Acta orthopaedica et traumatologica turcica最新文献

{"title":"Spinopelvic assessment in preoperative planning of total hip arthroplasty: a comparative cohort analysis.","authors":"Oğuz Çetin, Alpaslan Öztürk, Özgür Avci, Ali Ömer Kaya, Nazan Çevik, Yavuz Akalin","doi":"10.5152/j.aott.2025.24065","DOIUrl":"10.5152/j.aott.2025.24065","url":null,"abstract":"<p><p>Objective: This study aimed to evaluate the utility of preoperative spinopelvic analysis in reducing dislocation risk and to assess changes in spinopelvic mobility following total hip arthroplasty (THA). Methods: This cohort was assessed between 2018 and 2021, including 123 patients (123 hips) who underwent THA via the posterolateral approach. Group 1 (63 hips, 61 patients) underwent spinopelvic analysis with standing and sitting radiographs preoperatively and at 1- and 2-year follow-up, while Group 2 (62 hips, 62 patients) did not. Patients with Crowe type III-IV dysplasia, neurological or cognitive disorders, or acute trauma were excluded. Sacral slope (SS), spinopelvic tilt (sPT), and pelvic femoral angle were assessed. Intergroup comparisons were performed to evaluate the dislocation rates and changes in spinopelvic mobility. Results: One dislocation occurred in Group 1 and 3 in Group 2. In Group 1, significant changes were observed in sitting SS (preoperative to year 1: P < .001; year 2: P=.003) and sitting sPT (year 1: P=.004; year 2: P=.043), while standing measurements remained stable (SS: P=.762-.470; sPT: P=.683-.600). Mean sitting hip flexion also increased significantly (P < .001). Among 26 patients with hypermobility, 18 demonstrated normalization at 1 year, and 2 additional patients normalized at 2 years. In 1 patient with hypomobility, adjustment of acetabular anteversion based on spinopelvic findings successfully prevented dislocation. Conclusion: Preoperative spinopelvic analysis enabled the identification of mobility abnormalities and allowed for targeted surgical adjustments that may reduce dislocation risk. Notably, dislocations could potentially have been avoided with prior spinopelvic evaluation, underscoring its clinical relevance in preoperative planning. Postoperatively, SS increased exclusively in the sitting position, while remaining unchanged in standing position, reinforcing the necessity of seated imaging for comprehensive assessment. Level of Evidence: Level II, Cohort Study.</p>","PeriodicalId":93854,"journal":{"name":"Acta orthopaedica et traumatologica turcica","volume":"59 5","pages":"286-291"},"PeriodicalIF":1.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring shoulder abduction strength using 2 different dynamometers: comprehensive intrarater and interrater reliability and validity.","authors":"Ecenur Atli, Mahir Topaloglu, Zeynep Hosbay, Arzu Razak Ozdincler","doi":"10.5152/j.aott.2025.25299","DOIUrl":"10.5152/j.aott.2025.25299","url":null,"abstract":"<p><p>Objective: The purpose of this study is to investigate the intrarater and interrater reliability of handheld dynamometer (HHD) measurements in assessing isometric muscle strength of the shoulder abductors and to compare these results with those obtained using a fixed dynamometer (FD). Methods: The study involved 25 voluntary participants, all over the age of 18, asymptomatic (with no injuries in the upper extremity), and not engaged in overhead sports. The participants were evaluated twice by 2 di!erent testers who were experienced in orthopedic rehabilitation, at 90 degrees of shoulder abduction in the scapular plane. On the first measurement day, Tester 1 performed measurements using both HHD and FD, while on the second measurement day, both testers used only the HHD. A 3- to 7-day interval separated the 2 measurement sessions. Paired-samples t-tests were used to evaluate the systematic bias between the testers. Spearman's rank correlation coe\"cient, intraclass correlation coe\"cient, standard error of measurement, and minimal detectable change were calculated. The statistical significance level was accepted as P < .05. Results: Data from 22 participants (15 women, 7 men; mean age: 23.00 ± 3.19 years) were analyzed, as 3 individuals did not attend the final assessment. A strong correlation (r=0.772) was found between Tester 1's HHD measurements and FD, while a similarly strong correlation (r=0.748) was observed for Tester 2's HHD measurements. Excellent intrarater reliability (intraclass correlation coe\"cient [ICC]=0.941) was found between Tester 1's measurements, and excellent interrater reliability (ICC=0.889) was found between testers. Conclusion: Handheld dynamometer has demonstrated excellent interrater and intrarater reliability and high validity for assessing shoulder abductor muscle strength in research and clinical use. Since the muscle strength of testers using the HHD may influence the results, the FD may be a more appropriate option when the study population is stronger than the testers. Studies involving di!erent clinical populations and testers with varying experience levels are needed to improve the relevance of the results. Level of Evidence: Level III, Diagnostic Study.</p>","PeriodicalId":93854,"journal":{"name":"Acta orthopaedica et traumatologica turcica","volume":"59 5","pages":"259-264"},"PeriodicalIF":1.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MRI-based evaluation of tibial tunnel proximity to the anterior horn of the lateral meniscus in remnant-preserving anterior cruciate ligament reconstruction.","authors":"Hasan Bombaci, Mert Kahraman Marasli, Okan Akinci, Murat Ozogul","doi":"10.5152/j.aott.2025.24072","DOIUrl":"10.5152/j.aott.2025.24072","url":null,"abstract":"<p><p>Objective: This study aims to evaluate the proximity between the anterior horn of the lateral meniscus (AHLM) and the tibial tunnel on postoperative magnetic resonance imaging (MRI) in patients who underwent remnant-preserving anterior cruciate ligament reconstruction (RP-ACLR), in order to assess the potential risk of AHLM injury. Methods: Eighty patients who underwent RP-ACLR between 2014 and 2020 were retrospectively analysed using postoperative MRIs. A 4-layer hamstring graft was used in all cases, and the mean diameter of the tibial tunnel was 8.17 ± 0.67 mm (range: 7-10 mm). The nearest distances between the AHLM and the tibial tunnel were measured in the coronal and axial planes on postoperative MRIs. Pearson and Spearman correlation tests were used for the correlation analyses. Calculations were made for the intraclass and interclass correlation coe!cients (ICC). Results: In the axial plane, the tibial tunnel was tangential to the AHLM in 4 patients (5%) and in the coronal plane in 3 patients (3.8%), with the nearest distance measured as 0 mm. No contour irregularity of the lateral meniscus was observed in any patient; meniscal morphology and signal characteristics were preserved, and no complex tears, deformations, or extrusions were detected on MRI. Statistical analyses demonstrated excellent intraobserver (ICC: 0.97-0.98) and interobserver (ICC: 0.99) reliability of the measurement method. Additionally, no statistically significant correlation was found between the measured distances and Lysholm scores. Conclusion: This study demonstrated that, although the tibial tunnel in RP-ACLR is in close proximity to the AHLM, injury to the AHLM can be avoided by carefully adjusting the trajectory of the guide wire to ensure it exits through the centre of the remnant tissue. Level of Evidence: Level IV, Therapeutic Study.</p>","PeriodicalId":93854,"journal":{"name":"Acta orthopaedica et traumatologica turcica","volume":"59 5","pages":"280-285"},"PeriodicalIF":1.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative effects of cyclooxygenase-2 selective and nonselective nonsteroidal anti-inflammatory drugs and acetaminophen on rotator cuff tendon-bone healing in a rat model.","authors":"Ebubekir Bektaş, Mehmet Emin Çelebi, Tuhan Kurtulmuş, Filiz Yılmaz","doi":"10.5152/j.aott.2025.25278","DOIUrl":"10.5152/j.aott.2025.25278","url":null,"abstract":"<p><p>Objective: This study aimed to investigate and compare the e!ects of naproxen (a nonselective nonsteroidal anti-inflammatory drug [NSAID]), celecoxib (a cyclooxygenase (COX)-2 selective NSAID), and acetaminophen (an analgesic with minimal anti-inflammatory activity) on tendon and tendon-bone healing following surgically induced supraspinatus tendon repair in a rat model. Methods: In this experimental study, 56 adult male Wistar Albino rats (mean weight, 300 g) were randomized into 4 groups (n=14 per group): control (1% methylcellulose vehicle), naproxen, celecoxib, and acetaminophen. A standardized full-thickness tear of the supraspinatus tendon was surgically created, and repair was performed using transosseous suture fixation through a humeral bone tunnel. Postoperative treatments were administered via oral gavage for 14 days. Tendon healing was assessed at 28 days through histological evaluation using modified Bonar scoring (n=6 per group) and biomechanical testing via uniaxial tensile assays (n=8 per group). Primary outcome measures included Bonar scores, maximum tensile strength, displacement, and sti!ness. Results: The acetaminophen and control groups demonstrated superior maximum strength and sti!ness compared to the NSAID-treated groups; however, these di!erences did not achieve statistical significance (maximum strength: P=.28; sti!ness: P=.40). Histological analyses revealed significantly enhanced tendon-bone healing in the acetaminophen and control groups relative to the celecoxib and naproxen groups (P=.01). Conclusion: The early postoperative administration of COX-2 selective and nonselective NSAIDs may compromise early tendon-bone healing compared to acetaminophen. Although biomechanical di!erences were not statistically significant at 28 days, histological findings underscore the potential impact of analgesic selection on early postoperative tendon healing. Level of Evidence: N/A.</p>","PeriodicalId":93854,"journal":{"name":"Acta orthopaedica et traumatologica turcica","volume":"59 5","pages":"245-252"},"PeriodicalIF":1.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of single-leg versus double-leg weight-bearing radiographs on surgical decision-making in knee osteoarthritis.","authors":"Ömer Bozduman, Yasin Köker, Mesut Ozturk, İbrahim Tuncay, Burak Akan","doi":"10.5152/j.aott.2025.25286","DOIUrl":"10.5152/j.aott.2025.25286","url":null,"abstract":"<p><p>Objective: This study aimed to evaluate how single-leg weight-bearing and double-leg weight-bearing radiographs a!ect knee osteoarthritis assessment and treatment planning. Methods: Fifty orthopedic physicians were asked to assess the knee radiographs of 10 female patients (mean age: 68 ± 6.6 years) presenting with knee pain. The radiographs were obtained in both double-leg and single-leg weight-bearing positions. Physicians were asked to determine the appropriate treatment plan (conservative management, unicondylar knee replacement, or total knee replacement). If they opted for surgical intervention, they were further asked to specify which prosthetic material they required to be available during surgery (a unicondylar knee prosthesis, both unicondylar and total knee prostheses, a total knee prosthesis, both total and revision knee prostheses). Treatment plans based on double-leg and single-leg weight-bearing radiographs were compared. Results: Conservative management was more frequently selected based on double-leg weight-bearing radiographs (P < .001). In contrast, the requirement for additional surgical materials was significantly higher for single-leg weight-bearing radiographs (P < .001). Specifically, 53.6% of physicians preferred having both total and revision knee prostheses available based on double-leg weight-bearing images, compared to 64.2% for single-leg images. Moreover, 31.2% of physicians upstaged their treatment plans after reviewing single-leg radiographs. Additionally, 13% of physicians opted for a total knee prosthesis based on double-leg weight-bearing images, whereas this proportion increased to 29% with single-leg weight-bearing images. Conclusion: Single-leg weight-bearing radiographs prompted more invasive treatment decisions, highlighting their clinical utility in detecting pathology that may influence surgical planning. Level of Evidence: Level IV, Diagnostic Study.</p>","PeriodicalId":93854,"journal":{"name":"Acta orthopaedica et traumatologica turcica","volume":"59 5","pages":"274-279"},"PeriodicalIF":1.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Computed tomography-guided radiofrequency ablation in the treatment of intra-articular proximal femoral osteoid osteoma.","authors":"Mehmet Semih Çakır, Celal Caner Ercan, Mehmet Karagülle, Osman Emre Aycan, Berksu Polat, Bulent Acunas","doi":"10.5152/j.aott.2025.24164","DOIUrl":"10.5152/j.aott.2025.24164","url":null,"abstract":"<p><p>Objective: The present study aimed to evaluate the clinical success of computed tomography (CT)-guided radiofrequency ablation (RFA) in the treatment of proximal femoral located intra-articular osteoid osteoma (IAOO). Methods: This retrospective study included consecutive patients with clinical and CT imaging features suggestive of IAOO who were treated using a standardized CT-guided RFA technique between January 2020 and September 2024. The clinical, demographic, and radiological characteristics of the patients were documented. The e!cacy and results of the RFA treatment were evaluated. Results: Based on the inclusion criteria, 20 patients were included in the study. The mean follow-up period was 29.2 months (range: 6-48 months). The median procedure time was 43 minutes. No immediate or late major or minor complications were recorded. Technical success was achieved in 100% of the cases. In 3 of 20 patients, pain symptoms recurred within the first month, so RFA was performed again, and full clinical success was achieved. The preoperative mean Visual Analogue Scale (VAS) score was 7.4 (range: 5-10). The postoperative first month mean VAS score was 1.2 (range: 0-2). Conclusion: Computed tomography-guided RFA is a highly safe and e\"ective technique that can be considered as the first choice for treating symptoms associated with proximal femoral IAOO. Performing all manipulations under CT guidance at all stages of the procedure, accessing the nidus through extra-articular normal bone, and centralizing the nidus with the RFA probe facilitates the safety of the technique and prevents damage to the articular cartilage. Ü Level of Evidence: Level IV, Therapeutic Study.</p>","PeriodicalId":93854,"journal":{"name":"Acta orthopaedica et traumatologica turcica","volume":"59 5","pages":"292-298"},"PeriodicalIF":1.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the role of large language models in adolescent idiopathic scoliosis care: a comparison between ChatGPT and Google Gemini.","authors":"Semih Yaş, Dilek Yapar, Aliekber Yapar, Tayfun Özel, Mehmet Ali Tokgöz, Alim Can Baymurat, Alpaslan Şenköylü","doi":"10.5152/j.aott.2025.25279","DOIUrl":"10.5152/j.aott.2025.25279","url":null,"abstract":"<p><p>Objective: To evaluate the accuracy, applicability, comprehensiveness, and communication quality of responses generated by ChatGPT and Google Gemini in adolescent idiopathic scoliosis (AIS)-related scenarios, with the aim of assessing their potential utility as tools in patient management. Methods: Six case-based questions reflecting common patient concerns related to adolescent idiopathic scoliosis were developed by orthopedic specialists. Responses generated by ChatGPT and Google Gemini were independently evaluated by 61 orthopedic surgeons using a standardized rubric assessing accuracy, applicability, comprehensiveness, and communication clarity, each rated on a 1-5 Likert scale. Comparative analyses between platforms were performed using the Mann-Whitney U and Wilcoxon signed-rank tests. Additionally, open-ended feedback was collected to explore participants' perspectives on the potential and limitations of AI-based consultations. Results: ChatGPT outperformed Google Gemini in terms of accuracy (P = .013) in postoperative care scenarios. The results for applicability (P = .119), comprehensiveness (P = .619), and communication (P = .240) were not statistically significant. Orthopedic specialists rated both AI models significantly higher than residents in accuracy, applicability, and comprehensiveness. Most evaluators acknowledged the potential of AI to reduce physician workload and support patient guidance; however, concerns were raised regarding reliability, ethical implications, and the current limitations of AI in ensuring patient safety. Conclusion: ChatGPT and Google Gemini demonstrated moderate accuracy and communication quality in adolescent idiopathic scoliosis-related scenarios, with ChatGPT showing a modest advantage. Although both models show promising results as supportive tools for patient education and preliminary consultations, their current limitations in accuracy and comprehensiveness restrict their clinical reliability. Multidisciplinary collaboration is crucial to ensure e!ective applications of AI in orthopedic practice. Level of Evidence: Level III, Diagnostic Study.</p>","PeriodicalId":93854,"journal":{"name":"Acta orthopaedica et traumatologica turcica","volume":"59 4","pages":"222-229"},"PeriodicalIF":1.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of foot and ankle fixation using biointegrative implants-a retrospective study.","authors":"Colin O'Neill, Aayush Mehta, Abhinav Bhamidipati, Sarah Hearns, Soheil Ashkani-Esfahani, Gregory R Waryasz","doi":"10.5152/j.aott.2025.25292","DOIUrl":"10.5152/j.aott.2025.25292","url":null,"abstract":"<p><p>Objective: This study aimed to evaluate mid-term outcomes (>52 weeks) of biointegrative implants in foot and ankle surgery by assessing patient-reported outcome measures (PROMs) and comparing them with standard metal implants. Additionally, the study examined radiographic changes in diastasis of the Lisfranc and syndesmosis injuries to determine the e!ectiveness of biointegrative implants for maintaining reduction. Methods: This retrospective case-control study included 178 patients who underwent midfoot, hindfoot, or ankle syndesmosis surgeries at 3 centers within the same institution (91 cases, 87 controls). Of the 91 patients in the case group, 46 were female and 45 were male. The control group consisted of 43 females and 44 males. The mean age was 42.45 ± 18.89 years in the case group and 42.68 ± 18.32 years in the control group. Cases received biointegrative implants; controls received metal or flexible fixation. Procedures included fixation or fusion of the Lisfranc joint, tarsometatarsal joints, intercuneiform, navicular, cuneiforms, and cuboid; hindfoot arthrodesis; and medial malleolus or syndesmosis fixation. Visual analog scale (VAS) pain scores were recorded at preoperative, early postoperative, and at 3, 6, and 12 months. Patient-reported outcome measure scores (Pain Interference [PIF], Pain Intensity [PI], and Physical Function [PF]) were collected at baseline, early postoperative, and \"1-month postoperative. Diastasis and fixation integrity were assessed via radiographs and Computed Tomography. Re-operation and complication data were extracted from patient charts. Repeated-measures ANOVA was used for analysis. Results: Both groups showed significant reductions in VAS pain scores from preoperative to postoperative time points (P < .001). Further reductions were observed from the first postoperative visit to 3 and 6 months (P < .02), and from 3 to 12 months (P < .01). However, no significant di!erences were found between groups regarding VAS scores (P = .50). PROMIS scores significantly improved over time in both groups (PF: P < .001, PIF: P < .001, PI: P < .001), with no intergroup di!erences (PF: P = .52, PIF: P = .55, PI: P = .37). No di!erence in diastasis measurements was found between groups (P = .214). Hardware failure occurred in 5 cases and 14 controls; 2 surgical site infections were also observed in the control group. Conclusion: This study is among the first to evaluate mid-term outcomes of biointegrative implants in foot and ankle surgery. Patient-reported outcome measure scores showed significant improvement as early as the early postoperative period. Complication rates were comparable to metal implants. While findings support biointegrative screws as a viable fixation method, long-term and prospective studies are needed to confirm their safety and efficacy. Level of Evidence: Level III, Therapeutic Study.</p>","PeriodicalId":93854,"journal":{"name":"Acta orthopaedica et traumatologica turcica","volume":"59 4","pages":"191-194"},"PeriodicalIF":1.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting mechanical complications in adult spinal deformity patients with postoperative proportioned and moderately disproportioned alignment.","authors":"Baris Balaban, Nuri Demirci, Caglar Yilgor, Altug Yucekul, Tais Zulemyan, Sleiman Haddad, Shahnawaz Haleem, Feyzi Kilic, Ibrahim Obeid, Javier Pizones, Frank Kleinstueck, Francisco Javier Sanchez Perez, Ferran Pellise, Ahmet Alanay, Cetin Bagci, Osman Ugur Sezerman","doi":"10.5152/j.aott.2025.24146","DOIUrl":"10.5152/j.aott.2025.24146","url":null,"abstract":"<p><p>Objective: Mechanical complications are common after adult spinal deformity (ASD) surgery and can significantly impair outcomes. This study aimed to predict such complications in proportioned and moderately disproportioned patients using a machine learning approach, to inform preoperative planning and enable early preventive care. Methods: Prospectively collected clinical data, including preoperative, intraoperative, and postoperative variables, radiographic param- eters, technical details, and patient-reported outcomes, were obtained from a multi-center ASD surgery database. Parameter tuning of a random forest (RF) classifier was performed using 9-times 3-fold cross-validation over 3 rounds of grid search, with the F-score used as the primary optimization metric. The final RF model was used to derive a clinically interpretable rule set using the inTrees framework. Permutation-based feature importance was assessed for F-score, accuracy, and sensitivity. Results: The model was trained on 295 patients (237 female, 58 male; mean age, 50 ± 19 years) with a minimum 2-year follow-up (mean 53 months, range 24-101). Mechanical complications were observed in 100 patients (34%). A test cohort of 98 patients (33% complication rate) was used for external validation. The RF model achieved 72% accuracy, 91% sensitivity, 64% specificity, and 93% negative predictive value. The derived rule set, comprising 8 rules using 1 to 3 features each, yielded 74% accuracy, 81% sensitivity, 71% specificity, and 83% negative predictive value. The location of the lower instrumented vertebra (LIV) was the most influential predictor. Conclusion: By excluding patients with severe deformities, as defined by the GAP score, this study focused on the more clinically ambiguous group of proportioned and moderately disproportioned patients. To the authors' knowledge, this is the first study to develop predictive tools specifically for this subgroup to assess the risk of mechanical complications following ASD surgery. These tools may assist in early risk stratification and guide preoperative decision-making to reduce postoperative complications and improve patient outcomes. Level of Evidence: Level III, Prognostic Study.</p>","PeriodicalId":93854,"journal":{"name":"Acta orthopaedica et traumatologica turcica","volume":"59 4","pages":"210-221"},"PeriodicalIF":1.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iatrogenic injury to the descending branch of the lateral circumflex femoral artery during intertrochanteric fracture fixation: a case report of guide pin-related vascular complication.","authors":"Hong Man Cho, Haeryong Heo, Myung Cheol Jung","doi":"10.5152/j.aott.2025.24071","DOIUrl":"10.5152/j.aott.2025.24071","url":null,"abstract":"<p><p>Vascular injuries associated with femoral intertrochanteric fractures are rare but can result in serious complications. A case of iatrogenic injury to the descending branch of the lateral circumflex femoral artery in a patient who underwent surgical fixation of an intertro-chanteric femoral fracture is presented. The injury possibly occurred during the creation of the entry point for nail insertion using a guide pin. Clinical symptoms emerged 10 days postoperatively and were successfully managed with percutaneous embolization, without major complications. This case highlights that pseudoaneurysms can develop as a result of guide pin use during hip nailing procedures. Surgeons can avoid this complication by obtaining lateral and anteroposterior views of the hip. Level of Evidence: IV, Case Report.</p>","PeriodicalId":93854,"journal":{"name":"Acta orthopaedica et traumatologica turcica","volume":"59 4","pages":"237-240"},"PeriodicalIF":1.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}