This retrospective cross-sectional study aimed to evaluate the predictive value of SII (Systemic Immune Inflammation Index) and PNI (Prognostic Nutritional Index) with blood ratios on mortality in diabetic foot patients who underwent below-knee amputation. A total of 231 living (n = 71; 30.7%) and exitus (n = 160; 69.3%) patients were evaluated. The mortality group was divided into 3 groups: 30-day mortality (n = 62; 38.8%), 1-year mortality (n = 62; 38.8%), and over-1-year mortality (n = 36; 22.5%). The hemogram, SII, and PNI parameters of the patients were evaluated. Age, some blood count parameters and SII were significantly higher in the exitus group (P < .05). The lymphocyte, monocyte, eosinophil, albumin, and PNI levels were significantly higher in the living group (P < .05). Mortality was significantly predicted by age (B [regression coefficient] = 0.026, P < .05), NLR (neutrophil lymphocyte ratio) (B = −0.065, P < .05), PNI (B = −0.100, P < .01), and SII (B = 0.00000024, P < .01). The predictive values of CAR (C reactive protein albumin ratio), PNI, and SII were 77.3%, 77.0%, and 76.1%, respectively. For CAR of 30.88 cutoff value, the sensitivity and specificity were 79.4% and 64.8%, respectively. For the PNI 22.0143 cutoff value, the sensitivity and specificity were 66.9% and 5.6%, respectively. For the SII 732249.2481 cutoff value, the sensitivity and specificity were 91.9% and 31.0%, respectively. The predictive value of the PNI was significant for mortality time (B = 0.058; P < .01). The predictive value of PNI for 30-day mortality was significant (AUC (area under curve):0.632; P < .01), whereas its predictive value for 1-year mortality and over-1-year mortality after below-knee amputation was statistically insignificant (P > .05). Both the SII and PNI may be evaluated and used to predict mortality after below-knee amputation. The SII had a significant predictive value for 30-day mortality after below-knee amputation.

Posterior sternoclavicular joint dislocation (PSCJD) is quite a rare condition. Nearly half of the closed reduction attempts fail due to various reasons. In this paper, we present a 25-year-old male patient who was admitted to the emergency department in our hospital after having a motor-vehicle accident. It was decided to do PSCJD after physical and imaging studies. Following necessary preparations, closed reduction was attempted with abduction-traction maneuver under general anesthesia; however, adequate stabilization could not be achieved and redislocation was detected during control. Therefore, joint was stabilized with tension band technique using 6mm polyamide nonabsorbable type suture during open reduction. Painless and complete range of motion in shoulder was achieved at the postoperative 10th week. Posterior sternoclavicular joint dislocation (PSCJD) is quite a rare condition. Nearly half of the closed reduction attempts fail due to various reasons. In this paper, we present a 25-year-old male patient who was admitted to the emergency department in our hospital after having a motor-vehicle accident. It was decided to do PSCJD after physical and imaging studies. Following necessary preparations, closed reduction was attempted with abduction-traction maneuver under general anesthesia; however, adequate stabilization could not be achieved and redislocation was detected during control. Therefore, joint was stabilized with tension band technique using 6mm polyamide nonabsorbable type suture during open reduction. Painless and complete range of motion in shoulder was achieved at the postoperative 10th week.

Bilateral simultaneous intertrochanteric femur fractures are rare and usually occur as a result of major trauma. In this paper, we present a 76-year old male patient from Turkey referred to the emergency service of our hospital with severe pain and poor mobilization in both hips. There was no history of major trauma. The patient was treated with closed proximal femoral nailing in both hips in the same operation period. At last follow-up, 6 months after surgery, the patient was able to walk with the aid of his children and resumed his previous status, after he had completed an intensive rehabilitation program.

Patella fractures represent 1 % of all musculoskeletal system fractures. Fixation of patellar fractures using open reduction and tension band wiring is a commonly used and successful surgical fixation method. A 28-year-old male patient from Turkey presented to our clinic with complaints of palpable foreign bodies under the skin on the dorsolateral side of his right foot. Except for the palpable and moving body of about 6 cm length under the skin in his foot, he had no functional complaints. On X-ray, a Kirschner wire was visible in front of the lateral malleolus on the dorsolateral side of his right foot. In addition, there was a cerclage wire from the tension band fixation of his patella in the ipsilateral knee. The Kirschner wire was removed surgically. Despite the use of different fixation materials for the surgical treatment of patellar fractures, tension band wiring is still a commonly used technique. We recommend that after fixation of a patellar fracture using the tension band wiring technique, the ends of the Kirschner wires be bent and the wires then removed in the early phase after patellar union to prevent Kirschner wire migration.

The present retrospective study aimed to investigate the value of blood parameters in predicting mortality in patients with below‑knee amputation (BKA). A total of 178 patients with BKA were included in the present study. The patients were divided into two groups, namely the exitus group (n=136; 76.4%) and the survivors group (n=42; 23.6%). Patients in the exitus group were further divided into three subgroups: i) Those who experienced mortality in 12 months after surgery (n=33; 24.3%). Binary logistic regression and a generalized linear model were used for relational analysis, and a receiver operator characteristic curve was used for diagnostic tests. It was found that the parameters of age (B=0.061; P=0.01), eosinophil‑to‑lymphocyte ratio (ELR) (B=‑2.861; P<0.05), C‑reactive protein (CRP)/albumin ratio (B=0.027; P<0.01) and mean platelet volume (MPV)/lymphocyte ratio (B=0.310; P<0.01) had a significant effect on mortality at the multivariate level. Moreover, regression coefficients showed that the effect of age, CRP/albumin and MPV/lymphocyte ratios on mortality were positive, whereas the effect of the ELR was negative. The mortality predictive values of age [area under the curve (AUC)=0.681; P=0.01], ELR (AUC=0.630; P=0.01), CRP/albumin ratio (AUC=0.746; P=0.01) and MPV/lymphocyte ratio (AUC=0.676; P<0.01) were also found to be statistically significant. For the 27.51 CRP/albumin cut‑off value, the sensitivity was found to be 80.1%, whereas the specificity was 54.8%. For the 36.93 CRP/albumin cut‑off value, the sensitivity was 71.3%, and the specificity was 73.8%. Furthermore, MPV (B=‑0.37; P<0.01) and hemoglobin/red‑blood‑cell distribution width (RDW) ratio (B=5.20; P<0.01) were found to have a significant effect on the time to death at the multivariate level. The parameters MPV (AUC=0.648; P<0.01) and hemoglobin/RDW (AUC=0.673; P=0.01) had predictive value in terms of the time to death. The predictive value for MPV was found to be 64.8%, whereas that for the hemoglobin/RDW ratio was 67.3%. For the 0.54 cut‑off value for hemoglobin/RDW, the sensitivity was 74.5%, and the specificity was 11.1%. By contrast, for the 0.84 cut‑off value for the hemoglobin/RDW ratio, the sensitivity was 10.9% and the specificity was 81.5%. In conclusion, the CRP/albumin ratio was identified as a significant mortality parameter, whereas the hemoglobin/RDW ratio was a significant time to death predictor, according to the results of the present analysis. These results may guide clinical practices and further research in terms of predicting mortality in patients with BKA.