Frequently Asked Questions
Short and clear answers to frequently asked questions about orthopedics and traumatology.
Plates and screws are generally removed 12–18 months after the fracture has fully healed. However, removal is not mandatory if the implant is not causing any complaints. Removal is more commonly preferred in younger patients and for implants in superficial areas. The decision to remove the implant is based on the patient's age, the location of the fracture, and the discomfort caused by the implant.
An open fracture is an injury in which the broken bone tears through the skin and comes into contact with the external environment, requiring emergency surgery. It is classified into three types according to the Gustilo-Anderson classification, and the risk of infection is high. Treatment requires surgical debridement (wound cleaning), initiation of antibiotics, and stabilization of the bone within the first 6 hours. Treatment is planned in stages depending on the degree of soft tissue damage.
Fracture healing takes an average of 6–12 weeks depending on the location of the bone and the patient's age. Upper extremity fractures generally heal faster, while lower extremity fractures heal more slowly. Smoking, diabetes, and poor nutrition are the most important factors that prolong healing time. Healing is monitored with follow-up X-rays, and weight-bearing timing is determined accordingly.
Fracture nonunion is a condition in which the fracture fails to heal within the expected timeframe and loses its healing potential. It is generally considered nonunion when there are no radiological signs of healing despite 6–9 months having passed since the fracture. Treatment involves surgically refreshing the fracture ends, adding bone graft, and providing stable fixation. Quitting smoking and improving nutrition significantly increase the success of treatment.
In polytrauma patients, priority is determined according to the ATLS (Advanced Trauma Life Support) protocol based on life-threatening injuries. Airway, breathing, and circulation (ABC) are the first parameters assessed. From an orthopedic standpoint, open fractures, fractures accompanied by vascular injury, and pelvic fractures are conditions requiring emergency surgery. Following the damage control surgery principle, life-saving interventions are performed first, followed by definitive treatments.
A stress fracture is a micro-fracture that develops from repetitive loading on the bone, typically without a sudden impact. It is most commonly seen in runners and military personnel in the metatarsal and tibial bones. Pain that increases with activity and decreases with rest is the typical symptom. It may not be visible on early X-rays; MRI is the most sensitive diagnostic method.
Physical therapy after a fracture should begin as early as possible after surgical stabilization is achieved to prevent joint stiffness. Treatment is individually planned based on the fracture location, fixation method, and soft tissue condition. In the early period, isometric contractions and adjacent joint movements are performed, followed by active range of motion and strengthening exercises in subsequent weeks. Delayed rehabilitation increases the risk of joint stiffness and muscle atrophy.
Compartment syndrome is an emergency condition in which pressure within the muscle compartments rises to dangerous levels, obstructing blood flow to muscles and nerves. It is most commonly seen after tibial fractures and can lead to permanent muscle damage if left untreated. Symptoms include disproportionately severe pain, pain that increases with passive finger stretching, swelling, and a sensation of tightness. When diagnosed, emergency surgical fasciotomy is required to relieve the pressure.
Pelvic fracture treatment is planned according to the stability of the fracture and accompanying organ injuries. Stable fractures are managed with bed rest and pain control, while unstable fractures require surgical fixation. A multidisciplinary approach is essential in pelvic fractures due to the high risk of internal organ injury and hemorrhage. Early mobilization and thromboembolism prophylaxis after surgery are important components of treatment.
After hallux valgus surgery, walking with partial weight-bearing in a special shoe generally begins on the same day or the following day. Full weight-bearing becomes possible 4–6 weeks later depending on fracture healing. Transition to regular shoes typically occurs at 6–8 weeks. These timeframes may vary depending on the surgical technique; in patients who undergo osteotomy, bone healing time is awaited.
Return to sports after ACL reconstruction is generally possible between 9–12 months. The decision to return to sports is based on success in functional tests rather than time alone. Quadriceps and hamstring muscle strength must reach at least 90% of the healthy side, and single-leg hop tests must be symmetrical. Early return significantly increases the risk of re-tear.
Most posterior cruciate ligament injuries do not require surgery and are successfully treated with physical therapy. In isolated grade I–II injuries, a quadriceps-strengthening-focused rehabilitation program is applied. Surgery is preferred in multi-ligament injuries with accompanying ligament damage, grade III instability, and cases that do not respond to conservative treatment. Post-operative rehabilitation progresses more slowly compared to ACL.
After meniscus repair, running generally becomes possible at 3–4 months, while after partial meniscectomy it is possible at 4–6 weeks. The recovery period is longer after meniscus repair because the sutured tissue needs time to heal. Full range of motion and adequate muscle strength must be achieved before starting to run. Begin with light-paced running on flat ground and gradually increase intensity.
Recurrent shoulder dislocation should generally be treated with arthroscopic surgery because each dislocation increases the damage to the joint. Especially in patients under 25, the recurrence rate after the first dislocation can reach up to 70%. Bankart repair or the Latarjet procedure are the most commonly performed surgical methods. The amount of bone loss is the most important factor determining the choice of surgical technique.
A complete Achilles tendon rupture is treated with surgical repair in active and young patients. Surgical treatment reduces the risk of re-rupture and accelerates return to sports. After surgery, protection with a cast or special boot is applied for 6–8 weeks, followed by gradual rehabilitation. Return to sports is generally possible between 6–9 months.
In athletes with knee osteoarthritis, high-impact sports such as running, football, and basketball increase pain and accelerate disease progression. Low-impact sports such as swimming, cycling, and pilates help maintain an active lifestyle while protecting joint health. Sport modifications should be made based on the stage of osteoarthritis and severity of symptoms. With an appropriate muscle strengthening program, it is possible to continue many sports activities.
Partial rotator cuff tears and small full-thickness tears can significantly improve with physical therapy, but the tear does not close on its own. The goal of physical therapy is to reduce pain and improve function by strengthening the surrounding muscles. Surgery is recommended for large and massive tears, young active patients, and those who do not respond to conservative treatment. The treatment decision is individualized based on the size of the tear, the patient's age, and activity level.
The vast majority of ankle ligament injuries do not require surgery and heal with the RICE protocol (rest, ice, compression, elevation). In grade I and II sprains, return to sports is possible within 4–6 weeks with functional rehabilitation. Surgical ligament repair or reconstruction may be necessary in patients who develop chronic instability, meaning the ankle continues to sprain repeatedly. At least 3–6 months of conservative treatment should be attempted before considering surgery.
Patellofemoral syndrome is a condition that causes pain in the front of the knee due to abnormal tracking of the kneecap, and is particularly common in young athletes. Pain increases with climbing stairs, squatting, and prolonged sitting. The cornerstone of treatment is an exercise program that strengthens the quadriceps and hip muscles. Most patients do not require surgery; with proper rehabilitation, symptoms significantly decrease within 6–12 weeks.
A sports hernia is a soft tissue injury that causes chronic groin pain without a classic hernia sac and is particularly common in football players. Groin pain occurs with movements such as sudden changes of direction and kicking. Diagnosis is made through physical examination and MRI; ultrasound usually shows normal findings. In cases that do not respond to conservative treatment, successful results are achieved with surgical repair.
The average lifespan of modern knee prostheses is 15–20 years, and in more than 90% of patients the prosthesis functions without problems during this period. The most important factors affecting prosthesis lifespan are the patient's weight, activity level, and implant quality. Advanced materials such as cross-linked polyethylene have extended prosthesis life. When signs of prosthesis wear appear, revision surgery is planned.
After knee replacement, the patient stands up with the help of a walker on the day of surgery or the following day, and physical therapy begins. During the first 6 weeks, the patient walks with a walker or crutches, aiming for 90 degrees of knee flexion. By the third month, most patients return to independent walking and daily activities. Full recovery and maximum benefit from the prosthesis takes 6–12 months.
Shoulder replacement is performed on patients with advanced-stage shoulder osteoarthritis or irreparable rotator cuff tears who have not benefited from conservative treatments. Reverse shoulder prosthesis is especially preferred in elderly patients with rotator cuff insufficiency. Anatomical shoulder prosthesis is used in osteoarthritis patients with an intact rotator cuff. After surgery, the vast majority of patients experience significant pain reduction and regain overhead movements.
Robotic knee replacement is an advanced surgical technique in which the surgeon makes bone cuts with millimetric precision using robotic assistance to place the prosthesis in the ideal position. Pre-operative CT images are used to create a patient-specific 3D plan. The robotic system guides the surgeon's hand, preventing deviations from the plan. The goal is to achieve less soft tissue damage, faster recovery, and a more natural-feeling knee.
After joint replacement surgery, low-impact sports such as swimming, cycling, golf, walking, and pilates can be safely performed. High-impact sports such as running, football, basketball, and tennis are not recommended as they may shorten prosthesis lifespan. Activity selection is determined by the location of the prosthesis (knee, hip, shoulder) and the patient's pre-operative sports history. Regular exercise positively affects prosthesis lifespan by strengthening the muscles around the prosthesis.
A partial knee replacement replaces only the damaged portion of the knee, while a total replacement covers all joint surfaces. Partial replacement offers a smaller incision, less bone loss, faster recovery, and a more natural knee feel. However, it can only be applied to patients with single-compartment osteoarthritis, intact ligaments, and no axial malalignment. With appropriate patient selection, partial replacement results are as successful as total replacement.
Prosthesis loosening most commonly presents with pain that increases with activity and persists at rest. Instability felt during walking (a sense of looseness), swelling, and restricted movement are other symptoms. Diagnosis is made with X-rays and, if necessary, bone scintigraphy; blood tests are performed to differentiate infectious loosening. When loosening is detected, revision surgery for prosthesis replacement is planned.
Revision joint replacement surgery is the procedure of removing a worn, loosened, or infected prosthesis and replacing it with a new one. It is most commonly required due to prosthesis loosening, wear, infection, and recurrent dislocation. It is more complex than primary joint replacement because bone loss and soft tissue issues must be addressed. Successful outcomes are achieved using specialized revision implants and bone grafts.
After tendon repair, controlled passive movements begin within the first week with the assistance of a special splint. Early movement significantly improves functional outcomes by preventing tendon adhesion. Active movements generally begin at 4–6 weeks, and resistance exercises at 8–12 weeks. Compliance with the rehabilitation protocol after flexor tendon repair directly affects the outcome.
De Quervain's tenosynovitis is a condition in which the tendon sheath on the thumb side of the wrist becomes inflamed, causing pain and swelling. It is particularly common in new mothers caring for infants and in people who perform repetitive hand movements. Treatment first-line options include splinting, anti-inflammatory medications, and corticosteroid injection. In cases that do not respond to conservative treatment, a minor surgical procedure to release the tendon sheath is performed.
Dupuytren's contracture can recur in approximately 20–50% of patients over the years after surgery. The risk of recurrence is higher in patients with early onset, family history, and bilateral hand involvement. Regular hand exercises and splint use after surgery reduce the risk of recurrence. In recurrent cases, alternative treatments such as repeat surgery or collagenase injection may be applied.
Approximately 40–60% of ganglion cysts can spontaneously shrink and disappear. Painless cysts that do not cause functional impairment can be monitored with observation. For symptomatic cysts, aspiration (draining with a needle) can be attempted, but the recurrence rate is up to 50%. Surgical excision is the most definitive treatment method for frequently recurring cysts or those compressing nerves.
Most finger fractures are treated without surgery using a splint or buddy taping (taping to an adjacent finger). Surgical fixation is required when there is displacement, rotation, or intra-articular involvement between fracture fragments. Early finger movement is crucial to prevent joint stiffness. Untreated or malunited finger fractures can result in permanent restricted movement.
Hand and finger numbness is most commonly a symptom of nerve compression conditions such as carpal tunnel syndrome, cubital tunnel syndrome, or cervical disc herniation. Which fingers are affected helps identify the involved nerve: the thumb, index, and middle finger indicate the median nerve; the ring and little finger indicate the ulnar nerve. Systemic causes such as diabetes, thyroid disorders, and vitamin B12 deficiency can also cause hand numbness. For persistent or progressive numbness, nerve function should be evaluated with an EMG test.
Mallet finger is a condition in which the fingertip droops due to rupture of the extensor tendon at the fingertip, and most cases are treated without surgery. Treatment involves immobilizing the fingertip in a straight position with a special splint for 6–8 weeks. It is critical for treatment success that the fingertip is not bent at all during the splinting period. Surgical treatment is applied in cases with a bony avulsion fragment or those that do not respond to splint treatment.
A scaphoid fracture is a significant injury that carries the risk of nonunion and avascular necrosis due to the poor blood supply of the scaphoid bone in the wrist. In patients presenting with wrist pain after a fall, a scaphoid fracture should be suspected even if X-rays appear normal. If early diagnosis is not made, bone nonunion and wrist osteoarthritis may develop in subsequent years. MRI is the most sensitive diagnostic method; treatment is planned as cast immobilization or surgical screw fixation depending on the fracture location.
PRP treatment is generally administered as a total of 3 sessions at 2–4 week intervals. The frequency and number of sessions are individualized based on the patient's diagnosis and response. A single session may be sufficient for tendon injuries, while multiple sessions are more effective for joint osteoarthritis. The treatment effect generally becomes apparent 4–6 weeks after the last session.
Stem cell therapy shows promising results in reducing pain and improving function in early and moderate-stage knee osteoarthritis. It works by secreting growth factors that stimulate cartilage regeneration. Its effectiveness is limited in advanced-stage (bone-on-bone) osteoarthritis and does not replace joint replacement surgery. The best results are obtained in young, non-overweight patients with early-stage osteoarthritis.
Prolotherapy is a regenerative treatment method that triggers the body's natural healing response by injecting an irritant solution (usually dextrose) into joints and ligament tissues. It is applied for chronic tendon injuries, ligament laxity, and early-stage joint osteoarthritis. It generally requires 3–6 treatment sessions performed at 2–4 week intervals. It is more economical compared to other regenerative treatments, but its effectiveness may be more limited.
Hyaluronic acid injection is a treatment method that reduces pain and facilitates joint movement by supplementing the depleted joint fluid in osteoarthritis. It is most commonly applied for knee osteoarthritis, and its effect can last 6–12 months. Different formulations are available as a single dose or as a series of 3–5 weekly injections. It provides the most effective results in early and moderate-stage osteoarthritis; its effectiveness decreases in advanced stages.
PRP is a platelet concentrate obtained from the patient's own blood, while stem cell therapy uses regenerative cells obtained from bone marrow or adipose tissue. PRP primarily accelerates healing through growth factors, while stem cells directly support tissue regeneration. PRP is simpler, more economical, and can be applied in an office setting; stem cell therapy requires a more comprehensive procedure. The choice of treatment is determined by the type and stage of the disease.
Ozone therapy is a complementary treatment method in which medical ozone gas is injected into or around the joint to provide anti-inflammatory and analgesic effects. It can provide short-to-medium-term pain reduction, particularly in knee and shoulder osteoarthritis. It has a low side-effect profile and can be administered in combination with other treatments. However, long-term efficacy evidence is limited and it is not recommended as a standalone primary treatment.
The effect of regenerative therapies generally begins to be felt 4–6 weeks after application. This time is necessary for the body to initiate its healing response and activate the tissue repair process. The effect may begin earlier with PRP, while the full effect of stem cell therapy emerges in 3–6 months. A temporary increase in pain at the injection site during the first few days is a normal inflammatory response and indicates that the healing process has begun.
SVF is a cell mixture rich in stem cells and growth factors obtained by specially processing adipose tissue harvested from the patient's own abdominal area. Its most important advantage is that it can be harvested and applied in the same session. It is used for orthopedic conditions such as joint osteoarthritis, tendon injuries, and avascular necrosis. It is possible to obtain a higher cell count compared to bone marrow-derived stem cells.