Almost a half of the hip fractures are extracapsular and are subclassified as intertrochanteric and subtrochanteric. [1] Fracture stability or fracture classification systems are used for the recommendation of treatment in intertrochanteric fractures. Such classifications are also used to recommend proper implant or surgical techniques. The ideal classification system allows interaction between physicians, guides the planning, predicts the treatment outcome, and is applicable for clinical practice and research. Examination of the fracture evaluation by the same physician and different physicians should yield the same result each time (intraobserver and interobserver reliability).Objectives: This study aims to evaluate the effect of surgical experience on reliability for Boyd-Griffin, Evans/Jensen, Evans, Orthopaedic Trauma Association (main and subgroups), and Tronzo classification systems.Patients and methods: Between January 2013 and December 2014, radiological images of a total of 60 patients (13 males, 47 females; mean age: 78.9±21.9 years; range, 61 to 96 years) with the diagnosis of intertrochanteric femur fracture were analyzed. Radiographs were evaluated and classified by five residents and five orthopedics and traumatology surgeons according to the Evans, Boyd-Griffin, Evans/Jensen, OTA, and Tronzo classification systems. Intraand interobserver reliability were calculated using the kappa statistics. Results:The worst intraobserver compatibility among the residents was the classification system with OTA subgroups (k=0.516), while the classification system with the best intraobserver fit was found to be OTA main groups (k=0.744). The worst agreement among surgeons was in the Evans classification system (k=0.456). However, the best intraobserver agreement was in the OTA main groups (k=0.741). The best interobserver agreement was observed regarding the OTA main groups (k=0.699). Conclusion:The classification that has the best harmony both among residents and surgeons, and between residents and surgeons is the OTA main group classification.

Background Because of the broad anatomic variation in the course of the axillary nerve, several cadaveric studies have investigated the acromion-axillary nerve distance and its association with the humeral length to predict the axillary nerve location. This study aimed to analyze the acromion-axillary nerve distance (AAND) and its relation to the arm length (AL) in patients who underwent internal plate fixation for proximal humerus fractures. Methods The present prospective study involved 37 patients (15 female, 22 male; the mean age = 51 years, age range 19–76) with displaced proximal humerus fractures treated by open reduction and internal fixation. After anatomic reduction and fixation were achieved, the following parameters were measured in each patient before wound closure without making an extra incision or dissection: (1) the distance from the anterolateral edge of the acromion to the course of the axillary nerve was recorded as the acromion-axillary nerve distance and (2) the distance from the anterolateral edge of the acromion to the lateral epicondyle of the humerus was recorded as arm length. The ratio of AAND to AL was then calculated and recorded as the axillary nerve index (ANI). Results The mean AAND was 6 ± 0.36 cm (range 5.5–6.6), and the mean arm length was 32.91 ± 2.9 cm (range 24–38). The mean axillary nerve ratio was 0.18 ± 0.02 (range 0.16 to 0.23). There was a significant moderate positive correlation between AL and AAND (p = 0.006; r = 0.447). The axillary nerve location was predictable in only 18% of the patients. Conclusion During the anterolateral deltoid-splitting approach to the shoulder joint, 5.5 cm from the anterolateral edge of the acromion could be considered a safe zone to prevent possible axillary nerve injury.

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Aim: Acetabular fractures were evaluated by Judet and Letournel in two main groups as elementary and associated fractures. There are publications in the literature that the results are worse as the complexity of the fracture increases. The aim of this study was to evaluate whether clinical outcomes are worse in associated fractured patients. Material and Methods:The study included 48 acetabular fractures admitted to the emergency room and treated surgically between December 2011 and October 2020. Patient's trauma, additional injuries, surgical method, early or late complications, and range of motion at the last follow-up were documented. Clinical and radiological results of the patients were evaluated by modified Merle d'Aubigné, functional capacities by Harris hip scoring systems. Results: There were 25 elementary fractures and 23 associated fractures in patients. When the complication rates were examined, the rate of those without complications was 52.0% (n=13) among elementary fractures, while the rate was 34.8% (n=8) in associated fractures. When the fracture types were evaluated according to the Harris hip score, elementary fractures have better score than associated fractures, but no statistically significant difference was observed between them (p=0.056). When evaluated according to Merle d'Aubigne score, it was observed that elementary fractures had significantly better scores (p=0.004). Conclusion:As the complexity of the fracture increases, it can be predicted that the clinical outcomes of the patient will be worse. It is also concluded that the elementary fracture type had better clinical outcomes than the associated fracture type in our own surgically treated acetabular fractures.