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.

This study aimed to compare the clinical outcomes of parallel and orthogonal plating in the surgical treatment of AO/OTA type 13-C distal humerus fractures in patients over 50 years of age and to evaluate the predictive role of local bone quality, measured using Hounsfield Unit (HU), on these outcomes. In this retrospective study, 80 patients over the age of 50 who underwent surgery for AO/OTA type 13-C distal humerus fractures between 2012 and 2022 were analyzed. Patients were categorized into two groups according to the plating technique: parallel(n = 33) or orthogonal(n = 47). Functional and radiological outcomes were compared, including elbow range of motion, Mayo Elbow Performance Score (MEPS), QuickDASH, time to union, complication and reoperation rates, and presence of post-traumatic osteoarthritis. Bone quality was stratified based on HU measurements obtained from preoperative CT scans, specifically from the largest intact slice of the capitellum and trochlea in the sagittal view and from the axial slice just above the proximal fracture line, using a threshold value of 124.5 HU corresponding to the median HU value of the patient cohort. MEPS and QuickDASH were evaluated at the 12-month postoperative follow-up. Orthogonal plating was associated with longer union times (p < 0.001), higher complication rates (p = 0.008), and greater incidence of post-traumatic arthrosis (p = 0.027) compared to parallel plating. Subgroup analysis revealed that in patients with HU ≤ 124.5, orthogonal plating was linked to significantly increased nonunion risk (p = 0.03) and longer union times (p < 0.001), whereas parallel plating yielded more consistent results regardless of bone quality. Nonunion was significantly higher in the HU ≤ 124.5 subgroup (p = 0.031), and particularly more frequent in orthogonal plating within this group (p = 0.04). While both plating techniques provided comparable functional outcomes, orthogonal plating was associated with higher complication and nonunion rates, especially in patients with poor bone quality. This may be attributed to the reduced mechanical stability of orthogonal constructs in osteoporotic bone, which may compromise fixation strength and lead to higher failure rates. HU assessment from routine CT scans may aid in preoperative decision-making to optimize surgical outcomes.

Intraoperative patient positioning for trimalleolar ankle fracture fixation may affect surgical exposure, reduction quality, operative time, and complication rates. To compare the clinical, radiographic, and functional outcomes of trimalleolar ankle fracture fixation performed in the lateral-to-supine, prone-to-supine, and prone positions. Eighty-six patients who underwent open reduction and internal fixation for trimalleolar ankle fractures between 2018 and 2023 were retrospectively reviewed, with a minimum follow-up of 12 months. Patients were categorized according to intraoperative positioning: lateral-to-supine (n = 23), prone-to-supine (n = 28), and prone (n = 35). All procedures were performed by a single experienced orthopedic trauma surgeon using the same fixation system and standardized postoperative protocol. Demographic and perioperative variables, including age, sex, body mass index, smoking status, time to surgery, tourniquet and operative times, and number of fluoroscopic images, were recorded. Radiographic assessments included fibular shortening, medial and posterior step-off, medial clear space, and talar tilt. Complications such as infection, wound problems, implant irritation retained intraosseous hardware, sensory nerve injury, intra-articular screw penetration, nonunion, and reoperation were evaluated. Functional outcomes were assessed using the visual analog scale (VAS) for pain, ankle range of motion, and the American Orthopaedic Foot & Ankle Society (AOFAS) score. Baseline characteristics, including age, BMI, smoking status, and injury laterality, were comparable among groups (all p > 0.05). The prone group required more fluoroscopy (p < 0.001), while the prone-to-supine group had the longest operative time (p < 0.001) and highest infection rate (p = 0.03). The prone group showed greater medial malleolar step-off ≥2 mm and screw joint penetration, resulting in higher revision rates (p = 0.03, 0.04). Postoperative pain scores were lowest in the lateral-to-supine group (p = 0.03). The lateral-to-supine position provides safe, efficient, and reproducible access for trimalleolar ankle fracture fixation, with fewer complications, lower pain, and better radiographic alignment than prone and prone-to-supine positioning.