaps than distal fractures. It is associated with increased time to union and radiographic union scores as well as slightly higher complication and reoperation rates.

Objective: Anterior cruciate ligament (ACL) rupture is a potentially career-threatening injury in professional athletes. This study aimed to evaluate the epidemiology and injury characteristics of ACL rupture of male football players participating in the Turkish Super League. Materials and Methods: Epidemiologic characteristics of professional male football players participating in the professional first division Turkish Super League in 10 consecutive seasons were evaluated through a publicly available online soccer archive. Exposures in matches, as well as training, were calculated. Results: A total of 100 ACL injuries were included (mean age at the time of injury: 25.2±3.9). Of these, 13% were re-rupture and 11% were contralateral rupture. The ACL incidence rate was 0.4060 per 1000 hours of play during Super League matches, 0.0801 per 1000 hours of training (rate ratio [RR], 5.06; 95% CI, 3.25-11.84; p<0.001), and 0.0622 per 1000 hours of total play. Although there was a regular number in other periods, the most frequent injury was in August. Also, training injuries peaked in July. A significantly higher incidence rate was found for the teams ranked from 1^st to 5^thplace compared with teams ranked 6^th to 18^th (0.0654 vs 0.0317 per 1000 hours of training; RR, 2.06; 95% CI, 1.44-3.65; p<0.05). A similar finding was found for total injury incidence proportion (2.17% vs 1.36%; p<0.05). Conclusion: Epidemiologic data is important as a resource for athletes and those responsible for their health to develop appropriate training and preparation programs to reduce the risk of ACL injury.

Complex proximal ulna fracture dislocations include Monteggia-like fractures and transolecranon fracture dislocations. Since 2011, we introduced a structured classification and treatment algorithm for these fractures in a Swiss teaching hospital, considering ligamentous structures, the coronoid process, and the radial head. This classification, named the Montecranon classification (MC), was validated by users with varying experience levels through a retrospective clinical analysis. All consecutive patients treated for a complex proximal ulnar fracture dislocation between 2011 and 2022 were retrospectively analyzed. Fractures were classified according to the Bado, Jupiter, Mayo, and the new MC. For the clinical study, patients treated according to the MC were retrospectively analyzed including final range of motion, EuroQol 5-Dimensions-5-Levels Score, Quick DASH, Mayo Elbow Performance Score, analysis of complications/revisions, and radiographic assessment for posttraumatic arthritis. Patients included had at least one year of clinical and radiographic follow-up. For validation, 22 randomly selected cases were sent to 4 elbow experts, 3 young consultants, and 3 novice doctors. Of 43 patients (mean 55 years, range: 19-87) who suffered a complex proximal ulnar fracture dislocation, 30 patients met the inclusion criteria. Four patients (13%) had a transolecranon fracture dislocation, and 26 patients (87%) had a Monteggia-like fracture. The mean follow-up was 4.2 years (range: 1-10). At the final follow-up, the mean flexion-extension arc was 126° (range: 40-155), the mean Mayo Elbow Performance Score was 93 points (range: 70-100), and the mean qDASH was 19 points (range: 0-82). A total of 21 patients (70%) needed a secondary surgery after a mean of 364 days (range: 7-883). Whereof, hardware removal was performed in 12 (57%) patients. A significant correlation was found between decreased final range of motion and higher grade of MC fracture type. The interobserver correlation for MC was moderate for novice doctors and young consultants (kappa = 0.63 and 0.55) and poor for elbow experts (0.47). The intraobserver correlation was moderate to good in all groups (kappa = 0.76, 0.53, and 0.76). All participants found the MC helpful (22%) to very helpful (78%) for understanding the fracture and planning ORIF. The MC with special attention to involvement of ligamentous structures, the coronoid process, and the radial head, as well as an associated structured reduction technique, is helpful for the management of complex proximal ulna fracture dislocations. Despite the high rate of secondary surgeries, the final clinical outcome may lead to good to excellent results in 90% of the cases. However, young surgeons with less experience seemed to profit more from this classification than experts.

Developmental hip dysplasia is a common cause of hip arthrosis in young adults, necessitating total hip arthroplasty (THA) for improved function and pain relief. In cases of high-riding hips, transverse femoral shortening osteotomy is often required to facilitate reduction and prevent neurovascular complications. However, the choice of femoral stem in such cases remains controversial due to variations in design and osteoconductive properties. This study aimed to compare the clinical and radiological outcomes of three different femoral stems used in THA with transverse femoral shortening osteotomy. A retrospective cohort study was conducted on 107 patients who underwent THA with transverse femoral shortening osteotomy between 2004 and 2014. Patients were divided into three groups based on the femoral stem used: Group 1 (Summit Tapered Stem (Depuy®) (n = 39), Group 2 (SL-PLUS Rectangular Stem (Smith & Nephew®) (n = 31), and Group 3 (Wagner Cone Prosthesis (Zimmer®) (n = 37). Clinical outcomes were assessed using the Harris Hip Score (HHS), and radiological evaluations included osteointegration and union rates. One-way ANOVA was used to compare continuous variables among groups, and post-hoc Tukey’s HSD test was applied for pairwise comparisons. Kaplan-Meier survival analysis was performed to evaluate implant survivorship. The mean preoperative HHS significantly improved from 42.7 ± 6.7 to 84.6 ± 11.5 postoperatively (p < 0.001). Group 3 had significantly higher final HHS compared to Group 1 (p = 0.0002), while no significant differences were observed between Group 1 and Group 2 (p = 0.1947) or Group 2 and Group 3 (p = 0.0723). The overall 10-year survival rate was 87.8%, with Group 3 demonstrating the highest survivorship (91%) and Group 2 the lowest (83%). Intraoperative femoral fissure or fracture rates were significantly higher in Group 1 compared to Group 3 (p = 0.0006), and with a significantly increased need for additional plating in Group 1 (p = 0.0031). This study suggests that cylindrical fully porous-coated femoral stems (Wagner Cone Prosthesis) provide better clinical outcomes, fewer intraoperative complications, and higher long-term survival rates compared to tapered and rectangular stems in THA with femoral shortening osteotomy. These findings highlight the importance of implant selection in optimizing patient outcomes. Not applicable.