Özkan Öztürk

Background and Objectives: Nonunion remains an important clinical concern after nonoperative treatment of humeral shaft fractures. Although several patient- and fracture-related variables have been proposed as determinants of healing, their independent contributions remain uncertain. This study aimed to identify patient- and fracture-related factors independently associated with nonunion after nonoperative treatment of humeral shaft fractures. Materials and Methods: This single-center retrospective cohort study included adults with humeral shaft fractures treated nonoperatively between January 2015 and January 2025. Fractures were classified using the AO/OTA system. Patients with periprosthetic, pathological, pediatric, intra-articular fractures, previous nonunion, or insufficient follow-up were excluded. Treatment consisted of functional bracing after initial immobilization. Nonunion was defined as absence of clinical and radiographic union at or beyond 9 months after injury, with no radiographic progression over at least 3 months, persistent fracture-site pain, and absent bridging callus. Demographic characteristics, comorbidities, fracture-related variables, and radiographic parameters were recorded. Multivariable logistic regression was used to evaluate adjusted associations with nonunion, with Firth’s penalized regression performed as a sensitivity analysis. Results: Among 242 patients, union occurred in 207 (85.5%), while 35 (14.5%) developed nonunion. In the adjusted model, older age (OR = 1.76 per 10-year increase; 95% CI: 1.28–2.40), smoking (OR = 14.33; 95% CI: 4.16–49.32), and proximal-third fracture location (OR = 3.77; 95% CI: 1.38–10.31) were associated with nonunion. Firth’s penalized regression yielded similar findings. The association with diabetes mellitus was uncertain (OR = 2.63; 95% CI: 0.94–7.30). Conclusions: Older age, smoking, and proximal-third fracture location were associated with nonunion after nonoperative treatment of humeral shaft fractures. These exploratory associations may inform patient counseling and follow-up, but the limited number of events and wide confidence intervals warrant cautious interpretation.

Amaç: Bu çalışmanın amacı, pertrokanterik femur kırığı nedeniyle proksimal femoral çivi (PFN) ile tedavi edilen 65 yaş altı hastalarda kırık kaynama paternlerini ve klinik sonuçları etkileyen faktörleri değerlendirmektir. Gereç ve Yöntemler: 2013–2024 yılları arasında PFN ile tedavi edilen 65 yaş altı 158 hasta retrospektif olarak incelendi. Hastaların demografik verileri, travma mekanizması, kırık sınıflaması, redüksiyon kalitesi, kemik kalitesi, femoroasetabular impingement (FAİ) varlığı, osteoartrit progresyonu ve komplikasyon oranları değerlendirildi. Bulgular: Hastaların ortalama yaşı 51.1 yıl olup, %63.3’ü erkekti. En sık travma mekanizması yüksek enerjili travma (%43) olup, özellikle erkek hastalarda daha sık görüldü (p<0.01). Ortalama kırık kaynama süresi 2.3 ay olarak saptandı. İyi redüksiyon kalitesi, erken mobilizasyon ile anlamlı olarak ilişkiliydi (p<0.05). Hastaların %39.9’unda FAİ lezyonu mevcuttu ve cam veya pincer tipi FAİ’nin düşük enerjili travma ile daha sık ilişkili olduğu görüldü (p=0.06). Osteoartrit progresyonu hastaların %35.4’ünde izlenmiş olup; redüksiyon kalitesi, kemik kalitesi veya coxa valga varlığı ile anlamlı bir ilişki saptanmadı. Komplikasyon oranı %24.1 olup, en sık görülen komplikasyon heterotopik ossifikasyondu. Sigara kullanımı gecikmiş kaynama ile anlamlı olarak ilişkili bulundu (p<0.05). Sonuçlar: 65 yaş altı hastalarda pertrokanterik femur kırıkları daha sıklıkla yüksek enerjili travma ile ilişkilidir ve erkeklerde daha sık görülür. Redüksiyon kalitesi, daha erken mobilizasyon ile anlamlı derecede ilişkiliydi. Ameliyat öncesi FAI düşük enerjili travma geçiren hastalarda daha sık gözlemlenmiş olsa da, bu ilişki istatistiksel olarak anlamlı değildi. Bu bulgular, genç hastalarda fonksiyonel iyileşmede kırık özelliklerinin ve redüksiyon kalitesinin önemini vurgulamaktadır.

Objectives: Colistin is frequently used as a last-line treatment option for periprosthetic joint infections (PJIs) caused by multidrug-resistant (MDR) Gram-negative pathogens, and mortality rates are high in this patient group. This study aimed to evaluate 90-day mortality and its associated clinical factors in MDR Gram-negative PJI cases treated with colistin, with particular attention to the American Society of Anesthesiologists (ASA) score and changes in renal function during therapy. Methods: Patients diagnosed with MDR Gram-negative PJI and treated with intravenous colistin at a single center between 2010 and 2024 were retrospectively reviewed. Demographic data, infection localization, comorbidities, American Society of Anesthesiologists (ASA) score, causative pathogens, presence of sepsis, intensive care unit (ICU) admission, duration of colistin therapy, pre- and post-treatment renal function parameters, and mortality were all recorded. Survivors and non-survivors were compared using univariate analysis. Results: The cohort included 44 patients with a mean age of 72 years (23 women and 21 men). Infections involved the hip in 33 patients (75.0%) and the knee in 11 (25.0%). Twenty-two patients (50.0%) were in the high-ASA group (ASA ≥ III group). Within 90 days of initiating colistin therapy, 25 patients died and 19 survived. A high ASA score was significantly more common among non-survivors than among survivors (18/25 (72.0%) vs. 4/19 (21.1%); p < 0.001), and dialysis requirement was also more common among non-survivors [20/25 (80.0%) vs. 8/19 (42.1%); p = 0.013]. End-of-treatment renal parameters were significantly worse among non-survivors, including urea [71.2 (50.9–78.8) vs. 38.5 (34.8–42.5) mg/dL; p = 0.003], creatinine [2.29 (1.75–2.64) vs. 0.93 (0.72–1.60) mg/dL; p = 0.003], urea delta [42.8 (38.0–48.6) vs. −5.4 (−7.9 to −2.0) mg/dL; p = 0.006], and creatinine delta [0.78 (0.33–1.57) vs. 0.16 (0.10–0.57) mg/dL; p = 0.008] levels. In contrast, age, sepsis, ICU admission, and colistin treatment duration were not significantly associated with 90-day survival. Conclusions: In this high-risk cohort of patients with MDR Gram-negative PJI treated with colistin, the 90-day mortality rate was high and was associated with higher American Society of Anesthesiologists scores, dialysis requirements, and worsening renal function during treatment. No significant association was observed between treatment duration and response in this cohort. These findings should be interpreted cautiously, given the retrospective design and the limited sample size.