Diabetes mellitus (DM) is a major global health problem, and its incidence is growing. Depending on this increase, the number of diabetes-related complications will also rise. This study aimed to determine the risk factors associated with major and minor amputations resulting from diabetes. Patients diagnosed with diabetic foot complications (n = 371) and hospitalized between January 2019 and March 2020 were retrospectively evaluated using information obtained from the database of Diabetic Foot Wound Clinic. Examination of the data identified 165 patients for inclusion in the study, who were stratified into major amputation (group 1, n = 32), minor amputation (group 2, n = 66) and non-amputation (group 3, n = 67) groups. Of the 32 patients who underwent major amputations, 84% had a below-knee amputation, 13% had an above-knee amputation and 3% had knee disarticulation. At the same time, 73% of 66 patients who underwent minor amputation had a single-finger amputation, 17% had a multiple-finger amputation, 8% had a transmetatarsal amputation, and 2% had Lisfranc amputation. Laboratory results showed high acute phase protein and low albumin (ALB) levels in patients from group 1 (p < 0.05). Although Staphylococcus aureus was found to be the most common infectious agent, Gram-negative pathogens were dominant (p < 0.05). Also, there was a significant cost difference between the groups (p < 0.05). Furthermore, those aged over 65 had a high Wagner score, high Charlson Comorbidity Index (CCI), long diabetic foot ulcer (DFU) duration, and high white blood cell (WBC) count, all of which were risk factors for major amputation (p < 0.05). This study demonstrated an increased Wagner staging and incidence of peripheral neuropathy (PN) and peripheral arterial disease (PAD) in major amputation patients. In addition, the rate of distal vessel involvement was high in major amputation patients, with elevated acute phase proteins and low ALB levels crucial in laboratory findings.

Background and Objectives: This study aimed to evaluate the factors influencing early postoperative mortality in patients undergoing cementless hemiarthroplasty for proximal femoral fractures. Materials and Methods: The medical records of 227 patients treated between January 2019 and December 2020 were retrospectively reviewed. Patients were divided into two groups: survivors (Group 1, n = 160) and non-survivors (Group 2, n = 67). The variables assessed included demographic data, neutrophil-to-lymphocyte ratio, surgical duration, hospital stay, American Society of Anesthesiologists (ASA) score, cardiac ejection fraction (EF), Charlson Comorbidity Index (CCI), osteoporosis status, and hemoglobin and albumin levels. Clinical evaluation was performed using the Harris Hip Score. Binary logistic regression was used to analyze risk factors; receiver operating characteristic (ROC) analysis was applied to determine cutoff values. Results: The mean follow-up duration was 14.03 ± 10 months. The mean ages were 80 ± 7.68 yr in Group 1 and 83.99 ± 7.42 yr in Group 2. Statistically significant differences were found between groups regarding ASA scores, intensive care unit (ICU) admission rates, and osteoporosis status (p < 0.001). Preoperative and postoperative albumin levels were also significantly different (p < 0.001). The 1-year and 6-month mortality rates were 39.6% and 29.5%, respectively. Univariate analysis identified age, EF, ASA score, preoperative and postoperative albumin levels, CCI, ICU admission, and ICU stay duration as mortality-related factors. Multivariate binary logistic regression analysis revealed that low postoperative albumin levels may have a significant effect on mortality at 1, 3, and 6 months. ROC analysis showed a significant albumin cutoff value of 2.95 g/dL. Conclusions: Higher postoperative albumin levels were inversely associated with early mortality following hemiarthroplasty in elderly patients. Perioperative monitoring of albumin levels may help improve outcomes, particularly in individuals with severe comorbidities.

This retrospective study aimed to compare the effects of hemiarthroplasty and proximal femoral nail on one-year mortality in patients over 65 years of age with femoral intertrochanteric fractures. A total of 307 patients treated for femoral intertrochanteric fracture between January 1, 2019, and December 31, 2021, were evaluated and divided into two groups: hemiarthroplasty (Group 1) and proximal femoral nail (Group 2). Data collected included demographic information, pre- and postoperative hemoglobin and albumin levels, neutrophil-to-lymphocyte ratios, presence of osteoporosis, duration of surgery, length of hospital stay, postoperative intensive care unit requirement, presence of additional trauma, American Society of Anesthesiologists scores, cardiac ejection fraction values, and comorbidities assessed using the Modified Charlson Comorbidity Index. Receiver operating characteristic analysis was used to determine cut-off values for factors significantly affecting mortality. The mean age of the patients was 81.38 ± 8.014 years, with a mean follow-up of 14.48 ± 9.69 months (range = 1–36). The overall one-year mortality rate was 39.1% (n = 120): 41.9% in Group 1 and 32.6% in Group 2. Univariate regression analysis showed that age, sex, American Society of Anesthesiologists scores, ejection fraction, pre- and postoperative albumin levels, Modified Charlson Comorbidity Index, and intensive care unit stay duration significantly affected mortality. Multiple logistic regression identified male sex as a risk factor in Group 1 and intensive care unit admission in Group 2. This study demonstrates that, irrespective of the implant type, patients' existing chronic illnesses and metabolic conditions must be carefully assessed.

This study compared the impact of 2 antirotational implants on cutout risk and mid-term clinical outcomes in elderly patients with intertrochanteric femur fractures. Overall, 107 patients (mean age, 80.10 years) who underwent intramedullary nailing for intertrochanteric femoral fractures between April 2018 and December 2020 were included in this study. Patients were divided into 2 groups: those treated with Antirotator Proximal Femoral Nail (A-PFN; group A) and those treated with Interclaw Proximal Femoral Nail Antirotation (group I). This study evaluated lag screw positioning using the Bosworth–Cleveland scale, reduction quality based on Baumgartner’s criteria, tip-apex distance (TAD) values, cutoff values for TAD determined by receiver operating characteristic analysis, time from trauma to surgery, complications, and Harris Hip Score at the final follow-up. The mean follow-up durations were 18.4 ± 8.8 and 16.15 ± 4.72 months in groups A and I, respectively; operative times were 89.38 ± 30.45 and 71.15 ± 27.87 minutes, and time from trauma to surgery was 1.94 ± 1.52 and 1.56 ± 1.12 days, respectively. Nine patients required revision surgery because of implant failure: 2 nail breakages, 6 cutouts, and 1 periprosthetic fracture. No significant difference in complications was observed between the groups ( P = .812). Baumgartner’s criteria showed good results in 86.8% and 89.7% of groups A and I, respectively ( P = .765). The Cleveland scale indicated good outcomes in 79.4% and 69.2% of patients, respectively ( P = .237). Mean TAD was 23.6 ± 1.14 for group A and 25.7 ± 1.19 for group I ( P = .432), with a receiver operating characteristic analysis cutoff of 31.3. Harris Hip Score showed a stronger functional advantage in group I, with 85.5 points versus 77.5 points in group A ( P < .001). While both implants provided effective fixation, proper screw placement and anatomical reduction remained key factors in minimizing cutout risk, regardless of implant design.

Objective: Supracondylar humerus fractures (SHF) occur in the immature skeleton. They account for 60-65% of elbow fractures in children, with the most common age group being 4-7 years. The aim of this study is to compare the radiological and functional outcomes of lateral and cross pinning methods used in the closed surgery of pediatric SHF. Material and Method: This study was conducted on 46 patients with Gartland type 2 and 3 fractures. Group 1 who underwent only lateral pinning, and Group 2 patients who underwent both lateral and medial pinning. Anteroposterior and lateral elbow radiographs were taken postoperatively, at 3 weeks, and at 12 weeks, and radiological angles were measured and recorded. Elbow joint ROM was measured one year after the operation. Results: The mean age of the patients was 6.28 ± 0.44 years. The decrease in Baumann angle was 2.61 ± 0.36° in Group 1 and 2.64 ± 0.38° in Group 2. The decrease in carrying angle was 0.80 ± 0.14° in Group 1 and 1.36 ± 0.26° in Group 2. The increase in The lateral capitellohumeral angle (LCHA) was 5 ± 0.74° in Group 1 and 6.72 ± 0.93° in Group 2. The elbow joint range of motion (ROM) was 132.85 ± 0.76° in Group 1 and 132 ± 1.01° in Group 2. Based on the measurements, there was no statistically significant difference in radiological and clinical outcomes between lateral and cross pin configurations. Conclusion: Considering the possibility of iatrogenic ulnar nerve injury, lateral pinning may be considered a safer method.