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    Comparison of minimally invasive plate osteosynthesis and intramedullary nailing in the treatment of surgical neck fractures of the humerus in elderly patients
    (2025) Güzel, İsmail; Ulusoy, İbrahim; Kıvrak, Aybars; Yılmaz, Mehmet; Tantekin, Mehmet Fırat
    Proximal humerus fractures are common osteoporotic fractures in the elderly population, presenting challenges in treatment due to differences between surgical options. Minimally Invasive Plate Osteosynthesis (MIPO) and Intramedullary Nailing (IMN) are the primary techniques employed for managing these fractures, each offering distinct advantages and limitations. This retrospective study evaluated 56 patients aged 50 years or older who were treated for proximal humeral surgical neck fractures between 2018 and 2022. Locked plates were applied using the minimally invasive MIPO technique, while IMN was performed to enhance biomechanical stability. Patients were assessed for functional recovery (DASH scores), pain (VAS scores), and complication rates. The IMN group demonstrated superior functional outcomes with significantly lower DASH scores. Although pain scores were lower in the MIPO group, the difference was not statistically significant. Radiographic healing times were similar between the two groups, but the complication rate was higher in the MIPO group (12.% vs. 4.3%). While IMN appears to provide better functional outcomes, MIPO offers advantages in pain management and patient comfort due to its minimally invasive nature. However, the higher complication rates observed with MIPO warrant attention. Both IMN and MIPO are effective options for treating proximal humerus fractures in elderly patients. However, IMN is found to be more advantageous in terms of functional recovery and lower complication rates, making it a valuable alternative for specific patient populations.
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    Does timing matter? Impact of early versus delayed intramedullary nailing on healing and complications in isolated tibial shaft fractures
    (2025) Güzel, İsmail; Ulusoy, İbrahim; Tantekin, Mehmet Fırat
    This study aimed to compare the effects of early (<48 hours) and delayed (>48 hours) intramedullary nailing on fracture union time and complication rates in patients with isolated tibial shaft fractures. A total of 68 patients who underwent intramedullary nailing for isolated tibial shaft fractures were retrospectively included in the study. Patients were divided into two groups based on the timing of surgery: early surgery group (n=34) and delayed surgery group (n=34). Demographic data, AO classification, time to union, and complication rates were compared between the groups. The mean time to union was significantly shorter in the early surgery group (15.2 ± 3.4 weeks) compared to the delayed group (17.6 ± 4.1 weeks) (p=0.011). There was no statistically significant difference between the groups in terms of complication rates, including superficial/deep infections, nonunion, and implant failure (p>0.05). Fracture types according to the AO classification were evenly distributed between the groups. Early intramedullary nailing significantly shortens the union time in isolated tibial shaft fractures. However, surgical timing does not appear to have a significant effect on complication rates. Therefore, the decision on surgical timing should be individualized based on patient characteristics and soft tissue condition.
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    There Is No Role for Extracorporeal Shock Wave Therapy in Chronic Insertional Achilles Tendinopathy: A Comparative Study with Conservative Treatment
    (2026) Ulusoy, İbrahim; Yılmaz, Mehmet; Tantekin, Mehmet Fırat; Güzel, İsmail; Kıvrak, Aybars
    Background: Chronic insertional Achilles tendinopathy (CIAT) is a type of tendinopathy resistant to conventional conservative treatments. The efficacy of extracorporeal shock wave therapy (ESWT) remains controversial. This study aims to evaluate the effects of ESWT on pain management and functional improvement in CIAT patients and compare it with physical and medical treatments Methods: In this retrospective study, 372 patients diagnosed with CIAT between 2019 and 2023 were evaluated. The patients were divided into two groups: those who received only physical/medical therapy (Group 1) and those who underwent a combination of ESWT and physical/medical therapy (Group 2). Clinical outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) score and the Visual Analog Scale (VAS) scores. The severity of the disease was determined through magnetic resonance imaging (MRI). Group comparisons were conducted using the independent samples t-test and Fisher's exact test, while changes over time were assessed with repeated measures ANOVA. Correlation analyses were evaluated using Pearson and Spearman correlation coefficients. Results: Significant improvement in AOFAS and VAS scores was observed in both groups by the third month (p < 0.01). However, at 6 and 12 months, ESWT did not demonstrate superiority over physical/medical treatment. Correlation analysis showed a positive relationship between baseline AOFAS scores and functional improvement, while higher initial VAS scores correlated with greater post-treatment pain reduction. Cardiovascular risk factors negatively impacted both functional recovery and pain reduction (p < 0.05). Although patient satisfaction was higher in the ESWT group, the difference was not statistically significant. Conclusions: ESWT may provide short-term pain relief and functional improvement in CIAT but does not offer a long-term advantage over physical/medical treatment. The placebo effect may contribute to early positive outcomes. These findings do not support ESWT as a routine treatment for CIAT.