Background and Objectives: This retrospective cohort study aimed to evaluate the predictive validity of four frailty indices—Modified Frailty Index-5 (mFI-5), Edmonton Frail Scale (EFS), Clinical Frailty Scale (CFS), and Trauma-Specific Frailty Index (TSFI)—in forecasting postoperative complications and functional outcomes in elderly patients with proximal humerus fractures (PHFs) treated either surgically or conservatively. Materials and Methods: A total of 244 patients aged ≥60 years with PHFs treated at Erzurum Hospital between January 2018 and January 2023 were included. Patients were categorized into surgical (n = 110) and conservative (n = 134) groups. Surgical procedures included open reduction and internal fixation (n = 88), hemiarthroplasty (n = 10), and reverse shoulder arthroplasty (n = 12). Frailty was retrospectively assessed using mFI-5, EFS, CFS, and TSFI based on 24-month follow-up data. Outcomes included complications, reoperations, rehospitalizations, and functional results measured by the American Shoulder and Elbow Surgeons (ASES) score. Results: The overall complication rate was 13.1%, with nonunion being the most common. Reoperation and rehospitalization rates were 10.6% and 20%, respectively. The mean ASES score was 71.3 ± 15.2, with 60% of patients achieving good or excellent outcomes. Frailty scores, particularly mFI-5 and EFS, were significantly higher in the conservatively treated group compared to the surgical group (p < 0.01). Across both treatment modalities, patients with higher frailty scores had significantly increased complication rates; however, this effect was more pronounced in the surgical group. Multivariate logistic regression revealed that mFI-5 significantly predicted complications, reoperations, and rehospitalizations (p < 0.001). EFS was associated with reoperation risk (p = 0.018), while CFS and TSFI were not significantly correlated with any of the outcomes. Conclusions: Among the evaluated indices, mFI-5 showed the strongest predictive accuracy for adverse outcomes in elderly PHF patients. Notably, the negative impact of frailty was more evident among surgically treated patients. Routine frailty assessment may facilitate better risk stratification and individualized treatment planning in this population.

Background and Objectives: The objective of this study was to construct and validate a novel, clinically practical risk-stratification score, PEARL (Pelvic and Acetabular Adverse-event Risk Level), integrating established preoperative and intraoperative predictors, to accurately estimate the likelihood of major postoperative complications in patients undergoing open reduction and internal fixation for pelvic and/or acetabular fractures. Materials and Methods: We retrospectively analyzed 200 adult patients treated surgically between January 2019 and January 2024 at two tertiary trauma centers. Demographic, injury-related, and perioperative data were collected. Major complications were defined as postoperative adverse events occurring within 30 days after surgery or during hospitalization, whereas delayed union and nonunion were evaluated as secondary long-term outcomes. Multivariable logistic regression identified independent risk factors, which were weighted to create the PEARL score (range: 0–6). Predictive performance was assessed using ROC (Receiver Operating Characteristic) analysis. We randomly split the sample into a 70% derivation and a 30% validation cohort. A multivariable LASSO-penalized logistic model identified independent predictors, which were weighted to construct the PEARL score. Discrimination (AUC) and calibration (Brier score, calibration curve) were assessed. Results: Major complications occurred in 29% of patients. Four independent predictors were identified: age ≥ 60 years, BMI ≥ 30 kg/m², severe associated injury, and operative time ≥ 180 min. The score showed good discrimination (derivation AUC = 0.82) and acceptable external validation (validation AUC = 0.78), with Brier scores of 0.19 and 0.21, respectively. PEARL demonstrated good discriminative ability, AUC (Area Under the Curve) = 0.82. Complication rates increased across risk strata: low (7.5%), moderate (30%), and high risk (62%). Conclusions: The PEARL score is a simple, reliable tool to stratify the risk of major postoperative complications after pelvic and acetabular fracture surgery. Early identification of high-risk patients may facilitate targeted preventive strategies and improve outcomes. Further multicenter prospective validation is warranted.

Background/Objectives: Femoral head avascular necrosis (FAN) is a serious orthopedic disorder that causes the death of bone tissue as an outcome of occlusion or insufficiency of the vessels supplying blood to the femoral head. It is especially common in middle-aged men. Factors such as alcohol consumption, corticosteroid use, trauma, and systemic diseases have influential roles in the development of FAN, and the ensuing vascular disruptions can also negatively affect the patient’s broader systemic vascular health. Erectile dysfunction (ED) is a condition caused by impairment of the penile blood flow, which reduces quality of life in men and has psychosocial effects. This study examined the potential relationship between FAN and ED in consideration of the similar pathophysiological mechanisms of these conditions. Methods: The research was planned as a retrospective case-control study and conducted between January 2020 and December 2023. FAN was diagnosed based on the Ficat-Arlet classification using plain radiography and magnetic resonance imaging, and staging was performed with expert clinical evaluations. The International Index of Erectile Function (IIEF) scale was administered to evaluate ED. Data from 50 patients with FAN and 50 healthy men were evaluated using appropriate statistical methods including the Student t-test, Shapiro-Wilk test, Kruskal-Wallis test, and Dunn and Spearman correlation analysis. Results: The analysis revealed that an increase in FAN stage was associated with a significant increase in ED severity. The prevalence of ED among FAN patients was significantly higher compared to the control group with the Spearman correlation coefficient obtained for FAN stage and IIEF score (r=-0.631; p=0.001) supporting the significant relationship between these two conditions. There was no significant difference between the groups in age distribution. Conclusions: This study demonstrated that with the progression of FAN, systemic vascular deterioration affects penile blood flow, increasing the severity of ED. This finding highlights the common pathophysiological mechanisms of FAN and ED and reveals the importance of early diagnosis and multidisciplinary treatment approaches. This relationship should be examined in detail with larger samples and prospective designs in future studies.

Background/Objective: Marginal impaction in acetabular posterior wall fractures significantly influences long-term prognosis, yet current assessment methods remain qualitative. This study introduces quantitative volumetric analysis using three-dimensional computed tomography to evaluate the prognostic significance of impaction volume—representing the first volumetric quantification of marginal impaction in the literature. Methods: Twenty-two patients with acetabular posterior wall fractures and marginal impaction treated between May 2021 and October 2023 at a tertiary trauma center were retrospectively analyzed. Preoperative computed tomography scans were processed using 3D Slicer-5.8.1 software to measure impacted fragment volumes and impaction volume-to-acetabular volume ratios. Functional outcomes were assessed using Harris Hip Score (HHS) and Modified Merle d'Aubigné-Postel Score (MMAS) at 6 months and 2 years. Statistical analysis included correlation analysis, receiver operating characteristic curves, and multivariate regression to identify prognostic factors. Results: Mean patient age was 45.3 ± 16.8 years (range 23–74) with mean body mass index of 26.4 ± 3.8 kg/m ² . Mean impaction volume was 1,847.3 ± 1,124.6 mm ³ (range 89–3,842 mm ³ ). Receiver operating characteristic curve analysis identified an exploratory threshold of 2000 mm ³ for predicting poor functional outcomes, with area under the curve 0.91 (95% CI: 0.78–1.00, p < 0.001). Patients with impaction volumes > 2000 mm ³ (n = 8, 36.4%) demonstrated significantly worse functional outcomes at 2 years compared to those with ≤ 2000 mm ³ (HHS: 68.3 ± 10.8 vs 88.5 ± 7.2, p < 0.001; MMAS: 13.4 ± 2.3 vs 17.6 ± 1.2, p < 0.001). Post-traumatic osteoarthritis developed in 9 patients (40.9%), with significantly higher rates in the high-volume group (75.0% vs 21.4%, p = 0.012). Impaction volume showed strong negative correlation with functional scores at 2 years (HHS: r = -0.782, p < 0.001; MMAS: r = -0.758, p < 0.001). The impaction volume-to-acetabular volume ratio averaged 5.12 ± 3.15% and demonstrated similar prognostic value. Conclusions: This study presents the first quantitative volumetric measurement of marginal impaction in acetabular fractures, which may offer improved prognostic discrimination compared to qualitative assessment in this cohort. An exploratory threshold of 2000 mm ³ , derived from receiver operating characteristic analysis, appears to stratify patients into different risk categories in this cohort for poor functional outcomes. This objective measurement tool may enhance surgical decision-making and patient counseling in acetabular fracture management. Future multicenter studies are needed to validate this threshold and establish standardized volumetric protocols.