Inflammatory Index as a Predictor of Mortality in Elderly Patients With Intracapsular Femoral Neck Fracture.

A femoral neck fracture is a major cause of mortality in the elderly population, and intracapsular femoral neck fractures (ICFNFs) are commonly treated with hemiarthroplasty. The 30-day mortality rate for elderly hip fracture patients ranges from 1.0% to 6.5%, and one-year mortality increases significantly to 37.3%. Identifying predictors of mortality in these patients is crucial for better management. Inflammatory indices, such as neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and monocyte-to-lymphocyte ratio (MLR), have gained popularity for assessing mortality risk in various diseases. Several studies have demonstrated the value of these indices in predicting mortality after hip fracture. The pan-inflammatory immune value (PIV), which combines hematological parameters, has been shown to predict mortality in cancer patients. However, its role in predicting mortality in ICFNF patients treated with hemiarthroplasty has yet to be explored. This study aimed to assess the association of PIV, SII, NLR, and MLR with 30-day and one-year mortality in ICFNF patients. We also investigated the impact of surgical delay time (≤24h, 24-48h, ≥48h) on these inflammatory indices and mortality. Data from 522 patients with ICFNF treated with hemiarthroplasty were retrospectively collected. We observed 30-day and one-year mortality rates of 5.24% and 21.2%, respectively. Age, gender, and American Society of Anesthesiologists (ASA) score were identified as significant predictors of mortality. Preoperative PIV, SII, NLR, and MLR were significant predictors in the evaluation of early mortality. However, postoperatively, only NLR on the third day (NLR3rd) demonstrated statistical significance. Stepwise logistic regression further confirmed NLR3rd as the most effective predictor for early mortality. For mortality occurring between 30 to 365 days, NLR3rd remained statistically significant, albeit with diminished sensitivity. No other inflammatory index demonstrated significant predictive power for mortality during this later period. Our findings suggest different inflammatory indices may have varying predictive abilities depending on the mortality period. We recommend considering NLR3rd as a valuable and reliable predictor for early mortality in ICFNF patients treated with hemiarthroplasty. Respiratory system disease and preoperative chronic obstructive pulmonary disease (COPD) were identified as risk factors for mortality in our study, in line with previous research. In conclusion, our study highlights the potential of specific inflammatory indexes, particularly NLR3rd, in predicting mortality in elderly patients with ICFNFs treated with hemiarthroplasty. Further research is needed to validate these findings and optimize risk assessment in orthopedic practice.

Analysis of predictive factors for post-traumatic osteoarthritis and poor outcomes in acetabular fractures treated surgically.

OBJECTIVE: The aims of this study were (i) to assess the radiological and functional outcomes of surgically treated displaced acetabular fractures and (ii) to analyze the predictive factors of poor outcomes following surgery. METHODS: A total of 119 patients (24 female, 95 male) who were operated between 2009 and 2019 were included in the study. The mean age was 47.5 years (range=18-61). The mean follow-up was 92.3 months (range=24-120). Failure to preserve the biological hip joint, as treated with total hip replacement or the Girdlestone procedure, was defined as a poor outcome. Patients' demographic information, comorbidities, fracture types, surgical approach, concomitant injuries, reduction quality, and complications were analyzed. Computed tomography was utilized to evaluate the fracture type and quality of reduction. Factors affecting poor outcomes were analyzed by logistic regression analysis. The modified Harris Hip Score was also used to evaluate the functional status. RESULTS: The poor outcome rate was 10.1%. Multivariate logistic regression analysis revealed that dislocation (odds ratio: 44.87, confi- dence interval: 3.18-633.22, P=.005), wound site problems (odds ratio: 9.09, confidence interval: 1.01-81.12, P=.04), reduction quality (odds ratio: 77.88, confidence interval: 5.95-1019.07, P = .001), and diabetes (odds ratio: 7.29, confidence interval: 1.01-52.07, P = .04) were associated with poor outcomes. Eight of the 12 patients with poor outcomes had a fair Harris Hip Score, and 4 had a poor Harris Hip Score. The relationship between poor outcomes and Harris Hip Score was found to be significant (P < .001). CONCLUSION: For a favorable functional outcome in acetabular fractures, preservation of the biological hip joint should be a top priority. The accompanying dislocation and the patient's diabetes appear to be uncontrollable factors for the poor prognosis. Good reduction qual- ity and wound infection protection are modifiable factors. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

Trunnion fracture of a cobalt-chrome fully porous-coated femoral stem: A case report.

Modular femoral stem-head systems are used increasingly due to their ease of application and offset adjustment. However, this modular ity has brought complications of trunnion wear and breakage. Although very rarely encountered, trunnion fracture is a catastrophic com plication that requires challenging revision surgery. This report presents a trunnion fracture of a cobalt-chrome alloy, fully porous-coated femoral stem. Following single-stage revision surgery, full weight-bearing was achieved in six weeks, and the patient was painlessly mobile with a single cane and had a Hip Score of 81 in the last follow-up. Despite all the advantages of the femoral stem and head modu larity, one should remember that a catastrophic complication such as trunnion wear and fracture that require revision surgery is possible.

Predictive factors associated with thirty-day mortality in geriatric patients with hip fractures.

OBJECTIVE: This study aimed to determine the predictive factors affecting the 30-day mortality in geriatric hip fractures, investigate the effect of the timing of surgery, and thus determine the optimum cut-off time in delaying the surgery. METHODS: A total of 596 patients(205 men, 391 women; mean age = 78.3 years) were included in this retrospective study. All possible predictive factors encountered in the literature review, including age, sex, fracture type, comorbidities, American Society of Anesthesiologists (ASA) score, surgical delay time, anaesthesia type, surgery type, need for erythrocyte replacement, postoperative complications, and the need for postoperative intensive care were analyzed. The predictive factors that were found to be significant as a result of the univariate analysis were included in the multivariate logistic regression analysis. RESULTS: The reason for surgery was an extracapsular fracture in 359 patients (60.2%) and an intracapsular fracture in 237 (39.8%). Arthroplasty was performed in 256 patients (43%), while proximal femoral nails were used in 251 (42.1%), dynamic hips screws in 68 (11.4%), and cannulated screws in 21 (3.5%). 523 (87.8%) of the patients had an ASA score of 1 or 2, and 73 (12.2%) had an ASA score of 3 or 4. General anaesthesia was performed on 35.2% of the patients, while regional anaesthesia was administered to 64.8%. Major complications developed in 42 patients (7%), while minor complications were observed in 143 (24%). The mean surgical delay time was 3.21 days (1-9 days). The ASA score (P <0.001, OR: 56.83, CI: 5.26-2.820), anesthesia type (P = 0.036, OR: 3.225, CI: 0.079-2.264), surgical delay time (P <0.001, OR: 2.006, CI: 1.02-0.372) and major complication (P = 0.002, OR: 6.41, CI: 0.661-3.053) were determined to be predictive factors of 30-day mortality. CONCLUSION: This study found the median surgical delay time as three days in surviving patients and five days in deceased ones. Thus, a 3-day surgical delay may be acceptable and sufficient for medical optimization and the consensus of the multidisciplinary team. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

An extended distally based reverse posterior interosseous artery flap reconstruction for the thumb and distal defects of the fingers.

BACKGROUND: The reverse posterior interosseous artery flap is useful for covering hand defects. However, its major drawback is the short pedicle that limits the reach of the flap up to the metacarpophalangeal level. The authors performed a new modification extending the distal reach of the flap by including the recurrent branch of the posterior interosseous artery and they aimed to present the results of reconstruction with this technique. PATIENTS AND METHODS: Seven patients with a mean age of 35.2 years (range 17-64 years) underwent extended RPIAF surgery. Six patients were admitted to the emergency department with isolated hand trauma. One patient was present in elective settings with chronic osteomyelitis and skin loss of the thumb related to previous trauma. The defects were located on the distal metacarpophalangeal level (thumb and other fingers). PIA perforators and the recurrent branch were included into the pedicle (Type A) in five cases, whereas the flap was harvested based solely on the recurrent branch (Type B) in two cases. The type B flaps had longer pedicle lengths due to discarding the forearm skin. The donor sites were covered with skin grafts in six patients. RESULTS: The average size of the extended RPIAF was 3 × 3.5 cm to 10 × 6 cm (mean 8.28 × 4.14 cm). All of the flaps completely survived, and no complications were encountered during the postoperative period. Functional recovery of the operated hands were observed during the follow up period 13.5 months (8-24 months). Both the patient and our satisfactory levels were high and all of the patients returned to their works. Quick DASH score was used in the final functional evaluation retrospectively. Due to the pandemic, the evaluation could be made with a telephone. Two patients could not be reached in the evaluation. The mean quick DASH score of five patients was 28.64. CONCLUSION: The extended RPIAF is a reliable choice in distally located thumb and finger defects if the recurrent branch of the posterior interosseous artery is included in the pedicle.

The Effect of Religious Belief on Depression and Hopelessness in Advanced Cancer Patients.

This study was conducted to determine the effect of religious belief on depression and hopelessness in advanced cancer patients. The sample size of this cross-sectional study was determined as 267 as a result of the power analysis. The study was carried out between February 2018 and December 2018. "The Patient Information Form", "The Religious Attitude Scale", "The Beck Depression Inventory (BDI)", and "The Beck Hopelessness Scale (BHS)" were used to collect the data. It was determined that the total mean score of the cancer patients participating in the study for Religious Attitude Scale was 4.51 ± 0.44 (high level), their total mean score for depression inventory was 19.06 ± 9.38 (moderate level), and their total mean score for hopelessness scale was 10.23 ± 1.94 (moderate level). In the study, the difference between the religious beliefs and depression and hopelessness levels of the cancer patients was statistically significant (p < 0.05). In the study, it was determined that depression and hopelessness levels of cancer patients were moderate and their religious beliefs were high. It is recommended for healthcare professionals to add spirituality to healthcare in order to provide the spiritual relief of cancer patients.

Comparison of operating time, fluoroscopy exposure time, and functional and radiological results of two surgical methods for distal forearm fractures of both-bones in pediatric patients: Is it necessary to fix both bones?

OBJECTIVE: The aim of this study was to compare the functional results of internal fixation of both forearm bones versus fixation of the radius alone in the treatment of distal both-bone forearm fractures in children. METHODS: This study included a total of 34 children who were treated for distal forearm both-bone fracture. Patients were divided into two groups according to the technique used, which depended on the date of their surgery. Group 1 consisted of 18 children (14 males and four females; mean age: 10.3 years; age range: 7-16 years) who underwent both-bone fracture fixation using closed reduction and percutaneous pinning; Group 2 consisted of 16 children (12 males and four females; mean age: 10.1 years; age range: 6-15 years) who underwent only radius fracture fixation. The average follow-up was 65.6 months in Group 1 and 38.9 months in Group 2. Operating time, fluoroscopy exposure time, functional results (Mayo Wrist Score, visual analogue scale score, and range of motion), radiological results (time to union and malunion), and complications were recorded as outcome parameters. RESULTS: The mean operating time was 35 min (range: 30-45 min) in Group 1 and 19 min (range: 10-25 min) in Group 2 (p<0.001). The mean fluoroscopy exposure time was 54 sec (range: 40-70 sec) in Group 1 and 18 sec (range: 10-26 sec) in Group 2 (p<0.001). Only three patients in Group 1 and four patients in Group 2 exhibited <10° of limitation in pronation and supination. No significant differences were determined between the groups with respect to functional scores (p=1.000). Final follow-up radiographs showed no malalignment in either group. In terms of time to union, there was no significant difference between groups (p=1.000). Additionally, only three minor complications associated with the pin track (two patients in Group 1 and one patient in Group 2) were noted. CONCLUSION: In children with distal both-bone fractures, fixation of the radius fracture alone may be considered as an alternative method of treatment to fixation of both forearm bones as it results in satisfactory functional and radiographic outcomes. LEVEL OF EVIDENCE: Level III, Therapeutic study.