Ercan Bayar

Hip fractures represent a major public health concern due to their increasing incidence in the aging population and their association with significant morbidity and mortality. Comorbidities are known to complicate both the surgical management and rehabilitation process, yet their specific impact on outcomes remains variable across studies. This study aimed to determine the prevalence and distribution of comorbidities in patients who presented with hip fractures and underwent surgical treatment, to evaluate perioperative and postoperative risk factors retrospectively, and to compare these findings with the existing literature. A retrospective descriptive analysis was conducted on 589 patients aged ≥ 60 years who were surgically treated for hip fractures between 2013 and 2024 at a tertiary university hospital. Demographic characteristics, surgical protocols, anesthesia types, revision rates, infection, dislocation, mobilization outcomes, hospital stay, intensive care admissions, and mortality were systematically analyzed in relation to comorbidity profiles and the number of comorbidities. Statistical analyses included chi-square, Fisher’s exact test, Mann-Whitney U, and Kruskal-Wallis tests, with p < 0.05 considered significant. Hypertension (59.1%), diabetes mellitus (33.6%), coronary artery disease (21.4%), and Alzheimer’s disease (21.4%) were the most frequent comorbidities. Revision surgery was significantly associated with diabetes mellitus and congestive heart failure. Diabetes mellitus, coronary artery disease, and chronic renal failure were strong predictors of postoperative infection. While the mean hospital stay was significantly prolonged in patients with ≥ 3 comorbidities, mortality was significantly associated only with oncological diseases and chronic renal failure. Contrary to expectations, no significant association was found between overall mortality and the number of comorbidities. Comorbidities, particularly diabetes mellitus, congestive heart failure, oncological diseases, and chronic renal failure, substantially influence surgical outcomes, postoperative complications, and hospitalization in hip fracture patients. However, the number of comorbidities alone was not a predictor of mortality, highlighting the importance of the type rather than the quantity of comorbid conditions. These findings underscore the need for individualized perioperative planning and comprehensive patient counseling to reduce risks and improve postoperative outcomes.

Aims: This study aims to evaluate the clinical, radiological, and histological findings of patients who were treated for osteoid osteoma and discusses the diagnostic stages and surgical results of patients treated for osteoid osteoma.

Background Hip fractures are among the most common causes of morbidity and mortality in the elderly population. Hemiarthroplasty is frequently preferred for the surgical treatment of displaced femoral neck and unstable intertrochanteric fractures in older patients. However, postoperative complications such as infection, dislocation, and prosthesis-related failures remain significant concerns that may necessitate revision surgery and increase mortality rates. Methods This retrospective descriptive study included 529 patients (177 males, 352 females; mean age 78.7 ± 8.7 years) who underwent hemiarthroplasty for proximal femoral fractures at a single tertiary center between 2012 and 2023. Demographic characteristics, fracture type, surgical approach, operative time, use of additional fixation materials, hospitalization period, intensive care unit follow-up, and mobilization status were recorded. Postoperative infection, dislocation, and revision rates were analyzed. Statistical comparisons were performed using the chi-square test, Fisher’s exact test, and the Mann-Whitney U test. Results Postoperative infection occurred in 35 patients (6.6%), with a significantly higher rate in those operated on via the posterolateral approach and in patients requiring additional fixation materials (p<0.05). Longer hospital stays and delayed mobilization were associated with an increased risk of infection. Dislocation was observed in 18 patients (3.4%), with 72.3% requiring revision surgery. Prolonged operative time was significantly correlated with dislocation and revision rates (p<0.05). Overall, 35 patients (6.6%) underwent revision surgery, most commonly due to infection (45.7%), followed by dislocation (34.2%), aseptic loosening (11.4%), and periprosthetic fracture (8.6%). Conclusion Postoperative complications after hemiarthroplasty, particularly infection and dislocation, substantially contribute to morbidity and the need for revision surgery in elderly patients. Strategies such as minimizing the use of additional fixation materials, optimizing early mobilization, reducing hospital stay, and avoiding unnecessary prolongation of surgery may help lower complication and revision rates, thereby improving patient outcomes.

Background and Objective: Tenosynovial giant cell tumors (TGCTs) are benign but potentially aggressive soft-tissue tumors, most commonly affecting the hand and frequently associated with local recurrence despite surgical treatment. While positive surgical margins are recognized as the strongest predictor of recurrence, the preoperative identification of factors influencing margin status remains underexplored. This study analyzed the risk factors associated with surgical margin positivity and local recurrence in patients treated for localized hand TGCTs, contributing to more accurate preoperative risk stratification. Materials and Methods: A retrospective analysis was conducted on 44 patients diagnosed with localized TGCTs of the hand and treated surgically at a tertiary regional hospital between 2009 and 2023. Demographic characteristics, tumor size and location, anatomical relationships (bone, joint, and neurovascular proximity), Al Qattan classification, and surgical outcomes were recorded. Binary logistic regression was used to evaluate the impact of these variables on surgical margin status and recurrence. Postoperative satisfaction was assessed using a four-choice questionnaire. Results: The mean patient age was 47.5 years, with 68.2% being female. The most common tumor site was the second finger (31.8%), and 20.5% of patients had positive surgical margins. Recurrence occurred in four patients (9.1%). Bone invasion, interphalangeal joint proximity, neurovascular involvement, and Al Qattan type 2 tumors were statistically significant risk factors for both surgical margin positivity and recurrence. Lesions with periosteal involvement, however, did not significantly impact recurrence risk. Among patients with positive margins, 44.4% developed recurrence. Conclusions: Complete surgical excision with clean margins remains the cornerstone of TGCT management. This study uniquely identifies preoperative predictors of margin positivity—key contributors to recurrence—highlighting the importance of meticulous surgical planning in high-risk cases. Close postoperative follow-up is essential, particularly for patients with positive margins, to detect and manage recurrence promptly.

Background and Objectives: Proximal femur fractures represent a significant health issue in the elderly, associated with high morbidity and mortality rates. This retrospective cohort study investigated factors influencing mortality (age, gender, infection, mobilization status, hospital stay length, surgical delay) in patients undergoing hemiarthroplasty for proximal femur fractures in a tertiary university hospital in Turkey. Materials and Methods: A retrospective analysis was conducted on 481 patients who underwent hemiarthroplasty at 19 Mayıs University hospital in Turkey between 2012 and 2022, with final follow-up data collected in 2022. Data collected included demographic information, the type of surgical approach, the duration of surgery, comorbidities, postoperative complications, and mobilization status at 1 and 6 months post-surgery. Statistical analyses were performed using the Mann–Whitney U test for age and surgery delay; the Kruskal–Wallis test for comparisons of mortality subgroups; the Chi-square test for categorical variables such as gender, fracture type, anesthesia type, and postoperative complications; and the Z test for post hoc analysis of categorical data. Results: The overall mortality rate at final follow-up was 56.1% over the entire study period (2012–2022), with a 6-month mortality rate of 21.8% and a 1-year mortality rate of 33.2%. Age and male gender were significant predictors of mortality. Infection rates were significantly associated with higher mortality within the first year. The study found no significant relationship between surgical approach, duration of surgery, or anesthesia type and mortality. However, increased length of hospital stay and delayed surgery correlated with higher mortality rates. Mobilization status significantly impacted survival, with immobilized patients demonstrating the highest mortality rates. Conclusions: Mortality following hemiarthroplasty for proximal femur fractures is influenced by various factors, including age, comorbidities, infection, and mobilization status. Implementing strategies for early surgery and mobilization while maintaining strict aseptic techniques could potentially reduce mortality rates in this high-risk population.

Aims: This study aims to evaluate the clinical, radiological, and histological findings of patients who were treated for osteoid osteoma and discusses the diagnostic stages and surgical results of patients treated for osteoid osteoma. Methods: A retrospective examination was made of 38 patients who were treated in the Orthopedics and Traumatology Clinic of the 3rd Step University Hospital and diagnosed with osteoid osteoma between January 2010 and January 2023. The patients' demographic data and clinical, radiological, and histopathological evaluations were recorded. Results: In the surgical treatment of the 38 patients in this study, the nidus was excised with the en-bloc resection method or burr-down-assisted intralesional curettage. In the follow-up examination, a patient had a superficial wound site infection on the 14th day postoperatively, and daily dressings and antibiotic treatment were recommended. A significant decrease in pain was observed in 35 patients at the end of the month. In 2 patients, the pain had not recovered at the end of 6 months follow-up. After the second operation, all patients experienced significant relief from pain. Conclusion: Osteoid osteoma is a benign osteoblastic tumor primarily affecting young adults. Despite its benign nature, it often presents with localized nocturnal pain that is relieved by anti-inflammatory drugs. Treatment must be the complete removal of the nidus. Treatment options are evaluated according to the anatomical localization of the lesion.