Deniz Gulabi

Background: Pneumatic tourniquets are widely used in orthopedic surgery to create a bloodless operative field; however, improper use may result in skin, muscle, and nerve injuries, as well as rare but severe systemic complications. Despite their frequent use, the extent of theoretical knowledge and structured training among orthopedic surgeons remains unclear. This study aimed to evaluate knowledge levels, clinical practices, complication awareness, and training needs regarding pneumatic tourniquet use among orthopedic specialists and residents in Türkiye. Methods: This cross-sectional survey was conducted between April 1 and May 1, 2025, using an online questionnaire based on AORN 2007 pneumatic tourniquet safety guidelines. Orthopedic specialists and residents across various hospital types were invited to participate voluntarily. The questionnaire assessed demographic characteristics, training status, knowledge of safe tourniquet practices, and complication experiences. Data were analyzed using SPSS v25.0, with significance set at p < 0.05. Results: A total of 300 physicians participated; 45.3% were senior specialists. Although tourniquet use was frequent (48.7% in almost every surgery), only 35.7% received both theoretical and practical training. Notably, 248 participants reported that their knowledge was gained primarily through residency experience rather than structured education. Skin injuries (41.3%), muscle weakness (37.3%), and nerve injury (30.3%) were the most common complications. Knowledge gaps were prominent, particularly regarding IVRA-related systemic toxicity (24% correct), prolonged tourniquet use complications (48.3% correct), and physiological changes after deflation (68.7% correct). Experience and training level showed limited impact on overall knowledge, except for the question regarding prolonged tourniquet duration ( p = 0.01). Conclusion: Despite widespread use, substantial deficiencies exist in theoretical knowledge and structured training on pneumatic tourniquet application. Reliance on experiential learning during residency appears insufficient and contributes to inconsistent practices and increased complication risk. Standardized, evidence-based training programs are urgently needed to improve safety and reduce variability in clinical practice.

Background: Although advanced age is often linked to reduced bone quality in hallux valgus (HV), its direct impact on surgical outcomes is unclear. This study aimed to compare the functional and radiological outcomes of HV surgeries between patients aged ≥65 and 0.05). However, surgical technique significantly affected outcomes; arthrodesis resulted in greater angular correction and lower VAS scores than distal osteotomies (p0.05). Conclusions: Age does not significantly affect functional and radiological outcomes in HV surgery. The likelihood of surgical success depends on the technique used rather than the patient’s age. The utilization of individualized treatment plans tailored to the severity of the deformity has been demonstrated to yield superior outcomes, irrespective of the patient's age.

Objective: To evaluate the effects of surgical and conservative treatment on quality of life in patients with multiple metacarpal fractures. Patients and Methods: A retrospective review of patients with multiple metacarpal fractures was conducted, with a focus on their demographic characteristics, injury mechanisms, associated upper extremity fractures, and fracture patterns. The Quick Disabilities of the Arm, Shoulder and Hand (QDASH) score, along with the Physical Component Score (PCS-12) and the Mental Component Score (MCS-12) of the Short Form-12 (SF-12) Health Survey, were utilized to analyze functional outcomes. Results: Among the 31 multiple metacarpal fracture patients, the surgery/conservative ratio was 24/7. No disparities were found between groups in terms of demographic variables. A significant difference was observed in terms of concomitant upper extremity fractures between patients who underwent conservative and surgical treatment (p=0.038). Conservative treatment was not applied to any patient with concomitant upper extremity fractures. QDASH scores were significantly lower in the surgical intervention group (p

The growing population of centenarians poses unique challenges to healthcare systems, particularly in orthopedic care, where age-related factors like increase susceptibility to fractures and complicate treatment. This study investigates epidemiological features, mortality risk factors and 1-, 6-, and 12-month mortality rates among centenarians (aged 100 years and older) with orthopedic traumas, based on data collected from a tertiary trauma center. The hospital database searched from 2014 to 2023 revealed 23,458 trauma patients admitted to the emergency department of whom 116 were centenarians. 74 of them had bone fractures or dislocations that required treatment. Information of the patients were recorded from the patient's files, retrospectively. In this study, 82.4% of patients were female and the median age was 101 (100-108) years. Trauma ratio was found as 63.5% in the lower extremity and 36.5% in the upper extremity. Among the whole study group, 28.4% of the patients underwent surgery. The 1-month mortality rate was 16.2%, 6-month 28.4% and 1-year 41.9%. Males had a higher 6-month (p = 0.003) and 1-year mortality (p = 0.012) risks than females. Fracture localization and treatment preference were not associated with 6-month and 1-year mortalities. This study, which has the highest number of patients, explored factors affecting mortality in centenarians following orthopedic trauma showed, 1-month mortality rate was 16.2%, the 6-month mortality rate was 28.4% and the 1-year mortality rate was 41.9%, and revealed that fracture location did not influence 6-month or 1-year mortality. 3, case-control study. The online version contains supplementary material available at 10.1007/s43465-025-01429-y.

Distal radius intraarticular fractures in the elderly population are likely to cause impaired clinical outcomes. Intraarticular fracture treatment in the literature is a debatable issue with mixed results. Here, we aimed to present a tertiary trauma center experience with plate fixation and K wire-assisted external fixator in elderlies over 60 years old. Patients who were diagnosed with an unstable intraarticular distal radius fracture and received surgical treatment with plate fixation or K wire-assisted external fixator between 2016 January and 2020 January were included in the study. Patients were evaluated retrospectively in terms of radiologic stability criteria and clinical outcomes. There were 27 patients; 14 in the volar plate group (group 1) and 13 (group 2) in the external fixator group. The mean age was 64.2 (60-72) in group 1 and 67.7 (60-76) in group 2. The mean follow-up time was 31.6 (12-63) in group 1 and 28.8 (12-59) in group 2. The mean quick disabilities of the arm, shoulder, and hand (Q-DASH) score was 25.7 (5-75) in group 1 and 24.4 (10-87) in group 2. The mean patient-reported wrist evaluation (PRWE) was 27.1 (6-87) in group 1 and 31.4 (10-87) in group 2. There was no statistical difference between groups in terms of clinical scores, hospital stay, follow-up, and complications. (p>0.05). Although open reduction and plate fixation and K wire-assisted external fixator are viable options for providing radiologic union, unsatisfactory clinical outcomes were maintained independently of the fixation method in elderly patients.

Introduction In this study we investigated the effect of tranexamic acid (TXA) on fracture healing in an established animal model, when used to stop bleeding in orthopedic trauma surgery. Materials and Methods This study was a randomized, controlled, laboratory study. Eighteen Sprague-Dawley rats were randomly assigned to three groups, either receiving TXA intravenously (Group 1), TXA topically (Group 2), or isotonic TXA intravenously and TXA topically in the same amounts for the control group (Group 3). First, a Kirschner wire was inserted retrogradely into the femoral intramedullary canal. Then the femurs were fractured at the midshaft region with blunt guillotine. After 4 weeks, the rats were sacrified and the femurs harvested. Cortical bone volume, callus volume, and bone mineral density were calculated using computer tomography scans. Torsion tests were performed. Groups were compared by maximum torque to failure and callus stiffness. Results There were no statistical differences in torque to failure and stiffness between the 3 groups. There were no differences in mean total bone volume, callus volume, percent bone volume, or callus density between the groups. Conclusions A single dose of topical or intravenous TXA has no negative effect on fracture healing when used in traumatic femur fracture surgery in an animal model. Evidence level II; Randomized controlled experimental study.

Aim: Distal radius fractures are one of the most common fractures in the elderly population. In this study, we aimed to evaluate the changes in radiological parameters in patients treated conservatively for distal radius fractures according to fracture types and age groups.Methods: Patients who received conservative treatment for distal radius fractures between 10 January 2015 and January 2019 were retrospectively screened. Fractures of the patients were divided according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, and the patients were divided into two groups as under 75 years old and over 75 years old. Ulnar variance, radial inclination, and volar tilt values of the patients after fracture reduction and at the end of the treatment were examined and compared with each other.Results: Wrist radiographs of 232 patients were evaluated in the study. According to the AO classification, 151 patients had type A (A2:144, A3:7), 46 patients had type B (B1:6, B2:33, B3:7), and 35 patients had type C (C1:21, C2:10, C3:4) fractures. While there were 134 patients in the group under 75 years old, there were 98 patients in the patient group over 75 years old. Radiological parameters (except volar tilt in AO type C fractures) were found to be impaired according to the initial evaluation after treatment, regardless of the fracture type and age.Conclusion: It should be kept in mind that patients treated conservatively for distal radius fractures may impair the reduction quality of the patients, the accepted radiological parameters may deteriorate. In elderly patients, the deterioration in these parameters was independent of gender, the presence of ulnar fractures, and fracture classification.

Objectives: In this mechanical study, we aimed to compare two different screw trajectories in terms of durability against axial loads on oblique scaphoid fractures using composite bone models. Materials and methods: Oblique osteotomies were made along the dorsal sulcus of 14 composite scaphoid bone models. Following this, all bone models were randomly classified. One group of bones were fixed with a screw placed perpendicular to the osteotomy line and the other group was fixed with a screw placed centrally down the long axis of the scaphoid bone. Each scaphoid bone model was positioned on a mechanical testing machine. Subsequently, axial loading tests were applied on each bone model to measure the amount of loading required to cause 2-mm displacement and failure on the osteotomy side and maximum displacement at the time of failure on scaphoid bone models. Results: There was no statistically significant difference in load to 2-mm displacement and failure between the two groups (p>0.05). Also, there was no statistically significant difference between the two groups in terms of maximum displacement seen on failure (p>0.05). Conclusion: In our study, we found that the stability of the screws which laid perpendicular to the fracture line and parallel to the long axis of the scaphoid was the same in fixing oblique scaphoid fractures.