Endoscopic calcaneoplasty has gained increasing popularity in recent years for the treatment of Haglund’s deformity, which is characterized by a posterosuperior calcaneal prominence and associated retrocalcaneal bursitis. However, the relationship between preoperative calcaneal morphological parameters and postoperative clinical outcomes remains unclear. Therefore, the aim of this study was to investigate whether bump height and the bump–calcaneus ratio, measured on preoperative radiographs, are associated with clinical or radiological outcomes following endoscopic calcaneoplasty. A prospective evaluation was conducted on 22 feet in 22 patients who underwent endoscopic calcaneoplasty. Demographic data and radiographic parameters including bump height, bump-to-calcaneus ratio, and various angular measurements were recorded. Clinical outcomes were assessed using the American Orthopaedic Foot Ankle Society (AOFAS) score and visual analog scale (VAS) preoperatively and at 1, 3, 6, and 12 months postoperatively. Normality was assessed with Shapiro-Wilk test, and non-parametric tests were used for all analyses. Effect sizes (Cohen’s d) were calculated from Wilcoxon Z statistics. Minimal clinically important difference (MCID) was evaluated by comparing AOFAS improvement with literature values. Bonferroni correction was applied for multiple comparisons. The mean patient age was 46.2 ± 13.1 years, and the mean follow-up duration was 14 ± 2 months. The mean operative time was 63 ± 27 min. Both AOFAS and VAS scores demonstrated statistically significant improvement at all time points (p < 0.001), with large effect sizes (d = 1.75 for AOFAS, d = 1.76 for VAS). The mean Δ AOFAS at 12 months (41.1 ± 24.1) exceeded the established MCID range, confirming clinically meaningful improvement. No significant associations were identified between preoperative bump height or bump-to-calcaneus ratio and clinical outcomes (p > 0.05). No surgical complications or infections were observed. Endoscopic calcaneoplasty resulted in significant clinical improvement in patients with Haglund’s deformity, with substantial increases in AOFAS scores and reductions in VAS pain scores. In this cohort, no significant association was observed between preoperative bump height, bump–calcaneus ratio, and postoperative clinical outcomes. However, the relatively small sample size limits the generalizability of these findings, and larger prospective studies are warranted.

To determine the MRI prevalence of the semimembranosus–lateral meniscus (SM–LM) attachment and the imaging plane on which it is most conspicuous, and to evaluate its relationships with the meniscofemoral ligaments and the oblique popliteal ligament (OPL). In this retrospective single-center study, 205 1.5-T knee MRI examinations in patients ≥ 18 years (134 women, 71 men; median age, 38 years) were evaluated by a musculoskeletal radiologist, with a random subset of 100 independently evaluated by a second reader; those with prior ipsilateral knee trauma or surgery or Kellgren–Lawrence grade 3–4 osteoarthritis were excluded. Interobserver agreement was evaluated with Cohen κ; logistic regression and chi-square analyses were performed. The SM–LM attachment was identified in 32 of 205 knees (15.6

Herpes zoster is a viral infection caused by reactivation of latent varicella-zoster virus (VZV) in the dorsal root ganglia. It typically presents with unilateral dermatomal vesicular eruptions and neuropathic pain. Although herpes zoster is more common in elderly individuals, surgical procedures and trauma may act as triggering factors. We report the case of a 73-year-old female patient who developed acute herpes zoster after bipolar hip hemiarthroplasty performed for a femoral neck fracture. The patient initially presented with severe postoperative pain that mimicked early surgical complications, which resulted in delayed diagnosis. On postoperative day 6, characteristic vesicular lesions developed along the L1–L2 dermatomes, and herpes zoster was diagnosed clinically by a dermatologist. Serological confirmation with VZV IgG/IgM testing was not performed. The patient was treated with oral acyclovir and achieved complete recovery without postherpetic neuralgia. Herpes zoster should be considered in the differential diagnosis of acute postoperative pain after hip arthroplasty, particularly in elderly patients. Early recognition and prompt antiviral treatment are essential to reduce morbidity. In addition, preoperative assessment of herpes zoster vaccination status may be important in high-risk populations.

Avascular necrosis and failure are significant complications following surgical fixation of proximal humerus fractures. The Hertel criteria are a widely used morphological classification system intended to predict humeral head ischaemia. This study aimed to evaluate the correlation of Hertel criteria with the development of postoperative avascular necrosis and failure and to assess the prognostic value of other radiological parameters. In this retrospective cohort study, 94 patients with proximal humerus fractures treated with locking plate fixation and a minimum 2-year follow-up were included. Preoperative radiographs and computed tomography scans were used to assess Hertel criteria, Neer classification, and proximal humeral cortical thickness. Postoperative radiographs were evaluated for avascular necrosis and failure, defined as a composite of nonunion, severe avascular necrosis, screw penetration, severe deformity, or significant arthrosis. Clinical outcomes were assessed using the Visual Analog Scale and Disability of Arm, Shoulder and Hand scores. The presence of an anatomical neck fracture and tubercle displacement greater than 10 mm were significantly associated with both avascular necrosis and failure (p < 0.05). In contrast, other factors in the classical Hertel criteria, such as metaphyseal head extension less than 8 mm, medial hinge displacement greater than 2 mm, and humeral head angle greater than 45°, did not show a significant correlation with avascular necrosis and failure. More severe Neer fracture types were also significantly associated with worse outcomes. Cortical thickness was not a significant predictor. Anatomical neck fracture and tubercle displacement according to Hertel criteria are critical radiological risk factors for postoperative avascular necrosis and failure. However, other parameters do not show the same correlation. Level III, Retrospective cohort study.

Background and Objectives: Distal radius fractures (DRFs) are among the most common upper-extremity injuries in the elderly, with malunion leading to long-term pain and disability. This study aimed to compare the discriminative performance of the Cast Index (CI), Gap Index (GI), and Three-Point Index (TPI) for predicting malunion during follow-up after closed reduction and casting in elderly patients with dorsally displaced DRFs. Materials and Methods: This study retrospectively analyzed 274 patients aged ≥65 years (mean 73.6 ± 6.5 years) with dorsally displaced Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) 2R3A fractures treated conservatively between 2018 and 2023. Standard posteroanterior and lateral radiographs were evaluated immediately post-reduction, at 7–10 days, and at 4 weeks. Cast, Gap, and Three-Point Indices were measured independently by two observers, and the mean values were analyzed. Receiver operating characteristic (ROC) analysis was used to evaluate discriminative performance for the detection of malunion. Subgroup analyses were performed based on fracture stability according to La Fontaine criteria. Results: At the final follow-up, 136 fractures (49.6%) maintained acceptable alignment, while 138 fractures (50.4%) experienced malunion. There was no significant difference in radiographic parameters between groups immediately post-reduction or at 7–10 days. The Gap and Three-Point Indices were significantly higher in the malunion group at 7–10 days and at 4 weeks (p < 0.001), but the Cast Index showed no significant between-group difference. At 7–10 days, the Gap Index [Area Under the Curve (AUC) = 0.641; cut-off = 0.33] and the Three-Point Index (AUC = 0.640; cut-off = 1.51) demonstrated modest discriminative ability. In stable fractures, both indices were statistically significantly higher in the malunion group, whereas in unstable fractures, only the Three-Point Index was statistically significantly higher in the malunion group (p < 0.001). Conclusions: The Gap and Three-Point Indices showed greater discriminative ability than the Cast Index for malunion after conservative management of DRFs in elderly patients. Thresholds of GI ≥ 0.33 and TPI ≥ 1.51 at 7–10 days may serve as practical quantitative indicators to identify patients who may warrant closer follow-up and possible cast reassessment in conjunction with standard radiographic assessment and clinical judgment.

Manipulation under anesthesia can rapidly improve pain and motion in refractory frozen shoulder but usually requires operating-room and anesthesiology resources. This trial compared an ultrasound-guided wide-awake local anesthesia no tourniquet (WALANT)-based outpatient protocol with manipulation under general anesthesia. This single-center, prospective randomized controlled trial enrolled 72 adults with primary frozen shoulder persisting despite at least 6 months of conservative treatment. Participants were randomized 1:1 to ultrasound-guided WALANT-based manipulation in an outpatient setting or manipulation under general anesthesia in the operating room. The primary outcome was shoulder forward flexion at 4 weeks. Secondary outcomes included other range-of-motion measures, the visual analog scale (VAS), University of California Los Angeles (UCLA) Shoulder, Disabilities of the Arm, Shoulder and Hand (DASH), Constant–Murley, and six-item State-Trait Anxiety Inventory (STAI-6) scores, and early complications. Six participants in the general-anesthesia group did not complete follow-up; complete-case analyses included 36 WALANT and 30 general-anesthesia participants. At the prespecified 4 week primary endpoint, forward flexion was 170.56° ± 15.01° in the WALANT group and 159.60° ± 31.37° in the general-anesthesia group (between-group mean difference, 10.96°; 95

OBJECTIVES:To investigate the impact of os acromiale (OsA) on shoulder morphology and rotator cuff pathology by evaluating the critical shoulder angle (CSA), acromial index (AI), and the prevalence of tendon tears and joint degeneration. MATERIALS & METHODS:This retrospective single-center study included 247 patients (mean age, 56 ± 10.9 years; 178 women, 69 men), comprising 123 with OsA and 124 matched controls. MRI and radiographs were analyzed to assess CSA, AI, tendon pathology, glenohumeral and acromioclavicular osteoarthritis, and acromioclavicular step-off deformity. Two radiologists independently assessed findings. Group comparisons were performed using parametric or nonparametric tests as appropriate, ROC analysis was used to determine AI cut-off values, and agreement was evaluated using ICC and Cohen's kappa. RESULTS:CSA and AI were significantly higher in the OsA group on MRI (CSA: 35.13 ± 3.85 vs. 33.96 ± 3.33, p = 0.011; AI: 0.68 ± 0.08 vs. 0.63 ± 0.07, p < 0.001) and radiographs (AI: 0.80 ± 0.11 vs. 0.71 ± 0.07, p < 0.001). Glenohumeral osteoarthritis and step-off deformity were more prevalent in OsA patients (19.5% vs. 2.4%, p < 0.001; 58.5% vs. 12.1%, p < 0.001). Partial and full-thickness infraspinatus tears and partial subscapularis tears were significantly more frequent in OsA, while supraspinatus tear rates did not differ significantly between groups. Agreement was moderate to excellent except for acromioclavicular osteoarthritis. CONCLUSION:OsA is linked to higher CSA and AI, a greater prevalence of cuff tears, glenohumeral osteoarthritis, and step-off deformity, suggesting altered scapular morphology and biomechanics.

Background: Cast removal is an essential but often stressful component of the Ponseti method for idiopathic clubfoot. The impact of different cast removal techniques on infant stress, parental anxiety, and treatment outcomes remains insufficiently explored. Methods: This prospective, quasi-randomized controlled trial included 84 infants with unilateral idiopathic clubfoot treated using the Ponseti method. Patients were allocated to cast removal by oscillating saw in the outpatient clinic (Group 1, n = 42) or by soaking and peeling at home prior to clinic visits (Group 2, n = 42). The primary outcome was the number of casts required to achieve correction and readiness for percutaneous Achilles tenotomy. Secondary outcomes included infant crying time, maximum heart rate during cast removal, parental anxiety assessed using the Short State Anxiety Inventory Scale (SAIS), cast removal time, hospital stay duration, and cast-removal-related complications. Results: There was no significant difference between groups regarding pre- or post-treatment Pirani and Dimeglio scores or the number of casts required (p > 0.05). Infant crying time, heart rate during cast removal, and parental anxiety scores were significantly higher in the oscillating saw group (p < 0.001). Cast-removal-related complications were more frequent in the oscillating saw group (p = 0.003). Conclusions: In this study, home-based soaking and peeling provided clinical outcomes comparable to oscillating saw removal and was associated with lower infant distress markers, lower parental anxiety scores, and fewer observed cast-removal-related complications. These findings suggest that soaking and peeling may represent a family-centered alternative for selected families receiving appropriate instruction.

OBJECTIVES:In our study, we aimed to evaluate the efficacy of prophylactic ozone therapy (OT) for heterotopic ossification (HO) development after hip surgery in a rat model. MATERIALS AND METHODS:We randomly divided a total of 20 Wistar albino rats into two equal groups (n=10) as the control group (Group 1) receiving daily intraperitoneal injections of 1 mL of Ringer's lactate solution for a duration of two weeks after undergoing hip surgery and the group (Group 2) receiving OT daily at a dose of 1 mL of an ozone/oxygen combination via intraperitoneal route for a period of two weeks after hip surgery. Hip surgery was performed to mimic the formation of HO. After 12 weeks, the animals were evaluated functionally and sacrificed. Following sacrification, histopathological, and radiological assessments were performed. RESULTS:The modified Brooker staging method was used for radiological evaluation, and all animals in the control group showed at least Stage 1 HO formation. However, only three animals (30%) in the OT group showed HO formation (p=0.006). In histopathological evaluation, the median HO rates in the high power field were 42.5 (range, 30 to 55) in the control group and 0 (range, 0 to 25) in the OT group (p=0.003), and the median leukocyte count was 5.5 (range, 3 to 7) in the control group and 1 (range, 0 to 3) in the ozone group (p=0.006). Radiological HO, histopathological HO, and inflammation were significantly lower in the ozone group (p<0.05). CONCLUSION:Our study results suggest that OT is effective in decreasing HO formation in rats following hip surgery.

Determining the most appropriate level of amputation in patients with diabetes mellitus has not been well established. The purpose of this study is to determine whether muscle biopsy reveals predictive information about the success rate of patients undergoing diabetic major lower limb amputation. A prospective observational study was conducted among diabetic patients who underwent below-knee amputation. Skin-subcutaneous and muscle biopsy samples were obtained during the operation from 62 patients who undergo major limb amputation. Depending on the complications after surgery, patients were assigned into three groups: Group 1 consisted of patients with adequate wound healing without any complications; Group 2 included patients with prolonged wound healing requiring additional interventions like debridement; and Group 3 consisted of patients who underwent reamputation at a more proximal level. Biopsy samples of the groups were compared regarding degenerative cells, inflammatory cells, and the presence of infection. There was a significant difference between Groups 1 and 3 regarding the presence of abscess formation and infection (p < 001). Comparison of Groups 1 and 3 revealed significant differences regarding inflammatory cell count, respectively (p < 001). According to the results of the ROC analysis performed for histopathologic cellular evaluation, 15

Background: Chevron osteotomy is a popular technique for repairing complex distal humerus intra-articular fractures. However, refixation presents challenges like hardware prominence and soft tissue damage. Headless cannulated screws are gaining popularity for fixation due to better bone purchase and less irritation. This study aims to compare different fixation strategies with headless screws for Chevron osteotomy fixation. Methods: This study utilized 32 polyurethane foam ulna specimens for biomechanical testing. The Chevron osteotomy was performed with an oscillating saw for all specimens. Four different techniques were used for refixation: modified tension band wire fixation, plate- screw fixation, cannulated screw fixation, and headless cannulated screw fixation. The constructs were mounted to the testing machine, simulating the elbow in 90 degrees of flexion. All specimens were tested under axial traction. Displacements at 350N and 500N and loads at the failure were recorded. Results: At the load of the implant failure, headless cannulated screw fixation revealed higher force values when compared to the other constructs, and modified tension band wire fixation showed lower force values compared to the other 3 groups (P <.001). The headless cannulated screw fixation group showed no significant differences in osteotomy displacements when tested to a 350N load. There were no significant differences in displacements at a 500N load between the four groups (P 1/4 .275). Conclusion: This study suggests that headless cannulated screw fixation is a viable and effective option for Chevron osteotomies. Headless cannulated screw fixation makes it a promising alternative to traditional fixation methods. This technique may be a more reliable fixation technique during daily activities and moderate elbow motions, indicating that it has the potential to succeed. Level of evidence: Basic Science Study; Biomechanics (c) 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

INTRODUCTION:Total knee arthroplasty (TKA) restores the mechanical axis of the lower extremity, which is impaired due to gonarthrosis. Foot and ankle pain observed after TKA is not uncommon, and the exact cause has not been determined. This study aims to assess the role of the movement capacity of the subtalar joint and the clinical and radiological risk factors for foot and ankle pain after TKA. METHODS:This study included 184 patients who underwent TKA due to primary varus gonarthrosis. Patients were evaluated clinically and radiologically before and after surgery. Lower extremity mechanical axis, talar-tilt angle, foot ground-talar dome angle, heel alignment ratio, heel alignment angle, heel alignment distance, and postoperative changes were the radiological angles measured. The Oxford Knee Score, American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score, visual analog scale score, and ankle and subtalar joint range of motion examinations were used clinically. Patients were grouped as those whose American Orthopaedic Foot and Ankle Society scores did not worsen after surgery (group 1) and those whose scores worsened (group 2). RESULTS:The group 1 included 142 patients (77.2%) and group 2 included 42 patients (22.8%). The mean preoperative knee varus degree of group 1 was 11.49 ± 3.45, and that of group 2 was 14.26 ± 4.21 ( P < 0.001). The mean body mass index was 26.67 ± 2.31 for group 1 and 29.47 ± 3.14 for group 2 ( P < 0.001). Although no important difference was found between the groups in preoperative ankle motion capacity ( P = 0.086), subtalar joint motion was found to be markedly limited in group 2 ( P < 0.001). CONCLUSION:High preoperative knee varus degree and body mass index values, especially diminished preoperative subtalar joint motion capacity together with these values, are risk factors for postoperative foot and ankle pain after TKA. LEVEL OF EVIDENCE:Level III, Retrospective comparative study.

OBJECTIVE:Displaced fragments in meniscal flap tears may be challenging to detect radiologically but are clinically relevant for treatment planning. This study aimed to characterize fragment migration patterns on MRI and evaluate associated intra-articular pathologies. METHODS:In this retrospective analysis of 89 knee MRIs performed between January 2018 and May 2022, patients with confirmed meniscal flap tears were assessed for tear location, fragment displacement direction, and associated findings, including cartilage defects, ligament injuries, bone marrow edema, osteophytes, osteochondral lesions, and joint effusion. Statistical associations between tear features and accompanying pathologies were evaluated. RESULTS:Inferior coronary recess was the most frequent displacement site, especially in medial tears (68.8%, P =0.007). Medial tears more often had cartilage defects (66.3%, P =0.024) and osteochondral lesions (55.0%, P =0.015). Posterior horn involvement predominated, and ACL tears were strongly associated with intercondylar notch displacement (77.8%, P =0.001). CONCLUSION:Meniscal flap tears are most commonly located in the posterior horn of the medial meniscus and tend to displace into the inferior coronary recess. Their frequent association with cartilage damage, osteochondral lesions, and ACL injuries underscores the importance of careful MRI evaluation to support surgical decision-making.

This study aimed to evaluate the effect of using simultaneous double fluoroscopy, which provides anteroposterior (AP) and lateral images concurrently, on screw placement accuracy, surgical duration, and radiation exposure in the treatment of slipped capital femoral epiphysis (SCFE). A retrospective study was conducted on 92 patients (73 males, 19 females; mean age 12.78 ± 1.54 years) who underwent in situ screw fixation for SCFE between 2017 and 2024. Patients were divided into two groups according to intraoperative imaging technique: single fluoroscopy (Group 1, n = 44) and double fluoroscopy (Group 2, n = 48). Demographic, operative, and radiographic parameters were compared between groups. Screw entry point and physeal fixation were graded in both AP and lateral planes. There were no significant differences in demographic or preoperative radiological parameters between groups (p > 0.05). The mean preparation time was less in Group 1 (9.68 ± 1.83 min) compared to Group 2 (17.38 ± 1.93 min, p < 0.001). However, the surgical time was significantly longer in Group 1 (37.64 ± 10.68 min) compared to Group 2 (23.06 ± 6.45 min, p < 0.001). The total operation time was extended in Group 1 (47.32 ± 10.92 min) than in Group 2 (40.44 ± 6.68 min, p < 0.001). The mean fluoroscopy time was also longer in Group 1 (44.46 ± 9.15 s) than in Group 2 (39.73 ± 8.03 s, p = 0.01). Radiographic analysis revealed superior screw positioning in the double fluoroscopy group, with significantly higher rates of optimal entry points in the lateral plane (p = 0.004) and improved physeal fixation in both AP (p = 0.036) and lateral (p = 0.019) planes. Complication rates were lower in Group 2 (2

The selection of an implant is a critical factor in the surgical treatment of patella fractures due to the risk of various complications, such as non-union, implant failure, and irritation. The present study evaluated and compared the biomechanical strength of headless cannulated screws about screw length using the tension band wiring technique. Forty-eight sawbone patellas with transverse fractures were divided into three fixation groups based on the screw length used in tension band wiring. Overall, three different fixation groups were determined: Group 1 (recessed headless cannulated screw fixation), Group 2 (full-length headless cannulated screw fixation), and Group 3 (protruding headless cannulated screw fixation). A setup was used to simulate a knee with a flexion angle of 60 degrees. Specimens underwent biomechanical testing under axial traction (static test) and cyclic loading (dynamic test). Displacements at 300 Newtons (N), loads at 2 millimetres (mm) displacement, and failure loads were documented for each sample in the static test. In the dynamic test protocol, 10,000 repetitive cycles were performed under physiological load between 100 and 300 N, and final displacements were recorded. There were significant differences in the loads achieved at 2 mm displacement levels, and Group 3 demonstrated lower force values compared to other constructs in the static test (P = 0.003). All groups revealed similar displacements at 300 N and failure load values under axial traction. In the dynamic test, Group 3 had significantly higher fracture displacement under cyclic loading compared to the other specimens (P = 0.006). This study found headless cannulated screws for transverse patella fracture fixation provide sufficient stability; however, protruding headless screws reduce the fixation strength. Recessed or full-length screws may improve stability and bony healing, potentially preventing complications in patella fractures. Biomechanical study N/A.

The objective of the present study is to examine how repairing the capsule affects the radiological and clinical results of treating acute Rockwood type V acromioclavicular joint dislocations using the endobutton method. The study involved patients between the ages of 18 and 65 who had acute Rockwood type V acromioclavicular joint dislocation and were treated using the double endobutton technique, with or without capsule repair, from January 2021 to December 2023. Clinical and radiological assessment was conducted at various time points up to the last follow-up. Functional evaluation was conducted using the Disability of Arm, Shoulder and Hand (DASH) scoring system, Constant-Murley Score (CMS), and Specific Acromioclavicular Score (SACS) at the final follow-up. Radiological evaluation involved the measurement of the coracoclavicular distance and evaluation of complications. Statistical analysis was performed using Mann-Whitney U and Pearson’s Chi-Square and Fisher’s Exact test. In this study, a group of 23 patients were monitored over a period of approximately 20.91 ± 8.3 (12–36) months. Functional results were significantly different in favor of Group 2, when the groups were categorized from excellent to poor (p < 0.05). At the final radiograph, the mean coracoclavicular distance showed a statistically significant difference in favor of Group 2 (p = 0.039). Loss of reduction was statistically significantly seen more in Group 1 (p = 0.031). The total rate of complication was similarly in the two groups, showing no substantial variations. The combination of the double endobutton method and capsule repair is a secure and dependable procedure that provides sufficient stability. This technique has provided favorable clinical and radiologic results in the treatment of acute Rockwood type V acromioclavicular dislocation. Level III, Retrospective comperative study.

AIM:To evaluate the diagnostic performance of the fat-fluid level (FFL) on standing knee radiographs for detecting intra-articular fractures in acute trauma. MATERIALS AND METHODS:This retrospective, single-centre study included 76 patients with acute knee trauma who underwent standing radiography and knee computed tomography (CT) within 12 hours. Patients were divided into FFL (+) (n=32) and randomly selected FFL (-) control (n=44) groups. Radiographs were assessed for FFL visibility by projection (anteroposterior [AP], lateral, or both) and for fracture presence. CT served as the reference standard. Diagnostic performance metrics were calculated and interobserver agreement was assessed using Cohen's kappa. RESULTS:An FFL was observed in 32 patients (42 %), visible on lateral radiographs in all and on AP views in 56 %. In seven patients, FFL-positive patients (22 %), no fracture line was radiographically visible yet CT-confirmed fractures in all FFL (+) cases (positive predictive value [PPV] = 100 %). Overall, CT-confirmed fractures in 42 patients (55 %); of these, 10 were FFL (-). Using CT as the reference, FFL sensitivity, specificity, PPV, and negative predictive value were 76 %, 100 %, 100 %, and 77 %, respectively. Tibial fractures were most common (69 %), followed by patellar fractures (26 %). AP views were more sensitive for fracture detection, while lateral views better demonstrated the FFL. Interobserver agreement was almost perfect (κ = 0.84-0.90). CONCLUSION:The FFL on standing lateral radiographs is a highly specific and reproducible indirect indicator of intra-articular fracture. Incorporating standing lateral radiographs into acute knee trauma protocols may improve fracture detection, particularly where CT access is limited.

Lipohemarthrosis is a key finding in acute trauma patients and indicates an intra-articular fracture. The horizontal beam lateral radiography with supine position is known to be the best technique to demonstrate knee lipohemarthrosis. Our main purpose was to compare the sensitivity of supine and standing lateral knee radiographs to detect lipohemarthrosis. In our retrospective study, consecutive patients with lipohemarthrosis on computed tomography of the knee between October 2019 and September 2021 were included. Fractured bone, the presence of lipohemarthrosis, and image quality in both standing and supine anteroposterior and lateral knee radiographs were evaluated. Interobserver reliability of the three observers was calculated. Fisher exact chi-square and z-proportion tests were used to compare lateral and anteroposterior knee radiographs. Krippendorff’s Alpha and Kappa coefficients were used for inter-observer agreement. A total of 61 patients (38 men [62.3 • Fat-fluid level (lipohemarthrosis) is an important radiographic sign to assess patients with acute trauma. It almost always indicates an intra-articular fracture. • Our retrospective study results support that lipohemarthrosis sign could be observed more frequently in standing lateral knee radiographs than in supine lateral radiographs. • Knee trauma patients, when available, should be evaluated with standing lateral radiographs for the diagnosis of lipohemarthrosis.

The aim of this study; is to determine the level of pain and anxiety experienced by pediatric patients with operated humeral supracondylar fractures during pin removal, and to investigate the effectiveness of animated video impressions. This randomized controlled study included 180 patients aged between 4 and 12 years. The patients were divided into four groups: Group 1—control; Group 2—watched the introductory animation video before the procedure; Group 3—using analgesic before the procedure (ibuprofen 10 mg/kg); Group 4—watched the introductory animation video and used analgesic before the procedure. To assess pain before randomization, before-during-after procedure, and at outpatient clinic controls; the Wong-Baker Pain Scale (WBS), modified CHEOPS (Children’s Hospital of Eastern Ontario Pain Scale), and the child's heart rate were used. To assess anxiety; the Children's Anxiety Meter (CAM), The Short State Anxiety Inventory Scale (SAIS), and The Children's Emotion Management Scales (CEMS) were used. While a significant difference was detected between the groups in the tests performed at certain intervals (p < 0.001), no significant difference was detected between Groups 1–3 and Groups 2–4. The Modified CHEOPS and CEMS values obtained during the procedure showed significant variability between the groups (p < 0.001). Similarly, While a significant difference was detected between the groups in the WBS scores measured during the procedure (p < 0.001), it was observed that there was no significant relationship between Groups 1–3 and Groups 2–4 (p = 0.892, p = 0.820). Watching an introductory animated video before pin removal is an effective method to relieve the anxiety and pain felt in children with supracondylar fractures.

To investigate the correlation between MRI-based phenotypes (cartilage-meniscus, subchondral bone, and inflammatory) and radiography-based atrophic and hypertrophic phenotypes, aiming to demonstrate MRI’s diagnostic capability in identifying complex osteoarthritis phenotypes that radiography cannot fully capture. This single-center retrospective study examined knee radiographs and MRIs of patients from November 2021 to April 2023 to identify osteoarthritis phenotypes. Radiographs were staged by the Kellgren-Lawrence system, and both modalities were classified into atrophic or hypertrophic phenotypes. MRIs were further classified into three phenotypes: cartilage-meniscus, subchondral bone, and inflammatory. Associations between phenotypes, Kellgren-Lawrence stage, age, and gender were analyzed with Pearson chi-square test and student T-test. Reliability measurements were evaluated using kappa statistic. A total of 214 knees from 187 individuals (73.3