Cengizhan Kurt

Background: Hip fractures are a major cause of morbidity and mortality in the elderly, with 1-year mortality rates up to 40%. Malnutrition is a key determinant of adverse outcomes. The Geriatric Nutritional Risk Index (GNRI), based on serum albumin and body weight, is a simple nutritional tool. This study investigated whether GNRI independently predicts 1-year mortality after hip fracture surgery beyond conventional risk factors. Methods: We retrospectively analyzed 624 patients aged ≥65 years who underwent hip fracture surgery at two tertiary centers. Demographic, clinical, and perioperative data were collected. GNRI was calculated for all patients. Independent predictors of mortality were identified using logistic regression, and ROC analysis determined the optimal GNRI cut-off. Results: The 1-year mortality rate was 22.3%. In univariate analysis, older age, ASA class III–IV, low albumin, low GNRI, and multiple comorbidities were significantly associated with mortality. Each 0.1 g/dL increase in albumin was associated with 26% lower odds of 1-year mortality, and each 1-point increase in GNRI was associated with 25.5% lower odds of mortality (p < 0.001). In multivariate analysis, only age, ASA classification, and GNRI remained independent predictors. ROC analysis showed excellent discrimination for GNRI (AUC: 0.928), with a cut-off of 91.45 (sensitivity 87.8%, specificity 90.3%). Patients with GNRI ≤91.45 had a markedly higher 1-year mortality (72.2% vs. 3.7%; RR: 19.32, 95% CI: 12.01–31.09). Conclusions: GNRI independently predicted 1-year mortality in elderly hip fracture patients. A GNRI ≤91.45 was associated with a 19-fold higher risk, while higher scores had a protective effect, underscoring GNRI as a practical tool for perioperative risk stratification.

The purpose of this paper is to evaluate developments, focusing specifically on hydrogel applications used in the treatment of knee osteoarthritis. This evaluation aims to provide accurate and sufficient information, thereby preventing inaccurate or incomplete information among patients and healthcare professionals, clarifying the purpose of hydrogel treatment applications and their implications for patients, and preventing unnecessary expectations, disappointments, and financial losses that may arise in patients. A literature review was conducted, and relevant publications were accessed through the Scopus, Web of Science, EBSCO, and Google Scholar databases. Currently, an increasing number of studies focus on the use of hydrogel products in the treatment of osteoarthritis. While studies on hydrogel treatment have shown promising results, it is crucial to remember that their effectiveness can vary from patient to patient. In some cases, the need for surgical intervention can be postponed with the treatment applied, but this may not necessarily eliminate the need for surgical intervention in the long term. Furthermore, the products or materials used in hydrogel treatment have very different compositions and a wide range of products. Today's technology makes access to information much easier. Patients and healthcare professionals can be influenced by social media. It's important to understand that the term "hydrogel treatment" doesn't connote a single treatment modality, drug, or product. Healthcare professionals and patients should be informed on this matter. Treatments implemented with incomplete or flawed approaches, in particular, can lead to excessive patient expectations, disappointment, and a significant financial burden. This comprehensive review article presents basic information from the literature, along with new developments and research, to provide a simple and understandable overview of the products and methods that can be used in hydrogel treatment.

Background/Objectives: The medial meniscus is crucial for load transmission and knee stability. Meniscal tears disrupt joint biomechanics, increasing the risk of cartilage degeneration. However, few studies have quantitatively compared how different tear types affect stress and contact mechanics using finite element analysis (FEA). This study aims to analyze stress distributions for various meniscal tear types and develop a predictive model for meniscal stress behavior. This study investigates how stress distributions differ between healthy and torn medial menisci under identical loading conditions. The study examines which meniscal tear type produces the highest stress concentrations. The effects of different tear types on penetration, gap formation, pressure distribution, and sliding distance at the meniscus interface are also analysed. Materials and Methods: The FEA model of the knee joint, including femoral and tibial cartilage and the medial meniscus, was developed. Simulations were conducted for a healthy meniscus and for menisci with radial, horizontal and complex tears. Stress, penetration, gap, pressure, and sliding distance were calculated, and a mathematical model describing their relationships was established. Results: All torn menisci exhibited significantly higher stresses than the healthy meniscus (p < 0.001). Radial tears generated the highest stress concentrations (p < 0.001). Pressure was mainly influenced by meniscal geometry, while the gap remained nearly constant. Penetration increased slightly (p < 0.05). The predictive model demonstrated a strong correlation between meniscal stress and interface parameters (R² > 0.9). In a healthy meniscus, stress distribution is homogeneous (≈26 MPa). Stress concentration increases depending on the tear type: limited in a horizontal tear (≈26.5 MPa), significant in a vertical tear (≈30.8 MPa), and highest in a radial tear (≈40.6 MPa). These results indicate that as the tear progresses, the load-bearing capacity of the meniscus decreases, and stresses concentrate at the tear edges. Conclusions: Meniscal tears, especially radial ones, substantially alter knee biomechanics and elevate tissue stress. These biomechanical insights highlight the importance of early diagnosis and targeted rehabilitation strategies to prevent further cartilage damage and osteoarthritis progression.

Background: Rotator cuff tears commonly cause shoulder pain and functional impairment, prompting surgical intervention such as mini-open and arthroscopic methods, each with distinct benefits. This study aimed to compare the clinical outcomes and complications of these two approaches. Methods: A retrospective analysis was conducted on 165 patients who underwent rotator cuff repair using either arthroscopic-assisted mini-open or full arthroscopic approaches. Patient demographics, tear characteristics, clinical outcomes, and complications were assessed, with statistical analyses conducted to discern differences between the groups.Results: Among the patients, 74 (53.2%) received the mini-open approach, while 65 (46.8%) underwent arthroscopic repair, with a mean follow-up of 19.91 months. The mini-open group exhibited significantly higher postoperative American Shoulder and Elbow Surgeons (ASES) scores compared to the arthroscopic group (P=0.002). Additionally, the mini-open group demonstrated a more significant improvement in ASES scores from preoperative to postoperative assessments (P=0.001). However, the arthroscopic method had a significantly longer operative time (P<0.001). Complications, including anchor placement issues, frozen shoulder, infection, and re-rupture, occurred in 17.3% of patients overall. Re-rupture rates were 13.5% for mini-open and 6.2% for full arthroscopic repair, with no significant difference between the two methods (P=0.317).Conclusions: Both the mini-open and arthroscopic methods yielded favorable clinical outcomes for rotator cuff tear treatment, but the mini-open group exhibited superior results. Surgeons should consider patient characteristics, tear attributes, and surgical expertise when selecting the appropriate technique.Level of evidence: III.

Bu kitabın oluşmasında Türkiye’nin dört bir yanındaki meslektaşlarımızın katkısı olmuştur. Emeği geçen tüm yazarlara teşekkür ederiz. Eğitimimize ve bugünlere gelmemizde katkısı olan başta ailelerimiz olmak üzere bizi yetiştiren tüm hocalarımıza ithaf olunur.Tüm meslektaşlarımıza faydalı olması dileğiyle…Saygılarımızla.