Objective: This study aims to assess the histopathological and clinical characteristics of chondroblastomas (CBs), with particular emphasis on the correlation between local invasion and mitotic activity, cytological atypia, and recurrence. Methods: A retrospective analysis was performed on 26 cases of CB diagnosed between 2016 and 2024 and pathologically evaluated at a tertiary oncology center, with surgical procedures performed across 2 tertiary oncology referral centers. Clinical, radiological, and histopathological data were reviewed. For comparative analysis, tumors were grouped as non-infiltrative (confined to the bone) or infiltrative (showing invasion of the bone cortex and/or extracortical connective tissues). Tumors were assessed for cytological atypia, mitotic index, matrix production, calcification, aneurysmal bone cyst formation, and invasion pattern. Immunohistochemical staining for S100, DOG1, and Ki-67 was conducted. Statistical analyses included t-tests, Mann–Whitney U, chi-square, and correlation analyses. Results: The mean age at diagnosis was 17.7 years, with a male-to-female ratio of 1.36 : 1. The femur was identified as the most common site. Invasion beyond the bone cortex was observed in 16 patients (61.5%), including 4 instances of soft tissue involvement. Invasive tumors showed significant association with moderate cytological atypia (P = .022), higher mitotic index (P = .023), and lower extremity location (P = .02). A positive correlation was identified between mitotic index and both atypia (P = .001) and tumor invasiveness. Recurrence occurred in four patients (15.4%), all presenting invasive tumors. No metastases were reported during the mean follow-up period of 38.9 months. Conclusion: Although CB typically manifests benign behavior, a subset of these tumors demonstrates locally aggressive characteristics, such as cortical and soft tissue invasion. Elevated mitotic activity and moderate cytological atypia may serve as histopathological markers for local aggressiveness. Cite this article as: Aygün MİŞ, .omunoğlu C, Doğan B, Adaş M, Tanrıtanır R. Chondroblastoma: the relationship between local invasiveness, recurrence, and histopathological features. Acta Orthop Traumatol Turc., 2026; 60(4), 0407, doi: 10.5152/j.aott.2026.25407.
Objective: This study aimed to evaluate the potential of miR-655-3p as a diagnostic biomarker for primary osteoarthritis (OA) and to investigate its intrinsic molecular mechanisms as a means of addressing the lack of sensitive early diagnostic biomarkers and targeted anti-inflammatory therapies for this prevalent degenerative joint disorder. Methods: Quantitative real-time polymerase chain reaction was performed to measure (1) miR-655-3p levels in the serum of 93 primary OA patients and 60 non-OA controls, (2) miR-655-3p levels in the synovial fluid of OA patients, and (3) messenger RNA (mRNA) expression of TLR4, RelA, TNF-α, and IL-6 in the IL-1β–induced OA chondrocyte model. Enzyme-linked immunosorbent assay measured the secretion of IL-6 and TNF-α. Receiver operating characteristic curve (ROC) analysis assessed its diagnostic value in multiple clinical scenarios. Cell function assays investigated cell viability and apoptosis. Target genes were predicted via 3 databases, and the interaction between miR-655-3p and TLR4 was verified by dual-luciferase reporter assay and Western blot. Rescue experiments were performed to confirm the mechanistic specificity. Results: miR-655-3p was downregulated by 44.8% in OA serum (P < .001) and 46.7% in IL-1β–induced chondrocytes (P < .001). ROC curve analysis showed an overall area under the curve (AUC) of 0.9518 (95% CI: 0.920-0.983), with consistent high accuracy in distinguishing OA from healthy controls (AUC = 0.9509), meniscus injury patients (AUC = 0.9425), and mild OA from controls (AUC = 0.9306). Serum miR- 655-3p levels were negatively correlated with OA severity (American Academy of Orthopaedic Surgeons score, P = .010) and inflammatory factor levels (TNF-α, IL-6, both P < .001). Dual-luciferase assay confirmed TLR4 as a direct target of miR-655-3p; miR 655-3p overexpression reduced TLR4 protein expression by 48.7%, while inhibition increased it by 52.8%. TLR4 overexpression completely reversed the antiinflammatory and anti-apoptotic effects of miR-655-3p in OA chondrocytes. Conclusion: miR-655-3p is a highly accurate diagnostic biomarker for primary OA, and upregulating miR-655-3p may provide a novel clinical treatment direction by targeting TLR4 to alleviate joint inflammation. Cite this article as: Li R, Chen C, Chen D. MiR-655-3p is a highly accurate diagnostic biomarker for primary osteoarthritis and alleviates joint inflammation by targeting TLR4. Acta Orthop Traumatol Turc., 2026; 60(4), 0803, doi: 10.5152/j.aott.2026.25803.
Objective: The objective of this study was to investigate gait stability characteristics in patients with chronic ankle instability (CAI) by analyzing six degrees of freedom (6DOF) kinematic alterations in comparison with healthy controls. Methods: A cross-sectional study was conducted to evaluate 6DOF ankle kinematics in individuals with CAI and healthy controls using a dual fluoroscopic imaging system during treadmill walking. Three representative gait cycles were selected for each participant, normalized to 0–100% of the gait cycle, and averaged for analysis. Time-series kinematic differences were assessed using Statistical Parametric Mapping (SPM1D) with one-way ANOVA and post-hoc tests, while discrete variables were compared between groups with Bonferroniadjusted significance. Results: Compared with the control group, the contralateral limbs demonstrated greater distal displacement during 44–55% of the gait cycle (2.7–3.8 mm, p<0.001), whereas the CAI limbs exhibited reduced plantarflexion during 68–75% of the gait cycle (5.1–7.3, p<0.001). Additionally, the range of motion (ROM) for abduction-adduction (2.5Åã, p<0.05) and internal-external rotation (2.4, p<0.05) on the CAI sides was smaller compared with the contralateral sides. Both the CAI and contralateral limbs showed a decrease in medial-lateral displacement in the coronal plane relative to the control group (3.1mm, p<.05). Conclusion: This study demostrated that individuals with CAI exhibit distinct gait strategies compared to healthy controls, characterized by a reduction in plantarflexion in the CAI sides, an increase in distal displacement in the contralateral sides, and an overall decrease in the ROM on the CAI sides. Cite this article as: Chen H, Kang Q, Yao M, et al. The gait stability characteristics of individuals with chronic ankle instability. Acta Orthop Traumatol Turc., 2026; 60(4), 0567, doi: 10.5152/j.aott.2026.25567.
Objective: Unilateral biportal endoscopy (UBE) has gained prominence in the surgical treatment of lumbar disc herniation (LDH) because of its minimally invasive profile. How preoperative patient expectations align with postoperative satisfaction after UBE remains insufficiently characterized. The aim was to evaluate the relationship between preoperative expectations and 6-month postoperative satisfaction after single-level UBE discectomy, while also assessing perioperative safety and patient-reported outcomes. Methods: Retrospective, single-center cohort of consecutive adults undergoing single-level UBE discectomy (September 2022–January 2024) performed by a single surgeon. Preoperative expectations were captured with an 8-item Likert-type survey (scaled 0-100). Outcomes at 6 months included visual analog scale (VAS) (back/leg), Oswestry Disability Index (ODI), a single-item satisfaction score (0-100), and patient acceptable symptom state (PASS) derived by anchor-based receiver operating characteristic (ROC) analysis for ODI; a sensitivity analysis tested the fixed threshold ODI ≤25. Group comparisons used ANOVA/Kruskal–Wallis with Tukey post-hoc as appropriate. Associations were examined using Pearson correlation and restricted multivariable regression models adjusted for clinically prespecified covariates. Results: During the study period, 102 patients were screened; 73 were eligible after exclusions (n = 29). Six-month outcome data were available for 68/73 patients (5 lost to follow-up/incomplete records). The analyzed cohort had a mean age of 44.7 } 9.8 years and 55.9% were male. Perioperative metrics reflected a favorable minimally invasive profile (operative time 96.8 } 11.7 minutes; estimated blood loss 56.3 } 24.1 mL; length of stay 1.8 Å} 0.9 days; complications 5.9%, no reoperations). Pain and disability improved substantially from baseline to 6 months (VAS 7.6 } 1.1 to 1.9 } 0.8; Δ = −5.7 } 1.3; P < .001; ODI 56.3 } 8.7 to 17.5 } 6.1; Δ = −38.8 } 9.2; P < .001). The mean expectation rating score was 76.5 } 14.8 and satisfaction 82.1 } 12.4. Higher preoperative expectations correlated with lower satisfaction (r = −0.37; P = .02). Satisfaction differed across expectation strata (P < .01), with the highest scores in the moderate group and lowest scores in the high group; post-hoc significance was observed for moderate versus high expectations (Tukey, P = .004). Patient acceptable symptom state analysis identified a cohort-specific ODI threshold with high discriminative ability; overall PASS rates were high and did not differ across expectation groups. In multivariable models, higher expectations were independently associated with lower satisfaction but not with change in VAS/ODI or achievement of PASS. Conclusion: Single-level UBE discectomy yields robust improvements in pain and function with low morbidity. Higher preoperative expectation scores were independently associated with lower postoperative satisfaction, despite comparable clinical gains and PASS attainment. Satisfaction was highest in the moderate-expectation group and lowest in the high-expectation group, with pairwise significance observed only between the moderate- and high-expectation groups. These findings suggest that satisfaction after UBE discectomy is related not only to objective clinical improvement but also to expectation–outcome alignment. Cite this article as: Bayram Y, Karataş ME, Uzunlu İ, Bulum YE. Preoperative patient expectations and postoperative satisfaction following singlelevel unilateral biportal endoscopic lumbar discectomy: Are higher expectations associated with lower satisfaction?. Acta Orthop Traumatol Turc., 2026; 60(4), 0799, doi: 10.5152/j.aott.2026.25799.
Objective: Facet tropism has been proposed as a morphologic modifier of posterior element loading, but prior evidence in lumbar spondylolysis is inconsistent and often based on 2D measurements. This study aimed to evaluate whether facet tropism differs between patients with lumbar spondylolysis and controls using a CT-based three-dimensional (3D) morphometric workflow with vertebra-anchored reference planes. Methods: This retrospective case–control study included 39 individuals: 19 with CT-confirmed lumbar spondylolysis and 20 controls (age and sex comparable). Vertebrae L1-L5 were segmented, 3D surface models were generated, and best-fit planes were computed for each superior and inferior facet surface bilaterally. Facet orientation was quantified relative to sagittal, frontal, and transverse planes. Facet tropism (FT) was defined as the absolute right–left difference in facet angles for the same level and facet type; FT presence was descriptively defined as >5, while hypothesis testing used continuous FT values. Group comparisons were performed across L1–L5 and for prespecified lowerlumbar segment metrics (L4-L5 facet-plane mismatch and L5v intra-vertebral mismatch). Results: Spondylolysis involved L5 in 18/19 patients (4 unilateral, 14 bilateral) and L4 in 1/19. Across L1-L5, facet tropism (FT) did not differ between groups for either superior or inferior facets in any plane (all p > .05). The greatest numerical difference was observed for L5 inferior FT on the sagittal plane (controls 10.38 } 9.40 vs. patients 7.51 } 10.93), but this comparison did not reach statistical significance (p = .092). Lower-lumbar segment-focused mismatch measures also showed no between-group differences (all p > .05). Frontal-plane and sagittal-plane angles showed strong positive correlations in both groups (controls: r = 0.811-0.998; patients: r = 0.851-0.995; all p < .05), whereas transverse-plane parameters showed no meaningful associations. Conclusion: Using CT-based 3D morphometry, no statistically significant association between facet tropism and lumbar spondylolysis was demonstrated in the present study population, and facet tropism did not discriminate cases from controls across lumbar levels or lowerlumbar segmental mismatch metrics. In this cohort, which was predominantly characterized by L5 involvement and frequent bilateral defects, side-to-side facet asymmetry did not appear to represent a major independent morphologic marker when measured with a standardized 3D framework. Cite this article as: Karatas ME, .a.an MA, Türkten İ, Pen.e KB, Şakul BU. Facet tropism is not associated with lumbar spondylolysis: a computed tomography– based three-dimensional morphometric case–control study. Acta Orthop Traumatol Turc., 2026; 60(4), 1005, doi: 10.5152/j.aott.2026.261005.
This technical note describes the surgical technique of combining anterior latissimus dorsi and teres major (LDTM) tendon transfer with biceps superior capsular reconstruction (SCR) for the treatment of anterosuperior irreparable rotator cuff tears (AIRCTs). Anterosuperior irreparable rotator cuff tears, characterized by irreparable tears in the subscapularis and supraspinatus tendons, can lead to significant shoulder dysfunction. The described procedure aims to restore glenohumeral stability, prevent humeral head migration, and optimize shoulder mechanics. The LDTM tendon transfer replicates the function of the subscapularis, while the biceps SCR helps prevent superior humeral head migration. This technical note provides a comprehensive, reproducible, and effective surgical approach for managing AIRCTs. Cite this article as: Baek CH, Kim BT, Kim JG, Lim C. Combined anterior latissimus dorsi and teres major transfer and superior capsular reconstruction using autogenous biceps tendon for anterosuperior irreparable rotator cuff tears: technical note. Acta Orthop Traumatol Turc., 2026; 60(3), 0643, doi: 10.5152/j.aott.2026.25643.
Objective: Supracondylar humerus fractures (SHFs) are prevalent injuries in pediatric orthopedics and often necessitate surgical management to restore elbow function and prevent long-term complications. The study aimed to evaluate the biomechanical effects of different fracture levels relative to the olecranon fossa and the efficacy of different pin configurations. Methods: Synthetic humerus bone models were used to standardize the fracture patterns and simulate surgical interventions. Pin configurations, including lateral divergent and cross-pin configurations, were applied using 3D-printed custom guides. Bending and torsional tests were conducted to assess biomechanical stability, with stiffness values calculated for each fixation method. Statistical analysis was performed to compare outcomes between the groups. Results: Distinct biomechanical responses to bending and torsional loads at various fracture levels and fixation configurations were observed. Lower-level fractures demonstrated greater stability in bending forces (low cross bending–high cross bending, P = .025; low divergent bending–high divergent bending, P = .004), with cross-pin fixation providing advantages in torsional forces compared with lateral divergent pinning (low divergent torsion–high divergent torsion, P = .001). Conversely, no significant biomechanical superiority was observed in higher-level fractures. Statistical analysis highlighted significant differences in maximum forces and stiffness values between the fixation groups, indicating the selection of optimal fixation strategies based on fracture characteristics. Conclusion: Results showed that distal SHFs were biomechanically more stable under bending forces, with cross-pin fixation providing an advantage in torsional forces for lower-level fractures. However, no significant biomechanical superiority was found for high fractures. These findings contribute to the understanding of fracture fixation strategies and highlight the importance of tailored approaches based on the fracture level. Further clinical studies are warranted to validate these biomechanical findings and to assess their impact on patient outcomes. Cite this article as: Kaymakoğlu M, Ramazanov R, Güneş Z, Aksoy T, Yılmaz G. Does the level of the supracondylar humerus fractures affect the stability of pinning configurations? A biomechanical study. Acta Orthop Traumatol Turc. 2026; 60(4), 0352, doi: 10.5152/j.aott.2026.25352.
Objective: Research output on developmental dysplasia of the hip (DDH) in Türkiye is expanding; however, an analysis of collaboration was not undertaken. This study aimed to conduct a comprehensive bibliometric analysis of research on DDH in Türkiye for the last 25 years (2000-2025). Scientific output, citation impact, publication quality, and collaborative network structure compared to global trends were assessed. Strategies for enhancing research productivity and international visibility were identified. Methods: Data were retrieved from the Clarivate Web of Science and InCites databases for articles published between January 1, 2000, and December 31, 2025, with “Developmental Dysplasia of the Hip” or “Congenital Dislocation of the Hip” key words in the title, with country affiliation field defined as Türkiye or Turkey. The search strategy utilized the topic field tag to screen titles, abstracts, and keywords. A total of 363 publications from 113 journals were analyzed. Productivity metrics including publication count, annual growth rate, and document age; citation metrics including total citations, average citations per document, and H-index; impact indicators including Category Normalized Citation Impact, Impact Relative to World, and journal quality stratification according to the Journal Impact Factor Quartiles were covered. Institutional and author collaboration networks were analyzed using network analysis techniques to identify knowledge hubs, collaborative patterns, and research communities. Results: A steady annual growth rate of 6.1% with an average of 9.6 citations per document was identified. Turkish DDH publications increased from 5 documents in 2000 to a peak of 28 documents in 2021. Three researchers, .meroğlu H, Bi.imoğlu A, and Atalar H collectively accounted for nearly 50% of research productions. The top 10 most-cited articles generated 45-102 citations each, with research contributions concentrated in early diagnosis and conservative treatment of DDH in infants and total hip arthroplasty techniques for severe DDH in adults. Hacettepe University was the leading institution with 27 publications and 98 citations, followed by Istanbul University and Ankara Numune Training & Research Hospital. International collaboration, however, accounted for only 4.1% of all documents, and the institutional network exhibited a core structure dominated by Ankara and Istanbul-based institutions. The Journal of Pediatric Orthopaedics-Part B was the leading publication venue with 39 documents and 448 citations, while high-impact international journals achieved superior citation efficiency independent of publication volume. Conclusion: Turkish DDH research has increased in volume but not in global citation impact during the last 25 years. The field was mostly led by a few authors with expertise in infant diagnosis and adult surgical treatment. Limited international collaboration and publication primarily in national journals decreased global visibility and restricted the impact of Turkish contributions to DDH research. Cite this article as: Ko.ak M, .meroğlu H, Kapıcıoğlu MİS, Korkusuz F. A bibliometric analysis of research on developmental dysplasia of the hip: An evaluation of Türkiye’s scientific productivity, impact, and collaboration patterns. 2026; 60(4), 0885, doi: 10.5152/j.aott.2026.26885.
Objective: This study aimed to describe a novel minimally invasive surgical technique for the management of intraoperative and postoperative fractures occurring at the tip of intramedullary lengthening nails without altering the original treatment plan. Methods: This technical note describes a surgical technique applied in two representative cases of peri-implant fractures encountered during intramedullary limb lengthening procedures between 2011 and 2017. The technique involves bypassing the fracture line by utilizing the residual elongation capacity of the nail, followed by stabilization with a percutaneously applied locking compression plate (LC-DCP) and cable system. Key technical steps, intraoperative considerations, and postoperative management are outlined. Results: The described technique enabled successful stabilization of both intraoperative femoral and postoperative tibial fractures without implant exchange or alteration of the treatment plan. The planned lengthening goals were achieved, fracture healing was confirmed radiographically, and both patients regained pain-free ambulation with satisfactory functional outcomes. No major complications or alignment problems requiring additional intervention were observed. Conclusion: This technique provides a practical, reproducible, and minimally invasive solution for managing peri-implant fractures associated with intramedullary lengthening nails. By preserving the existing implant and avoiding additional surgical procedures, it may reduce treatment complexity, cost, and morbidity while maintaining satisfactory clinical outcomes. Cite this article as: Armağan R, Sülek Y, Kanar M, Eren OT. Minimally invasive management of peri-implant fractures in intramedullary limb lengthening: A technical note. Acta Orthop Traumatol Turc. 2026; 60(4), 0503, doi: 10.5152/j.aott.2026.25503.
Bilateral anterior cruciate ligament (ACL) agenesis is an exceptionally rare condition. Only a limited number of bilateral ACL agenesis cases have been reported in the literature, and these patients typically present with additional congenital anomalies or other pathologies involving the knee joint. Here, a 12-year-old male patient was reported with bilateral absence of the ACL, who had no comorbidities other than a history of casting and Achilles tenoplasty performed for pes equinovarus. The patient presented to the clinic with bilateral knee laxity and a sense of instability during daily activities. Magnetic resonance imaging of both knees revealed bilateral ACL agenesis. Unlike most previously published cases, the patient had no associated congenital anomalies or accompanying pathologies, making this case a rare example in the existing literature.
Objective: This study aimed to evaluate the short-term clinical and radiological outcomes of lower extremity and spinal changes following total hip arthroplasty (THA) in patients with unilateral Crowe type III and IV hip dysplasia. Methods: This prospective study included patients who have Crowe type III and IV hip dysplasia evaluated at a high-volume arthroplasty center. Demographic and surgical characteristics were documented. Clinical assessments included the Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short Form-12 (SF-12), Kujala Score, Oxford Knee Score, Oswestry Disability Index (ODI), Roland-Morris Questionnaire, American Orthopedic Foot and Ankle Society (AOFAS) Score, and Foot and Ankle Disability Index (FADI). Radiological assessments included standing anteroposterior (AP) pelvis, AP leg length, and standing/seated lumbosacral AP and lateral radiographs preoperatively and at 1-year postoperatively. Results: Thirty-three patients (mean age 52.7 Å} 11.8 years) were followed for an average of 18.3 Å} 7.0 months. Significant improvements were observed postoperatively in HHS and WOMAC scores for both ipsilateral and contralateral hips, SF-12, ODI, Roland-Morris, and ipsilateral knee WOMAC scores (all P<0.05). Radiologically, postoperative improvements included a significant reduction in leg length discrepancy (P<0.001), medial mechanical axis deviation on the ipsilateral side (P<0.001), increased joint line convergence angle and ankle joint line orientation, and spinopelvic alingment with increased sacral slope (P=0.027) and decreased lumbar lordotic angle (P<0.001). Conclusion: Unilateral high-grade hip dysplasia, when treated with total hip arthroplasty (THA), results in significant short-term improvements in clinical outcomes and lower extremity alignment. In patients with an average follow-up duration of 18.3 Å} 7.0 months, although the valgus deformity on the operated side improved, neutral alignment was not achieved. The contralateral limb remained in varus alignment. While spinopelvic parameters remained within normal limits, significant changes were observed in sacral slope and lumbar lordosis. Cite this article as: Kaya HB, Çiçek EB, Yıldız F, et al. Lower extremity and spinopelvic alignment changes after total hip arthroplasty in unilateral Crowe III-IV dysplasia: clinical and radiological outcomes. Acta Orthop Traumatol Turc., 2026; 60(4), 0689, doi: 10.5152/j.aott.2026.25689.
Objective: This study aimed to evaluate the association between spinopelvic mobility, functional safe zone (FSZ) conformity, and patient reported outcomes following total hip arthroplasty (THA). Methods: This retrospective observational study included 60 patients (22 males, 38 females; mean age 62.5 Å} 9.7 years) who underwent primary THA between October 2021 and October 2023 and completed at least 1 year of follow-up. Mean time since surgery was 22.18 Å} 6.31 months. Spinopelvic mobility was assessed using standing and relaxed-seated lateral radiographs and categorized as stiff ((sacral slope) ΔSS ≤ 10Åã), normal (ΔSS 11Åã-29Åã), or hypermobile (ΔSS ≥ 30Åã). Acetabular component orientation was evaluated according to FSZ conformity using the combined sagittal index. Clinical outcomes were assessed using the Harris Hip Score (HHS), Oxford Hip Score (OHS), Short Form-12 (SF-12), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Group comparisons were performed using one-way analysis of variance (ANOVA) or Welch’s ANOVA with Bonferroni or Games–Howell post-hoc analyses, as appropriate. Results: Spinopelvic mobility was classified as stiff in 18 patients (30%), normal in 34 patients (56.6%), and hypermobile in 8 patients (13.3%). Patients with normal spinopelvic mobility demonstrated significantly better postoperative HHS, OHS, WOMAC, and SF-12 scores compared with the stiff and hypermobile groups (all P < .001). Acetabular components were classified as FSZ-conforming in 38 hips and FSZ-non-conforming in 22 hips. The FSZ-conforming group demonstrated significantly superior HHS (P = .003), OHS (P = .025), WOMAC (P = .001), and SF-12 scores (P = .028) compared with the non-conforming group. Conclusion: Normal spinopelvic mobility and FSZ-conforming acetabular component alignment were associated with superior postoperative functional outcomes and quality of life after THA. These findings highlight the clinical relevance of dynamic spinopelvic assessment and patient-specific cup positioning during preoperative planning for THA. Cite this article as: Polat Y, Polat EA, Alparslan M, et al. Impact of spinopelvic mobility and functional safe zone conformity on functional outcomes after total hip arthroplasty. Acta Orthop Traumatol Turc., 2026; 60(3), 0365, doi: 10.5152/j.aott.2026.25365.
Objective: To evaluate the analgesic and functional efficacy of intra-articular adipose-based cells (ABCs) therapy in knee osteoarthritis (KOA). Methods: Systematic review and meta-analysis of randomized controlled trials comparing ABCs therapy with placebo, hyaluronic acid, or platelet-rich plasma for pain and function in KOA. Results: Ten RCTs (592 patients, follow-up 6-60 months) were included. The ABCs therapy produced clinically relevant reductions in pain: VAS −1.7 (95% CI −2.5, −0.9), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)-pain −7.3 (−14.2, −0.4) and Knee Injury and Osteoarthritis Outcome Score (KOOS)-pain +12.1 (0.1, 24.1). In contrast, pooled changes in WOMAC function (−9.2, P = .10) and KOOS-ADL (−8.3, P = .10) did not reach statistical significance. Conclusion: The ABCs therapy confers reliable short-term pain relief, but long-term functional benefit remains uncertain. Robust, stagespecific randomized trials with ≥24-month follow-up and standardized rehabilitation are required before routine clinical adoption. Cite this article as: Wang G, Shen Z, Zhang Y, et al. Adipose-based cell therapy for the treatment of knee osteoarthritis: a meta-analysis and systematic review. Acta Orthop Traumatol Turc., 2026; 60(3), 0206, doi: 10.5152/j.aott.2026.24206.
Objective: This study aimed to investigate the impact of different compression magnitudes and durations on peripheral nerve conduction and the time required for recovery in a porcine model. Methods: Six adult male farm pigs (Sus scrofa) were allocated to 3 experimental groups. Transcutaneous motor-evoked potential (TcMEP) responses were recorded using surface electrodes. To assess the impact of compression on nerve conduction, compression was applied to the sciatic nerve to reduce the TcMEP by 50%, 70%, and 90% in the first, second, and third groups, respectively. Each compression was applied for durations of 1, 5, and 8 minutes, with TcMEP measurements taken at 5 seconds, 1 minute, 5 minutes, 10 minutes, 30 minutes, and 60 minutes post-compression. Results: In the first group, after 1 minute of compression, the average recovery time for TcMEP values to return to baseline was 118 Å} 25 seconds (range, 60-130 seconds). Following 5 minutes of compression, recovery occurred after an average of 28 Å} 8 minutes (range, 20-38 minutes). However, after 8 minutes of compression, TcMEP values did not return to baseline. In the second group, the recovery time after 1 minute of compression was significantly longer compared to the group with 50% TcMEP reduction (P < .001). After 5 minutes of compression, TcMEP values failed to return to baseline. In the third group, where TcMEP reduction exceeded 90%, no recovery to baseline was observed regardless of compression duration, suggesting irreversible nerve damage. Conclusion: The findings suggest that prolonged compression times result in more significant reductions in TcMEP values, indicating irreversible nerve conduction damage. Further studies are warranted to investigate the clinical implications of these findings, particularly regarding the thresholds for permanent nerve damage. Cite this article as: Karalar Ş, Bayram S, Yağci TF, Akgül T. Electrodiagnostic evaluation of the effect of compression time and intensity on the conduction and recovery time of nerves in the peripheral nervous system. Acta Orthop Traumatol Turc.2026; 60(3), 0068, doi: 10.5152/j.aott.2026.24068.
Objective: To compare clinical, radiological, and functional outcomes of casting vs. closed reduction percutaneous pinning (CRPP) in pediatric Gartland type 2 supracondylar humerus fractures. Methods: This retrospective single-center study included 34 children (mean age 7.9 Å} 2.1 years) with type 2 supracondylar fractures treated between 2015 and 2022. Patients were divided into 2 groups: cast immobilization (n = 20) and CRPP (n = 14). Demographics, radiographic parameters (Baumann angle, anterior humeral line, carrying angle), range of motion, and functional scores (modified Disabilities of the Arm, Shoulder, and Hand (DASH)) were assessed. Statistical comparisons were performed using t-test, Mann–Whitney U, and chisquare analyses, with significance set at P < .05. Results: No significant differences were observed between groups in elbow flexion (131.8Åã in the casting group vs. 131.3Åã in the CRPP group, P = .09), extension (1.1Åã vs. 0.3Åã, P = .08), carrying angle (12.4Åã vs. 14.9Åã, P = .32), Baumann angle (74Åã vs. 73.7Åã, P = .44), or modified DASH scores (5.8 vs. 5.0, P = .31). Loss of reduction occurred in 3 cast patients and 1 CRPP patient, but final outcomes remained comparable. Conclusion: Casting provides similar clinical, radiological, and functional outcomes to CRPP in Gartland type 2 supracondylar humerus fractures. Conservative treatment may represent an effective, less invasive alternative when anatomical reduction is achieved and maintained. Cite this article as: Gokceoglu YS, Darilmaz MF, Demir TB, Bayram S, Cakmak EG, Saglam Y. Is casting as effective as pinning in Gartland type 2 supracondylar fractures? Acta Orthop Traumatol Turc., 2026; 60(3), 0750, doi:10.5152/j.aott.2026.25750.
Objective: The study aimed to investigate the incidence and risk factors of occult infection following intramedullary nail fixation in patients with intertrochanteric fractures and to establish a reliable predictive model for clinical use. Methods: This retrospective study included 1000 patients with intertrochanteric fractures who underwent internal fixation with either proximal femoral nail antirotation (PFNA) or InterTan nails between January 2020 and December 2025. Occult postoperative infection was diagnosed according to the criteria for fracture-related infection. Potential risk factors were first screened through univariate analysis, followed by feature selection using least absolute shrinkage and selection operator (LASSO) regression. Three predictive models logistic regression, random forest, and XGBoost—were constructed and compared. Results: The incidence of occult infection was 5.0%. Least absolute shrinkage and selection operator regression identified 9 independent risk factors: diabetes mellitus (P = .001), osteoporosis (P < .001), type A3 fracture (P < .001), lateral wall damage (P < .001), poor reduction quality (P = .001), intraoperative glove perforation (P < .001), prolonged operation time (P < .001), elevated body mass index (BMI) (P = .008), and increased tip-apex distance (P < .001). Among the 3 predictive models, the XGBoost model demonstrated the best performance, with an area under the curve of 0.79, accuracy of 91%, sensitivity of 62%, and specificity of 95%. The infection rate increased progressively with the predicted probability, confirming the model’s strong discriminative ability. Conclusion: Diabetes mellitus, osteoporosis, type A3 fracture, lateral wall damage, poor reduction quality, intraoperative glove perforation, prolonged operation time, elevated BMI, and increased tip-apex distance are significant predictors of postoperative occult infection in intertrochanteric fracture patients. The XGBoost model provides effective risk prediction and stratification, supporting early identification and prevention of occult infection. Cite this article as: Liu Z, Zhu R, Ge W, Han J, Zou G. Establishment and comparison of machine learning models for predicting occult infection after intramedullary nail internal fixation of intertrochanteric fractures. Acta Orthop Traumatol Turc., 2026; 60(3), 0569, doi: 10.5152/j.aott.2026.25569.
Objective: This study aimed to evaluate the course of non-ossifying fibromas (NOFs) on basis of radiological parameters, determine the risk factors for management and define follow-up strategies. Methods: A retrospective review was performed on 104 skeletally immature patients who were followed for a minimum of 3 consecutive years. Radiographic evaluations included measurement of lesion size, cortical thinning, and distance from the physis. Lesions were classified according to the radiological maturation stages described by Ritschl et al, and the transition time between each stage was recorded. Fracture risk was assessed using radiographic, computed tomography, and magnetic resonance imaging (MRI)-based criteria, including cortical involvement percentage, cortical breach, lesion size, absence of neocortex, presence of syndesmosis, and the “Pac-Man sign” as defined by Baghdadi et al. Results: The mean age at diagnosis was 11.3 years. Pathological fractures occurred in 11 patients (10.6%), with 90.9% showing >50% cortical involvement on anteroposterior views and 100% on lateral views. Cortical thinning and disruption were present in all fracture cases. The mean time for radiological progression from Ritschl stage A to B was 17.3 Å} 9.9 months, from stage B to C was 24.9 Å} 16.2 months, and from stage C to D was 27.3 Å} 15.9 months. Overall, the average duration from initial stage A to complete resolution at stage D was 44.9 Å} 26.9 months. The fracture risk score in initial radiologic evaluation was significantly higher in patients who presented with fractures (P = .001). In distal tibial lesions, the “Pac-Man” sign was related to fractures (P = .001). Conclusion: This study demonstrated that stage B lesions, cortical thinning, and involvement of more than 50% of bone markedly increased the risk of pathological fracture, and the presence of the “Pac-Man” sign served as a reliable predictor. These findings held important clinical value, as they supported proactive monitoring and timely intervention in high-risk NOF lesions to prevent preventable fractures. Cite this article as: İğde N, Aycan OE, Doğan B, Polat B, Sobayapan M, Arslan MC. Fracture risk and follow-up indications in lower limb non-ossifying fibromas. Acta Orthop Traumatol Turc., 2026; 60(3), 0318, doi: 10.5152/j.aott.2026.25318.
I recently read with great interest the article by Abul et al1 entitled “The impact of bursa repair and steroid injection on lateral trochanteric pain following total hip arthroplasty: a retrospective cohort study.” The authors are to be commended for addressing lateral trochanteric pain, a common yet frequently underestimated contributor to postoperative dissatisfaction following total hip arthroplasty (THA). While the study provides valuable information regarding postoperative pain outcomes, several aspects merit further discussion to facilitate appropriate clinical interpretation of the findings. In particular, the choice of outcome measures, the role of postoperative rehabilitation, and patient selection considerations deserve attention. Cite this article as: Yildirim E. Letter to the editor concerning “The impact of bursa repair and steroid injection on lateral trochanteric pain following total hip arthroplasty: a retrospective cohort study.” Acta Orthop Traumatol Turc. 2026; 60(3), 0852, doi: 10.5152/j.aott.2026.26852.
Objective: This study aimed to assess orthopedic surgeons’ knowledge and protective behaviors related to intraoperative fluoroscopy, and to examine the impact of professional experience and different healthcare setting contexts. Methods: A cross-sectional online survey was distributed between January and March 2024 to actively practicing orthopedic surgeons. The questionnaire included 36 structured items covering demographics, fluoroscopy usage patterns, protective equipment habits, training background, and radiation-related symptoms. Knowledge and behavior scores were calculated and analyzed using appropriate statistical tests. Results: A total of 230 orthopedic surgeons participated. The mean knowledge and behavior scores were 48.7 Å} 11.6 and 70.7 Å} 14.2, respectively. While lead apron use was high (82.2%), the use of thyroid shields (68.7%), lead goggles (12.6%), gloves (5.7%), and dosimeters (7.0%) remained limited. Only 23.9% of participants had received radiation safety training. Surgeons with more than 10 years of experience had significantly higher behavior scores (P = .006). Differences in behavior scores were observed across country of employment, including Türkiye (P < .001). Regression analysis identified age (P = .035), knowledge score (P < .001), and country of employment (P = .001) as independent predictors of behavior score. Age was also independently associated with higher knowledge scores (P = .026). Symptom reporting after fluoroscopy use was not significantly associated with behavior scores (P = .372). Conclusion: Fluoroscopy use in orthopedic surgery remains insufficiently supported by protective behavior, despite moderate knowledge levels. Low use of dosimeters and complementary equipment reflects both individual and systemic shortcomings. Enhancing radiation safety requires not only improved knowledge but also implementation of mandatory, behavior-focused training supported by institutional policies. Cite this article as: Kaya O, Dalkir KA, Olke HC, Mirioglu A, Tekin M. Fluoroscopy use and radiation safety in orthopedic surgery: A cross-sectional survey of knowledge and protective behaviors. Acta Orthop Traumatol Turc. 2026; 60(3), 0521, doi: 10.5152/j.aott.2026.25521.
