The ability to identify patients at high risk for poor outcomes before hip fracture operations is clinically important, as hip fractures may result in mortality or insufficiency in daily living activities in the elderly population. [1] Due to the high mortality rates associated with hip fractures, identifying high-risk patients is critical in terms of treatment management and prevention of a substantial economic burden on healthcare services. [2] In addition, preoperative identification of high-risk patients may be helpful for optimal timing of the operation, administration of critical care during the treatment, preparation of patient-specific informed consent, and developing a better understanding of the prognosis.Objectives: In this study, we aimed to compare the neutrophil-tolymphocyte ratio (NLR), red blood cell distribution width (RDW), and Nottingham Hip Fracture Score (NHFS) according to one-year mortality estimation after hip fracture surgery in elderly.Patients and methods: Between January 2015 and December 2019, a total of 190 elderly patients (63 males, 127 females; mean age: 82.8±6.1 years; range, 70 to 98 years) who were diagnosed with collum femoris fractures treated with hemiarthroplasty were included. The cohort was divided into two groups with NHFS ≤4 and >4 as the low-and high-risk patients, respectively and one-year mortality was assessed for both groups. The RDW was evaluated with blood values sampled on the day of admission. A cut-off of 14.5% was considered for the RDW values. The NLR values calculated on admission (NLR-D0) and postoperative Day 5 (NLR-D5) were considered the primary outcome measures.Results: A total of 46 patients (24.2%) developed any type of complication. The NLR values higher than 5 on Days 0 and 5 were more frequently seen in the complicated patients (p=0.0016 and p<0.001). There were significantly more patients with higher RDW values (>14.5%) in the complicated group (p<0.001). The median NHFS and the rate of patients with NHFS >4 were significantly higher in the complicated patients (p<0.001 for both). The NHFS value higher than 4 had a sensitivity of 87.7% and specificity of 84.0% in predicting mortality (area under the curve [AUC]= 0.910, 95% confidence interval [CI]: 0.860-0.947, p<0.001). Estimation of mortality using an RDW cut-off value of >14.5 showed 87.7% and 80.0% sensitivity and specificity, respectively (95% CI: 0.789-0.904, p<0.001). The AUC of the NLR Day 5 using a cut-off value of >6.8 was 0.953 for the prediction of mortality (95% CI: 0.912-0.978, p<0.001). Conclusion:Age, NLR Day 5 (>5), RDW (>14.5%) and NHFS (>4) were strongly associated with mortality prediction. The NHSF and RDW values had the highest and similar sensitivity merit, while the highest specificity was in NLR-D5. Therefore, NLR, RDW and NHFS values can be used to classify risk factors in estimating one-year mortality rates in elderly patients operated for hip fractures. A multidisciplinary approach should be standardized in determining the risk factors before treatment in patients with...

Aim: Results of the surgical and medical treatments of giant cell tumor of the bone (GCT) in terms of local recurrence and prognostic factors associated with local recurrence are evaluated in this study. Material and Method: Patients treated with either surgical or medical methods for GCT between 2011 and 2021 were retrospectively evaluated. Gender and age of the patients, localization of tumors, the existence of pathological fractures, grade of the tumor, soft tissue expansion, and resection types were evaluated. Postoperative local recurrence and metastasis were analyzed, and the risk factors associated with local recurrence were determined. Results: The mean age of the 117 patients (51 female and 66 male) was 36.1±9.3 years. The mean follow-up was 71.2±48.3 months. Forty patients were Grade I, 56 were Grade II, and 21 were Grade 3, according to the Campanacci Grading System. Soft tissue expansion was present in 21 (17.9%) patients. 59.8% of the patients were undergone intralesional curettage, 32.4% of the patients were treated with marginal or wide local excision combined with adjuvant therapy with liquid nitrogen and poly-methyl methacrylate (PMMA) application, and 5.9% of the patients have treated with en bloc wide resection and reconstruction or arthrodesis. Two patients suffering from sacral involvement were treated with radiotherapy. There was local recurrence after surgery in 19 (16.2%) of the patients. Conclusion: Local recurrence is an important cause of morbidity in the treatment of GCT, which is a benign but aggressive tumor of the bone. In this study, in which we investigated the causes of local recurrence, Campanacci Grade and soft tissue expansion were found to be associated with the development of local recurrence.

This study aims to evaluate the prognostic factors and treatment outcomes of patients with extremity-localized myxoid liposarcoma (MLS).Patients and methods: Between January 2001 and October 2019, a total of 43 patients (29 males, 14 females; mean age: 56.3±11.4 years; range, 34 to 76 years) who were histopathologically diagnosed with MLS in our clinic were retrospectively analyzed. Data including demographic characteristics, tumor localization, tumor volume and length, histopathological characteristics, the surgery and chemotherapy (CT)/radiotherapy (RT) applied, survival rates, and complications such as local recurrence and metastasis were recorded. The treatment results and potential prognostic factors were identified. The overall survival (OS) and cancer-specific survival (CSS) rates were evaluated. Results:The mean follow-up was 106.8±54.1 (range, 29 to 204) months. The mean tumor size was 11.4±6.5 (range, 4.7 to 36) cm. Tumor localization was determined as lower extremity in 76.7% of cases and upper extremity in 23.2%. The patients were divided into two groups according to the type of RT they received as follows: the patients who underwent neoadjuvant RT + wide surgical resection (n=14, 32.5%) and patients who underwent extensive surgical resection + adjuvant RT (n=29, 67.4%). To four patients who developed distant metastasis and to two who developed local recurrence, adjuvant CT was applied. In the whole cohort, the OS rate was 87.1% at five years and 73.2% at 10 years. The five and 10-year CSS rates were 83.5% and 66.4%, respectively. Local recurrence developed in 12 (27.9%) and distant metastasis in four (9%) patients. In the multivariate analysis, high tumor grade, R2 margins, and metastasis were found to be independent risk factors for OS. Although wide resection provided significantly good local control, neoadjuvant RT and adjuvant CT were not found to be prognostic factors for OS or CSS (p>0.05). Conclusion:High tumor grade, R2 margins, and metastasis are independent risk factors for increased OS and OSS. Surgery with CT and neo/adjuvant RT is not an independent risk factor for OS or CSS. Despite patients with a larger tumor size and neurovascular proximity, similar disease-free survival rates can be achieved in the patients receiving neoadjuvant RT. Neoadjuvant RT can be considered in lesions close to neurovascular structures or in large lesions, with a high risk of wound complications.

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Amaç; Klavikula, omuz ve kolun hareketlerinde önemli bir göreve sahip olan anatomik bir yapıdır. Klavikula kırıkları iskelet sistemi yaralanmaları içerisinde sık karşılaşılan bir problemlerdendir. Klavikula kırıklarında, kırığın türüne göre çeşitli implantlar kullanarak omuzun ağrısız ve fonksiyonlarını en uygun düzeye getirmek asıl amaçtır. Bu çalışmada klavikula kırıklarında kullanılan anatomik plak uygulamasının biyomekanik açıdan incelenmesi amaçlanmıştır. Yöntem; Bu çalışmada, DICOM formatında bilgisayarlı tomografi görüntüleri kullanılarak normal anatomiye sahip klavikula modellenmiş ve klavikula üzerinde kırık hattı oluşturularak superior ve anteriora plak yerleştirilmiştir. Plaklarda meydana gelen gerilmeler, oluşturulan modeller üzerine eksenel kompresyon ve konsol bükme yüklemeleri uygulanarak non-lineer sonlu elemanlar yöntemi ile incelenmiştir. Analizler, ANSYS (surum 18) sonlu elemanlar programında yapılmış ve tüm modellerde aynı sınır şartları uygulanmıştır. Bulgular; Analizlerde plaklar üzerinde meydana gelen maksimum eşdeğer gerilmelere (MES) bakılmış ve özellikle anteriora yerleştirilen plakta gerilmenin azaldığı tespit edilmiştir. Klavikula üzerine yerleştirilen plakların konumlarına göre yorulma davranışları karşılaştırılmıştır. Sonuçlar; Bu çalışmada, klavikulanın anteriorüne yerleştirilen plaklarda gerilmenin daha az olduğu sonlu elemanlar yöntemi ile gösterilmiştir. Ayrıca, anterior bölgeye yerleştirilen plakların en uzun ömre sahip olmasından dolayı kırılma kararlığı açısından daha güvenli olduğu belirlenmiştir.