Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.

Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.

Supracondylar humerus fractures are common in the pediatric population, but flexion fractures are very rare in this population. The need for open reduction in these fractures is high and can be challenging for orthopaedic surgeons. In this article, we report a 9-year-old patient with bilateral flexion-type humeral fracture treated with closed reduction, which, to our knowledge, is the first report in the literature. We concluded that the first step in the treatment of flexion-type supracondylar fractures should be closed reduction with the help of an experienced assistant surgeon and that successful results can be obtained even in bilateral flexion-type fractures with appropriate treatment and follow-up.

Aim: Our study aimed to examine the effects of Linagliptin, Pioglitazone, and their combination on fracture healing in a diabetes rat femur fracture model. Material and methods: Type 2 diabetes mellitus (T2DM) induced rats were randomly divided into four groups: non-treated diabetes group (TD), Pioglitazone group (P), Linagliptin group (L), and Pioglitazone and Linagliptin group (PL). Daily oral dosage of pioglitazone (10 mg/kg/day), linagliptin (10 mg/kg/day), and their combination were administered. Femur fractures were stabilized intramedullary. At weeks 2 and 6, rats were sacrificed for evaluation radiologically, biomechanically, histopathologically, histomorphometrically, and immunohistochemically. Results: Flexural strength of the L and PL groups were significantly higher compared to the P group. The highest healing score was in the L group and lowest in the P group, while the highest inflammation score was in the P group and lowest in the L group. A cluster of differentiation (CD) CD 34 reactivity was highest in the L group and lowest in the PL group. Conclusion: Linagliptin treatment significantly increased histological healing scores, callus volume, biomechanical strength, and vascularity, however, minimized the inflammatory process, which was increased by pioglitazone. The combination of linagliptin and pioglitazone restored BMD and increased biomechanical strength. Linagliptin monotherapy is rarely indicated; hence, T2DM patients with a high risk of bone fractures can be considered for combined therapy of pioglitazone and linagliptin.

Osteonecrosis of the femoral head (ONFH) is a debilitating condition characterized by bone tissue necrosis due to vascular insufficiency, often triggered by corticosteroid use. Steroids are commonly employed in the management of autoimmune diseases, organ transplantation, and COVID-19. Early detection is crucial, as ONFH primarily affects young and middle-aged individuals and often progresses to femoral head collapse if untreated. To evaluate the protective effects of Apelin-13 (Ap-13) on steroid-induced ONFH (SONFH) in a rat model. Thirty-two female Sprague-Dawley rats were randomized into four groups: Control, Ap-13 only, ONFH, and ONFH + Ap-13. SONFH was induced using lipopolysaccharide (LPS) and methylprednisolone (MPS). The treatment group received daily intraperitoneal Ap-13 injections. At the fourth week, radiological, histopathological, immunohistochemical, and biochemical analyses were conducted on femoral heads. Micro-CT showed no significant differences in bone mineral density or trabecular parameters. Histopathology revealed increased osteonecrosis, empty lacunae, and vascular thrombosis in the ONFH group, which were significantly reduced in the ONFH + Ap-13 group (p < 0.05). Ap-13 decreased serum malondialdehyde (MDA) levels (p = 0.0002), reduced caspase-3 expression (p < 0.05), and elevated VEGF expression (p = 0.046), indicating reduced oxidative stress, apoptosis, and enhanced vascularization. Additionally, LDL and triglyceride levels were significantly lower in the Ap-13 treated group (p < 0.05). Apelin-13 demonstrates protective effects against SONFH by reducing oxidative stress, apoptosis, and improving vascularization. It may represent a promising noninvasive therapeutic strategy for early-stage ONFH.

Kanser tedavilerindeki teknolojik gelişmeler hastaların sağ kalım oranlarını artırırken, radyoterapi sonrası uzun vadede sekonder bir komplikasyon olarak gelişen "radyasyon ilişkili sarkomlar" (RİS) literatürde önem kazanmıştır. Vücudun mezenkimal dokularından köken alan bu malign tümörlerin, genel sarkom vakalarının %3-5'ini oluşturduğu tahmin edilmektedir. RİS'lerin yaklaşık %20-30'u kemik kaynaklı olup en sık osteosarkom şeklinde izlenmektedir. Risk faktörleri arasında yüksek radyasyon dozu (özellikle 15 Gy üzeri), genç maruziyet yaşı, alkilleyici kemoterapi ajanlarının kullanımı ve Li-Fraumeni gibi genetik sendromlar yer almaktadır. Tanısal süreçte, radyasyon hasarlı dokuların varlığı fizik muayeneyi zorlaştırdığı için düz radyografiler, MR ve BT görüntülemeleri ile kapalı iğne biyopsileri kritik rol oynar. Cahan kriterlerine göre, sarkomun eski ışınlama alanında çıkması, primer tümörden farklı histolojide olması ve genetik yatkınlığın dışlanması gerekir. Santral yerleşim, tam cerrahi eksizyon zorluğu ve sınırlı adjuvan tedavi seçenekleri nedeniyle bu hastaların prognozu primer sarkomlara göre daha kötüdür. Tedavinin temelini agresif neoadjuvan/adjuvan kemoterapi ile geniş cerrahi rezeksiyon oluşturur. Advances in oncological treatments have significantly improved patient survival, yet "radiation-induced sarcomas" (RIS) arising as a secondary complication long after radiotherapy have increasingly been documented. These malignant tumors, originating from mesenchymal tissues, account for approximately 3-5% of all sarcoma cases. Bone-derived sarcomas represent about 20-30% of all RIS, with osteosarcoma being the most frequent histological subtype. Key risk factors include higher radiation doses (especially above 15 Gy), younger exposure age, concurrent alkylating chemotherapy agents, and genetic syndromes like Li-Fraumeni. Due to radiation-induced tissue alterations complicating physical examinations, diagnostic workflows rely heavily on plain radiographs, advanced MRI and CT imaging, and closed needle biopsies. According to Cahan's criteria, the sarcoma must arise within the previously irradiated field, exhibit a distinct histology from the primary tumor, and genetic predispositions must be excluded. The prognosis for RIS is markedly poorer than for sporadic sarcomas due to a higher prevalence of central localization, limits in achieving wide surgical margins, and restricted adjuvant therapeutic choices. Management demands aggressive multi-modal therapy consisting of intensive neoadjuvant/adjuvant chemotherapy combined with extensive surgical resection.