Preoperative Albumin and Postoperative CRP/Albumin Ratio (CARS) are Independent Predictive Factors in Estimating 1-Year Mortality in Patients Operated for Proximal Femoral Metastasis with Endoprosthesis

Background

Proximal femur resection and prosthetic reconstruction are preferred in patients with extensive bone destruction, pathological fractures, tumours resistant to radiation therapy, and patients with more proximal metastatic lesions. There is increasing evidence that the CRP/albumin ratio (CAR) is an independent marker of inflammation in various primary organ cancers and maybe a more accurate prognostic factor. We aimed to evaluate whether preoperative and postoperative CAR values could be a factor in predicting mortality in these patients. We hypothesized that CAR could predict these patients' postoperative 90-day and 1-year mortality.

Methods

The patient's age and gender, primary tumour, number of bone metastases, and presence of visceral metastases were recorded using imaging techniques such as computed tomography and bone scan or positron emission tomography. The following laboratory data were analyzed before and after surgery.

Results

The mean age of the patients was 62.67 ± 14.8; 56.9% were female (n:29), and 43.1% were male (n:22). When the results of the ROC analysis of the parameters in predicting 1-year mortality were examined, and the cut-off value for preoperative albumin was taken as ≤ 3.75, the AUC value was found to be statistically significant as 0.745 (p:0.003). When the cut-off value for postoperative CAR was taken as ≥ 87.32, the AUC value was found to be 0.7 statistically significant (p:0.015).

Conclusion

Length of stay, preoperative albumin and postoperative CAR values can be used as independent predictive values in predicting 1-year mortality in patients undergoing endoprosthesis due to proximal femur metastasis.

Sexual Dysfunction in Women After Tibial Fracture: A Retrospective Comparative Study

BACKGROUND Tibial fractures, common in adults, are often treated with external or internal fixation methods. While effective, external fixation (EF) can lead to sexual dysfunction (SD), especially in young patients. This study aimed to assess SD in women undergoing EF versus internal fixation for tibial fractures. MATERIAL AND METHODS Sexual function and frequency of monthly sexual intercourse (SI) were evaluated using the Female Sexual Function Index (FSFI) before surgery, with the fixator, after at least 6 months following fixator removal in EF group, and after achieving bone union for at least 3 months in the IF group. RESULTS The EF group consisted of 107 (mean age 28.5 years; 19-40 years) and IF group consisted of 106 patients (mean age 32.1 years; 18-40 years). The duration of EF was an average of 4.7 months (range, 2.5-13 months). FSFI scores were significantly lower in the EF group compared to the IF group (9.33 versus 27.3, P<0.001). Also, there was no significant difference between the FSFI scores before EF and after EF was removed (34.22 versus 33.8, P=0.413). FSFI sub-group scores such as desire, arousal, lubrication, and orgasm were significantly lower in the EF group (P<0.001). The monthly average frequency of SI before surgery and after the removal of EF was 10.2 and 9.1, respectively, while this frequency was 2.56 when EF was present (P<0.001). CONCLUSIONS The quality and frequency of SI in women significantly deteriorate and decrease during the period of extremity fixation following tibial diaphyseal fractures treated with EF, but return to normal after removal.

Long-Term Outcomes of Decompression and Grafting in Acute Pathological Proximal Femur Fractures in Children with Unicameral Bone Cysts: A Retrospective Study Utilizing a 120° Fixed-Angle Low-Contact Locking Pediatric Hip Plate

BACKGROUND Unicameral bone cysts (UBCs) are benign tumor-like lesions that are the most common cause of pathological proximal femur fracture in children. This study aimed to present the outcomes of acute, unstable, pathological proximal femur fractures secondary to UBCs in children. MATERIAL AND METHODS We retrospectively reviewed data on 12 patients with a mean age of 9.3 years (7-12 years) who were initially treated with decompression and grafting, followed by stabilization using a 120° fixed-angle low-contact locking pediatric plate (LCLPP). The Musculoskeletal Tumor Society (MSTS) scores, Capanna classification of cyst repair, time to union, collodiaphyseal angle (CDA), and limb length discrepancy (LLD) were evaluated. RESULTS The mean follow-up was 33.1 months (range, 13-96 months). The mean union time was 9.5 weeks (8-14 weeks). The mean time for reparation of the cyst was 6.9 months (range 3-9 months). Four patients had Dormans type IB, while the remaining had type IIB fractures. According to the Capanna classification, repairs in 10 cases were grade I and in 2 cases grade II. At the last follow-up, the mean 120.8° of preoperative CDA was corrected to 140.9° (P<0.001) and there was no difference compared to the healthy side (P=0.214). The mean postoperative MSTS score was 97.1% (29.1 points). Two patients experienced LLD at the affected extremities, while the other 10 patients healed without any complications. CONCLUSIONS Fixation of acute unstable fractures secondary to UBCs with a 120° fixed-angle LCLPP is a reliable and successful option after decompression and grafting of the lesion.

The Preoperative Neutrophil-Lymphocyte Ratio Is an Independent Predictive Factor in Predicting 1-Year Mortality in Amputated Diabetic Foot Patients

In this study, we aimed to evaluate the efficacy of neutrophil/lymphocyte ratio values in preoperative blood tests of patients amputated due to diabetic foot in predicting 1-year mortality. We assumed that the neutrophil/lymphocyte ratio predicted 1-year mortality in these patients. The inclusion criteria were as follows: to be diagnosed with diabetic foot, being >18 years of age, having a confirmed type 1 or type 2 diabetes mellitus diagnosis, stage 3 to 5 Wagner ulcers, and having at least 1 year of follow-up. The patients with acute traumatic injuries observed in less than 1 week, traumatic amputations, and nondiabetic amputations, and those whose data could not be obtained were excluded from the study. After the exclusion, 192 patients were included in the study. Age (p < .001), low preoperative hemoglobin (p = .024), high preoperative neutrophil (p < .001), low preoperative lymphocyte (p = .023), low preoperative albumin (p < .001), high preoperative neutrophil-to-lymphocyte ratio (p < .001), major amputation (p = .002), and were related to 1-year mortality. According to these results: (1) it was observed that a preoperative neutrophil/lymphocyte ratio value over 5.75 increases the risk of death 1.1 times and (2) it was observed that a preoperative albumin value under 2.67 increases the risk of death 5.74 times. In conclusion, the age, preoperative neutrophil/lymphocyte ratio, and albumin values of patients planning to undergo amputation surgery can be independent predictive factors in predicting 1-year mortality.

Neutrophil-lymphocyte and C reactive protein-albumin ratios as predictors of re-surgery in adult native knee septic arthritis

Objectives. Septic arthritis is a medical emergency with a mortality rate of approximately 10%, the knee being the most commonly affected joint (about 50% of cases). The systemic inflammatory response caused by septic arthritis may be affected by the severity of the infection or the success of surgical joint debridement. Materials and Methods. This article was a retrospective study on patients admitted to our hospital (between 2013 and 2020) with septic arthritis of the knee. Patients were diagnosed based on history, examination, blood test results, and knee aspirate fluid. The patient's response to antibiotic therapy was monitored in the outpatient setting using serological markers. Results. Of the 48 patients included in the study, 26 were male, and 22 were female. Based on the ROC analysis, the optimal cutoff value of preoperative NLR was 8.33. The AUC was 0.782 for postoperative NLR level (95% CI,0,626–0.938; p:0.009) and 0.922 for postoperative CAR level (95% CI,0.844–0.999; p <0.001). Postoperative NLR and CAR cutoff values are 15.4 and 115, respectively. Conclusions. Preoperative NLR elevation in septic arthritis may be associated with recurrent surgical debridement postoperatively. In addition, postoperative NLR and CAR values can predict debridement rates in patients after septic arthritis surgery.

Social media use and ethics violations: Nurses' responses to hypothetical cases

AIM

This study aimed to evaluate nurses' ability to evaluate ethical violations to hypothetical case studies involving social media use.

BACKGROUND

Inappropriate use of social media necessitates health institutes, academic institutes, nurses and educators to consider occupational ethical principles while creating a  policy and guide on the usage of social media.

METHOD

The data were collected confidentially from the nurses working at a university hospital in Turkey, using the Personal Information Form and the Ethic Case Form. The study was carried out using descriptive and inferential analysis.

FINDINGS

Analysis of the data showed that the majority of the nurses had received training in ethics, used WhatsApp social media application most often, spent less than an hour a day on social media platforms and used social media to follow daily posts. Analyses of the ethical case evaluations showed that nurses' level of education and ethics training status was influential on their Case 1 evaluations and the length of time they had worked was effective in Case 2 evaluations. When Case 3 evaluations of nurses were analysed according to ethics training, statistically significant differences were found. The analyses of the Case 4 and Case 5 evaluations showed that no statistically significant differences were found according to nurses' descriptive characteristics.

CONCLUSION

The study determined that education level, ethical training status, the source of ethics training and the duration of their work in the profession were effective regarding the case evaluation of the nurses.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Nursing policymakers, educators, administrators and clinicians need to cooperate in the development of ethical awareness and creation of solutions to violations, the preparation of guidelines for social media use.

Infrapatellar Fat Pad Excision during Total Knee Arthroplasty Did Not Alter the Patellar Tendon Length: A 5-Year Follow-Up Study

Partial or total resection of the infrapatellar fat pad (IPFP) helps surgeon improve access to lateral tibial plateau for better placement of the knee prosthesis. We aimed to investigate the effect of IPFP excision on clinical and radiologic outcomes including patellar tendon length (PTL), range of motion, and functional scores after total knee arthroplasty (TKA) at 5-year follow-up. We retrospectively evaluated postoperative first X-rays (day 0) and postoperative final 5-year control views of 228 knees in patients with primary osteoarthritis who underwent TKA between September 2006 and December 2009 in our hospital. Exclusion criteria were patients who had lateral release, patellar resurfacing, septic or aseptic loosening, fracture around the replaced knee, any other prior knee surgery, or any systemic inflammatory disease. IPFP was completely resected in all knees to enhance surgical exposure and patellar mobilization. Radiologic evaluation of PTL was performed in early postoperative and 5-year control X-rays comparatively. The mean early postoperative PTL was 47.4 ± 6 (range: 35-72), the mean final postoperative PTL was 47 ± 6.3 (range: 33-68) (p = 0.1). The average preoperative flexion was 115 ± 11 degrees, whereas it was 111 ± 4 degrees, postoperatively (p = 0.73). Both the clinical and functional outcome scores improved in all patients. IPFP excision during TKA did not alter PTL at 5-year follow-up. A focus on other surgical and/or host-related factors may help clarify contradictory patellar tendon shortening reported in the literature.

Results of minimal invasive coracoclavicular fixation by double button lift-up system in Neer type II distal clavicle fractures

AIM

We aimed to evaluate clinical and functional outcomes of indirect fracture reduction performed by coracoclavicular fixation with minimal invasive double button lift-up system in Neer type IIa unstable fractures of distal clavicle.

MATERIAL AND METHODS

22 patients with Neer type 2 distal clavicle fracture were enrolled in that prospective study. All patients underwent indirect reduction and osteosynthesis performed by coracoclavicular fixation with minimal invasive double button lift-up system. Postoperative follow-up was carried out clinically and radiologically with plain X-rays and utilization of Constant and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (ASES) shoulder scores. Mean follow-up time was 15 months. A standard sling was applied for 2 weeks, postoperatively. Rehabilitation program was started on postoperative day 1.

RESULTS

Mean age was 39 (range: 21-60), 18 of the patients were male. Right dominant extremity was affected in 14 patients. Mean duration of the surgical intervention was 40 min (range: 30-55 min). Mean union time was found to be 14 weeks (range: 7-21 weeks). Mean postoperative ASES and Constant scores were 79.9 (66.9-88.3) and 82.2 (71-100), respectively. The duration of return to normal daily activities were found to be 4.5 months. Any loss of reduction, AC joint arthrosis, and clavicular shortening were not detected in X-rays.

CONCLUSION

This study has demonstrated that indirect osteosynthesis performed by coracoclavicular fixation with double button lift-up system in the treatment of unstable Neer type IIa fractures of the distal clavicle had successful clinical, radiological, and functional outcomes.

An evaluation of meniscus tears in lateral tibial plateau fractures and repair results

BACKGROUND

Soft tissue injuries may co-occur with tibial plateau fractures. These injuries may include medial or lateral ligament ruptures, peroneal nerve lesions, anterior cruciate ligament ruptures, and meniscus tears.

OBJECTIVE

The aim of this study was to investigate the frequency of meniscus tears in lateral tibial plateau fractures and to evaluate the clinical and radiological results of meniscus repairs.

MATERIALS AND METHOD

The study included 19 patients who underwent surgery for a closed lateral tibial plateau fracture. Anteroposterior and lateral radiographs of the knee, followed by magnetic resonance imaging (MRI) examinations, were undertaken for all cases. The clinical and radiological evaluation of the surgical treatment results was performed according to the Rasmussen criteria.

RESULTS

Meniscus lesions were found in 10 (52.6%) patients. Nine meniscus tears were found in patients with type 2 fractures, and one meniscus tear was found in a patient with a type 3 fracture. All of the menisci were separated from the peripheral capsule adhesion point. On the MRI examination during follow-up, all of the repaired lateral menisci were determined to be in their original anatomic location.

CONCLUSION

For successful outcomes in lateral plateau fractures, it is essential to determine whether there is a meniscus tear. In cases with meniscus tears, meniscus repair can be easily performed and should be considered because it has a positive impact on the treatment outcome.

Surgical treatment of the neglected achilles tendon rupture with Hyalonect

BACKGROUND

The purpose of this study was to report the management and outcomes of ten patients with chronic Achilles tendon rupture treated with a turndown gastrocnemius-soleus fascial flap wrapped with a surgical mesh (Hyalonect).

METHODS

Ten men with neglected Achilles tendon rupture were treated with a centrally based turndown gastrocnemius fascial flap wrapped with Hyalonect. Hyalonect is a knitted mesh composed of HYAFF, a benzyl ester of hyaluronic acid. The Achilles tendon ruptures were diagnosed more than 1 month after injury. The mean patient age was 41 years. All of the patients had weakness of active plantarflexion. The mean preoperative American Orthopaedic Foot and Ankle Society score was 64.8.

RESULTS

The functional outcome was excellent. The mean American Orthopaedic Foot and Ankle Society score was 97.8 at the latest follow-up. There were significant differences between the preoperative and postoperative scores. Ankle range of motion was similar in both ankles. Neither rerupture nor major complication, particularly of wound healing, was observed.

CONCLUSIONS

For patients with chronic Achilles tendon rupture with a rupture gap of at least 5 cm, surgical repair using a single turndown fascial flap covered with Hyalonect achieved excellent outcomes.

Effects of the lower extremity external fixators on the sexual life of males

OBJECTIVE

In tibial fractures, the use of an external fixator (EF) may be associated with sexual dysfunction (SD) in sexually active male patients. We aimed to investigate the influence of EF applied for tibial fracture on the sexual life in male patients.

METHODS

We retrospectively evaluated 137 male patients who presented with tibial fractures and underwent surgical intervention with unilateral or circular EF. The patients completed the Brief Sexual Function Inventory (BSFI) form during the interview. We evaluated the incidence of the development of SD and the severity of SD with the use of an EF, and the relation with the type of EF and SD was investigated. The responses were compared with the results of the completed BSFI forms of 119 male patients who were treated with internal fixation (IF) for tibial fractures.

RESULTS

In total, 108 patients (mean age, 42.8 years) treated with EF accepted the invitation and filled the form. The score of those patients were worse compared with that of the patients who were treated with IF (p<0.001). Postoperative sexual functions were the same with the preoperative sexual function in 12 patients (11%). However, the postoperative scores were decreased in 96 (89%) patients, which meant that the sexual functioning was impaired. None of the patients reported persistent SD.

CONCLUSION

EF in the cruris may impair sexual functions in males. The rate of SD was higher in male patients who were treated with EF. Thus, SD might be associated with physical, psychological, and social limitations caused by EF.

Anterograde Headless Cannulated Screw Fixation in the Treatment of Medial Malleolar Fractures: Evaluation of a New Technique and Its Outcomes

OBJECTIVE

To evaluate the functional and radiological outcomes of anterograde headless cannulated screw fixation for medial malleolar fractures.

SUBJECTS AND METHODS

This study included 12 patients (8 males, 4 females; age 27-55 years) with medial malleolar type B fractures according to the Herscovici fracture classification who had undergone anterograde headless cannulated screw fixation surgery between 2012 and 2014. Seven had an isolated medial malleolar fracture and 5 a bimalleolar fracture. All of the bimalleolar fractures were classified as 44-B2 based on the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classification. Postoperatively, bone union was evaluated on direct radiographs at the final follow-up examination. The American Orthopaedic Foot and Ankle Society (AOFAS) scoring system was used for clinical evaluation.

RESULTS

The mean follow-up period was 17.2 ± 5.3 months (range 12-23). Full union was achieved in all fractures. The mean time to union was 3.4 ± 1.5 months (range 2-5). No instability, loss of reduction, non-union or infection was observed in any patient. The mean AOFAS score was 95.0 ± 5.4 (range 87-99). Based on the AOFAS score, 4 patients showed good results and 8 excellent results. The mean time to return to the previous level of activity was 4.0 ± 2.5 months (range 2-5).

CONCLUSION

In this study, anterograde headless cannulated screw fixation yielded good clinical outcome in the surgical treatment of Herscovici type B fractures.

Measurement of the knee joint line in Turkish population

OBJECTIVE

The aim of the present study was to determine the knee joint line level by its distance to the adductor tubercle and the apex of the fibular head in the Turkish population.

METHODS

The study included 117 knees of 108 patients (63 males, 45 females; mean age: 31.3 years, range: 16 to 82 years). Femoral width and the distance from the apex of the fibular head to the joint line as well as the distance from the adductor tubercle to the joint line were measured on anteroposterior radiographs.

RESULTS

Mean femoral width was 87.2 mm. The average distance from the adductor tubercle to the joint line was 47.9 mm and from the fibular head to the joint line was 20.5 mm. A linear correlation was found between the distance from the adductor tubercle to the joint line and femoral width, with a ratio of 0.55. There was no significant correlation between the distance from the fibular head to the joint line and femoral width.

CONCLUSION

There was a linear correlation between the femoral width and the adductor tubercle-joint line distance irrespective of any factors such as age, gender and height. Therefore, the adductor tubercle can be used as a reliable landmark to determine the joint line level for easy evaluation and measurement during surgery.

Successful treatment of bilateral open calcaneal fractures with concomitant lower extremity injuries: A case report

Open calcaneal fractures are high morbidity injuries and the risk of complications depends on the concomitant injuries, on the size and the position of the traumatic wound. A 53-year-old male patient with bilateral open calcaneal fractures and associated concomitant lower extremity injuries such as subtalar dislocation, talonavicular dislocation and open distal tibial metaphyseal fracture was immediately operated by percutaneous Kirschner wire fixation combined with external fixators. He was able to walk with full weight bearing without any assistance at the end of the first postoperative year. Early aggressive debridement and irrigation followed by fixation with percutaneous Kirschner wires and external fixator can supply bony alignment in open comminuted calcaneal fractures associated with concomitant lower extremity injuries and should be considered for the healthy and active patients before primary arthrodesis.