Objective: Frozen shoulder, a condition characterized by the limitation of active and passive shoulder movements, is predominantly managed conservatively. Corticosteroid injection stands as a widely utilized and effective method for treatment. Nevertheless, the optimal approach for administering the injection remains a subject of controversy. We hypothesized that the injection of corticosteroid through anterior into the extra-articular area would yield superior results than the posterior intra-articular injection. Methods: This prospective, randomized, single-blind, and single-center clinical study aimed to compare the therapeutic effectiveness of ultrasound (USG)-guided injection techniques in patients with primary frozen shoulder. We continued the study with 54 patients who met the inclusion criteria. We evaluated patients pre-injection and at the first, third, and sixth weeks after injection. Two distinct approaches were employed: (1) Injection through the anterior extra-articular area around the coracohumeral ligament (CHL), and (2) injection through the posterior route into the glenohumeral joint. Evaluation parameters, including Visual Analog Scale (VAS) scores, active range of motion (ROM), American Shoulder and Elbow Surgeons (ASES) scores, and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores, were assessed pre-injection and at the first, third, and sixth weeks post injection. Results: No significant differences in the demographic and clinical characteristics, laboratory, or radiological findings were observed between the groups. It was observed that both groups exhibited similar and significant improvement in all measured parameters within their respective groups. Regarding pain scores, a notable decrease in VAS scores was observed in both groups (P = .000). There was no difference between the groups in terms of pre-injection VAS, QuickDASH, and ASES scores and active ROM measurements. Conclusion: The study concluded that there was no significant difference between ultrasound-guided injection of posterior intra-articular injection and anterior extra-articular injection concerning pain, ROM, and functional scores. Both techniques can be considered as viable options in the early stage of the disease. Level of Evidence: Level I, Therapeutic study. Cite this article as: Sensoz E, Sevım OF, Cakmak H, Edız SS, Ecevız E, Ergun S. Similar short-term outcomes of ultrasound guided posterior intra-articular and anterior extra-articular corticosteroid injection in the treatment of primary frozen shoulder. A randomized controlled, single-blind study. Acta Orthop Traumatol Turc., 2024;58(4):223-228.

Background: The posterior tibial slope (PTS) is an important feature in knee joint biomechanics and indicates anterior-posterior knee stability. Increased PTS is a known risk factor for both primary anterior cruciate ligament (ACL) rupture and postreconstruction rerupture. Purpose: To investigate the effect of long-term exposure to ACL deficiency on the PTS and the sagittal anatomy of the proximal tibia. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 44 patients (38 men, 6 women) with a history of knee injury and ACL rupture confirmed by magnetic resonance imaging and physical examination were included in this study. Patients were divided into those with chronic ACL deficiency (group 1: injured ≥5 years prior; n = 22) and acute ACL deficiency (group 2: injured <1 year prior; n = 22). The medial and lateral tibial plateau PTS and anterior tibial translation were measured on monopodal weightbearing knee radiographs at 20° of flexion. The mechanical tibiofemoral angle (MTFA) and the medial proximal tibial angle (MPTA) were measured using an orthoroentgenogram. The side-to-side difference between the affected and unaffected knees was also calculated for all measurements. Results: The mean duration of exposure to ACL deficiency was 7.6 years (range, 5-15 years) in group 1 and 4.4 months (range, 1-11 months) in group 2. Regarding the side-to-side differences in angular measurements, a higher medial PTS (affected vs unaffected: 12.4° vs 10.1°; P = .007), higher lateral PTS (11° vs 8.9°; P = .011), and increased varus alignment on both the MTFA (4.3° vs 2.4°; P = .036) and the MPTA (84.9° vs 86.3°; P = .033) were found in group 1, while no significant differences in angular measurements were found in group 2. Compared with group 2, patients in group 1 had a significantly higher side-to-side difference in the medial PTS (2.3° vs 0.1°; P = .0001), lateral PTS (2.1° vs 0.4°; P = .0001), and MPTA (1.4° vs 0.1°; P = .002). Conclusion: This study showed that the affected knees of patients with chronic ACL deficiency (≥5 years) had higher medial and lateral PTS compared with the unaffected contralateral knees. Therefore, when planning ACL reconstruction for patients with a history of long-term ACL deficiency, it is crucial to measure the preoperative PTS accurately.

Periprosthetic joint infections caused by Brucella melitensis are rare and present significant diagnostic and therapeutic challenges, especially in endemic regions such as Anatolia. The indolent nature of Brucella infections often results in subclinical presentations, complicating early detection and management. This case series highlights the importance of recognizing Brucella melitensis as a potential pathogen in periprosthetic joint infection and explores the treatment options for this condition. Herein, we present five cases of Brucella melitensis -associated periprosthetic joint infections involving three hip replacements and two knee replacements. Diagnoses were confirmed through advanced diagnostic techniques, including prolonged cultures and serological testing, as routine methods often yielded negative results. Two patients underwent one-stage revision arthroplasty, two underwent two-stage revision arthroplasty, and one patient was managed conservatively with targeted antibiotics due to the absence of prosthetic loosening. All patients showed excellent functional recovery and infection eradication at follow-up, with normalized inflammatory markers and no evidence of recurrence. This case series emphasizes the importance of clinical suspicion and the use of advanced diagnostics in endemic areas for timely recognition of Brucella -associated periprosthetic joint infections. One-stage revision arthroplasty combined with prolonged antibiotic therapy demonstrated favorable outcomes and may serve as an effective treatment strategy.

Objective: Intertrochanteric femur fractures (ITFF), more so reverse oblique fractures (AO/OTA 31-A3), are the most challenging clinically, with significant morbidity and mortality. Early stable fixation should be achieved to allow early mobilization and reduce complications. This study evaluates the functional and radiological outcomes of three Proximal Femoral Nail (PFN) techniques – PFN alone, Cable + PFN, and Monocortical reconstruction plate (MRP) + PFN– in managing reverse oblique ITFF, to determine the most ideal of them. Methods: A retrospective analysis was performed on 106 patients treated from 2015 to 2022. The patients were classified by the surgical intervention: Cable + PFN (n = 37), MRP + PFN (n = 29), and PFN (n = 40). The critical parameters analyzed included healing time, quality of reduction, rates of complications, and functional outcomes of Trendelenburg gait. Results: The bone healing time was significantly faster in the Cable + PFN group and MRP + PFN group as compared to the PFN group, 4.43 ± 0.92 and 4.44 ± 0.90 months versus 6.40 ± 2.41 months, respectively (p < 0.001). Compared with the PFN group, the number of cases with Trendelenburg gait in the Cable + PFN group was significantly lower, 10.8%. The number of patients showing the Trendelenburg gait trended lower in the MRP + PFN group but was insignificant (p = 0.075). Radiological outcomes did not differ significantly among the groups. Conclusion: The use of Cable + PFN and MRP + PFN techniques has superior outcomes with earlier bone union and far less incidence of Trendelenburg gait than PFN alone. These findings can help hint that perhaps the usage of cables and recon plates enhances the stability and functional restoration in patients who have sustained reverse oblique ITFF. Level of evidence: III

Objective: This study aimed to evaluate the clinical outcomes of preserving and repairing the bursal tissue—rather than excising it—during total hip arthroplasty (THA), and to assess the additional e!ect of administering a steroid injection into the repaired bursa. Methods: Patients who underwent total hip arthroplasty (THA) via a posterior approach were retrospectively reviewed and dividedinto three groups based on the intraoperative bursal tissue management technique. The first group (PB) included patients who received an intraoperative injection of corticosteroid (40 mg methylprednisolone) and local anesthetic (bupivacaine 5 mg/mL) into the preserved bursa. The second group (BR) consisted of patients who underwent bursal repair without injection. The third group (BE) comprised patients who underwent total excision of the bursa. Clinical outcomes were assessed using the Harris Hip Score (HHS), the Visual Analogue Scale (VAS) for pain during daily activities, and VAS for pain while lying on the ipsilateral hip at 6 and 24 months postoperatively. Results: A total of 41 patients (27 females, 14 males) who underwent THA were included in the study. No statistically significant di!erences were observed between the groups in lateral trochanteric VAS scores during daily activities at both 6 and 24 months postoperatively (P > .05). However, a significant di!erence was found in VAS scores assessed while lying on the operated side at 6 months, favoring the PB group (P < .001). Additionally, Harris Hip Score (HHS) values were significantly higher in the PB group compared to the other groups at both 6 months (P < .001) and 24 months (P=.006). Conclusion: Intraoperative corticosteroid and local anesthetic injection, in addition to bursa repair, may improve early postoperativeoutcomes and pain relief in patients undergoing THA using the posterior approach, without increasing infection risk. Cite this article as: Abul MS, !ahiner D, Sevim ÖF, Hekim Ö, Ergün S, Eceviz E. The impact of bursa repair and steroid injection on lateral trochanteric pain following total hip arthroplasty: a retrospective cohort study. Acta Orthop Traumatol Turc., 2025;59(4):195-200.