The diagnosis of femoroacetabular impingement can be made on pelvis radiographs using deep learning methods.

OBJECTIVES: The aim of this study was to evaluate diagnostic ability of deep learning models, particularly convolutional neural network models used for image classification, for femoroacetabular impingement (FAI) using hip radiographs. MATERIALS AND METHODS: Between January 2010 and December 2020, pelvic radiographs of a total of 516 patients (270 males, 246 females; mean age: 39.1±3.8 years; range, 20 to 78 years) with hip pain were retrospectively analyzed. Based on inclusion and exclusion criteria, a total of 888 hip radiographs (308 diagnosed with FAI and 508 considered normal) were evaluated using deep learning methods. Pre-trained VGG-16, ResNet-101, MobileNetV2, and Inceptionv3 models were used for transfer learning. RESULTS: As assessed by performance measures such as accuracy, sensitivity, specificity, precision, F-1 score, and area under the curve (AUC), the VGG-16 model outperformed other pre-trained networks in diagnosing FAI. With the pre-trained VGG-16 model, the results showed 86.6% accuracy, 82.5% sensitivity, 89.6% specificity, 85.5% precision, 83.9% F1 score, and 0.92 AUC. CONCLUSION: In patients with suspected FAI, pelvic radiography is the first imaging method to be applied, and deep learning methods can help in the diagnosis of this syndrome.

YouTube provides low-quality videos about talus osteochondral lesions and their arthroscopic treatment.

BACKGROUND: Medical professionals and patients commonly use the YouTubeTM platform in their research on health information. The quality of videos about talus osteochondral defect (OCD) and arthroscopic surgery has not been evaluated previously. The aim of this study was to interpret the quality and sufficiency of YouTubeTM videos about talus OCD and arthroscopic surgery. METHODS: The present study is a quality control study of videos on OCD and their arthroscopic treatment. The videos were interpreted in terms of Journal of the American Medical Association (JAMA), DISCERN (Quality Criteria for Consumer Health Information), The Global Quality Score (GQS) and Talus OCD - Specific Score (TOCDSS) by two blinded observers to assess the accuracy of these methods. RESULTS: Inter-observer agreement was "very high" for JAMA, DISCERN, and TOCDSS, while "high" for GQS. There was a statistical relationship and a positive correlation between the scoring systems. CONCLUSION: The content and quality of YouTubeTM videos about talus OCD and arthroscopic treatment are insufficient.

The effect of comorbid factors and amputation level on mortality in geriatric patients with diabetic foot.

OBJECTIVES: The aim of this study was to evaluate the factors that influenced one-year and five-year mortality and to compare major and minor amputations in diabetic patients with comorbidities. PATIENTS AND METHODS: Between February 2008 and November 2014, a total of 201 type 2 diabetic foot patients (147 males, 54 females; median age: 65.99 years; range, 50 to 92 years) who underwent amputation were retrospectively analyzed. The patients were divided into two groups according to their initial amputation level: Group 1 (n=100), minor amputation group, which included the distal region of the ankle joint and Group 2 (n=101), major amputation group, which included trans-tibial amputation, trans-femoral amputation and hip disarticulation. Clinical data including patients' demographic features, re-amputation degree, length of hospitalization, hyperbaric oxygen therapy, comorbidities, blood parameters, and survival rates were recorded. RESULTS: The regression analysis of one-year mortality found that the presence of cerebrovascular disease increased death by 2.463 times (p=0.002). Minor amputation increased mortality by 2.284 (p=0.006), and each unit increase in patient age increased mortality by 1.05 (p=0.008). Chronic renal failure increased death by 3.164 times (p<0.001) in the five-year mortality regression analysis. CONCLUSION: Minor amputations have an effect on one-year mortality, as do cerebrovascular disease and age. On the other hand, chronic renal failure has a negative impact on five-year mortality. Minor amputations may have a detrimental effect on mortality due to the ongoing progression of diabetic foot disease and the involvement of comorbidities. Comorbidities associated with amputations of the diabetic foot have a significant impact on mortality.

Is iliac autogenous graft augmentation in medial open wedge high tibial osteotomies superior to no augmentation in terms of bone healing?

OBJECTIVES: This study aims to investigate if iliac autogenous graft augmentation in medial open wedge high tibial osteotomies (OWHTOs) is superior to no augmentation in terms of bone healing. PATIENTS AND METHODS: Twenty-five patients (14 males, 11 females; mean age 40.9±4.0 years; range, 33 to 48 years) with medial compartmental osteoarthritis of knee joint who underwent high tibial osteotomy with medial open wedge between January 2016 and December 2018 were included in this retrospective study. Twelve of the operated knees were the right knee. Graft was used in 13 patients (52%). Data including age, gender, body mass index (BMI), direction, follow-up period, union, Lysholm and International Knee Documentation Committee (IKDC) scores, pre- and postoperative femoral tibial angles (FTAs) and posterior tibial slopes were evaluated. RESULTS: The mean BMI was 26.4±1.9 (range, 22.0 to 30.0). Only 48% of the patients were smoking. The mean follow-up period was 28.6±5.3 months (range, 24 to 38 months). No statistically significant difference was found between the grafted and non-grafted groups in terms of age, BMI, follow-up time, gender, side and smoking status (p>0.05) There was no statistically significant difference between two groups in terms of pre- and postoperative Lysholm scores, pre- and postoperative IKDC scores, or pre- and postoperative FTA values (p>0.050). CONCLUSION: Iliac autogenous graft augmentation in medial OWHTO has no effect on union but shortens the union time. Preoperative high varus degree adversely affects union. Therefore, routine use of iliac crest autograft is not recommended.

Endoscopic treatment of bilateral hallux saltans in an ordinary woman.

In this article, we present a 47-year-old female patient applying with pain in posteromedial of ankle and trigger toe complaints. There was no predisposing factor such as dance or sports or any radiological sign such as os trigonum. Posterior ankle endoscopy technique was used for evaluation and it was observed that the FHL tendon was triggered. Fibrous thickening around the tendon was released with endoscopic instruments. After release, it was observed that the FHL tendon was not triggered with toe movements. Hallux saltans can be treated by posterior endoscopic methods with an attention to the tibial nerve such as other joint and soft tissue pathologies. To the best of our knowledge, this is the first case report of endoscopic treatment of bilateral HS in an ordinary female patient.

Single-Step Arthroscopic Repair With Cell-Free Polymer-Based Scaffold in Osteochondral Lesions of the Talus: Clinical and Radiological Results.

PURPOSE: To report the clinical and radiological results of patients with talar osteochondral lesions who were treated by microfracture and cell-free scaffold implantation in a single-step arthroscopic surgery. METHODS: Forty patients, treated with a single-step arthroscopic surgery, were evaluated in this single-center-based retrospective study. Patients with degenerative arthritis (n = 1), history of ankle fracture (n = 1), kissing lesions (n = 1), lower extremity deformity (n = 1), and lesions <1.5 cm2 (n = 4) were excluded. Oversized (>10 mm depth) bone cysts were additionally treated with bone graft. Patients were evaluated clinically, using the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score. Radiological assessment was performed with magnetic resonance imaging, using the magnetic resonance observation of cartilage repair tissue (MOCART) score. RESULTS: Thirty-two patients with a mean age of 38 ± 12 years were evaluated. The mean defect size was 2.5 ± 0.8 cm2 and the mean defect volume was 2.4 ± 1.9 cm3. The mean preoperative AOFAS score was 52.8 ± 13.9 and increased to 87.1 ± 11.1 postoperatively at the mean follow-up of 33.8 ± 14.0 months (P = .0001). A total of 84.4% of patients had good to excellent clinical scores. Clinical scores had no significant relation with age, lesion size, depth, or body mass index. The mean MOCART score was 64.2 ± 12.0. There was no significant correlation between the total MOCART and AOFAS scores (P = .123). A significant relation was found between the defect filling (the subgroup of the MOCART score) and the clinical outcomes (P = .0001, rho = 0.731). CONCLUSIONS: The arthroscopic scaffold implantation technique is a single-step, safe, and effective method for the treatment of talar osteochondral lesions with satisfactory clinical and radiological outcomes. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Neglected bilateral congenital dislocation of the patella.

Congenital dislocation of the patella is a disorder that presents with dysfunction in extensor mechanism. Although congenital dislocation of the patella mostly occurs in children with genetic disorders, it may also occur in totally healthy children, despite rarely. In this article, we report a 16-year-old male patient who referred to our clinic with complaints of gait disturbance, frequent falls, and muscular weakness in lower extremity. The patient had no complaints during walking, but had difficulty in running and walking up and down the stairs. It was observed that the range of motion of the knee joint was completely painless and the quadriceps muscle strength was evaluated as 3/5. An evaluation of computed tomography and magnetic resonance imaging results showed that the patella was dislocated. It became clear with magnetic resonance imaging that extensor mechanism was continuous but patellar tendon was not attached to its anatomical position. Surgical treatment was not planned because the patient did not describe any pain complaint and there was no limitation of joint movement, he could walk without support and without device and also refused to be operated. The choice of treatment should be based on the patient's preference, and pain and functional status.

Treatment of Osteochondral Lesions of the Talus With Cell-free Polymer-based Scaffold in Single-Step Arthroscopic Surgery.

Arthroscopic techniques have recently gained popularity for the treatment of osteochondral defects of the talus. The microfracture procedure is the most commonly applied arthroscopic technique. However, it is not effective for the treatment of larger lesions. Tissue-engineered scaffolds have been used for cartilage regeneration arthroscopically, and promising results have been reported. We treated larger osteochondral lesions of the talus with polyglycolic acid-hyaluronan scaffold biomaterial (Chondrotissue, BioTissue AG, Zurich, Switzerland) in a single-step arthroscopic surgery. Traction methods and fibrin glue were avoided.