This study addresses the challenges faced by diabetic patients undergoing lower extremity amputation due to diabetic foot, particularly focusing on the implications for wound healing and early mortality. The wounds at the amputation stump may necessitate multiple surgical interventions. The aim is to identify prognostic factors associated with these outcomes, shedding light on the complexities surrounding the postamputation phase. A prospective study was conducted on 39 diabetic patients who underwent lower extremity amputation due to diabetic foot between 2021 and 2022. Comprehensive preoperative data, encompassing parameters such as blood count, erythrocyte sedimentation rate, C-reactive protein, procalcitonin, hemoglobin A1c, albumin, protein, transferrin, ferritin levels, age, gender, body mass index, smoking habits, dialysis, revascularization, duration of surgery, and the use of tourniquet during the procedure were meticulously recorded. Additionally, cognitive performance and depression status were assessed preoperatively using the Mini-Mental State Examination (MMSE) and Beck Depression Inventory (BDI), respectively. A follow-up period of 3 months postsurgery allowed for the comparison of patients who developed infections at the amputation stump with those who did not, as well as the distinction between patients who survived and those who succumbed to mortality. The study revealed that the use of a tourniquet during surgery significantly increased the risk of infection (p = .027), and higher BDI scores were associated with increased risks of both infection (AUC = 0.814) and mortality (AUC = 0.769), with cut-off scores of 24.0 and 23.5 predicting these outcomes with high sensitivity and specificity, respectively. Additionally, lower MMSE scores were associated with increased short-term postoperative mortality. There were no statistically significant differences between the groups in parameters such as complete blood count, ESR, CRP, procalcitonin, HbA1c, albumin, total protein, transferrin, ferritin levels, age, gender, BMI, smoking, dialysis, revascularization, and surgery duration. This investigation highlights the significance of considering tourniquet usage during amputation, preoperative depression status, and cognitive function in patients who undergo amputation due to diabetic foot. The use of a tourniquet during surgery is a significant risk factor for infection, and elevated BDI scores are strong predictors of both infection and mortality in patients undergoing amputations. The findings underscore the importance of a multidisciplinary neuropsychiatric evaluation preoperatively to enhance patient care and outcomes. (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Objective: This study aimed to assess the contributions and global impact of Turkish orthopedics and traumatology research published in high-impact international journals over the past decade (2014-2023). By examining article types, citation metrics, journal impact factors, and author affiliations, the aim was to highlight publication trends, strengths, and areas needing improvement within Turkish orthopedic research. Methods: Using the Web of Science database, keywords were searched under journal categories including “Orthopedics,” “Orthopedics, Rehabilitation and Sports Medicine,” and “Sports Sciences.” Articles from the top 40 orthopedic journals indexed in Science Citation Index Expanded were identified and selected based on their 2022 impact factors. Articles published between January 2014 and December 2023 with first authors affiliated with a Turkish institution were included. Citation density was calculated by dividing the total number of citations by the number of years since publication. Data extracted included publication type, citation count, citation density, research methodology, author affiliations, and institutional contributions. Results: Out of 70 279 articles published globally, 425 orthopedic articles with Turkish first authorship were identified in the selected journals. Most articles were clinical (88.7%), with the most frequent article types being case presentations (31.3%), retrospective cohort studies (17.9%), and laboratory research (11.3%). The least common types were expert opinions, epidemiological studies, and meta-analyses. The majority of articles appeared in Spine Journal (34.6%) and Knee Surgery, Sports Traumatology, Arthroscopy (27.3%), with no articles published in the highest-ranked journal (British Journal of Sports Medicine). Spine surgery was the leading subfield (29.9%), followed by sports, shoulder, and elbow surgery (22.6%) and reconstructive surgery (16%). Orthopedic specialists comprised 56% of first authors, with multicenter studies representing 65.4% of the articles. Public institutions accounted for 80.1% of published articles, while private institutions contributed 19.9%. A total of 356 articles were cited 8349 times, with a median citation number of 9 per article. Mean citation density was highest in meta-analysis (8.5 citation/year), epidemiological studies (8.3 citation/year), and randomized controlled trials (7.8 citation/ year), while lowest in case presentations (0.3 citation/year), expert opinions (0.4 citation/year), and laboratory research (2.2 citation/year). Conclusion: Turkish orthopedic research has maintained a significant presence in top orthopedic journals, mostly through clinical studies, especially in spinal and sports injury subfields. Despite high publication volume, citation impact remains relatively lower. Future efforts should encourage higher-impact study designs, international collaborations, and standardized research evaluations to enhance the global influence of Turkish orthopedic literature. Level of Evidence: N/A.Cite this article as: Korkmaz T, Afaca MY, Elibollar C, Cıbıkcı AOG, Karaismailoğlu B, Seker A. A bibliometric analysis of turkish orthopedics and traumatology in high-impact global literature over a decade (2014-2023). Acta Orthop Traumatol Turc., 2025;59(5):315-321.

Background: Anterior shoulder dislocation is a common and functionally limiting injury in professional martial arts (MA) athletes. While arthroscopic Bankart repair is widely performed, data on long-term functional and sport-specific outcomes in elite-level MA athletes after a first-time dislocation remain scarce. Purpose: To evaluate the 5-year clinical and functional outcomes of arthroscopic Bankart repair using bioabsorbable suture anchors in elite MA athletes who sustained a first-time traumatic anterior shoulder dislocation without bony Bankart lesions. Study Design: Case series; Level of evidence: 4. Methods: A total of 27 elite international-level MA athletes who experienced a first-time anterior shoulder dislocation and underwent arthroscopic Bankart repair with bioabsorbable suture anchors were included. All surgeries were performed within 3 weeks after the injury. Patients with bony Bankart lesions and those who had undergone either remplissage for large Hill-Sachs lesion or previous shoulder surgery were excluded. Functional evaluation included pre- and postoperative assessments using Rowe, Athletic Shoulder Outcome Scoring System, Shoulder Sport Activity Score, forward flexion, and external rotation in adduction. Return to sport and return to preinjury competitive level were also recorded. Postoperative magnetic resonance imaging (MRI) at 6 months assessed anchor position, stability, and cartilage or bony lesions. Outcomes were compared between athletes who returned to their previous competition level and those who did not. Results: The mean age was 24.3 years and the mean follow-up was 63.0 ± 2.5 months (range, 54-69 months). All athletes returned to sports, with 85.2% (n = 23) resuming competition at their preinjury level. Significant improvements were observed in all functional scores ( P < .001 for all), while a slight postoperative decrease in range of motion parameters was noted. No significant differences were found in clinical scores between those who returned to their preinjury level and those who did not. Recurrent dislocation occurred in 2 athletes (7.4%) during competition. Radiological follow-up with postoperative MRI was available for all 27 athletes. At 6 months, all patients demonstrated proper anchor position and stability, with no evidence of displacement or loosening. No cartilaginous or bony lesions were detected. Conclusion: Arthroscopic Bankart repair with bioabsorbable suture anchors is a safe and effective treatment for first-time anterior shoulder dislocation in elite MA athletes. This approach results in excellent long-term functional outcomes and a high rate of return to elite-level competition, with a low risk of recurrence when patients are properly selected.

Background: Soccer places substantial mechanical demands on the lumbar spine through repeated sprinting, rotation, and contact-related loading. Although lumbar magnetic resonance imaging (MRI) abnormalities are frequently observed in athletes, data studying the prevalence and distribution of lumbar disc pathology in this population remain limited. Hypothesis: Asymptomatic lumbar disc herniation may be common in elite male soccer players and disc herniation burden may not necessarily be associated with lumbar-related missed training sessions. Study Design: This is a retrospective observational cohort study evaluating lumbar MRI findings obtained at team entry and their relationship with missed training sessions. Level of Evidence: Level 4. Methods: MRI and training data were analyzed from 46 male soccer players from a single elite European team between 2020 and 2024. Outcomes observed included number of lumbar disc herniations, disc height loss, herniation levels and subtypes (central vs paracentral), and number of missed training sessions. Data analysis was completed using SPSS v27. Results: A total of 43 male soccer players were included. Asymptomatic lumbar disc herniations were common (43.2%). Lower lumbar levels were disproportionately affected with herniations occurring most frequently at L4-L5 (31.6%) and L5-S1 (39.5%) ( P < 0.001). Central herniations predominated compared with paracentral herniations ( P < 0.001). Disc herniation burden was not positively associated with missed training sessions. Conclusion: Lumbar disc herniations on MRI are common in asymptomatic elite male soccer players and occur predominantly at the L4-L5 and L5-S1 levels, with central herniations being the most frequent subtype. Lumbar disc herniation burden may not necessarily correlate with missed training sessions. Clinical Relevance: Asymptomatic lumbar disc herniations may be common in elite male soccer players, without any correlation with participation in training sessions.

Purpose: To evaluate return-to-sport duration and factors associated with delayed recovery and early reinjury in elite professional football players with Grade II hamstring injuries, with emphasis on the Munich muscle injury classification.Methods: This retrospective observational cohort study included 42 elite professional football players treated for acute Grade II hamstring injury between 2016 and 2024. Injuries were subclassified according to the Munich classification as Type 3A or Type 3B. Demographic, anthropometric, injury-related, and sport-specific variables were recorded, including age, height, body weight, body mass index, injury side, playing position, and previous hamstring injury history. Returnto-sport time was defined as the number of days from diagnosis to unrestricted return to full team training and/or match availability. Reinjury was defined as a new hamstring injury in the same extremity within two months after return tosport. Nonparametric analyses were performed.Results: Median return-to-sport time was 19 days, ranging from 11 to 54 days. Thirty-nine injuries were classified as Munich Type 3A and three as Type 3B. Type 3B injuries had significantly longer return-to-sport duration than Type 3A injuries, with median values of 30 and 18 days, respectively (p = 0.026). Return-to-sport time was not significantly associated with playing position, injury side, age, or body mass index. In the Type 3A subgroup, return-to-sport time was not associated with age, height, body weight, body mass index, or playing position. Reinjury occurred in three players. Players with reinjury had shorter initial return-to-sport duration than those without reinjury, with median values of 14 and 20 days, respectively (p = 0.026).Conclusion: In elite professional football players with Grade II hamstring injuries, Munich classification subtype was associated with return-to-sport duration, whereas demographic, anthropometric, and position-related variables were not. Shorter return-to-sport duration was associated with early reinjury; however, because only three reinjury events were observed, this finding should be considered exploratory and should not be interpreted as evidence of causality. These findings support MRI-based subclassification and criteria-based return-to-sport decision-making.