Serkan Aydin

Background/Objectives: Bone is the third most common site of solid-tumor metastasis, and surgical management spans a wide spectrum from observation to curative en bloc resection in selected patients. 18F-FDG PET/CT has been reported to alter oncologic management in 20% to 45% of patients across diverse settings, yet its specific impact on surgical decision-making within a multidisciplinary orthopedic oncology board (MOOB) reassessment and the predictors of decision change remain undefined. Methods: We retrospectively analyzed consecutive patients with histopathologically confirmed bone metastases evaluated at a tertiary-care MOOB between February 2023 and February 2026. For each patient, the surgical plan was recorded twice: first by the orthopedic team based on available conventional imaging (radiography, computed tomography, magnetic resonance imaging) and then as the final PET/CT-informed MOOB review. This design evaluates changes in decision-making intent after PET/CT-informed multidisciplinary reassessment, rather than the isolated causal effect of PET/CT or actual surgical implementation. Surgical plans were categorized as no surgery, palliative stabilization, palliative resection, or curative-intent resection, and changes were classified as no change, escalation, de-escalation, or cancellation. Results: Among 73 patients (mean age 64.7 ± 12.1 years; 53.4% male), the most frequent primaries were lung (37.0%), breast (21.9%), and renal cell carcinoma (13.7%). Following PET/CT-informed MOOB reassessment, the intended surgical plan changed in 53.4% of cases (p < 0.001), comprising surgery cancellation (27.4%), escalation (17.8%), and de-escalation (8.2%). Patients directed to no surgery increased fourfold (6.8% to 28.8%), and curative resection emerged as a post-reassessment recommendation (0% to 10.9%). SUVmax did not predict overall decision change, but higher SUVmax was associated with cancellation/de-escalation in the directional analysis. In exploratory multivariable analysis, polymetastatic disease (OR 0.051; 95% CI 0.005 to 0.547; p = 0.014), long-bone diaphyseal location (OR 0.133; p = 0.006), and higher Eastern Cooperative Oncology Group (ECOG) performance score (OR 2.109 per point; p = 0.018) independently predicted decision change. Conclusions: PET/CT-informed MOOB reassessment was associated with substantial changes in intended surgical strategy for metastatic bone disease. The findings support careful multidisciplinary integration of metabolic imaging, metastatic burden, anatomic location, and performance status, but should be regarded as hypothesis-generating until validated prospectively with data on treatment delivery and downstream outcomes.

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.

Aim: This study aimed to evaluate the types of peripheral nerve injuries that developed after the Kahramanmaraş earthquakes of February 6, 2023, the accompanying complications, the treatments applied and the functional outcomes obtained at the end of a two-year follow-up period. The study also sought to reveal the long-term functional impact of nerve damage caused by crush injuries and compartment pressure following earthquakes. Methods: This retrospective study included 19 patients diagnosed with peripheral nerve injury after the earthquake, who completed a 24-month follow-up. Diagnoses were confirmed through physical examination, electromyography (EMG) and magnetic resonance imaging (MRI) when necessary. Data regarding the affected nerve, surgical interventions, systemic complications, orthosis use and rehabilitation processes were recorded. Functional outcomes were assessed with nerve-specific validated scales: peroneal (FAAM, AOFAS), radial (DASH), sciatic (LEFS) and brachial plexus (CSS). Results: The most frequently affected nerve was the peroneal nerve (42%), followed by sciatic, radial and brachial plexus injuries. Fasciotomy was performed in 62% of the patients and 74% underwent additional surgical procedures. Functional scores remained generally low at the end of the second year; however, patients who maintained regular rehabilitation follow-up demonstrated more notable improvement. Regression analysis showed that prolonged time under debris and undergoing fasciotomy independently predicted poorer functional outcomes. Conclusion: Peripheral nerve injuries following earthquakes may be overlooked in the acute period but can lead to long-term functional deficits. Regular follow-up, a multidisciplinary approach and uninterrupted rehabilitation are essential for optimal recovery. Disruption of rehabilitation services in disaster settings significantly limits functional improvement.

Objectives: This study aimed to compare the clinical, functional, and radiological outcomes of three different fixation techniques—dorsal locking plate, crossed cortical screw, and a combination of both—used in first metatarsophalangeal (MTP) joint arthrodesis for advanced-stage hallux rigidus. The goal was to provide evidence-based guidance for surgical technique selection. Methods: This retrospective cohort study included 52 patients with advanced hallux rigidus (stage III–IV, Coughlin–Shurnas classification) who underwent surgical treatment between 2023 and 2025 at the Department of Orthopedics and Traumatology of Ankara Etlik City Hospital, with a minimum follow-up of one year. Patients were categorized into three groups according to the fixation technique used. Visual Analog Scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) score, and Foot Function Index (FFI) were assessed using validated Turkish-language versions of the questionnaires. Radiological parameters included hallux valgus angle, first toe dorsiflexion angle, distal interphalangeal (DIP) arthritis, and radiographic union—defined as trabecular bridging across at least three cortices on weight-bearing anteroposterior and lateral radiographs. ANCOVA was performed with age as a covariate. Results: A total of 52 patients were included: Group 1 (dorsal plate fixation, n = 19), Group 2 (crossed cortical screw fixation, n = 16), and Group 3 (combined fixation, n = 17). Group 1 patients were significantly older (mean age: 64 ± 6 vs. 55 ± 6 and 59 ± 5 years; p < 0.001). After age adjustment, VAS pain scores were significantly higher in Group 1 compared to Group 3 (mean VAS: 2.8 ± 0.6 vs. 1.9 ± 0.5; p = 0.010). AOFAS scores did not differ significantly (p = 0.166), although Group 2 showed the highest median value (90 [70–93]). FFI scores differed significantly (p < 0.001), with Group 1 reporting worse outcomes (19 [17–31]) than Group 2 (15 [13–22], p = 0.03) and Group 3 (15 [11–16], p = 0.01). Dorsiflexion angle was significantly lower in Group 2 than Group 1 (median 19° vs. 27°; p = 0.04), though all remained within the physiological range. Radiographic union was achieved in 50/52 patients (96.2%), without significant intergroup differences (p = 0.612). Complications included two cases of wound dehiscence in Group 1; no infections, symptomatic non-union, malalignment, or hardware irritation were observed. Conclusions: Crossed cortical screw fixation yielded the most favorable functional outcomes, whereas the combined technique achieved the lowest postoperative pain scores. Dorsal plate fixation alone consistently underperformed. While outcomes were adjusted for age, residual confounding cannot be excluded. These results highlight the importance of tailoring fixation strategy to patient profile, with crossed screw and combined methods representing reliable choices for optimizing postoperative outcomes in advanced hallux rigidus.

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.