Assessment of the risk factors determining the prognosis of major and minor limb amputations in patients with diabetic foot ulcers.

BACKGROUND: Diabetes mellitus (DM) is a major global health problem, and its incidence is growing. Depending on this increase, the number of diabetes-related complications will also rise. OBJECTIVES: This study aimed to determine the risk factors associated with major and minor amputations resulting from diabetes. MATERIAL AND METHODS: Patients diagnosed with diabetic foot complications (n = 371) and hospitalized between January 2019 and March 2020 were retrospectively evaluated using information obtained from the database of Diabetic Foot Wound Clinic. Examination of the data identified 165 patients for inclusion in the study, who were stratified into major amputation (group 1, n = 32), minor amputation (group 2, n = 66) and non-amputation (group 3, n = 67) groups. RESULTS: Of the 32 patients who underwent major amputations, 84% had a below-knee amputation, 13% had an above-knee amputation and 3% had knee disarticulation. At the same time, 73% of 66 patients who underwent minor amputation had a single-finger amputation, 17% had a multiple-finger amputation, 8% had a transmetatarsal amputation, and 2% had Lisfranc amputation. Laboratory results showed high acute phase protein and low albumin (ALB) levels in patients from group 1 (p < 0.05). Although Staphylococcus aureus was found to be the most common infectious agent, Gram-negative pathogens were dominant (p < 0.05). Also, there was a significant cost difference between the groups (p < 0.05). Furthermore, those aged over 65 had a high Wagner score, high Charlson Comorbidity Index (CCI), long diabetic foot ulcer (DFU) duration, and high white blood cell (WBC) count, all of which were risk factors for major amputation (p < 0.05). CONCLUSIONS: This study demonstrated an increased Wagner staging and incidence of peripheral neuropathy (PN) and peripheral arterial disease (PAD) in major amputation patients. In addition, the rate of distal vessel involvement was high in major amputation patients, with elevated acute phase proteins and low ALB levels crucial in laboratory findings.

An outbreak analysis of wound infection due to Acinetobacter baumannii in earthquake-trauma patients.

BACKGROUND: Multidrug-resistant Acinetobacter baumannii is still a major contributor to outbreaks and infections health care-associated infections. This study aimed to investigate an outbreak of wound infection due to A baumannii in trauma patients injured in the Kahramanmaras earthquake. METHODS: This retrospective case-control study was conducted on an outbreak of wound infection caused by A. baumannii in trauma patients affected by the February 6 Turkey earthquake. Among the patients who underwent at least one extremity surgery due to earthquake-related crush-trauma injury, patients with wound infection due to A baumannii were included in the case group and without infection were included in the control group. Multivariate analysis and logistic regression were performed to identify risk factors. Environmental cultures were taken to identify the source of the outbreak. Molecular typing by pulsed-field gel electrophoresis was used to confirm the relationships of the wound infection agent A. baumannii strains. RESULTS: A total of 44 patients were included in the case group and 62 patients in the control group. Time under the debris; 22.0 versus 35.7 (odds ratio [OR]:1.02, 95% confidence interval [CI]: 1.00-1.04) and hemodialysis (OR: 6.09, 95% CI: 1.64-22.66) were identified as risk factors for in the multivariate analysis. Performing the first intervention in a fully equipped tertiary hospital was seen as an infection-reducing factor compared to performing it in a field hospital (OR: 0.21, 95% CI: 0.06-0.68). Dressing trolleys and scissors were identified as the source of the outbreak. CONCLUSIONS: After devastating earthquakes, a large number of patients are admitted and require emergency interventions due to life-threatening conditions. Organ failure often develops and requires the use of invasive catheters and procedures. Compliance with infection control measures and clean surgical interventions reduce wound site infections and allow extremities to heal, while problems in adhering to infection control measures can lead to many problems such as outbreaks of gram-negative bacteria. This highlights the importance of infection control measures.

The Evaluation of Different Treatment Approaches in Patients With Earthquake-Related Crush Syndrome.

BACKGROUND: On February 6, 2023, an earthquake occurred in Kahramanmaras, Turkey, resulting in loss of life, injuries, and the displacement of thousands of people. The aim of this study is to determine the factors affecting amputation and fasciotomy decisions in patients with crush syndrome, along with clinical laboratory parameters. MATERIALS AND METHODS: The study included patients over 18 years of age who presented with crush injuries and exhibited systemic symptoms. Inclusion criteria comprised patients with creatine kinase (CK) levels exceeding 1,000 IU/L, oliguria (urine output less than 400 mL per day), elevated blood urea nitrogen (BUN) levels surpassing 40 mg/dL, serum creatinine exceeding 1.5 mg/dL, potassium levels over 6 mEq/L, phosphorus levels surpassing 8 mg/dL, and serum calcium levels below 8 mg/dL. Multiple parameters were evaluated, including blood glucose, serum sodium, potassium, calcium, phosphorus, BUN, creatinine, uric acid, CK, albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, direct bilirubin, prothrombin time (international normalized ratio (INR)), urinalysis, C-reactive protein (CRP), venous blood gas, ECG, and chest radiography. RESULTS: Following the Maras earthquake, a total of 3,184 patients were admitted to our hospital within the first seven days. Out of these patients, 2,216 received outpatient treatment, 639 were hospitalized in the general ward, and 128 were admitted to the intensive care unit. Among the admitted patients, 237 were diagnosed with crush syndrome, with 126 being male and 111 being female. The average duration of being trapped under debris was eight hours, ranging from four to 36 hours. In the study population, extremity trauma was observed in 84 patients, thoracic trauma in 32 patients, and abdominal trauma in 20 patients. Erythrocyte replacement was administered to 123 patients, while fresh frozen plasma was given to 69 patients, for a total of 1008 units utilized. Mannitol infusions were provided to 58 patients, while bicarbonate infusions were administered to 116 patients. Among the cohort, 71 patients underwent dialysis, with nine of them receiving hemodialysis along with mannitol. Additionally, 67 patients experienced stage 3 acute kidney injury, and 41 patients were deceased. None of the patients required permanent hemodialysis. CONCLUSION: Earthquakes are considered to be one of nature's most significant and inevitable disasters. While it is impossible to prevent them, effective management strategies are crucial in mitigating the ensuing chaos and reducing casualties. In order to achieve this, it is imperative to draw lessons from past seismic events and apply appropriate treatment protocols to the affected individuals.

Effects of anterior cruciate ligament rupture and reconstruction on sexual activity of male patients.

OBJECTIVES: This study aims to investigate the impact of anterior cruciate ligament (ACL) injury and its reconstruction on men's sexual functions. PATIENTS AND METHODS: Between February 2016 and November 2019, a total of 27 sexually active male patients (mean age: 33.7±4.3 years; range, 26 to 40 years) who were operated for ACL injury at least six months after trauma were retrospectively analyzed. Erectile function was assessed using the International Index of Erectile Function questionnaire (IIEF) and knee function was evaluated by using the International Knee Documentation Committee (IKDC) Scoring System, Lysholm Knee Scoring Scale, and Tegner Activity Score. Sexual and functional questionnaires were applied to evaluate three different periods retrospectively. These periods were as follows: the period before an ACL injury (Period I); the period in which the patient suffered from an ACL injury, but not operated (Period II), and the period after the ACL reconstruction (Period III). RESULTS: There was a statistically significant difference in the comparison of knee function scores according to three different periods. Sexual function scores were significantly different between Periods I and II, and between Periods I and III. However, although the IIEF value was higher in Period III than in Period II, no statistically significant difference was observed. A moderate correlation was found between the sexual functional scores of IIEF and IKDC scores. CONCLUSION: Our study results suggest that ACL injury affects sexual functions adversely. The change in sexual functions after ACL surgery depends on the success of surgery. While deciding on the treatment of ACL injury, the patient's sexual life should be questioned along with his expectations.

The Influence of Component Rotational Malalignment on Early Clinical Outcomes in Total Knee Arthroplasty.

Background The most important cause of patient dissatisfaction following total knee arthroplasty (TKA) is pain. Component rotation is an important factor in the clinical success of TKA. This study aims to determine component rotational errors in patients with mobile- and fixed-bearing polyethylene inserts after TKA and also to evaluate the effect of possible malrotations on clinical outcomes. Methods Seventy-five knees from sixty-six patients who underwent TKA were evaluated retrospectively. The patients were divided into two groups according to whether they received a mobile-bearing polyethylene insert (group 1, n = 48) or a fixed-bearing polyethylene insert (group 2, n = 27). The Hospital for Special Surgery (HSS) score, the Western Ontario and McMaster Universities Arthritis Index (WOMAC), the Lysholm Knee Scoring Scale, and the Oxford Knee Score were used for the clinical evaluation of the patients. The rotational state of the components was evaluated by computed tomography. Results The HSS, WOMAC, Lysholm, and Oxford clinical scores were not significant between the two groups (p > 0.05). The effect of femoral versus tibial component rotational deviation on clinical scores was not significant between the two groups (p > 0.05). Component rotational differences did not have a significant effect on the degree of knee flexion and extension between groups (p > 0.05). When the combined rotations of the components were compared with the clinical scores of function, no significant difference was detected between groups (p > 0.05). In addition, no significant difference between the operated sides of the patients and the combined component internal rotations was found (p > 0.05). Conclusion Although component rotation is an important factor in the clinical success of TKA, the current study did not find a clear association between the clinical results after TKA and the internal rotation of components. Component internal rotation alone is not an important predisposing factor for pain development after TKA. We believe that this may be attributed to the significant effects of patient expectation, which is often ignored, on clinical scores.

The finite element method-based pattern recognition approach for the classification of patient-specific gunshot injury.

Violence related injuries and deaths mostly caused by firearms are a major problem throughout the world. Understanding the factors that control the extent of hard-soft tissue wound patterns using computer imaging techniques, numerical methods, and machine learning algorithms may help physicians to diagnose and treat those injuries more properly. Here, we investigate the use of computational results coupled with the pattern recognition algorithms to develop an approach for forensic applications. Initially, computer tomography (CT) images of the patient whose leg was shot by a 9 × 19 parabellum bullet are used to construct the FE models of that patient's femoral bone and the surrounding soft tissues. Then, Hounsfield units-based material properties are assigned to elements of the bone. To simulate the full range of loading conditions encountered in ballistic events, a constitutive model that captures the strain-rate dependent response is implemented. The entrance pathway vector of the bullet is directed in accordance with the patient's wound and the simulations are deployed for the cases having various inlet velocities such as 150, 200, 250, 300, and 350 m/s. Once the FE results for each case are obtained, they are processed with supervised machine learning algorithms to classify the wound and inlet velocity correspondence. The results demonstrate that they can be diagnosed with a percent accuracy of 97.3, 97.5, and 98.3 for the decision tree (DT), k-nearest neighbors (kNN) and support vector machine (SVM) classifier, respectively. This approach may provide a useful framework in classifying the wound type, predicting the bullet impact velocity and its firing distance.

Effect of boric acid on cartilage formation of osteochondral defects in rabbit knee: An experimental study.

BACKGROUND: The present study aimed to investigate the healing of articular cartilage with boric acid (BA) injection in an experimental cartilage defect model of rabbit knee. METHODS: Nine skeletally mature female New Zealand White rabbits were used. The right knees of the rabbits were assigned as the study group and injected with the BA solution and the left knees of the rabbits as the control group. Under anesthesia, a cylindrical full-thickness osteochondral defect (4 mm in diameter and 3 mm in depth) was formed using a drill on the anterior side of the articular surface of the medial femur condyle. The BA solution was administered to the right knees of rabbits in the form of an intra-articular injection (8 mg/kg) for 6 weeks, at the same day and hours each week. The animals were euthanized at the end of the 2nd month. RESULTS: In both macroscopic evaluation and microscopic evaluation, statistically significant differences were observed in the BA injection group compared with the control group (p<0.05). In the macroscopic examination of the defect area, statistically significant differences were observed between the groups in terms of degree of defect repair, integration to border zone, and macroscopic appearance (p<0.05). The averaged results of all evaluated parameters of the International Cartilage Repair Society visual histological assessment score were better for the BA group. CONCLUSION: The healing process of the cartilage injury could be improved by BA injection administration. In future, BA may safely be used as an additional treatment modality in clinical practice to enhance the healing process of cartilage injuries, which are commonly observed orthopedic problem.

Biomechanics of the Femoral Head Cartilage and Subchondral Trabecular Bone in Osteoporotic and Osteopenic Fractures.

This study aimed to investigate the relationship between the micro structural properties of the subchondral trabecular bone (STB) and the macro mechanical properties of the articular cartilage (AC) in patients with osteoporotic (OP) and osteopenic (OPE) fractures. Sixteen femoral head samples (OP;OPE, n = 8 each) were obtained from female patients who underwent hip hemiarthroplasty. STB and AC specimens were harvested from those heads. Bone specimens were scanned using µ-CT to determine the micro structural properties. In-situ nondestructive compressive tests were performed for the cartilages to obtain elastic properties. The finite element technique was implemented on STB models created from µ-CT data to compute apparent elastic modulus. In addition, dynamic cyclic destructive tests were performed on STB and AC specimens to assess failure cycles. The results demonstrated that STB specimens in OPE group have more interconnected structure and higher cyclic dynamic strength than those in OP group. Furthermore, bone mineral density, failure cycle, and trabecular number of STB were positively correlated with the cartilage failure cycle, which indicates that STB alteration may affect the macroscopic mechanical properties of AC. The findings suggest that STB loss correlates with a decrease in cartilage strength and that improving of bone quality may prevent cartilage weakness.

Efficacy of calcium phosphate cementing in the surgical treatment of Sanders Type II and III calcaneal fractures using screw fixation with sinus tarsi approach.

OBJECTIVE: This study aimed to determine the effectiveness of calcium phosphate cementing in the surgical treatment of Sanders type II and III calcaneal fractures using screw fixation with sinus tarsi approach. METHODS: In this retrospective study, 85 feet of 84 patients (74 males, 10 females; mean age 43 [17-61] years) in whom screw fixation was performed using the sinus tarsi approach for Sanders type II or III calcaneal fractures were included. The mean follow-up was 28 (14-39) months. Patients were categorized into 2 groups on the basis of whether calcium phosphate cement (CPC) was used. Group 1 had 37 patients with CPC (38 calcaneal fractures) and group 2 had 47 patients without CPC (47 calcaneal fractures). In the clinical assessment, the American Orthopedic Foot Ankle Society (AOFAS) hind foot score and the Maryland Foot Score (MFS) were used at the final follow-up. In the radiological assessment, Bohler's angle on plain radiograph and posterior facet step-off on computed tomography were measured pre-and postoperatively. RESULTS: At the final follow-up, the mean Bohler's angle was 26.2° (20°-33°) in group 1 and 26° (17°-30°) in group 2 (P = 0.85). The mean posterior facet step-off was 1.6 (0-5) mm in group 1 and 1.5 (0-5) mm in group 2 (P = 0.85). The mean AOFAS score was 83.8 (59-100) in group 1 and 85.8 (60-100) in group 2 (P = 0.5). The mean MFS was 86.3 (66-100) in group 1 and 87.7 (66-100) in group 2 (P = 0.62). CONCLUSION: Evidence from this study have shown that CPC may have no significant effect on clinical and radiological outcomes in the surgical treatment of Sanders type II and III calcaneal fractures using screw fixation with sinus tarsi approach.

Catastrophic failure and metallosis of the acetabular component in total hip arthroplasty.

BACKGROUND: To evaluate the clinical features and results of the revision total hip arthroplasties (THA) in patients with catastrophic failures and metallosis. METHODS: Fifteen hips of 14 patients with catastrophic failure and metallosis in hip arthroplasties were evaluated. They were followed for at least 4.2 years after the revision THA. Clinical evaluation was performed using Harris hip score. Osteolysis, loosening or presence of metallosis was evaluated with standard radiographs. Metallosis was evaluated intraoperatively according to the metallosis severity classification. RESULTS: The mean time from failure until revision surgery was 9.4 years. It was observed that in the primary THA, metal-on-ceramic (MoC), ceramic-on-ceramic (CoC) and metal-on-conventional polyethylene (MoCPE) bearings were used in 1, 3 and 11 hips, respectively. Grade III metallosis was observed in all patients during revision surgeries. The mean Harris hip score increased from 55 points before revision THA to 75 points at the final follow-up. In revision arthroplasty, MoCPE and CoC bearings were used in 13 and 2 hips, respectively. The femoral stem was replaced in 5 hips. All acetabular cups, except that of one hip, were revised. CONCLUSIONS: Revisions of THAs with catastrophic failures and metallosis are quite challenging. Routine follow-up of arthroplasty patients is beneficial to examine for osteolysis, loosening, and asymmetric wear.

Are vitamin D and vitamin D receptor levels different in children with developmental dysplasia of the hip?

INTRODUCTION: Developmental dysplasia of the hip (DDH) is a common disorder and associated with significant morbidity of the hip joint. Several risk factors have been identified for DDH. The aim of this study is to investigate whether vitamin D and vitamin D receptor (VDR) levels differ in children with DDH and whether they have an effect on DDH development. MATERIALS AND METHODS: A total of 40 (17 males, 23 females; 9 right hips, 16 left hips, 15 bilateral hips) children who were treated for developmental dysplasia and 40 (23 males, 17 females) healthy children without any musculoskeletal system and metabolic disorders were included in this study between January and June 2019. Blood samples from the DDH and control groups of children were collected to measure the serum levels of vitamin D, VDR, calcium (Ca), phosphorus (P), and alkaline phosphatase (ALP). The levels of Ca, P, and ALP were analyzed using the automated standard spectrophotometric laboratory method. The levels of vitamin D and VDR in the samples were analyzed using enzyme-linked immunoassay. RESULTS: There were no significant differences in the serum levels of Ca, P, ALP, and vitamin D between the DDH and healthy groups (Ca 9.96 ± 0.47 vs. 9.92 ± 0.48 mg/dL, respectively, p = 0.721; P 5.3 ± 0.94 vs. 4.82 ± 0.88 mg/dL, respectively, p = 0.23; ALP 252.22 ± 170.15 vs. 245.3 ± 130.93 U/L, respectively, p = 0.839). However, serum VDR levels were significantly lower in children in the DDH group (5.77 ± 3.51 ng/mL) than in the healthy control group (9.25 ± 6.43 ng/mL) (p = 0.004). CONCLUSIONS: In conclusion, we believe that low VDR levels can affect DDH regardless of the serum levels of Ca, P, ALP, and vitamin D. More comprehensive studies involving parents are needed to understand whether VDR levels mediate genetic transmission in DDH or not.

Midterm Results of Tension Band Wiring Technique for Acute Rockwood Type III Acromioclavicular Joint Dislocation.

Background The aim of this study was to evaluate the clinical and radiological results of patients with acute type III Rockwood acromioclavicular joint (ACJ) dislocation treated surgically by employing tension band wiring. Methods The study included 24 patients with traumatic type III ACJ dislocations according to the Rockwood classification. The clinical and radiological outcomes of patients were assessed at the final follow-up visit. Implant failure and reduction loss were assessed using radiographs, whereas the Constant-Murley scoring system was used to assess the patients clinically. Results The mean follow-up period was 3.5 ± 1.3 years (range: 1-6 years). The mean age of the patients was 41.8 ± 11.7 years (range: 19-64 years) and the mean length of hospital stay was 2.3 days (range: 1-6 days). The fixation material was removed postoperatively at an average of 7.2 ± 9.9 months (range: 3-40 months). At the end of the follow-up period, the mean Constant-Murley score was 72.5 ± 12.8 (range: 50-90). The ACJ reduction was stable in 13 (54.2%) patients. Residual subluxation was detected in 11 (45.8%) patients. Distal clavicular osteolysis was noted in six (25%) patients. Acromioclavicular osteoarthritis was detected in five (20.8%) operated shoulders on follow-up radiographs. During the follow-up, Kirschner-wire migration and breakage occurred in four (16.6%) and seven (29.1%) patients, respectively. Conclusions This study showed that surgical treatment with the tension band wiring method provided functionally satisfactory results even if complications developed because of the presence of implants. Independent of age, we can recommend it as the primary treatment method for patients who do not have very high expectations regarding their shoulder function. Additionally, we think that reducing the duration of implant retention will reduce the incidence of complications.

Drug response prediction by ensemble learning and drug-induced gene expression signatures.

Chemotherapeutic response of cancer cells to a given compound is one of the most fundamental information one requires to design anti-cancer drugs. Recently, considerable amount of drug-induced gene expression data has become publicly available, in addition to cytotoxicity databases. These large sets of data provided an opportunity to apply machine learning methods to predict drug activity. However, due to the complexity of cancer drug mechanisms, none of the existing methods is perfect. In this paper, we propose a novel ensemble learning method to predict drug response. In addition, we attempt to use the drug screen data together with two novel signatures produced from the drug-induced gene expression profiles of cancer cell lines. Finally, we evaluate predictions by in vitro experiments in addition to the tests on data sets. The predictions of the methods, the signatures and the software are available from http://mtan.etu.edu.tr/drug-response-prediction/.

Lateral Locked Plating or Dual Plating: A Comparison of Two Methods in Simple Bicondylar Tibial Plateau Fractures.

BACKGROUND: In this study, our aim was to compare the results of the dual locking plate fixation technique and lateral locking plate fixation technique for tibial bicondylar plateau fractures without posteromedial fragment. METHODS: We evaluated 20 patients who underwent surgical treatment due to bicondylar tibial plateau fracture between 2010 and 2015. Ten patients were included in group 1, in which a dual locking plate was employed, whereas 10 patients were included in group 2, in which a lateral locking plate was used. In both groups, functional and clinical outcomes after treatment were rated according to the Knee Society Knee Scoring System, Rasmussen functional score, and Rasmussen radiological score. RESULTS: The mean follow-up time was 24 months. There were no significant differences between the groups with respect to functional and radiographic outcomes at the final follow-up. CONCLUSIONS: In bicondylar tibial plateau fractures without posteromedial fragment, the lateral locking plate fixation technique showed the similar clinical and radiological outcomes as the dual locking plate fixation technique.

Traumatic Anteromedial Radial Head Dislocation in an Adult: A Case of Brachialis Tendon Entrapment.

Isolated traumatic anteromedial radial head dislocation is an uncommon injury in adults. The brachialis tendon interposition rarely interferes with the radial head reduction procedure. In the present paper, we report the case of an 18-year-old male who sustained an injury to his right elbow during a wrestling match and developed isolated anteromedial radial head dislocation. Open reduction had to be performed due to entrapment of the radial head at the brachialis tendon.

Is Subacromial Balloon Spacer Appropriate for Treatment of Irreparable Rotator Cuff Tears in Elderly Patients?

BACKGROUND: The aim of this study was to evaluate the clinical and radiographic results of surgical treatment of irreparable rotator cuff tears by subacromial balloon spacer insertion in patients over 65 years old. MATERIAL AND METHODS: Results of patients with failed conservative treatment for irreparable rotator cuff tears and who underwent subacromial balloon spacer insertion were evaluated retrospectively. The VAS and Quick-DASH scores were used for clinical and functional assessment. RESULTS: Eleven patients were included. Mean age of patients was 69.1 (range: 65-77) years old. Evaluation of anteroposterior shoulder x-rays revealed Hamada grade 2 and grade 1 arthropathy in 10 patients (91%) and 1 patient (9%),respectively. Mean duration of follow-up was 45.09 (±5.43,37-52) months. The difference in the subacromial space measured from standard AP shoulder x-rays in the preoperative period, in the 6th postoperative month, and at the end of follow-up was 5.44 mm (2.29), 6.51 mm (±2.23), and 5.08 mm (±2.13), respectively. Mean Quick-DASH score was 74.49(±14.36) in the preoperative period, compared to 72.19 (±14.38) at the end of follow-up. There was no statistically significant difference between preoperative period and end of follow-up scores in terms of mean Quick-DASH scores (p= 0.232). Mean VAS score was 7.09 (±0.831) in the preoperative period and 6.64 (±0.809) at the end of follow-up. No statistically significant difference was revealed in terms of mean VAS scores when preoperative and end of follow-up scores were compared (p=0.333). CONCLUSION: Clinical and radiographic results of subacromial balloon spacer insertion in the treatment of irreparable rotator cuff tears could not be evaluated as satisfactory.

Corrective Osteotomy for Coronal Plane Malunion of the Medial Femoral Condyle.

Medial femoral condyle malunion in the coronal plane is a very rare injury. In this presented case, we performed intra-articular corrective osteotomy for a malunited medial femoral condyle in the coronal plane of a 22-year-old man and obtained good functional and radiographic results. Corrective osteotomy for a malunited medial Hoffa fracture is technically very challenging, but intra-articular corrective osteotomy for these malunited fractures offers a good outcome and should be considered as a salvage treatment.

Evaluation of Risk Factors for Second Hip Fractures in Elderly Patients.

BACKGROUND: Hip fracture is a worldwide public health problem that primarily affects osteoporotic individuals and the elderly. A second hip fracture can occur in elderly patients who have already suffered an initial hip fracture. The aim of this study was to investigate possible risk factors for second hip fractures in elderly patients with hip fractures. METHODS: Between 2010 and 2014, 230 patients who underwent uncemented bipolar hemiarthroplasty for hip fractures were retrospectively analyzed. The patients were divided into two groups: those with a first hip fracture (group 1) and those with a second hip fracture (group 2). RESULTS: The mean time from the first hip fracture to second hip fracture was 22 months. There were no significant differences in the American Society of Anesthesiologist scores, comorbidities were observed in the two groups. The mean length of hospitalization was not significantly different between the two groups. The mean postoperative functional scores after second hip fractures were significantly lower in group 2 than in group 1. CONCLUSIONS: Although there are not certain risk factors for second hip fractures in elderly patients with hip fractures, to prevent second hip fractures, elderly patients should be provided with physical and medical therapy as well as orthotic support and their functional activity should be maintained.

Evaluation of major and minor lower extremity amputation in diabetic foot patients

Background/aim: We evaluated the existing risk factors with clinical results in patients who underwent major and minor amputation of the lower extremity as a result of diabetic foot ulcers (DFUs). Materials and methods: We retrospectively studied 107 patients who had undergone lower extremity amputation. The patients were divided into minor (Group 1, n = 75) and major (Group 2, n = 32) amputation groups. On clinical evaluation, the type of surgery performed, smoking history, comorbidities, duration of diabetes mellitus (DM) diagnosis, duration of DFU presence, peripheral neuropathy, peripheral arterial disease, results of deep tissue culture, length of hospitalization, and blood parameters were investigated. Results: In Group 2, mean hospitalization time was significantly longer than in Group 1 (P < 0.05). The proportion of patients with Wagner Grade 4 was significantly higher in Group 2 than in Group 1 (P < 0.05). The duration of DM and DFU was significantly longer in Group 2 (P < 0.05). The number of polymicrobial agents was significantly higher in Group 1 (P < 0.05). Conclusion: In our study, the most important risk factors that led to major amputation in patients with DFU were age, Wagner classification, duration of DM, duration of DFU, and C-reactive protein level.

Chronic Achilles Tendon Rupture Reconstruction Using the Lindholm Method and the Vulpius Method.

BACKGROUND: We investigated the clinical and functional outcomes of chronic Achilles tendon rupture reconstruction via the Lindholm technique and via the Vulpius' lengthening of the gastrocnemius. METHODS: We evaluated 15 patients with chronic Achilles tendon rupture (Lindholm technique in eight patients and primary repair with the Vulpius technique in seven patients). In the final follow-up, the Hooker scale was used to measure the ankle functional capacity in all patients. The patients were evaluated on the basis of their capability to stand on tiptoe on the affected limb and the time required to return to pre-injury daily activities. RESULTS: The mean follow-up time was 19.6 months (range, 12 - 38 months). The mean time to return to work and daily activity was 3.2 months. The mean calf atrophy at the end of follow-up was 1.2 cm (range, 0 - 2.5 cm). At the last follow-up visit, no patient had any limitation in the activities of daily living and the active and passive ankle range of motion was good. All patients were able to perform single-leg heel rises at the end of follow-up and the Hooker scores were excellent for 11 patients and satisfactory for four patients. CONCLUSION: The reconstruction of chronic Achilles tendon ruptures via the Lindholm technique or via the Vulpius technique is associated with good clinical and functional outcomes.