Objective: The anteroposterior (AP) pelvic X-ray is commonly used for assessing conditions affecting the bony pelvis. The objective of this study was to develop new pelvic X-ray assessment software (CalculOrther) to assess AP pelvic X-rays and evaluate its reliability. Methods: CalculOrther was developed in 4 stages. Initially, a dataset comprising pelvic X-rays was generated. During the second stage, the convolutional neural network model was trained to identify anatomical landmarks in the pelvic X-ray images. The Hough transform was used to locate the circle and center of the femoral head in the third stage. The border pixels were generated using mathematical morphological processes, and the requisite angles were measured in the fourth stage. Then manual measurements and the software developed were analyzed with Pearson’s correlation and intraobserver and interobserver correlation coefficients. Subsequently, the mean error and the root mean square error (RMSE) were acquired. Results: The Pearson’s correlation coefficients varied from 0.84 to 0.99 (P < .001). The interobserver and intraobserver correlation coefficients ranged from 0.77 to 0.99 and from 0.75 to 0.94, respectively. The RMSE ranged from 0.31 to 4.38 and the mean error from 0.05 to 2.86. The mean duration for manual measurements was 230 (177-284) seconds and 215 (160-255) seconds, respectively. The software required an average time of 3.18 (2.95-3.52) seconds to make the same measurements. Conclusion: Regarding femoroacetabular impingement and hip dysplasia, artificial intelligence can analyze pelvic radiographs and generate equally accurate results within a shorter duration compared to traditional measuring methods. Cite this article as: Yilmaz A, Selcuk T, Aksoy T, Atilla B. Evaluation of the reliability of novel pelvic X-ray assessment software: CalculOrther. Acta Orthop Traumatol Turc., 2026; 60(1), 0268, doi: 10.5152/j.aott.2026.25268

Objective: Periacetabular osteotomy (PAO) is a well-established surgical technique that is used to enhance femoral head coverage in patients with developmental dysplasia of the hip (DDH). Although 2-dimensional radiographs remain standard for evaluating acetabular coverage, 3-dimensional (3D) computed tomography (CT)-based measurements using acetabular sector angles (ASAs) provide higher precision. This study aimed to analyze acetabular coverage through ASA parameters and to investigate the long-term clinical outcomes following PAO. Methods: This retrospective study included 35 hips from 29 patients who underwent PAO for DDH. Radiographic measurements comprised the T.nnis angle, Sharp angle, lateral center-edge angle (LCEA) and anterior center-edge angles (ACEA), anterior center margin angle (ACMA), extrusion index, and hip lateralization index (HLI). The CT-derived variables included acetabular version (AV), anterior ASA (AASA), posterior ASA (PASA), and horizontal ASA (HASA). Clinical outcomes were assessed by using the Harris Hip Score (HHS). Results: The mean patient age was 19.9 years, with a mean follow-up period of 8.7 years. Significant postoperative improvements were noted in AASA, HASA, T.nnis angle, Sharp angle, extrusion index, AV, LCEA, ACEA, acetabular depth, and HHS (all P < .05). No significant differences were observed in PASA, HLI, or ACMA. The HHS showed a negative correlation with HLI (P < .05) and a positive correlation with postoperative LCEA (P < .01). Patients with postoperative LCEA < 25Åã demonstrated superior functional outcomes compared with those with LCEA ≥ 35Åã (P = .034). Eight patients experienced complications, and 2 patients required conversion to total hip arthroplasty. Conclusion: The PAO provides durable long-term results in the management of DDH. Incorporating 3D ASA analysis enhances both preoperative planning and postoperative evaluation, contributing to more precise acetabular reorientation and improved clinical assessment Cite this article as: Güneş Z, Çağlar Ö, et al. Assessment of 3-dimensional acetabular coverage based on acetabular sector angles following periacetabular osteotomy: long-term clinical, radiological, and survivorship outcomes. Acta Orthop Traumatol Turc., 2026; 60(1), 0334, doi: 10.5152/j.aott.2026.25334

Objective: Local anesthesia with sedoanalgesia and general anesthesia are widely used in percutaneous kyphoplasty (PKP) for vertebral compression fractures (VCF). The aim of this study was to compare erector spinae block (ESP) with conventional local infiltration anesthesia (CLIA) and extrapedicular infiltration anesthesia (EPIA) with respect to analgesic efficacy in patients who underwent elective PKP for VCF. Methods: A total of 90 American Society of Anesthesiologists (ASA) 1-3 patients were randomly assigned into 3 groups: group CLIA (n = 30), group EPIA (n = 30), and group ESP (n = 30). The same amount of local anesthetic mixture (6 mL lidocaine 1% and 14 mL bupivacaine 0.5%) was used for regional anesthetic techniques in all groups. Fentanyl 0.1 μg/kg and midazolam 0.1 mg/kg were administered intravenously (IV) before prone positioning. Pain was evaluated using the visual analog scale (VAS) and sedation level using the Ramsay Sedation Scale (RSS) during the procedure. Primary outcome measure were VAS and RSS scores. Secondary outcome measures were hemodynamic changes and additional analgesic and sedative consumptions. Results: Mean baseline VAS scores were similar between groups (5.62 ± .39; P > .05). Intraoperative mean VAS scores were significantly higher in group CLIA compared to EPIA and ESP groups at all timepoints (P < .01). Time-bound changes in VAS scores showed a progressive decrease from baseline until the end of the procedure in EPIA (5.60 ± 1.38 to 1.10 ± 0.85; P < .01) and ESP groups (5.30 ± 1.44 to 1.17 ± 0.95; P < .01), while an increase was detected from baseline to the 20th minute in group CLIA (5.97 ± 1.35 to 7.07 ± 0.94; P < .01) that followed a decrease until the end of the procedure (3.47 ± 0.86; P < .01). The mean RSS scores were similar at baseline and at the end of the procedure in all groups (P > .01), but significantly lower in group CLIA compared to EPIA and ESP groups at the other timepoints (P < .001). Time-bound changes in RSS scores showed a progressive increase from baseline until the 20th minute of the procedure that followed a decrease until the end of the procedure in EPIA (5.60 ± 1.38 to 1.10 ± 0.85; P < .01) and ESP groups (5.30 ± 1.44 to 1.17 ± 0.95; P < .01). Conclusion: Better anesthetic advantages of ESP and EPIA over CLIA concerning intra-operative analgesia, analgesic and sedative consumption were demonstrated. ESP and EPIA can be used as a suitable anesthetic method in VCF patients undergoing single-level PKP, with stable hemodynamic parameters and analgesia in the intra-operative period. Cite this article as: Eşkin MB, Özhan MÖ, Şimşek F, Eksert S, Ceylan A, Başak AM. Anesthesia for vertebral compression fractures treated with percutaneous kyphoplasty: comparison of erector spinae plane block, extrapedicular infiltration anesthesia, and conventional local infiltration anesthesia. Acta Orthop Traumatol Turc., 2026; 60(1), 0549, doi: 10.5152/j.aott.2026.25549

Objective: Desmoid tumors are fibroblast-derived rare soft tissue neoplasms with unclear borders that invade the surrounding structures. Despite the non-metastasizing nature, these tumors often relapse due to strong local aggressive behavior. The aim of this study was to analyze the demographic and clinical characteristics of patients with extraabdominal desmoid tumor, who underwent surgery between 2012 and 2022 and to determine the risk factors affecting recurrence. Methods: Thirty-five patients (14 males, 21 females; mean age 41.2 years (range: 11-80) underwent operation between the years 2012 and 2022 and followed up for a mean of 52 months. The diagnosis was confirmed with biopsy, and the plan for surgery and adjuvant radiotherapy was decided by the multidisciplinary tumor council. Demographic, radiologic, and management data of the patients were collected. Potential effects of surgical margin status, estimated tumor volume (ETV), and radiotherapy on recurrence were investigated. Estimated tumor volume was calculated from dimensions on pathologic specimens. Results: While wide surgical resection was aimed for all patients, R0 margins were achieved only in 40%, whereas R1 and R2 margins were obtained in 22.9% and 37.1% of these patients respectively. The local recurrence rate was 40%. No significant correlation was observed between surgical margin positivity and the recurrence or progression of the tumor, when patients with R0 margin are sta-tistically compared with the rest (P = .067). On the other hand, when R0 and R1 margins were compared with each other in terms of recurrence or progression, there was a statistically significant difference (P = .006). While the impact of radiotherapy on recurrence or pro-gression could not be determined due to inadequate sample size, the recurrence rate increased significantly with increasing ETV (P = .01). Conclusion: Extraabdominal desmoid tumors are ill-defined locally aggressive neoplasms with an unpredictable and challenging clinical course. When the disease-free and recurring patients were compared, the recurrence rate increased significantly as the ETV increased. Achieving negative margins is still the benchmark for surgery; however, the risks and benefits of an aggressive surgery should always be reevaluated when there is a high possibility of a complex reconstructive surgery that has the capability to affect the functional outcome adversely. Cite this article as: Şirin E, Koç E, Yiğit O, Şahbat Y, Sofulu Ö. Challenging aggressive surgical strategies in extraabdominal desmoid tumors: is tumor volume the missing key? Acta Orthop Traumatol Turc., 2026, 60(1), 0103, doi: 10.5152/j.aott.2026.24103

Objective: The Masquelet technique is a 2-stage surgical method used for the reconstruction of critically sized bone defects due to various etiologies. Estrogen is known to have anabolic effects on bone metabolism. In this study, based on literature data, the aim is to systematically evaluate the histological and immunohistochemical effects of adding different doses of estrogen to polymethylmethacrylate cement on induced membrane tissue. Methods: Twenty-eight male rats were included in the study and divided into 4 groups. Three experimental groups received different doses of estradiol, a subtype of estrogen mixed with bone cement, while a control group received only bone cement. Approximately 10 mm defects were created in single femurs of all rats. Bone cement appropriate for each experimental group was placed in these defects, and bone fixation was performed with mini plates and screws. Tissue samples taken from all animals at the end of the sixth week were evaluated by histological and immunohistochemical methods. Results: Histological and immunohistochemical evaluations of the induced membranes obtained at the end of the experiment revealed signs of bone formation in all subgroups. A significant increase in bone formation was observed with increasing doses in groups E1, E2, and E3 compared to the control group (P < .05). The histological scores of the study groups were found to increase statistically significantly with increasing estrogen dose (P < .05). Furthermore, immunohistochemical analyses revealed that the immuno-reactive scores for bone morphogenetic protein-4 and insulin-like growth factor-1 expression were significantly higher in the E3 group compared to the other groups (P < .05). Conclusion: In this study, it was found that enriching the cement content with estrogen during bone cement placement, the first step of the Masquelet technique, improved the quality of the formed membrane. This improvement in membrane quality is promising for increasing treatment efficacy and shortening the treatment duration. Cite this article as: Çiftçi MU, Purelku M, Özönder F, et al. Dose-dependent effects of estrogen-enriched bone cement on membrane quality in the masquelet technique: experimental rat model. Acta Orthop Traumatol Turc., 2026; 60(1), 0355, doi: 10.5152/j.aott.2026.25355.

Objective: This retrospective case series aimed to establish a standardized protocol for the procurement, processing, and surgical application of fresh osteochondral allografts (OCA) in Türkiye and to report the early clinical outcomes of this biological salvage treatment for knee cartilage defects. Methods: Ten fresh OCA transplantations were performed between July 2019 and June 2024, with a mean follow-up of 26.1 months. Patients were evaluated using the International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), and a 10-cm Visual Analog Scale (VAS) for knee pain. Magnetic resonance imaging was obtained at >12 months postoperatively to assess graft survival. Results: The mean patient age was 30.3 ± 5.7 years (6 males, 4 females). The mean graft area was 5.1 cm² (range: 2.5-7.5 cm²). The IKDC scores improved from 37.5 to 65.4, KOOS scores from 38 to 69.6, and VAS scores from 6 to 1.6. Magnetic resonance imaging evaluation beyond 12 months showed no evidence of graft failure. Conclusion: Fresh OCA represents a reliable and effective treatment option for knee cartilage defects. Establishing its availability in Türkiye has the potential to broaden access, enabling more surgeons to adopt the technique and more patients to benefit from this biological salvage procedure. Cite this article as: Meriç G, Eren O, Kocadal O, Ateş U. Implementation of a fresh osteochondral allograft protocol for the knee: a case series from Türkiye. Acta Orthop Traumatol Turc., 2026, 60(1), 0310, doi:10.5152/j.aott.2026.25310

Objective: This study aimed to compare the clinical and radiological results of scaphocapitate fusion (SCF) and capitohamate fusion (CHF) combined with lunate excision in advanced Kienböck’s disease. Methods: Patients over 18 years of age who were in stages IIIB-IIIC according to the Lichtman classification, and who had at least 1 year of follow-up, were included in the study. All patients had unilateral disease. Patients were divided into 2 groups according to whether they had CHF or SCF. The range of motion (ROM) and grip strength of the operated and contralateral active wrist joint were measured. Radiological evaluation of the severity of the disease was determined preoperatively using Lichtman staging. Preoperative and postoperative carpal height ratios (CHRs) were measured on anteroposterior radiographs. The presence of osteoarthritis was evaluated. Functional outcome was assessed using the Disability of the Arm, Shoulder, and Hand (DASH) and Visual Analogue Scale (VAS) scores. Results: The mean age of the 27 patients (12 CHF and 15 SCF) was 32.5 years. There was no statistically significant difference between the 2 groups in terms of demographic characteristics, Lichtman stages, and mean follow-up time. No difference between the groups regarding ROM, grip strength, VAS, and DASH scores could be found. The preoperative and postoperative CHRs were compared, and no difference was found between the groups. Conclusion: Although SCF has some advantages over CHF regarding joint ROM and clinical scores, no difference was found between the groups (clinically and radiologically). Both SCF and CHF combined with lunate excision seem to be effective in the treatment of advanced Kienböck’s disease in the mid-term. Cite this article as: Sener İM, Ozturk T, Aldemir C, et al. Lunatum excision and limited intercarpal fusion in advanced Kienb.ck’s disease: scaphocapitate versus capitohamate fusion. Acta Orthop Traumatol Turc. 2026, 60 (1), 0270, doi:10.5152/j.aott.2026.25270.

Objective:This study aimed to evaluate whether sagittal plane range of motion (ROM) and isokinetic muscle strength of the ankle are affected following surgical treatment of patients with Myerson type B Lisfranc injuries.Methods:This retrospective controlled study included 14 patients who underwent open reduction and internal fixation for Myerson type B Lisfranc injuries and 14 age- and sex-matched healthy controls. Ankle dorsiflexion and plantarflexion ROM were measured, and isokinetic strength was assessed bilaterally at 30°/s and 120°/s. Clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Score and the Foot and Ankle Outcome Score (FAOS). Radiographic assessments were performed at final follow-up.Results:At a mean follow-up of 77 months, the mean FAOS was 83.5 ± 15.6. According to the AOFAS classification, 21% of patients were rated as excellent, 43% good, 14% fair, and 21% unsatisfactory. Dorsiflexion ROM was significantly lower on the affected side compared to both the contralateral limb (5.57° ± 3.94 vs. 18.36° ± 3.08, P = .003) and the control group (22.57° ± 4.22, P < .001). While plantarflexion ROM did not significantly differ, isokinetic strength was significantly reduced in most parameters, particularly in dorsiflexion.Conclusion:Patients with surgically treated Myerson type B Lisfranc injuries exhibit persistent deficits in ankle dorsiflexion ROM and in isokinetic strength and endurance of both dorsiflexion and plantarflexion, despite favorable clinical scores and radiographic outcomes. These findings highlight the importance of incorporating objective functional assessments in the long-term follow-up of these patients.Level of Evidence:Level III, Therapeutic study.

This study aimed to evaluate the reported efficacy of electrical bone stimulation (EBS) in promoting union in foot and ankle fractures and arthrodesis by synthesizing the available literature. A literature review was conducted using PubMed/Medline, EMBASE, ScienceDirect, Web of Science, and CINAHL. Study type, patient demographics, interventions, and outcomes were extracted. The Methodological Index for Non-Randomized Studies assessment tool was used for methodological quality assessment and for evaluating outcomes regarding union rates. Fourteen studies involving 1253 patients met inclusion criteria from a total of 668 screened articles. These studies involved 1253 patients treated with EBS for foot and ankle fracture and fusion surgeries. The majority of investigations reported increased success unionization and reduced time to union using EBS methods including direct current, capacitated coupling, pulsed electromagnetic field (PEMF), low-intensity pulsed ultrasound (LIPUS), and combined magnetic field. Although existing evidence suggests that EBS may enhance union rates, there is no consensus regarding the most effective stimulation modality due to limited comparative data. Emerging modalities such as PEMF and LIPUS demonstrate promising results; however, well-designed comparative studies are needed to clarify their relative efficacy and safety profiles. Cite this article as: Schluter R, McLeod H, Ebrahimi A, et al. The effect of electrical bone stimulation on bone union in foot and ankle injuries: A scoping review. Acta Orthop Traumatol Turc., 2025;59(6):349-360.

Cite this article as: Ashkani-Esfahani S, Aslan L. AOTT special issue Editorial. Acta Orthop Traumatol Turc., 2025;59(6):337-339.