Bedirhan Sarı

Proximal humerus fractures (PHFs) are fragility fractures that commonly occur in elderly patients and are frequently associated with osteoporosis. Despite the widespread use of locking plate fixation for displaced fractures, complication and reoperation rates remain high, particularly in complex three- and four-part fracture patterns. Although increasing screw density improves fixation stability, the relative significance between screw number and screw position (particularly medial column support) remains unclear. This study aims to determine whether fixation failure is driven by screw density or by the quality of medial column support and fracture biology in osteoporotic PHFs. This retrospective cohort study included elderly patients (≥ 65 years) with confirmed osteoporosis who underwent locking plate fixation for three- or four-part PHFs between January 2018 and December 2023 with a minimum radiological follow-up of 24 months and subsequently required revision surgery due to radiological failure. The patients were classified based on screw density (low vs. high), and the distribution of mechanical and biological causes of revision was analyzed. In a second analysis, patients who underwent revision surgery were compared with those who did not to examine the relationship between medial support quality (defined by inferomedial and calcar screw placement) and the likelihood of revision. A total of 24 patients who required revision surgery were included in the primary analysis (15 with low and nine with high screw density). The distribution of revisions for mechanical and biological reasons did not differ between the groups (p > 0.05). In a secondary analysis involving 166 patients (24 revision, 142 non-revision), limited medial support (one inferomedial/calcar screw) was significantly more common among revision cases than non-revision cases (37.5% vs. 4.9%), whereas adequate medial support (≥ 2 inferomedial/calcar screws) predominated in patients without revision (95.1%) (p < 0.001). In osteoporotic PHFs requiring surgical fixation, revision risk is not determined by the total number of screws but by the quality of medial column support. Adequate inferomedial and calcar screw placement was strongly associated with a lower revision rate, emphasizing that targeted screw positioning rather than increased screw density is the critical determinant of fixation durability in osteoporotic bones. Retrospective cohort study.

Purpose: Floating knee (FK) injuries are complex high-energy traumas associated with poor functional outcomes. This study aimed to identify independent predictors of functional prognosis and to develop a novel, multidimensional scoring system to predict long-term functional outcomes. Methods: A retrospective analysis was performed on 182 adult patients with ipsilateral femur and tibia fractures treated between January 2010 and December 2023. Functional outcomes were assessed using the Karlström–Olerud criteria and dichotomized as excellent–good versus fair–poor. Variables significant in univariate analysis were entered into a multivariate logistic regression model. Independent predictors were used to construct the FKS-score. Predictive performance was evaluated using ROC analysis. Results: Of the 182 patients, 103 (56.6%) achieved excellent–good outcomes, while 79 (43.4%) had fair–poor results. Multivariate analysis identified Fraser IIA–B (OR 2.12), Fraser IIC (OR 3.85), Gustilo I–II (OR 1.42), Gustilo IIIA–B (OR 2.61), Gustilo IIIC (OR 3.22), segmental fractures (OR 2.18), extensor mechanism injury (OR 2.04), vascular injury (OR 4.89), intra-articular extension (OR 1.92), and patella fracture (OR 1.76) as independent predictors of poor functional outcome. The FKS-score, ranging from 0 to 15, demonstrated high predictive accuracy (AUC = 0.89). An optimal cut-off value of ≥9 points yielded a sensitivity of 78% and specificity of 85%. Conclusions: The FKS-score is the first comprehensive prognostic scoring system specifically developed for floating knee injuries. It provides a reliable, practical tool for early risk stratification and the prediction of long-term functional outcomes, thereby supporting clinical decision-making and patient counseling.

Objective: The aim of the study was to compare postoperative pain, functional recovery, knee stability and complication profiles between the all-inside technique and the conventional full tibial tunnel technique for anterior cruciate ligament (ACL) reconstruction. Methods: This retrospective comparative cohort study included 104 patients who underwent primary ACL reconstruction between 2018 and 2020. Surgical technique allocation was non-randomized. Patients were divided into two groups based on the surgical technique employed; the conventional full tibial tunnel group (n = 58) and all-inside group (n = 46). Hamstring tendon autografts were used in all cases, and the procedures were performed by the same surgical team to ensure consistency. Clinical outcomes were evaluated using the Visual Analog Scale (VAS) for pain, Lysholm knee score and International Knee Documentation Committee (IKDC) score. Knee stability was assessed with the Lachman and pivot-shift test. Additionally, postoperative complications and revision rates were recorded. Results: The study included 104 patients, with 58 treated using the conventional technique and 46 using the all-inside technique. Baseline characteristics, trauma mechanisms, and follow-up duration were comparable between groups (p > 0.05). Four patients in each group underwent revision surgery and excluded from the final analysis. Revision rates were comparable between groups (6.9% vs. 8.6%) and were considered descriptively when interpreting outcomes. The preoperative VAS, Lysholm and IKDC scores were comparable between groups. At 3 months, the all-inside group demonstrated significantly lower VAS pain scores and higher Lysholm and IKDC scores (with moderate-to-large effect sizes) (all p < 0.01). No significant differences were observed at the 12-month or final follow-up. Postoperative knee stability was comparable between groups, whereas anterior knee pain was significantly less frequent in the all-inside group (p < 0.001). Moreover, patients treated with the all-inside technique returned to sports significantly earlier than those treated with the conventional technique (13.25 ± 2.70 vs. 16.40 ± 5.85 months, p < 0.001; Cohen’s d = 0.66). However, the proportion of patients who returned to their preinjury sports level was comparable between the two groups (81.0% vs. 83.3%, p = 0.78). Conclusions: The all-inside ACL reconstruction technique was associated with superior early pain relief and short-term functional outcomes compared with the conventional technique, while achieving comparable knee stability and mid-term clinical results. These advantages occur without increasing complications or revision rates. These findings support the all-inside technique as patient-centered, optimizing early recovery without sacrificing mid-term clinical durability. These findings should be interpreted in the context of the non-randomized retrospective study design.

Aims: This study aims to evaluate the clinical outcomes of three commonly used treatment methods—banding, nail brace, and the Winograd procedure—in patients with Heifetz stage 2 ingrown toenails. Parameters such as recurrence rate, infection rate, postoperative pain, and patient satisfaction were assessed to guide clinical decision-making. Methods: This retrospective study included 91 patients diagnosed with Heifetz stage 2 ingrown toenail, who were treated using one of three methods. Patients were divided into three groups: banding, nail brace, and Winograd procedure. Visual Analog Scale (VAS) scores were recorded on the third postoperative day to assess pain levels. The short-term outcomes, recurrence rates, and complications were analyzed. Ethical approval was obtained and the study adhered to the principles of the Declaration of Helsinki. Results: The nail brace method showed a significantly shorter return-to-work duration (mean 10.2±9.5 days) compared to the Winograd procedure (19.0±6.4 days, p

Objective: The aim of this study was to review the characteristics and classifications of pelvic injuries due to earthquake trauma, to determine the treatment options and outcomes, and to present the experiences of our single trauma center. Methods: Sixty patients (23 male, 37 female) who underwent surgical treatment for pelvic ring injuries after the earthquake were analyzed in this study. Demographic data, such as age and gender, operations, and fracture details were recorded. Laboratory results and the amount of blood used were included in the analysis. Fractures were classified according to the Young–Burgess classification. Surgical treatment methods, side of injury, accompanying injuries, and treatment results were analyzed using SPSS software. Results: Left-sided trauma was the most common mechanism of injury, with 36 patients (60%) sustaining left-sided pelvic fractures. Pelvic ring fractures were detected in 78.3% of patients, and combined acetabulum and pelvic ring fractures were identified in 21.7% of patients. Thoracic trauma and extra-pelvic fractures were seen in 12 (20%) and 18 (30%) patients, respectively. Twenty percent of patients underwent emergency abdominal surgery prior to pelvic surgery. Complications were observed in 7 patients (11.6%) in the early period. The average amount of blood used for patients was 2.91 U (min: 0, max: 13 U, SD: 2.66). Conclusion: This study has shown us that lateral compression injuries are more common, and that low hemoglobin levels, high inflammation parameters, previous abdominal surgery, accompanying fractures, and lung injury are the main characteristics of patients with earthquake-related pelvic injuries. It also demonstrates that for the optimal use of materials and implants, experience in different techniques is required, and shows the significant need for blood transfusions in the treatment of these injuries. Level of Evidence: Level IV, Therapeutic study. Cite this article as: Pazarcı Ö, Ali Talmaç M, Sarı B, Sökücü S. Review of the treatment options and results of earthquake-related pelvic injuries after the Türkiye earthquake on 6th february. Acta Orthop Traumatol Turc., 2024;58(4):229-234.