Background: Ankle fractures constitute 10% of all traumatic fractures in clinical practice. Concurrent tibiotalar dislocations form 21% to 36% of all ankle fractures. Although mechanism of injury is similar to nondislocated ankle fractures, fracture-dislocations cause more extensive bone and soft-tissue damage. Treatment is a challenge for orthopedic surgeons due to concomitant pathologies. It is associated with malreduction, chronic pain, and post-traumatic osteoarthritis. We aimed to investigate the relationship between ankle osteoarthritis radiographic stage and clinical outcomes. Methods: Records and data of 27 patients were retrospectively analyzed. Clinical status at final follow-up was evaluated by a single orthopedic surgeon. Range of motion, American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score, and visual analog scale score were the clinical parameters that were assessed. Radiologic assessment was made by standard anteroposterior, lateral, and mortise views. Preoperative osseoligamentous injury pattern, presence of posterior malleolar fracture, syndesmosis injury, and postoperative ankle osteoarthritis were investigated. Results: At final follow-up, mean ± SD Ankle-Hindfoot Score was 98.25 ± 1.06 and visual analog scale score during daily activities was 1.52 ± 0.70. Mean ± SD ankle dorsiflexion and plantarflexion were significantly lower on the affected sides (14.07° ± 7.97° and 36.30° ± 6.59°) than on the unaffected sides (28.15° ± 2.82° and 46.30° ± 2.97°), respectively ( P < .001). No significant difference for inversion and eversion was observed. Twenty-four patients demonstrated radiographic signs of ankle osteoarthritis and three did not. No significant difference was found among Takakura stages in any of the variables. Conclusions: Although the post-traumatic osteoarthritis rate was high for ankle fracture-dislocation, surgical treatment achieved excellent functional results. Even if advanced stages of ankle arthritis according to Takakura classification developed, patients had satisfactory clinical and functional results.

Amaç: Bu çalışmanın amacı, intertrokanterik kırık tanısı ile proksimal femur antirotasyon çivisi (PFNA) kullanılarak başarılı radyolojik kaynama elde edilmiş hastaların, postoperatif dönemdeki klinik fonksiyonel durumlarının araştırılmasıdır.Gereç ve Yöntem: Tek bir merkezde, 2015 – 2017 yılları arasında, düşme sonucu başvurarak, intertrokanterik femur kırığı tanısı ile PFNA kullanılarak opere edilen 65 yaş üzeri hastalar çalışmaya dahil edildi. Hastaların günlük aktivite düzeyinin ve kalça kaynaklı fonksiyonel durumlarının araştırılması için Türkçe geçerlilik ve güvenilirlik çalışması yapılmış olan “Oxford kalça skoru (OKS)” ve “Kalça yetersizliği ve osteoartrit sonuç skoru – Fiziksel fonksiyon kısa form (HOOS-PS)” değerlendirmeleri, hastaların kendileri veya birinci derece yakınları ile iletişime geçilip yanıtları işlenerek kullanıldı. İstirahat halinde ve aktivite sırasındaki ağrıyı değerlendirmek üzere ortalama istirahat ve aktivite vizüel analog skala (VAS) skorları kullanıldı. Mobilizasyon düzeylerini araştırmak için “Palmer – Parker Mobility Score (PPM)” kullanıldı. Bulgular: Yirmi bir hastanın fonksiyonel skor değerlendirmeleri ameliyattan ortalama 18,1±9 ay sonra araştırıldı. Bu 21 hastanın; ortalama istirahat VAS skorları 2.3±1.4, aktivite VAS skorları 3,5±1,8; OKS 30,4±12,2; HOOS-PS 10,9±5,1 ve PPM 5,5±3,3 olarak kaydedildi. Sonuç: Geriatrik populasyonda sık görülen femur intertrokanterik kırıklarında, PFNA ile osteosentez uygulanarak başarılı radyolojik sonuçlar sağlanan hastalar; her ne kadar ağrı yönünden iyi sonuçlara sahip olsalarda, fonksiyonel ve mobilizasyon düzeyleri düşük olmaktadır.

Lateral epicondylitis is a common musculoskeletal disorder that lacks a universally accepted treatment algorithm. Thus, management strategies may vary among medical specialties. This study aimed to evaluate current treatment approaches for lateral epicondylitis and compare the preferences of orthopedic surgeons and physical medicine and rehabilitation (PM&R) specialists. A cross-sectional survey was conducted among orthopedic surgeons and PM&R specialists in Türkiye. The questionnaire included items regarding diagnostic methods, treatment preferences, injection practices, and perceptions of injection therapy outcomes. Treatment approaches to lateral epicondylitis were compared between specialties. A total of 101 physicians participated in the study, including 51 orthopedic surgeons and 50 PM&R specialists. Physical examination was the most commonly preferred diagnostic method (98%). The most frequently preferred first-line treatment was a combination of rest, nonsteroidal anti-inflammatory drugs (NSAIDs), and physical therapy (88.1%). Second-line treatment preferences differed significantly between specialties ( P < .001). Orthopedic surgeons more frequently preferred injection therapy (72.5%), whereas PM&R specialists more commonly preferred extracorporeal shock wave therapy (ESWT) (52.0%). PM&R specialists reported transitioning to injection therapy earlier ( P = .016) and more frequently reported using ultrasound guidance than orthopedic surgeons (70.2% vs 4.3%, P < .001). No statistically significant between-specialty difference was detected in perceived short-term ( P = .224) or long-term ( P = .546) effectiveness ratings. The most frequently selected first-line treatment was the same in both specialties, whereas reported second-line treatment preferences differed. Orthopedic surgeons more frequently selected injection therapy, whereas PM&R specialists more frequently selected ESWT. These findings reflect self-reported treatment preferences and perceptions and should not be interpreted as evidence of treatment effectiveness or as nationally representative estimates. Level IV, cross-sectional survey study.

Objective Although the recommended treatment for stage III posterior tibial tendon dysfunction (PTTD) is triple joint complex fusion, the literature is limited on this topic. No study has specifically investigated the influence of rheumatoid arthritis (RA) on the outcomes of triple arthrodesis. This study aimed (1) to report mid-to-long-term results of triple arthrodesis for stage III PTTD and (2) to investigate the difference in the results of triple arthrodesis between rheumatoid and nonrheumatoid patients. Methods Thirty feet of 25 patients (16 females, 9 males; mean age 53, (39-71)) with stage III PTTD who were treated by triple arthrodesis were retrospectively analyzed. The mean follow-up was 82 (28 – 144) months. Patients were divided into two groups based on etiology: group ID (idiopathic PTTD) and group RA (PTTD secondary to RA). All clinical and radiographic outcomes were compared. The mean American Orthopedic Foot and Ankle Society (AOFAS) score was measured preoperatively and at the final follow-up. The 36-Item Short Form Survey (SF-36) and visual analog scale (VAS) were measured at the final follow-up. Results The mean AOFAS score improved from 57±6.81 (46–68) and 49±14.66 (18–79) preoperatively to 82±15.57 (44–94) and 77±14.46 (48–94) in group ID and group RA, respectively, with no significant difference between thepre- and postoperative values between the groups (p <.001). The mean VAS score at rest was 0.45±0.68 (0–2) in group ID and 1±1.08 (0–3) in group RA (p =.23). There was no significant difference in any SF-36 domain(p >.05) except for physical health, which was lower in the RA group (p =.002). Conclusion Although rheumatoid patients present with radiographically more severe flatfoot deformity, triple arthrodesis can provide similar satisfactory clinical and radiological outcomes with a low complication rate for stage III PTTD in rheumatoid patients as much as nonrheumatoid patients in long-term follow-up. Level of Evidence: Retrospective cohort study, Level 3 Evidence

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.