Aim: Intertrochanteric femur fractures (IFF) are a major cause of morbidity and mortality in the elderly population. Proximal femoral nail-anti-rotation (PFNA) is one of the most preferred surgical treatment methods. This study aimed to compare the clinical and radiologic results of two different patient positions used during PFNA and to reveal the intraoperative advantages and disadvantages. Material and Method: Cases operated due to IFF between January 2020 and December 2022 were retrospectively analyzed. The study was conducted with 123 patients meeting the inclusion criteria. The minimum follow-up period was determined as one year. Two groups were formed: those operated on the traction table (opereted-TT) and those operated in supine lithotomy without traction table (operated-SP). The groups were compared regarding operative time, reduction quality, type-apex distance (calTAD), and radiologic and clinical results. Results: There were 76 patients in the operated-TT group and 47 in the operated-SP group. The mean age of the operated-TT group was 81.00±8.52 years, and the mean age of the operated-SP group was 79.30±8.12 years. (p=0.213) Gender, follow-up time, time from trauma to surgery, and fracture classification were similar for the groups. The mean operative time was 95.18±8.54 minutes in the operated-TT group and 88.23±7.12 minutes in the operated-SP group, and the operation was completed in a shorter time in the operated-SP group. (p=0.001) There were no differences between the groups in terms of reduction quality, calTAD, Harris Hip Score, VAS score, infection rates, and cut-out rates. Conclusion: Based on this study, the radiologic and clinical results of the cases operated with manual traction in the supine position and those operated using a traction table in treating IFF with PFNA are similar. In addition, it was concluded that shorter operation time was an advantage of the operated-SP group.

OBJECTIVE: Knee Osteoarthritis, a prevalent degenerative joint condition, poses a significant global burden, while proximal femur fractures are increasingly common among the geriatric population. Understanding the relationship between these entities remains crucial for effective clinical management. This study aims to investigate the association between knee osteoarthritis severity and the nature of proximal femur fractures in geriatric patients undergoing proximal femoral nailing for intertrochanteric femoral fractures. MATERIAL AND METHODS: A retrospective cohort study was conducted on 420 geriatric patients who underwent proximal femoral nailing (PFN) for femoral fracture between 2016 and 2021. Data on demographic characteristics, osteoarthritis severity (Kellgren-Lawrence classification), fracture type (AO/OTA classification), and clinical outcomes were collected. Statistical analysis was performed to evaluate the correlation of the hip fracture type with mild (Kellgren-Lawrence grades I/II) and severe (grades III/IV) knee osteoarthritis. RESULTS: Significant associations were observed between osteoarthritis severity and fracture type (p = 0.001). Patients with mild osteoarthritis predominantly exhibited AO/OTA type 1 fracture (74.7%), whereas those with severe osteoarthritis had a higher prevalence of AO/OTA type-2 (67.9%) and AO/OTA type 3 (18.6%) fractures. However, no significant difference was found in overall survival (p = 0.138) or revision rates (p = 0.978) between patients with mild and severe osteoarthritis. CONCLUSIONS: As the severity of osteoarthritis increased, the fracture type changed and was associated with a more comminuted fracture pattern.

SUMMARY OBJECTIVE: Venous thromboembolism prophylaxis remains a complex and controversial issue in orthopedic practice, with persistent variability in recommendations even among experts. With the growing use of online platforms and artificial intelligence, the aim of this study was to evaluate the quality and clinical adequacy of artificial intelligence-generated recommendations regarding venous thromboembolism. METHODS: Thirty-three guideline-based questions derived from International Consensus Meeting, National Institute for Health and Care Excellence, American College of Chest Physicians, and American Academy of Orthopaedic Surgeons recommendations were independently submitted to ChatGPT (Generative Pre-trained Transformer [GPT]-4.0) by two orthopedic surgeons, resulting in 66 generated responses for analysis. Responses were assessed using the DISCERN instrument, Journal of the American Medical Association benchmark criteria, and a novel clinically oriented scale, the Thromboembolism Digital Knowledge Level. Inter-rater reliability was evaluated using intraclass correlation coefficients. RESULTS: According to DISCERN, 62.1% of responses were classified as good quality, whereas Thromboembolism Digital Knowledge Level evaluation demonstrated that only 45.45% of responses were clinically adequate, with no responses classified as excellent. The same responses were systematically categorized into higher quality levels by DISCERN compared to Thromboembolism Digital Knowledge Level. All scoring systems demonstrated excellent inter-rater reliability (Intraclass Correlation Coefficient range: 0.897–0.961). Although differences between scoring systems were statistically significant, the effect size was moderate (r=0.39). Strong correlations were observed between evaluators across all scales (p<0.001). CONCLUSION: ChatGPT-generated responses demonstrated good structural quality but limited clinical adequacy for thromboembolic prophylaxis after arthroplasty. These findings suggest that artificial intelligence systems should be used cautiously and may not be sufficient as standalone clinical decision-support tools.