Background and Objectives: Lateral epicondylitis, commonly known as tennis elbow, is a prevalent condition characterized by pain and tenderness over the lateral epicondyle. Various treatment options, including corticosteroids, platelet-rich plasma (PRP), and saline injections, are utilized, yet their comparative efficacy remains unclear. Hypothesis: This study hypothesizes that PRP injections result in superior functional and clinical outcomes compared to corticosteroid and saline treatments, as assessed by clinical scoring systems and radiological findings. Materials and Methods: The study enrolled patients aged 18 years and older with pain and tenderness over the lateral epicondyle persisting for at least three months and no prior treatment. Patients with comorbidities affecting the upper extremity were excluded. Fifty-five elbows from 50 patients were randomized into three groups (glucocorticoid, PRP, and saline). Functional outcomes were assessed using the Visual Analog Scale (VAS), Patient-Rated Tennis Elbow Evaluation (PRTEE), and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Radiological evaluations included vascularity and superb microvascular imaging (SMI) indices via ultrasonography before injection and three months post-injection. Results: Fourteen patients were lost to follow-up, leaving 36 patients (36 elbows, 16 males and 20 females; mean age 42.4 ± 6.15 years) for analysis. The glucocorticoid group included 13 elbows, PRP group 14 elbows, and saline group 14 elbows. Baseline functional and radiological scores were similar across groups. At three months, PRP and glucocorticoid groups showed no significant differences in VAS scores (p = 0.7), but PRP outperformed both of the other groups in DASH and PRTEE scores, with the saline group performing the worst (p < 0.001). PRP consistently achieved the best outcomes at both three and six months. Radiological assessments revealed no significant group differences in vascularity or SMI indices (p = 0.3 and p = 0.2, respectively). Conclusions: PRP treatment demonstrated superior functional outcomes in early and mid-term evaluations compared to glucocorticoid and saline. However, ultrasonographic measures of vascularity and SMI did not correlate with functional outcomes. Clinical Relevance: PRP offers a promising treatment option for lateral epicondylitis, with superior functional improvements over other commonly used injections. Radiological assessments of vascularity and SMI may not reliably predict clinical outcomes.

Background and Objectives: Adolescent idiopathic scoliosis (AIS) may influence pelvic orientation and lower-limb alignment; however, data on coronal lower-limb alignment after completion of spinal treatment remain limited. This study aimed to evaluate lower-limb radiographic alignment in AIS patients after spinal treatment and to determine whether these parameters differ according to main curve location. Materials and Methods: In this retrospective study, 70 AIS patients treated surgically (n = 52) or with brace therapy (n = 18) between 2010 and 2020 were analyzed. Patients were grouped according to main curve location as thoracic (n = 28), lumbar (n = 21), or thoracolumbar (n = 21). Pre-treatment standing full-spine radiographs were used to assess Cobb angle, coronal balance, and pelvic coronal obliquity angle (PCOA). After completion of spinal treatment, full-length weight-bearing lower-limb radiographs were evaluated for femoral and tibial lengths, mechanical axis deviation (MAD), femoral neck–shaft angle (NSA), anatomical lateral distal femoral angle (aLDFA), and mechanical lateral distal femoral angle (mLDFA). Additional treatment-stratified, treatment-adjusted, and threshold-based analyses were performed. Results: PCOA, coronal balance, bilateral MAD, right aLDFA, and right mLDFA differed significantly among the three curve-location groups. The lumbar group demonstrated more negative MAD values than the thoracic group, indicating a tendency toward valgus alignment (right MAD: −5.88 ± 8.8 mm vs. 3.65 ± 7.9 mm, p = 0.004; left MAD: −3.5 ± 7.5 mm vs. 3.75 ± 7.0 mm, p = 0.005). After adjustment for treatment modality, age, and main Cobb angle, curve location remained significantly associated with right MAD, left MAD, right aLDFA, and right mLDFA. However, the proportion of patients with clinically relevant malalignment, defined as MAD exceeding ±10 mm in at least one limb, did not differ significantly among the groups. Conclusions: AIS patients show subtle but measurable differences in coronal lower-limb alignment after completion of spinal treatment. Lumbar and thoracolumbar curves are associated with greater pelvic obliquity and a tendency toward more valgus mechanical-axis alignment, whereas limb lengths and NSA remain comparable among curve-location groups. These findings appear to represent mainly radiographic or biomechanical variations rather than overt clinically relevant deformity in most patients.

Objectives: We aimed to compare clinical and functional results of treatment of scaphoid pseudoarthrosis between patients undergoing wide-awake local anesthesia no tourniquet (WALANT) versus axillary block anesthesia. Methods: The patients diagnosed with scaphoid non-union who underwent pseudoarthoris surgery were divided into WALANT group ( n = 12) and axial block group ( n = 11). Visual analog scores (VAS) were measured by calling the patients via phone on postoperative days 1, 2, 3, and 7. The VASs were also measured on the 14^th day during patient check-ups. At the end of 12 months, Michigan Hand Questionnaire was used to assess clinical recovery. Bone union rate and surgery time were also investigated. Radiological and clinical examinations were compared between the groups. Results: Eleven patients (91.7%) in the WALANT group and 10 patients (90.9%) in the axillary block group achieved bone union ( P = .94). Although there was no significant difference in preoperative VAS score between the groups, the WALANT group had significantly lower VAS score of the first 3 days postoperatively. However, there was no significant difference in VAS score between the groups on the seventh and 14^th day postoperatively. There was no significant difference between the groups regarding Michigan score, time to surgery, time to union and operation time. Conclusion: The scaphoid pseudoarthrosis surgery can be done safely with WALANT technique which has significant lower VAS score on the first 3 days postoperatively.

Background: Adolescent idiopathic scoliosis (AIS) may influence pelvic orientation and lower limb alignment, but data after completion of spinal correction are limited . Methods: In this retrospective study, 70 consecutive AIS patients (61 females, 9 males; mean age 17.0 ± 3.2 years, range 13–30 years) treated surgically (n = 52) or with brace therapy (n = 18) between 2010 and 2020 were analyzed. Patients were grouped by main curve location as thoracic (n = 28), lumbar (n = 21) or thoracolumbar (n = 21). Pre treatment standing full spine radiographs were used to measure Cobb angles, coronal balance and pelvic coronal obliquity angle (PCOA). After completion of spinal correction, full length weight bearing lower limb radiographs were obtained to assess femoral and tibial lengths, mechanical axis deviation (MAD), femoral neck–shaft angle (NSA), and distal/proximal femoral mechanical and anatomical angles. Results: Mean PCOA for the whole cohort was 2.3 ± 1.9°, and mean MAD was −0.41 ± 10.2 mm on the right and −0.7 ± 8.0 mm on the left. PCOA, coronal balance, MAD, right anatomical lateral distal femoral angle (aLDFA) and right mechanical lateral distal femoral angle (mLDFA) differed significantly among the three groups (p<0.05). Thoracolumbar versus thoracic curves showed higher PCOA and greater coronal imbalance (p = 0.011 and p = 0.004). The lumbar group demonstrated bilateral valgus alignment with more negative MAD values than the thoracic group (right MAD −5.88 ± 8.8 mm, left MAD −3.5 ± 7.5 mm; p = 0.004 and p = 0.005). The thoracic group had higher right aLDFA and mLDFA than lumbar and thoracolumbar groups (all p0.05) Conclusions: After spinal correction, AIS patients show subtle but measurable differences in coronal lower limb alignment according to curve location. Pelvic obliquity and MAD are more pronounced in lumbar and thoracolumbar curves, whereas limb lengths and NSA remain comparable among groups. These small deviations may influence long term load distribution and should be considered in the clinical assessment of AIS, particularly in patients with distal curve patterns.

Background: Lateral epicondylitis, commonly known as tennis elbow, is a prevalent condition characterized by pain and tenderness over the lateral epicondyle. Various treatment options, including corticosteroids, platelet-rich plasma (PRP), and saline injections, are utilized, yet their comparative efficacy remains unclear. Hypothesis: This study hypothesizes that PRP injections result in superior functional and clinical outcomes compared to corticosteroid and saline treatments, as assessed by clinical scoring systems and radiological findings. Methods: The study enrolled patients aged 18 years and older with pain and tenderness over the lateral epicondyle persisting for at least three months and no prior treatment. Patients with comorbidities affecting the upper extremity were excluded. Fifty-five elbows from 50 patients were randomized into three groups (glucocorticoid, PRP, saline). Functional outcomes were assessed using the Visual Analog Scale (VAS), Patient-Rated Tennis Elbow Evaluation (PRTEE), and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Radiological evaluations included vascularity and superb microvascular imaging (SMI) indices via ultrasonography before injection and three months post-injection. Results: Fourteen patients were lost to follow-up, leaving 36 patients (36 elbows, 16 males, and 20 females; mean age 42.4 ± 6.15 years) for analysis. The glucocorticoid group included 13 elbows, PRP group 14 elbows, and saline group 14 elbows. Baseline functional and radiological scores were similar across groups. At three months, PRP and glucocorticoid groups showed no significant differences in VAS scores (p=0.7), but PRP outperformed both other groups in DASH and PRTEE scores, with the saline group performing worst (p< 0.001). PRP consistently achieved the best outcomes at both three and six months. Radiological assessments revealed no significant group differences in vascularity or SMI indices (p=0.3 and p=0.2, respectively). Conclusion: PRP treatment demonstrated superior functional outcomes in early and mid-term evaluations compared to glucocorticoid and saline. However, ultrasonographic measures of vascularity and SMI did not correlate with functional outcomes.

Background/Objectives: Humeral head osteonecrosis is a recognised complication following locked plate fixation of complex proximal humeral fractures, yet the clinical relevance of necrotic lesion extent remains poorly characterised. This study aimed to quantify MRI-defined osteonecrosis extent and examine its associations with radiographic severity, shoulder motion, and functional outcomes. Methods: Twenty-five patients with Neer three- or four-part proximal humeral fractures treated by locked plate fixation between 2010 and 2022 were retrospectively reviewed. Active shoulder range of motion, Constant score, American Shoulder and Elbow Surgeons (ASES) score, and visual analogue scale (VAS) pain were assessed at final follow-up. Osteonecrosis severity was graded using the Cruess classification. MRI necrotic extent was quantified with a modified angle-based method on coronal and axial images; associations with outcomes were assessed by linear regression. Results: At a mean follow-up of 85.4 ± 34.1 months, osteonecrosis was identified in 12 of 25 patients (48%). Patients with osteonecrosis demonstrated significantly lower shoulder abduction (96.7 ± 27.1° vs. 121.8 ± 29.2°; p = 0.031), internal rotation (48.3 ± 15.9° vs. 66.4 ± 15.5°; p = 0.014), and external rotation (36.7 ± 16.7° vs. 51.8 ± 26.4°; p = 0.041) than those without. Functional outcome scores did not differ significantly between groups. Greater total necrotic angle was associated with higher radiographic Cruess stage and reduced shoulder abduction (β = −0.141; 95% CI −0.259 to −0.024; p = 0.020). Conclusions: MRI-defined osteonecrosis extent correlates with radiographic severity and reduced shoulder motion after locked plate fixation of proximal humeral fractures. Larger necrotic lesions are associated with decreased shoulder abduction, whereas no clear relationship was identified between necrotic extent and global functional outcome scores. Quantitative MRI assessment may provide additional clinically relevant information on the structural severity of post-traumatic humeral head osteonecrosis.