In this study, we aimed to evaluate the long-term clinical and radiological results of single-stage open reduction through a medial approach and Pemberton acetabuloplasty in developmental dysplasia of the hip. We treated 32 hips (22 patients) with developmental dysplasia by a single-stage open reduction through Ferguson's medial approach and Pemberton acetabuloplasty. The procedure was performed bilaterally in 10 patients. The mean age of the patients at the time of the operation was 19.8 months (16-24 months). The mean follow-up period was 10.9 years (7-19 years). Group I avascular necrosis according to the Kalamchi and MacEwen classification was observed in two hips and group II in one hip. Radiologically, 90.6% of the hips were classified as Severin class I and 9.4% of the hips were classified as Severin class II. At the latest follow-up, 30 hips were assessed clinically as excellent and two hips as good. No patient required subsequent surgery. We conclude that single-stage medial open reduction and Pemberton acetabuloplasty represent an effective method for developmental dysplasia of the hip in children older than 15 months of age.

Objective: This study evaluates the performance of large language models (LLMs)—ChatGPT-4.0, Gemini 2.0 Pro, o3-mini, Doctor GPT and DeepSeek-V3—in a national orthopaedic proficiency examination and explores their implications for health informatics and medical education. The responses of these models were analysed to assess accuracy rates and differences between models. Method: A total of 100 multiple-choice questions from the 2024 TOTEK examination were administered to each AI model under identical conditions. Correct and incorrect responses were recorded, and differences in performance were evaluated using chi-square testing and frequency analysis. Question categories were also compared to identify domain-specific variations. Results: o3-mini achieved the highest accuracy rate (79%), while Gemini 2.0 showed the lowest (68%); all models exceeded the 60% pass threshold. A statistically significant difference between models was identified in the Surgical Procedures category, in which Gemini 2.0 answered fewer questions correctly (23/36) than the other models (30–32/36) (χ ² = 9.87, df = 4, p = 0.043). No significant differences were observed in the remaining categories (all p > 0.05), and the overall difference in accuracy between models did not reach statistical significance (χ ² = 4.01, df = 4, p = 0.405). Clinical decision-making and visual content-based questions were the most challenging for all models. Conclusion: AI models demonstrate generally high accuracy in medical examinations; however, they struggle with interpreting clinical context, recognising atypical medical scenarios and answering questions involving visual content.

Diagnostic Performance of Neutrophil-to-lymphocyte, Platelet-to-lymphocyte, and Monocyte-to-lymphocyte Ratios in Aseptic Loosening after Hip and Knee Arthroplasty - The Medical Bulletin of Haseki

The aim of this study is to compare the clinical results of proximal femoral nail (PFN) and proximal femoral anatomic plate (PFA) methods used in the treatment of proximal femoral fractures through a multicenter retrospective review, and to determine which method is more advantageous for specific patient groups. The study aims to evaluate the effectiveness of PFN and PFA techniques and presents findings that can guide clinical decision-making by revealing the differences between these two methods. Between 2016 and 2021, 106 patients with proximal femur fractures classified as type 31A1 and 31A2 according to the AO/OTA (the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association) classification system were retrospectively examined. Patients were treated with either PFN or PFA, and the clinical results were compared. The variables evaluated included Oxford Hip Score, time to surgery, operation time, hospital stay, blood loss, and follow-up duration. Statistical analyses were performed using the chi-square test, independent-samples t-test, and Mann-Whitney U test. When the clinical outcomes of patients treated with PFN and PFA were compared, the PFN group had shorter operation time and less blood loss than the PFA group, and this difference was statistically significant (p<0.05). In addition, hospital stay was shorter in the PFN group, also showing a statistically significant difference (p0.05). However, the Oxford Hip Score was higher in the PFN group compared to the PFA group, indicating better postoperative functional results (p0.05). Patients who underwent PFN had advantages such as shorter surgical time, less blood loss, and shorter hospital stay compared to patients who underwent PFA. In this context, PFN can be considered superior in terms of clinical outcomes, as it is less invasive and allows faster recovery. However, no significant difference was observed in follow-up duration.

Introduction: Currently Salter-Harris (SH) classification is generally used in physeal fractures. It is reliable and valed in many cases. In general concept, although this clasification system describes many different fracture configurations, there is an unclassifed group. Case: Here we present an eleven years old boy who underwent surgery after an unclassifed fracture of distal radial epiphysis according to SH. The main reason for the research was that we could not decide about the treatment initially after the first operation. We discussed the current classsifications near SH and essentials on the neccesity of surgical approach. Conclusion: Surgical attempt must be done in such cases which can not be decided whether if a SH type 2 or 3. Beside this situation, an attempt must be done for the classification of the fracture (Ogden tip 2b, Sferoupulos tip 3). Continuous...

Sacroiliac joint (SIJ) disruption alters posterior pelvic ring stability and can produce abnormal sacral stress redistribution; the symmetry of sacral load transfer following different fixation strategies remains controversial. This study compared sacral stress patterns under unilateral and bilateral SIJ instability for three fixation constructs using a three-dimensional finite element (FE) model. A lumbosacral–pelvic FE model was reconstructed from computed tomography data of a healthy adult and validated against previously published pelvic biomechanical data. SIJ instability was simulated by reducing the friction coefficient to represent ligamentous failure. Three fixation constructs were analyzed: anterior plate combined with posterior screw fixation (Model 1), spinopelvic fixation (Model 2), and hybrid fixation (Model 3). A 750 N axial compressive load was applied to simulate static standing. Peak sacral von Mises stress, stress amplification factors (SAFs), and left–right asymmetry ratios were computed and compared with the intact reference. Model 1 produced the highest sacral stress amplification (SAF = 3.46 under unilateral instability; peak stress 265.40 MPa). Model 2 reduced peak sacral stress (125.66 MPa under bilateral instability; SAF = 1.64), but values remained above the intact-model baseline. Model 3 yielded sacral stress closest to the intact condition under bilateral instability (81.64 MPa; SAF = 1.06), with near-symmetric load distribution in the bilateral injury configuration. Fixation topology strongly influenced sacral load transfer: hybrid fixation (Model 3) produced sacral stress magnitudes closest to the intact model, particularly under bilateral instability, whereas spinopelvic fixation (Model 2) showed more consistent left–right symmetry under unilateral injury. No single construct was superior across all symmetry-related outcomes. Hybrid stabilization may provide a biomechanically balanced approach to highly unstable posterior pelvic ring injuries under the simulated static axial-loading conditions.