Evrim Duman

Background and Objectives: The quality of life of patients decreases significantly after pathological long bone fractures. Therefore, rapid and effective treatment of these fractures is necessary in these patients with a low life expectancy. The aim of this study was to evaluate the results of intramedullary nailing in patients with pathological humeral diaphyseal fractures. Materials and Methods: Patients who underwent intramedullary nailing due to pathological humeral diaphyseal fractures between 2022 and 2025 were analyzed retrospectively. All patients were operated on using the same technique. Preoperative and postoperative complete blood count tests were performed to indirectly assess perioperative blood loss by evaluating changes in hemoglobin levels. The EQ-5D-5L (EuroQol Group-5 Dimensions-5 Levels) scale was used at the second, fourth, and eighth weeks postoperatively to assess the functional outcome of patients. Results: In total, 18 patients with a mean age of 64.6 years (range, 47–77 years) were included in the study. The most common primary diagnosis was multiple myeloma (n = 7, 38.9%). The primary diagnoses of two patients (11.1%) were unknown. An average decrease of 11% (range, 5.2–24.7) was observed in the postoperative hemoglobin values of the patients compared to the preoperative values. Radiographic fracture union was observed in all 12 evaluable patients with a follow-up longer than 3 months. The EQ-5D-5L scores improved significantly across the second, fourth, and eighth postoperative weeks in all five dimensions (Friedman tests, all p < 0.001). All pairwise comparisons remained significant after Bonferroni correction (adjusted p = 0.000023–0.005859). Conclusions: In this small, single-center case series, fracture union was observed in all 12 evaluable patients treated with minimally invasive intramedullary nailing without cement augmentation, and the EQ-5D-5L scores improved over the first eight postoperative weeks. These descriptive findings do not establish comparative benefit; controlled studies are needed to determine the relative outcomes of this approach.

Background/Objectives: The number of hip fractures among centenarians is rising, yet their outcomes and the factors influencing mortality remain inadequately characterized. This study compared postoperative outcomes between centenarians and non-centenarians and examined perioperative factors associated with mortality. Methods: This retrospective cohort study included 31 centenarians (≥100 years) who underwent hip fracture surgery between October 2022 and March 2024 and 176 consecutive non-centenarians (65–99 years) admitted between October 2022 and April 2023. Associations between centenarian status, American Society of Anesthesiologists (ASA) score, comorbidity-only Charlson Comorbidity Index (CCI), surgical procedure, and time to surgery with 30-day and 12-month mortality were analyzed using logistic regression with clinically pre-selected covariates (Firth’s method for 30-day mortality). Results: Centenarians exhibited higher ASA scores, while CCI values did not differ between groups. Centenarians experienced longer intensive care unit and hospital stays. The complication rate was numerically higher among centenarians (35.5% vs. 30.1%), although this difference was not statistically significant (p = 0.55). Thirty-day mortality was 29.0% for centenarians compared to 6.2% for non-centenarians, and 12-month mortality was 80.6% versus 30.1% (both p < 0.001). Centenarian status (30-day odds ratio [OR] 4.87, 95% confidence interval [CI] 1.73–13.60; 12-month OR 8.19, 95% CI 3.16–24.22) and higher ASA scores were associated with increased mortality, whereas CCI was not. Longer time to surgery was associated with higher 12-month mortality (OR 1.23 per 24 h, 95% CI 1.01–1.51). Conclusions: Centenarians demonstrated substantially higher short- and long-term mortality following hip fracture surgery compared to younger older adults. Extreme age and elevated ASA scores were associated with increased mortality, although unmeasured factors such as frailty may contribute to these associations. Hip fracture in centenarians should be considered a major life-limiting event that necessitates early goals-of-care discussions.

Bone fractures are a common medical problem struggled by many people throughout their lives and are the most common cause of hospitalisation following trauma. In Australia there are 150000 hospital...

Aim: Prosthetic joint infections (PJIs) are severe complications of joint arthroplasty, and their management has become increasingly complex in the era of antimicrobial resistance. This study aimed to evaluate the microbiological characteristics and clinical outcomes of PJIs in a high-resistance clinical setting. Material and Methods: This retrospective study included 74 patients diagnosed with PJI between January 2019 and June 2022 at a tertiary care hospital. Microbiological findings, antimicrobial resistance patterns, treatment outcomes, recurrence, and mortality were analyzed. Results: Microbiological growth was detected in 75.0% (n=54) of cases; 25.0% (n=18) were culture-negative. Among the 84 isolated pathogens, gram-negative bacteria accounted for 55.9% (n=47) and predominated particularly in early-onset infections. Staphylococcus aureus was the most frequently identified pathogen; however, carbapenem-resistant gram-negative organisms were common and were significantly associated with treatment failure (p=0.004) and mortality (p=0.011). Polymicrobial infections (35.2%, n=19) were independently associated with recurrence (p=0.001) and increased the odds of mortality (OR=7.91, 95% CI=1.42-52.61, p=0.017). Treatment success was significantly higher in patients with primary knee prostheses compared with hip or revision prostheses (p=0.029). Conclusion: PJIs in this study were characterized by a high burden of gram-negative and multidrug-resistant pathogens. Carbapenem resistance and polymicrobial etiology were key determinants of adverse outcomes, emphasizing the critical role of local antimicrobial resistance surveillance in guiding empirical treatment decisions.

Background and Objectives: Intertrochanteric femur fractures are very common, especially in the elderly population, and cause serious morbidity and mortality. Today, the most commonly used implants in the treatment of these fractures are proximal femoral nails (PFNs). This study aimed to analyze the clinical and radiological results of patients who underwent surgical treatment with a proximal femoral nail (PFN) for intertrochanteric femur fractures and later required revision surgery for various reasons. Materials and Methods: Patients who underwent surgical treatment PFN due to intertrochanteric femur fractures between 2022 and 2025 were included in the study, and the patients were divided into revision and non-revision groups. Demographic information, postoperative radiological measurements, complications, and reasons for revision surgery were noted, and risk factors leading to revision were determined using bivariate and multivariate analyses. Results: A total of 207 patients, 97 revision (46.9%) and 110 non-revision (53.1%), were included in this study. Cut-out was identified as the most common revision cause (n = 52, 53.6%), followed by loss of reduction (n = 15, 15.5%), implant failure (n = 14, 14.4%), nonunion (n = 6, 6.2%), infection (n = 4, 4.1%), cut-through (n = 3, 3.1%), and avascular necrosis of the femoral head (n = 3, 3.1%). When bivariate analysis was performed to identify risk factors for revision, it was observed that female gender (p = 0.004), presence of posteromedial comminution (p < 0.001), operation under spinal anesthesia (p = 0.023), surgery in supine position (p < 0.001), using closed reduction techniques (p < 0.001), presence of infection (p = 0.004), and higher Charlson comorbidity index values (p < 0.001) increased the risk of revision. Additionally, positive and neutral medial cortex support (p < 0.001) decreased the risk of revision. Multivariate analysis was also applied to the parameters found to be significant in bivariate analysis. As a result of this analysis, surgery in the supine position (p < 0.001), using closed reduction techniques (p < 0.001), and higher Charlson comorbidity index values (p < 0.001) remained significant. Conclusions: Careful evaluation of the fracture morphology, ensuring optimal reduction, and considering the accompanying comorbidities of the patients in the surgical planning of unstable trochanteric fractures stand out as key elements in increasing surgical success.

Chronic nonbacterial osteomyelitis (CNO) is a rare autoinflammatory disease affecting the bone in which, diagnostic delays are common due to lack of physician awareness. The aim of this study was to evaluate the knowledge of orthopedic surgeons and pediatricians about CNO and to investigate the effect of professional experience on this process. This study was conducted between January-February 2025 using a 13-item online questionnaire comprising multiple-choice questions with clearly defined correct and incorrect answers. The questionnaire consisted of two main categories. The first category included questions regarding the clinicians' areas of specialization, professional experience, and training needs. The second category aimed to assess clinicians' knowledge levels about CNO. For each participant, the number and rate of correct and incorrect responses were calculated. The questionnaire was sent to a total of 551 clinicians and 244 of them (44.2%) (130 orthopedic surgeons, 114 pediatricians) completed the questionnaire. Of the 61 items, orthopedic surgeons had a median of 30 correct responses (26-35), while pediatricians had a median of 32 (28-36) (p = 0.023). The rate of giving the correct answers to the questions increased with the professional experience of the clinicians (p = 0.02). 116 (47.5%) clinicians stated that they didn't think to have sufficient knowledge about CNO and 212 (86.8%) clinicians stated that they'd like to participate in a training about CNO. This study demonstrates that both orthopedic surgeons and pediatricians still have significant knowledge gaps regarding CNO. Although the current level of awareness remains limited in both groups, they appear willing to acquire further knowledge. These findings highlight the need for focused educational programs to improve patient care.

Background: The revision of total hip arthroplasty (THA) is more challenging and has less successful outcomes than primary THA. Revision surgery takes more time, results in more blood loss, and has higher complication risks compared to primary surgery. Common reasons for revision include painful component loosening, implant failure, dislocations, infections, and periprosthetic fractures. Advances in surgical methods, implant designs, and bone loss management have assisted surgeons in addressing the challenges of revision THA and improving outcomes for patients undergoing this complex procedure. Methods: In this retrospective cohort study, the THA revision surgeries of two groups conducted two decades apart were evaluated. All patient data, including age, gender, date of primary THA, date of revision surgery, reason for revision, and detailed intraoperative findings were recorded. Results: The demographics were similar in both groups, but the average age was statistically significantly different (p

Background Cementless hip hemiarthroplasty is one of the options for the treatment of osteoporotic femoral neck fractures. Intraoperative periprosthetic femoral calcar fractures sometimes occur during the surgery, and the use of cerclage wiring to maintain the position and stability of the femoral stem and prevent the progression of the fracture. This study examines the outcomes of cerclage wiring to treat intraoperative periprosthetic calcar fractures in cementless hip hemiarthroplasty in osteoporotic femoral neck fractures. Materials and methods A retrospective review of femoral neck fractures treated with cementless hemiarthroplasty was conducted. Twenty-one calcar fractures that underwent cerclage wiring were compared with a demographically similar control group of 21 patients without intraoperative fractures. Radiological parameters, including proximal femoral morphology and stem subsidence, and Harris Hip score were evaluated for clinical outcomes. Results A tapered wedge-shaped type cementless stem was used in all of the cases. The most common femur types were Dorr B in both groups. The average stem subsidence of wires applied below a lesser trochanter was less than above (p = 0.905). The fracture group had a mean HHS of 83.85 ± 6.62, and the control group had a mean HHS of 88.00 ± 5.76 (p = 0.067). Conclusions Using cerclage wiring in treating intraoperative periprosthetic femoral calcar fractures provides adequate fixation for the stability of the femoral stem either above or below the lesser trochanter.