The Dias-Tachdjian classification is the most commonly used system for the classification of pediatric ankle fractures, but its inter- and intra-observer reliability has not been studied in detail. Also, the impact of the clinician’s experience and expertise on the reliability of this system is unknown. This study aimed: (1) to determine the intra- and inter-observer reliability of the Dias-Tachdjian classification and (2) to investigate the effect of the clinician’s experience and expertise on the reliability of this system. Anteroposterior and lateral ankle radiographs of 56 children (34 male, 22 female) with ankle fractures, aged between 3 and 14 years, with open growth cartilages, were retrospectively identified and included in the study. Each patient radiograph was examined by 10 observers from two different specialties with different levels of clinical experience (two orthopedic surgeons with interest in pediatric orthopedics, three orthopedic surgeons with no interest in pediatric orthopedics, three orthopedic residents, and two radiology specialists) from two different specialties (orthopedics and radiology). All observers were then asked to classify pediatric ankle fractures at 6-week intervals per the Dias-Tachdjian classification system. Overall, intra-observer reliability as substantial to very good (κ = 0.77–0.95, P < 0.01), but inter-observer reliability as fair for both assessments (κ = 0.21, P < 0.01 and κ = 0.20, P < 0.01 for the first and second occasions, respectively). Inter-observer reliability among pediatric orthopedic surgeons as very good (κ = 0.90, 95% CI = 0.86–0.94, P < 0.01 and κ = 0.82, 95% CI = 0.71–0.93, P < 0.01 for the first and second occasions, respectively). Orthopedic surgeons with no special interest in pediatric orthopedics demonstrated substantial agreement in the first occasion (κ = 0.63, 95% CI = 0.53–0.72, P < 0.01) but moderate in the second one. Orthopedic residents exhibited moderate levels of agreement in each assessment period (κ = 0.58, 95% CI = 0.47–0.68, P < 0.01 and κ = 0.44, 95% CI = 0.37–0.51, P < 0.01 for the first and second occasion, respectively). Considering that the specialists dealing with pediatric orthopedics show very good consistency for Dias-Tachdjian classification, both within and between observers, consistency in the identification of the ankle fracture models increases as the interest in the field of pediatric orthopedics intensifies.

Objective: The aim of this study is to compare the clinical and functional results of single-radius (SR) and multi-radius (MR) femoralcomponents in total knee arthroplasty (TKA). Methods: A total of 74 patients who underwent TKA surgery by a single surgeon between 2018 and 2021 were included in the study. The patients were then divided into 2 groups according to their femoral component design: group SR (38 patients) and group MR (36 patients). Except for gender and follow-up duration (P < .05), no significant difference was observed in age, American Society of Anesthesiologists scores, and BMI (P > .05). Knee range of motion, visual analogue scale (VAS), and combined KSS (Knee Society Score) were evaluated at the preoperative and final controls of the patients. In addition, frequency of anterior knee pain (AKP), AKP scale, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Hospital for Special Surgery (HSS) score, and the Forgotten Joint Score-12 (FJS12) were evaluated at the final follow-up. Results: There was no difference between the 2 groups in terms of postoperative range of motion (ROM), VAS, combined KSS, and HSS (P > .05). The frequency of AKP in patients with SR was found to be statistically lower than those with MR (P=.021; P < .05). The AKP scale was found to be statistically significantly lower in patients with prosthetic type MR compared to patients with SR (P=.04; P < .05). Singleradius patients had significantly better FJS-12 (P=.014; P < .05) and WOMAC scores (P=.003; P < .05). Conclusion: The results of this research showed that good clinical and functional results are obtained with TKA regardless of the femoral component design. Single-radius prostheses show better results than MR prostheses in terms of the frequency and severity of AKP. While there is no difference between femoral designs in terms of TKA-specific functional results such as KSS and HSS, the WOMAC score, which measures disease-related functions, provides better clinical results in SR designs. Additionally, SR designs show significantly better results in functional scores indicating patient satisfaction, such as FJS-12. Cite this article as: Şentürk F, Demirel M, Yenigün MY, Canbolat N, Sağlam Y, Şen C. Functional outcome comparison of single-radius and multi-radius femur inNtotal knee arthroplasty. Acta Orthop Traumatol Turc., 2025;59(3):156-163.

Background and Objectives: Serum albumin has been widely studied as a prognostic marker after geriatric hip fracture, whereas less is known about total protein and the additional prognostic information provided by these markers beyond routine clinical factors. This study examined the associations of preoperative albumin and total protein with one-year mortality in older patients with intertrochanteric femur fractures treated with proximal femoral nailing and assessed whether these markers improved mortality prediction when added to routinely available clinical and laboratory variables. Materials and Methods: This retrospective cohort study included 317 patients aged ≥65 years who underwent proximal femoral nailing for intertrochanteric femur fractures. Clinical variables and admission laboratory parameters, including hemoglobin, creatinine, neutrophil and lymphocyte counts, neutrophil-to-lymphocyte ratio, albumin, and total protein, were evaluated. The primary outcome was all-cause mortality within one year after surgery. Multivariable logistic regression was used to identify factors independently associated with mortality. The additional prognostic value of albumin and total protein was assessed by changes in the area under the receiver operating characteristic curve (AUC) and likelihood-ratio tests. Results: Among 317 patients, 133 (42.0%) died within one year. Age (adjusted odds ratio [aOR] 1.14 per year, 95% CI 1.09–1.19; p < 0.001), ASA class III (aOR 4.71, 95% CI 1.27–17.47; p = 0.021), time to surgery (aOR 1.27 per day, 95% CI 1.12–1.44; p < 0.001), and log-transformed creatinine (aOR 3.56 per e-fold increase, 95% CI 1.89–6.69; p < 0.001) were independently associated with one-year mortality. Albumin was lower among patients who died (median 3.60 vs. 3.80 g/dL; p = 0.009), but its adjusted association with mortality was not statistically significant and was imprecisely estimated (aOR 0.78, 95% CI 0.37–1.64; p = 0.506). Total protein was also not independently associated with mortality (aOR 1.11, 95% CI 0.68–1.82; p = 0.681). The base clinical model had an AUC of 0.809 (95% CI 0.761–0.854), compared with 0.810 (95% CI 0.764–0.855) after addition of albumin and total protein (ΔAUC = 0.0013, 95% CI −0.0029 to 0.0058; likelihood-ratio p = 0.801). Conclusions: Age, ASA class, time to surgery, and renal function were independently associated with one-year mortality. Although lower preoperative albumin was associated with mortality in unadjusted analysis, its adjusted association was not statistically significant and was imprecisely estimated. In this cohort, there was no clear evidence that adding albumin and total protein provided incremental prognostic value beyond the base clinical model.

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.

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.