Burhan Kurtuluş

Background/aim: This study aimed to evaluate the prognostic significance of preoperative inflammatory markers including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), C-reactive protein (CRP), and procalcitonin in predicting 30-day and 1-year mortality in patients undergoing femur fracture surgery. Materials and methods: This retrospective, multicenter cohort study included patients who underwent surgical treatment for femur fractures between January 2018 and December 2024. Patients were stratified into survivor and nonsurvivor groups based on 30-day and 1-year outcomes. Demographic characteristics, comorbidities, laboratory parameters, and inflammatory indices were recorded and analyzed. Linear and multivariate logistic regression analyses were performed to identify independent predictors of mortality. Receiver operating characteristic (ROC) curve analysis was used to assess the predictive performance of the inflammatory markers. Results: A total of 430 patients were included, 310 (72.1%) of whom survived while 120 (27.9%) died during the 1-year follow-up. The 30-day mortality rate was 15% (n = 65) and the 1-year mortality rate was 38% (n = 163). Nonsurvivors were significantly older (81.3 ± 9.6 vs. 75.2 ± 10.1 years, p < 0.001) and had higher rates of diabetes mellitus (45% vs. 30%, p = 0.003), hypertension (80% vs. 40%, p < 0.001), and chronic kidney disease (55% vs. 16%, p < 0.001). Laboratory analysis showed elevated white blood cell count, red cell distribution width, neutrophils, CRP, procalcitonin, NLR, PLR, and MLR, while albumin was lower in nonsurvivors (all p < 0.05). Multivariate analysis identified age, chronic kidney disease, low albumin, elevated creatinine, CRP, the MLR, and hospital stay as independent mortality predictors. The MLR showed the strongest association (OR = 4.12 for 30-day mortality; OR = 3.85 for 1-year). ROC analysis revealed CRP (AUC = 0.811 and 0.783) and the MLR (AUC = 0.765 and 0.751) as the most accurate predictors, followed by the NLR and hospital stay. Conclusion: Preoperative inflammatory markers, particularly the MLR and CRP, were strongly associated with short- and long-term mortality in femur fracture surgery. Their integration into preoperative assessment may enhance risk stratification and guide clinical decision-making.

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

Objectives: This study aimed to determine the incidence of postoperative deep vein thrombosis (DVT) and pulmonary embolism (PE) following orthopedic surgeries and to identify independent clinical, laboratory, and procedural factors associated with thromboembolic risk. Materials and Methods: A retrospective cohort analysis was conducted on 300 patients who underwent elective or emergency orthopedic surgeries (hip/knee arthroplasty, fracture fixation, and spinal procedures) between January 2020 and December 2024 at two tertiary centers. Demographic, clinical, and biochemical data were collected. Patients were stratified into two groups: those who developed DVT/PE and those who did not. Univariate analyses were performed to identify significant factors, and a multivariate logistic regression model with stepwise variable selection was applied in accordance with the events-per-variable (EPV) criterion. Receiver operating characteristic (ROC) curve analyses were conducted to evaluate the discriminative performance of significant predictors. Results: Among 300 patients who underwent orthopedic surgery, postoperative deep vein thrombosis (DVT) and/or pulmonary embolism (PE) occurred in 50 cases (16.7%). Patients who developed thromboembolic events were older (72.5 ± 8.7 vs. 65.2 ± 10.1 years, p < 0.001), had higher body mass index (32.1 ± 5.3 vs. 28.3 ± 4.5 kg/m², p < 0.001), and showed a greater prevalence of diabetes mellitus (40% vs. 20%, p < 0.01) and chronic kidney disease (24% vs. 10%, p < 0.001) compared to those without DVT/PE. Laboratory analyses revealed significantly elevated neutrophil count, D-dimer, C-reactive protein (CRP), glucose, and troponin levels in the DVT/PE group. In the stepwise multivariate logistic regression model, age (OR = 1.44, p = 0.003), diabetes mellitus (OR = 2.88, p = 0.046), chronic kidney disease (OR = 2.33, p = 0.014), D-dimer (OR = 2.15, p = 0.019), and immobilization duration (OR = 2.21, p = 0.028) emerged as independent predictors of thromboembolic events. ROC analysis revealed that D-dimer > 0.9 mg/L had the highest discriminative performance (AUC = 0.89, sensitivity 88%, specificity 84%, p = 0.003), followed by troponin > 0.5 U/L (AUC = 0.86, p = 0.005), immobilization > 3 days (AUC = 0.82, p = 0.012), and age > 65 years (AUC = 0.74, p = 0.021). Conclusions: DVT and PE remain significant postoperative complications with a multifactorial etiology in orthopedic surgeries. Advanced age, comorbidities (such as diabetes mellitus and chronic kidney disease), and elevated inflammatory and metabolic markers (including neutrophil count, glucose, CRP, and D-dimer), together with procedural factors like prolonged immobilization, were identified as independent risk factors. Early recognition of these high-risk features and implementation of individualized prophylaxis strategies may improve postoperative outcomes and reduce thromboembolic risk.

Background/aimThe aim of this study is to compare the results of pemberton osteotomy (PO), salter innominate osteotomy (SO), open reduction (OR) and closed reduction (CR) applied in the treatment of Developmental Dysplasia of the Hip (DDH).Materials and methods101 hips of 82 patients treated at Orthopedic Clinic between 2017 and 2023 were included in the study. Preoperatively, postoperatively and at final follow-up of patients were evaluated. The results of these patients were evaluated according to Severin's radiological and Barret's clinical classifications. Patients who developed avascular necrosis (AVN) were evaluated according to the Bucholz and Ogden classification.ResultsIn terms of preoperative acetabular angle (AA) values, those who underwent PO were significantly higher than the other three, and those who underwent SO were significantly higher than the other two (OR and CR) (p<0.001). There was a significant difference in the last follow-up AA values of patients who underwent SO and PO compared to OR and CR (p<0.001). The most corrections were achieved with PO (average 27.94° ± 4.89°). There was a significant difference between PO and OR and PO and CR in terms of preoperative collodiaphyseal angle (CDA) values (p<0.05). There was the greatest decrease in those who underwent PO (22.44°±9.45°). AVN developed at various stages in 15 of 79 hips (14.85%) that underwent surgical treatment. While AVN developed at a rate of 22.22% in PO, 18.18% in SO, and 17.85% in OR, no AVN developed in the 22 hips that underwent CR.ConclusionUnderstanding normal and abnormal values by age is essential for selecting appropriate treatments. Plan acetabulum-related surgeries for patients over 1.5 years with an angle above 30 degrees. Early diagnosis and closed reduction treatments yield excellent results and low AVN rates. Various DDH treatments in our clinic show low AVN rates, indicating safety and efficacy.

Objectives: The pathophysiology of osteoarthritis is mainly unknown. Matrix Gla protein (MGP) and Gla-rich protein (GRP) are both vitamin-K-dependent mineralization inhibitors. In this study, we aimed to compare the levels of MGP and GRP in the synovial fluid of osteoarthritic (OA) and non-osteoarthritic (non-OA) knee joints. Materials and Methods: Two groups were formed, with one consisting of patients with OA and the other non-OA, serving as a control group. The non-OA group included individuals who had arthroscopic surgery for non-cartilage-related issues. In the OA group, all participants had undergone total knee arthroplasty because of grade 4 primary degenerative osteoarthritis. During the operation, at least 1 mL of knee synovial fluid was collected. The GRP and MGP levels in the synovial fluid were measured using an ELISA kit. Results: The mean age in the OA group (62.03 ± 11.53 years) was significantly higher than that in the non-OA group (47.70 ± 14.49 years; p = 0.0001). GRP levels were significantly higher in the OA group (419.61 ± 70.14 ng/mL) compared to the non-OA group (382.18 ± 62.34 ng/mL; p = 0.037). MGP levels were significantly higher in the OA group (67.76 ± 11.36 ng/mL) compared to the non-OA group (53.49 ± 18.28 ng/mL; p = 0.001). Calcium levels (Ca⁺⁺) were also significantly higher in the OA group (12.89 ± 3.43 mg/dL) compared to the non-OA group (9.51 ± 2.15 mg/dL; p = 0.0001). There was a significantly positive correlation between MGP levels and age (p = 0.011, R = +0.335). Linear regression analysis was performed to determine the effect of age on MGP levels (p = 0.011, R-Square = 0.112). The dependent variable in this analysis was MGP (ng/mL), and age was the predictor. Conclusions: In conclusion, both GRP and MGP are potentially usable biomarkers in osteoarthritis. However, GRP seems to be more valuable because it is not associated with age. In the future, both proteins could provide important contributions to the diagnosis and treatment of osteoarthritis.

Introduction: Our study aimed to determine the impact of preoperative red blood cell distribution width on length of intensive care unit and hospital stays, and short- and long-term mortality in elderly patients undergoing hip fracture surgery. Materials and Method: This prospective cohort study included 414 patients aged 65 and older who presented with hip fractures between November 2021 and November 2022. Patients’ demographic characteristics, American Society of Anesthesiologists score, Revised Cardiac Risk Index, comorbidities, and preoperative complete blood counts (hemoglobin, red blood cell distribution width, platelet count, etc.) were recorded at the preoperative visit. Length of intensive care unit and hospital stays were documented postoperatively. Patients were followed for one year after surgery in terms of mortality. Results: Patients with high red blood cell distribution width levels (≥14.25%) were older, had more comorbidities, and had higher American Society of Anesthesiologists score and Revised Cardiac Risk Index scores (p<0.001). In the high red blood cell distribution width group, length of hospital stays was longer (p<0.001). There was no significant difference between red blood cell distribution width groups in terms of intensive care unit stay duration and readmissions (p=0.304 and p=0.664, respectively). According to the multivariate logistic regression analysis, an red blood cell distribution width of ≥14.25 was found to increase the risk of 30-day mortality by 4.7 times and 1-year mortality by 2.74 times. Conclusion: Red blood cell distribution width is a useful, practical, and cost-effective indicator of short- and long-term mortality in elderly patients undergoing hip fracture surgery. Keywords: Aged; Anemia; Hip fracture; Mortality.

Aims: The mitogenic and cell protective effects of epidemal growth factor (EGF) in wound healing stimulate the growth, re-covering the surface of the wound area. In this research we tried to elucidate the effectiveness of intradermal EGF application on wound healing in diabetic foot ulcers regarding the fact that EGF can accelerate the formation of skin cover layer on the infected surface, even in relatively ischemic cases. Methods: The data of 68 patients who applied to our institution’s orthopedics and wound care outpatient clinic with the diagnosis of diabetic foot ulcer, who underwent wound care, debridement and follow-up were retrospectively analyzed. All of the patients included in this study were classified as Wagner Stage III and Stage IV diabetic foot ulcers and were followed up with standard wound care. EGF application was initiated if there was not enough bleeding on the wound borders and defect floor after debridement. Results: The rate of patients with 50% or more granulation in the second week of treatment in the groups was 35.7% (n=10) in the standard treatment group, it was 60% (n=24) in the EGF group (p

Aims: It was aimed to determine the prevalence of lumbosacral anomalies in young male population. Methods: 56.798 male patients, between 18-49 years old, were included in this study during their medical screening in Dışkapı Yıldırım Beyazıt Training and Research Hospital from July 2016-July 2020. The presence of spina bifida occulta (SBO) and transitional vertebrae (TV) anomalies were recorded in the candidates. SBO patients were evaluated according to their S1 and L5 origins, and TV patients were evaluated separately according to sacralization and lumbarization. We identified transitional vertebrae by counting down from the last thoracic vertebra on the AP X-rays, then if necessary looking at the lateral view for confirmation. If hypoplastic ribs were identified, the vertebra immediately beneath would be designated as L1. Castellvi types I, II, III, and IV were included as transitional states. Results: 56798 patients were evaluated retrospectively. The mean age of the patients was 23.28 (18-49 years). Radiological anomalies were detected in 2577 (4.5%) of 56798 cases. No radiological anomaly was observed in other cases. Spina bifida occulta was detected in 1478 (2,6%) patients. Lumbosacral transitional vertebrae were detected in 1099 cases (1.9%). 745 (1.3%) of these anomalies are sacralization and 354 (0.6%) of them are lumbalization. Conclusion: In the light of this information, we think that knowing the frequency of lumbosacral anomalies, especially LSVT, in our society should be considered in the evaluation before spinal surgery operations.