Cross-cultural adaptation and validation of the Turkish version of the Toronto Extremity Salvage Score in patients with musculoskeletal tumors.

OBJECTIVE: The aim of the study was to translate theToronto Extremity Salvage Score (TESS) into Turkish and perform acrosscultural adaptation for patients with musculoskeletal tumors. METHODS: Thirty-six patients (20 male, 16 female; mean age = 36.6 ± 15.4 years) who were diagnosed with malignant bone and soft tissue sarcoma or benign aggressive bone tumors between the years 2007 and 2012 were included in the study. TESS was translated into Turkish and back translated to determine language validity. To test convergent validity, the Turkish versions of the Short Form-36 (SF-36), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Disabilities of the Arm, Shoulder and Hand (DASH) were used. SF-36 was used on all patients while WOMAC and DASH were used onpatients with lower extremity tumors and upper extremity tumors respectively. The tests were repeated 15 days later and the intraclass correlation coefficient (ICC) was used to determine test-retest reliability. RESULTS: The Turkish version of TESS was found to have a strong negative correlation with WOMAC (r = -0.702; P < 0.001) and DASH (r = -0.774; P < 0.001) as well as a strong negative correlation with ROMS (r = 0.601; P < 0.001). Turkish TESS also had a statistically significant correlation with SF-36-Physical functioning, SF-36-Role Physical, SF-36-Bodily Pain, and SF36-General Health at levels ranging from 0.326 to 0.669 (r values ranging from 0.326 to 0.669, P < 0.001). The internal consistency (Cronbach's α:0.96 for lower extremity and Cronbach's α:0.94 for upper extremity) and test-retest reliability of Turkish TESS were found to be excellent (ICC lower extremity: 0.96 [0.935-0.983]; P < 0.001 and ICC upper extremity: 0.99 [0.967-0.997]; P < 001). ICC values varied between 0.674 and 0.987 for each item of the scale for both extremities. Conlusion: The Turkish version of TESS seems to be a valid and reliable patient-reported outcome measure to evaluate physical function after musculoskeletal tumor surgery in Turkish patients. LEVEL OF EVIDENCE: Level II, Diagnostic Study.

Cross-cultural adaptation and validation of the Turkish version of the Musculoskeletal Tumor Society scoring system in patients with musculoskeletal tumors.

OBJECTIVE: This study aimed to translate and cross-culturally adapt the musculoskeletal tumor society (MSTS) scoring system into Turkish and to determine the reliability and validity of the translated version for the functional evaluation of patients with musculoskeletal tumors. METHODS: A total of 36 patients (16 women, 20 men; mean age=36.6; age range=13-75 years) who underwent limb-salvage surgery owing to benign aggressive or malignant musculoskeletal tumors were included in the study. Translation and back translations of the MSTS were performed according to the published guidelines. Short form (SF) 36 physical component, Western Ontario and McMaster Universities Arthritis Index (WOMAC), disabilities of the arm, shoulder, and hand (DASH), and range of motion scale (ROMS) that were previously analyzed for Turkish validation were used for validity. Reliability of MSTS Turkish version was evaluated by calculating test-retest reliability and internal consistency. Intraclass correlation coefficient (ICC) was used to evaluate the inter-observer consistency and test-retest reliability. Alpha coefficient (Cronbach's alpha) was used to evaluate the internal consistency. RESULTS: It was observed that total MSTS score has a strong negative correlation with DASH (r=-0.689; p<0.001) and WOMAC scores (r=-0.634; p<0.001) and moderate correlation with the ROMS score (r=0.521; p<0.001). Total MSTS score also had a statistically significant strong correlation with SF-36 scores (r values ranging from 0.425 to 0.609, p<0.001). Inter and intra-observer reliability of the MSTS scale was found to be excellent (Cronbach's α=0.97 p<0.001; ICC: 0.97 (0.96-0.99; p<0.001). Unlike other subscales, statistical correlation between dexterity and hand-positioning subscales of MSTS with DASH scores was found to be insignificant (r=-0.533, p =0.061 and r=-0.336, p=0.261, respectively). CONCLUSION: The Turkish version of the MSTS scoring system seems to be a valid and reliable scale that measures the correct and desired values in the evaluation of health-related quality of life in orthopedic oncology. Reliability coefficients of the Turkish version of MSTS were determined to be strong. LEVEL OF EVIDENCE: Level II, Diagnostic Study.

Osteochondroma of the talus.

Osteochondroma is the most common benign bone tumor, and occurs most frequently in the proximal humerus, tibia, and distal femur. It rarely affects talus. Therefore, we report a patient with osteochondroma of the talus. Excision is a successful method of treatment for symptomatic osteochondromas with a low morbidity. Precise surgical planning will prevent the recurrence of this lesion.