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  • Küçük Resim
    Öğe
    Comparison of sinus tarsi approach versus extensile lateral approach in the management of displaced intra-articular calcaneal fractures: A single-center study
    (Turkish Association of Trauma and Emergency Surgery, 2023) Ersin, Mehmet; Demirel, Mehmet; Ekinci, Mehmet; Sungur, İbrahim; Yılmaz, Murat
    BACKGROUND: Controversy still exists for optimal treatment for displaced intra-articular calcaneal fractures (DIACFs). Conven-tionally, the extensile lateral approach (ELA) has been the most preferred approach. Although ELA provides excellent fracture access and direct evaluation of the depressed posterior facet, this approach has a high rate of serious complications, such as hematoma, superficial/deep infection, and wound healing issues. To overcome such complications, more minimally invasive techniques including external fixation, percutaneous fixation, arthroscopic assisted fixation, and sinus tarsi approach (STA) have been recently described. The primary aim of this study was to compare STA and LEA in the treatment of DIACFs.METHODS: Patients who were operated for DIACFs in our clinic were included in the study. Patients with closed DIACFs of Sanders Type II, III, IV, and over 18 years of age were identified. Physical examinations and radiological evaluations of the patients were per-formed, and clinical scores were filled. Patients were divided into subgroups according to the Sander's classification and comparisons were made again according to these subgroups.RESULTS: There were 37 patients (four female and 33 male) in STA group and 44 patients in LEA group (six female and 38 male). The mean age was 44.42 & PLUSMN;13.57 years (range, 18-61) for STA group and 37.32 & PLUSMN;11.09 years (range, 18-56) for the LEA group. In clinical outcomes, except for short-form survey (SF-12)/MCS-12 (Mental Score) and visual analog scale score, all the parameters were signifi-cantly better in STA group compared to LEA group. No significant difference was observed between the two groups in radiographic results, except for the Bohler angle. Significantly less infection occurred in the STA group compared to LEA group (P=0.021). According to Sander's classification, American Orthopedic Foot and Ankle Society, foot and ankle disability index, and SF-12/PCS-12 and foot function index scores, no significant differences were determined between STA and LEA groups for Sanders Type 2, whereas the values were considerably higher in STA group than in LEA group for Sanders Type 3 and 4.CONCLUSION: In DIACFs, STA is considered a safe and effective method for restoring the width, height, and length of the calca-neus and reconstruction of joint alignment and has now become our standard technique for all calcaneal fractures requiring operative treatment.
  • Küçük Resim Yok
    Öğe
    Epidemiology, treatment, and mortality of femoral neck fractures in patients over the age of 65 years: a nationwide retrospective cohort study of 83,789 cases in Turkey
    (2025) Demirel, Mehmet; Birinci, Murat; Hakyemez, Ömer Serdar; Azboy, Nesrullah; Bingöl, İzzet; Azboy, İbrahim; Şen, Cengiz
    Background: A population-based study delineating the epidemiologic, clinical, and treatment characteristics of femoral neck fractures (FNFs) in elderly patients has not yet been conducted in Turkey. In this nationwide study, the epidemiologic, clinical, and treatment characteristics of patients aged ⩾65 years with FNFs who underwent osteosynthesis, hemiarthroplasty (HA), or total hip arthroplasty (THA) were examined. Methods: Patients aged ⩾65 years with FNFs were identified in this retrospective, nationwide study. Then, the patients who underwent osteosynthesis or total/hemiarthroplasty from 2016 to 2021 were included. All the outcome variables were collected from patient medical records stored in the e-health database of the Republic of Turkey Ministry of Health. Results: A total of 83,789 FNFs treated surgically were analysed. Osteosynthesis was performed on 21,130 FNFs (25.2%), HA on 56,378 FNFs (67.3%), and THA on 6281 FNFs (7.5%). From 2016 to 2021, the overall revision rates for THA and HA were 14.6% (914/5367 patients) and 5.9% (3301/53,077 patients), respectively. The rate of revision prosthetic surgery was significantly higher after THA than after HA (p < 0.001). Mortality rates at 1 year were 25% (n = 5293) for osteosynthesis, 14.7% (n = 924) for THA, and 71.1% (n = 40,109) for HA (p = 0.001). The multivariate model of 1-year postoperative mortality revealed 7 independent predictors: male sex (odds ratio [OR] 1.694; 95% confidence interval [CI], 1.640–1.751), use of a cemented femoral stem (OR 1.182; 95% CI, 1.117–1.250), acute myocardial infarction (AMI) (OR 1.317; 95% CI, 1.240–1.400), cerebrovascular accident (CVA) (OR 1.379; 95% CI, 1.333–1.425), chronic liver disease (CLD) (OR 2.188; 95% CI, 1.802–2.489), diabetes mellitus (DM) (OR, 1.160; 95% CI, 1.122–1.200), and age >81.50 years (OR 2.654; 95% CI, 2.569–2.742). Conclusions: Our study suggested that a hemiarthroplasty is the most common treatment modality for FNF followed by osteosynthesis (25.2%) and THA (7.5%) in Turkey. Revision rates after THA for FNF are concerning. The 1-year mortality rates are highest after HA, followed by osteosynthesis and THA. Male sex, cemented fixation, CVA, CLD, liver failure, DM, and age >81.50 are the independent predictive factors for postoperative 1-year mortality in this specific group of patients.