Traumatology Clinic Research Articles

Laboratory possibilities of prognosis of local complications in hip replacement

BACKGROUND: Endoprosthetics of large joints is a frequently performed operation in traumatology practice. The progression of local infectious sequela among postoperative patients is of major socio-economic importance since more than 30% of cases of inflammatory postoperative reactions are complicated by sepsis. In recent years, new criteria have been sought to assess the risks of infection in the field of surgical intervention, and prognostic scales have also been developed. AIM: The aim of the study was to evaluate the prognostic value of coagulological, biochemical and hematological indicators of the risk of hemorrhagic complications in patients after hip replacement. MATERIALS AND METHODS: The study included 85 patients who were in the clinic of Traumatology and Orthopedics of the I.I. Mechnikov for planned hip replacement. The average age of the patients was 64 ± 10 years. There were 46 women (54%), 39 men (46%). All patients underwent clinical and laboratory examination before surgery, the day after surgery and before discharge. All patients received rivaroxaban (10 mg 1 time/day) after surgery for the prevention of venous thromboembolic complications (46 patients) or apixaban (2.5 mg 2 times/day) (39 patients) during the entire period of stay in the clinic. Retrospectively, depending on the occurrence of complications, the patients were divided into 2 groups: group 1 — 78 patients (42 women and 36 men), whose postoperative period passed without complications, and group 2 — 7 patients (4 women and 3 men), who had hemorrhagic cases. Screening coagulogram (International Normalized Ratio, Activated partial thromboplastin time, fibrinogen) was performed on the STA Compact analyzer (Stago, France), biochemical parameters (alanine aminotransferase, aspartate aminotransferase, creatinine, total calcium, ionized calcium, serum iron, C-reactive protein) were determined on the COBAS Integra 400plus analyzer, hematological parameters on the DxH800 analyzer (Beckman Coulter, USA). RESULTS: A retrospective analysis revealed that a decrease in serum iron in male patients before surgery is a marker of the prognosis of hemorrhagic complications. Prognostic significant laboratory indicators of the development of hemorrhagic complications in patients in the early period after hip replacement include an increase in fibrinogen and C-reactive protein; a decrease in serum iron. During the recovery period, the concentration of C-reactive protein and the relative number of monocytes are the most significant for assessing the risk of complications. CONCLUSIONS: Among the laboratory indicators in the structure of the weight coefficients of the prognosis of complications in patients undergoing hip replacement, it is necessary to evaluate the concentration of serum iron before surgery, especially in men, in the early postoperative period — C-reactive protein, fibrinogen and serum iron and at discharge — C-reactive protein and the number of monocytes as additional criteria for the risk of complications.

Surgical results in cases of osteoid osteoma: a single-center retrospective study

Aims: This study aims to evaluate the clinical, radiological, and histological findings of patients who were treated for osteoid osteoma and discusses the diagnostic stages and surgical results of patients treated for osteoid osteoma. Methods: A retrospective examination was made of 38 patients who were treated in the Orthopedics and Traumatology Clinic of the 3rd Step University Hospital and diagnosed with osteoid osteoma between January 2010 and January 2023. The patients' demographic data and clinical, radiological, and histopathological evaluations were recorded. Results: In the surgical treatment of the 38 patients in this study, the nidus was excised with the en-bloc resection method or burr-down-assisted intralesional curettage. In the follow-up examination, a patient had a superficial wound site infection on the 14th day postoperatively, and daily dressings and antibiotic treatment were recommended. A significant decrease in pain was observed in 35 patients at the end of the month. In 2 patients, the pain had not recovered at the end of 6 months follow-up. After the second operation, all patients experienced significant relief from pain. Conclusion: Osteoid osteoma is a benign osteoblastic tumor primarily affecting young adults. Despite its benign nature, it often presents with localized nocturnal pain that is relieved by anti-inflammatory drugs. Treatment must be the complete removal of the nidus. Treatment options are evaluated according to the anatomical localization of the lesion.

Can a cementless partial hip prosthesis be preferred in patients with hip fractures when the Spotorno criterion is greater than 5?

Aims: Partial hip arthroplasty is preferred in elderly patients with low activity levels, numerous comorbidities, and limited mobility for hip fractures. To decide whether to use cement in femoral stem implantation, scoring systems such as Spotorno, Dorr, and Canale Flare Indices are used. Generally, cemented application is frequently for patients with over 5 points according to Spotorno criteria. In this study, our aim is to present the outcomes of patients who had a score of 5 or more according to the Spotorno criteria and required cemented prostheses but instead received cementless partial hip prostheses. Methods: Patients who underwent partial hip arthroplasty due to post-traumatic femoral neck fractures in our hospital’s orthopedics and traumatology clinic between 2017 and 2021 were retrospectively evaluated. To calculate the total score according to the Spotorno criteria, which evaluate age, sex, singh index and morphological cortical index, the radiographs of the patients included in the study were assessed, and the Singh index and morphological cortical index (MCI) were calculated.Periprosthetic fractures, prosthesis dislocations, heterotopic ossification, femoral loosening and mortality had been recorded. A total of 192 patients over the age of 70 with ASA III and ASA IV who underwent cementless partial hip arthroplasty were included in the study. Among these patients, 126 were female (% 5.7) and 66 were male (%34.3). Mean follow up was 5.8 years (0-7 years). Results: According to the Spotorno criteria, the total score for all patients was greater than 6. Periprosthetic fractures were detected in % 3.1. Heterotopic ossification was observed in %9.3. In the postoperative 1st month, mortality was observed in %5. Conclusion: Cementless hip arthroplasty in elderly patients with a Spotorno score of 5 or higher can be as effective and applicable as cemented hip arthroplasty. Although the literature generally recommends cemented hip prostheses for such patients, cementless partial hip arthroplasty can be a viable option if standard latest-generation cementing systems are not available.

Changing trends in injury patterns of undocumented migrants along the Hungarian–Serbian border from 2018 to 2022

ObjectiveThe Traumatology Clinic of the University of Szeged is a level one Trauma center situated near the Hungarian - Serbian border, where a 4 m tall fence constructed in 2018 serves as a barricade leading to numerous trauma cases. The objective of this study is to characterize the epidemiology of injuries, challenges, and recent trends whilst treating these undocumented migrants in Hungary. Materials and methodsA national retrospective mono-centrical study was performed, examining 982 patients who were admitted to the emergency trauma center in the University of Szeged between January 2018 and December 2022, using data from our electronic administrative system (eMedSol). Factors such as basic epidemiology, country of origin, fractures- according to the AO classification- and its respective treatments, mechanism of injury, duration of stay, and costs were assessed to set as a basis for prediction using a regression model. ResultsA total of 982 patients from 2018 to 2022 were included in the study. Patterns of injury included calcaneal fractures in 2018 and 2019 whereas in 2021 and 2022 along with the exponential increase in patient number, bilateral calcaneal fractures, open and multi-fragmentary tibial fractures were also observed. Additionally, seasonal variations, favoring the months of September through November were observed. Treatment cost ratios, especially surgeries, have also been consistent with the pattern of proximalizing injuries; more proximal surgeries indicate higher surgical costs which is evidently visible in the significantly higher cost ratio dedicated to surgery in 2022. ConclusionWhile migration seems to be a global problem affecting governments and citizens alike, rarely do we understand the direct consequences of illegal migration affecting healthcare services. Hungary in particular created a 4 m tall wall between Serbia in 2019 with means of preventing illegal migration, which in turn led to gradual and later an exponential increase in the number of injured patients particularly in the years 2021 and 2022. Undocumented migrant cases have increased exponentially between 2018 and 2022, with certain patterns seen not only in the injury types but also in seasonal variations and cost expectations. Injuries have been showing a trend of proximalization and have been of more serious quality, including bilateral and/or open injuries. Revisions after surgery were virtually impossible due to the discharging of patients back to border control after their definitive treatment. The need for adequate quality surgical care, manpower and financial aid should be considered.

The Effect of Video-Assisted Education on Knee Function and Quality of Life after Total Knee Replacement: A Randomized Controlled Trial

Objective: This study aims to investigate the effect of video-assisted patient education (VPE) on knee functions, quality of life (QoL) and decrease complications in total knee replacement (TKR) patients. Methods: This study is designed as a prospective, parallel, two-arm, randomized clinical trial. It included 44 patients who underwent elective TKR at an orthopedics and traumatology clinic. The VPE group received VPE including early postoperative care for TKR, activities of daily living, and gradual exercise program in addition to the existing routine care at the clinic. The control group received only routine care. The results were collected with Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Short Form-36 (SF-36) scores measured at baseline, 1st and 3rd months after TKR. Results: The mean scores of the VPE group on the pain, stiffness, and physical function of the WOMAC were significantly lower in 3rd month after TKR than the control group. The VPE group had significantly higher scores than the control group on SF-36 of all subcategories except pain, emotional role, and mental health in 3rd month after TKR. Conclusion: The VPE can improve knee function and QoL in TKR patients. Nurses can use the VPE method in patients to improve knee functions and QoL after TKR.

Enhancing Outcomes in Prosthetic Joint Infections: The Significance of the Periprosthetic Joint Infection Tumor, Node, and Metastasis (PJI-TNM) Classification and Biodegradable Antibiotic Beads.

Periprosthetic joint infections (PJIs) that occur after hip and knee arthroplasty have a major influence on patient outcomes and healthcare expenses. This study assesses the effectiveness of the PJI tumor, node, and metastasis (PJI-TNM) categorization system and the latest developments in local antibiotic delivery methods for the treatment of PJIs. The study involved a retrospective analysis of 23 patients who received treatment for septic hip or knee prostheses at the SUUB Orthopedics and Traumatology Clinic between January 1, 2022, and February 10, 2024. Approval was gained following ethical considerations. Patients were categorized using the PJI-TNM system, and their therapy was customized based on the severity of the infection. The surgical procedures involved either one-stage or two-stage revisions, utilizing vancomycin and gentamicin antibiotic-loaded calcium sulfate beads to administer antibiotics locally. Data pertaining to demographics, clinical characteristics, and microbiology were gathered and examined. The study comprised 14 male and 9 female patients, with an average age of 68 years. The presence of chronic infections was mostly seen, indicating the development of mature biofilm. Prevalent coexisting medical conditions included diabetes, obesity, and heart failure. The duration of infection control measures was, on average, six months, and 65% of patients reported experiencing enhanced mobility. Acute infections with positive antibiotic responses underwent one-stage modifications. For the majority of patients, a treatment approach involving two-stage modifications, which includes the use of antibiotic-loaded spacers followed by the installation of a prosthesis, proved to be beneficial. The PJI-TNM classification system improves the management of PJI by offering a systematic method for customized therapy. Calcium sulfate beads, which are biodegradable carriers for antibiotics, provide notable advantages, especially for individuals with severe comorbidities. Continuous progress in diagnostic techniques and localized administration of antibiotics is essential for enhancing the therapy of PJI and improving patient outcomes.

Retrospect?ve compar?son of cl?n?cal and rad?olog?cal results of conservat?ve and lock?ng anatom?cal plates for neer type 2 and type 3 prox?mal humerus fractures ?n pat?ents over 40 years of age

Proximal humerus fractures are one of the most common fractures in adults. Its incidence is increasing day by day with the increase in life expectancy in society. It was aimed to compare the radiological and functional results of patients over the age of 40 who were treated with conservative and anatomical locking plate (Philos) in our clinic due to Neer type 2 and type 3 proximal fractures. 82 patients who came to Bursa Uludağ University Hospital Orthopedics and Traumatology Clinic and Polyclinic with the diagnosis of Neer type 2 and type 3 proximal humerus fractures between January 2010 and December 2020, whose treatment was planned and completed, and who came for periodic control after discharge, were included in the study. For this purpose, X-ray radiographs, surgery notes and electronic file records in the PACS system were used. The functional results of the patients were evaluated according to the physical examinations at their last follow-up and Constant, ASES and DASH shoulder scoring. There was no significant difference in functional and radiological results between patients treated with conservative treatment and plate. In the measurements made at the last follow-up, the average head-neck angle was 136.2 (115-165) in the conservative group and 134.4 (113-165) in the surgical group. According to the Constant-Murley scoring in the evaluation made at the last follow-up of the patients, the median value out of a total of 100 points was 65.9 (10-98) in the conservative group and 73.9 (35-98) in the surgical group. ASES score is calculated out of a total of 100 points. The median value was 63.3(5-100) in the conservative group and 68.3(23.3-95) in the surgical group. DASH score is calculated from 0 at best to 100 at worst. The median value was 33.3(0-97.5) in the conservative group and 25(4.2-71.7) in the surgical group. In proximal humerus fractures, the fracture type and morphology should first be well defined and classified. When planning the treatment of patients, decisions should not only be made based on the type of fracture, but the treatment plan should also be taken into account by taking into account the patient's functional expectations and comorbidities.

Morphological features of the synovial membrane in patients with osteoarthritis after knee arthroplasty

BACKGROUND: Inflammation of the synovial membrane is a common manifestation in osteoarthritis which plays a role in complex pathophysiology of osteoarthritis. Synovitis leads to complications during knee replacement. AIM: To give clinical and morphological characteristics of the knee joint condition by histological assessment of the synovial membrane. MATERIALS AND METHODS: In the clinic of traumatology and orthopedics of North-Western State Medical University named after I.I. Mechnikov in 2022, 187 total knee arthroplasty operations were performed in patients with osteoarthritis. For morphological study of the synovial membrane of the knee joint biopsy specimens were taken from 30 patients (19 women and 11 men) by randomized sampling method. The age of patients: from 40 to 76 years, the average age was 59,3 ± 6,7 years. Immunohistochemical reactions were performed to characterize the cellular composition of the inflammatory infiltrate; antibodies to CD68, CD3, CD20, CD138, Ki-67 were used. Morphometry was performed at ×400 magnification. RESULTS: Only 48 (25.7%) patients had at least one course of inpatient conservative or minimally invasive surgical treatment for osteoarthritis of the knee joint before total knee arthroplasty. 18 (9.6%) patients had intraoperative and postoperative complications. Among 30 morphological studies conducted, 3 (10%) patients had verified stage I osteoarthritis of the knee joint, 8 (26.7%) were diagnosed with stage II osteoarthritis, and 19 (63.3%) — stage III osteoarthritis. Significant correlation was obtained between cells stained with antibodies to CD3 and CD20 (r = 0.69; p 0.05), CD68 and CD138 (r = 0.66; p 0.05). Cluster analysis identified three groups of patients with severe (10%), moderate (30%) and weak/absent infiltration (60%). CONCLUSIONS: To correct the treatment strategy for patients with osteoarthritis of the knee joint, it is advisable to strengthen the role of arthroscopic methods in the diagnostic and treatment processes.

Cost analysis of total knee arthroplasty surgeries in Turkey.

While working with increasing costs, hospital enterprises try to develop strategies to provide high quality services. In this study, we intended to perform the cost analysis of total knee arthroplasty. A total of 503 patients who were treated with total knee arthroplasty surgery due to gonarthrosis at Nevşehir State Hospital Orthopedics and Traumatology clinic were included in the study. Procedures performed while the patient is in hospital were analyzed by dividing them into the costs of the implant applied to the patient, surgical procedure, medications used, blood and blood products transfusion, medical tests, anesthesia procedure, bed fee and other applied procedures. The mean total cost was 7560.2 Turkish Lira (TL). The mean cost of the implant applied to the patient was 4847.7 TL, that of surgical procedure was 1800 TL, medications used 371.1 TL, blood and blood products transfusion 38.7 TL, medical tests 38.3 TL, anesthesia procedures 142.7 TL, bed fee 195.2 TL and other applied procedures 122.9 TL. In the cost analyses made in this study, it is observed that the share of implant, surgical procedure and anesthesia costs within the total cost is approximately 90%. It is not possible to cut back on the producedures in this 90% part and to modify them. To reduce the total cost, it seems most reasonable to focus on the costs of blood and blood products transfusion, medical tests, medications used and bed fees.

Comparison of clinical results of flattapered and rectangular stems in partial hip replacement based on proximal femur fracture

Aim: Hemiarthroplasty is commonly used in proximal femur fractures to provide early mobilization and weight bearing to the patient. Cemented and cementless femoral stems are commonly used in this procedure. Cementless prostheses have many advantages and disadvantages, and their relevance to stem design is controversial. This study aimed to compare flat-tapered and rectangular femoral stems in hemiarthroplasty. Methods: The study population consisted of a third-level hospital’s archive orthopedics and traumatology clinic. Our study was retrospective. A total of 176 patients who underwent cementless hemiarthroplasty in proximal femoral fractures between January 2017 and January 2022 were included in the study. Within these protocols, 64 patients underwent hemiarthroplasty using a flat-tapered stem (Group 1), and 58 patients underwent hemiarthroplasty using a rectangular stem (Group 2). At the last follow-up of the patients, the Harris hip score, Visual Analogue Scale, and early and long-term complications were evaluated. Results: No significant differences among the patients were observed regarding Harris hip scores and Visual Analogue Scale values. The study groups were analyzed in terms of developing complications. Similar results were found in both groups regarding periprosthetic femur fractures. Conclusion: Our study found no significant difference between flat-tapered and rectangular stems in terms of clinical outcomes and periprosthetic femur fracture in cases of cementless hemiarthroplasty. As a result, rectangular stems can be safely preferred in hemiarthroplasty.

Intramedullary stabilization of dislocated clavicle fractures with a compression rod

Despite the favorable prognosis of conservative treatment for clavicle fractures, unsatisfactory consequences reach 10–30 % cases. Surgical methods of treatment for dislocated clavicle fractures, such as osteosynthesis with a plate or an elastic titanium rod, are mostly used in practice. The disadvantage of the latter is the possible migration of the implant with perforation of the skin. The purpose was to study the effectiveness of an intramedullary rod, improved by us, for osteosynthesis of dislocated clavicle fractures type OTA 15A and OTA 15B according to the AO/ASIF classification. The essence of the improvement was the possibility of closed minimally invasive intramedullary osteosynthesis of the clavicle body, with a simplified technique of the surgical intervention itself, prevention of implant migration. The latter was achieved by the fact that one of the ends of the rod had a drill, which eliminated the need for predrilling the medullary cavity of the clavicle to insert the rod, and its opposite end had a thread onto which a nut is screwed to achieve compression between the clavicular fragments. Forty-two patients with closed dislocated clavicle fractures were under supervision in the clinic of traumatology and orthopedics of Kyiv City Clinical Hospital 6. They underwent intramedullary osteosynthesis for clavicle fractures with an improved compressing rod (closed in 28 cases, open in 14) under regional anesthesia. In dyna-mics of the postoperative period, a clinical and radiological examination was performed, the severity of the pain syndrome and the function of the upper limb were assessed according to the visual analog scale (VAS), Disability of Arm, Shoulder and Hand (DASH). As shown by the results of X-ray examinations, the average period of clavicle fracture union was 10.1 ± 1.4 weeks (range 8–12 weeks). During the observation of the patients, favorable dynamics on the VAS and DASH were noted; by the end of the study (12 months after the operation), the functional capabilities of the upper limb on the DASH corresponded to 1.54 ± 0.84 points, VAS score was 9.60 ± 2.11 points. The improved construction of the intramedullary rod for osteosynthesis of dislocated clavicle fractures of the OTA 15A and OTA 15B type can be recommended for use in practice, as it has demonstrated favorable clinical, radiological, and functional outcomes.

Determination of the effect of preoperative knee joint function on postoperative quality of life in patients with total knee arthroplasty.

Primary total knee arthroplasty (TKA) is one of the most successful procedures for end-stage knee osteoarthritis. To determine the effect of preoperative knee joint function on postoperative quality of life in patients undergoing primaryTKA. This descriptive cross-sectional study was conducted with a total of 208 patients in the orthopedics and traumatology clinic. Data were gathered with a personal information form, the Oxford Knee Score (OKS), and the EQ-5D-5L Quality Of Life Scale in the preoperative period,at postoperative 6th week, and at postoperative 3rd month. The data were analyzed using descriptive statistics, one-way analysis of variance (ANOVA), correlation analysis, and simple linear regression analysis. The mean age of the patients was 65.65 ± 7.01 years. Most patients (86.1%) were women, and 51.4% underwent left TKA. OKS scores indicated poor knee function preoperatively and gradually increased at postoperative 6th week and 3rd month. Preoperative OKS was a significant predictor of postoperative knee joint function and quality of life. This study shows that preoperative knee joint function significantly affects postoperative knee joint function and quality of life. These results demonstrate the importance of the surgery timing and suggest that performing surgery earlier in functional decline may be associated with a better outcome.

The economic impact of two-stage knee arthroplasty revisions: a projection for a specialized health center in Türkiye

Objectives: The increase in the number of arthroplasty surgeries worldwide also leads to an increase in revision surgeries. This study examines the costs of primary and revision arthroplasty treatments in a tertiary university hospital's orthopedics and traumatology clinic. It also explores the impact of revision surgeries on the healthcare system. Methods: Seventy-six patients who had total knee arthroplasty at a university hospital between 01.01.2017 and 30.09.2022 were included in the study. The patients were divided into three groups: primary (n=25), aseptic reasons one-stage revision (n=27), and septic reasons two-stage revisions (n=24). For each patient included in the study, detailed documents regarding medical supplies, anesthesia, operating room, intensive care, consultation, medicine/serum, medical treatment, laboratory, blood and blood products, microbiology, radiology, food, bed, and attendant fees were provided separately by the hospital purchasing and statistics departments. Results: When comparing the costs of primary, one-stage revision, and two-stage revision surgeries, the average costs were 5689 Turkish Lira (₺), 8294.97 ₺, and 40919.67 ₺, respectively. In patients with septic reasons, the group that underwent two-stage revisions had significantly higher costs than the aseptic group in terms of surgery time, hospital stay duration, medication, treatment, surgery, anesthesia, intensive care, laboratory tests, imaging, blood center services, consultations, visits, meal expenses, and invoiced amount (P<0.001). Conclusion: Preventing and treating periprosthetic infections is costly and challenging. We need more research to develop effective protocols and reduce costs. As the number of patients undergoing knee arthroplasty is expected to rise, healthcare systems must ensure the sustainability of public financial resources, especially in public university hospitals.

Evaluation of musculoskeletal system injuries after the 2023 Kahramanmaraş Turkey earthquakes: Our single-center experience.

This study aimed to retrospectively analyze patients who presented to the orthopedic and traumatology clinic following the 2023 Kahramanmaraş earthquakes. Over a week after the earthquakes, two hundred and sixty patients were consulted at our clinic. Demographic data of the patients, duration of being under the rubble, fracture locations, types of surgeries performed, number of surgical sessions attended by individuals, and early mortality rate within one month were determined. The mean age of the patients was 40.2 ± 22.4 years. One hundred thirty-eight (53.1%) were female, and 122 (46.9%) were male. The average duration of being under the rubble was determined as 27.1 ± 28.0 hours. Sixteen patients died within one month after the earthquake. The one-month mortality rate among patients with orthopedic injuries was 6.15%. Forty-seven fasciotomies were performed in 35 patients, and 22 amputations were performed in 19 patients. The most injured region was the lower extremity (78 cases, 40%). The ratio of external and internal fixation in extremity fractures was 22%. The management of musculoskeletal injuries can be successful with proper triage and treatment plans. Decisions regarding fasciotomy and amputation in patients with crush syndrome following an earthquake should be individualized. Implant sets should be planned accordingly, especially considering the higher occurrence of lower extremity injuries.

Effect of Family Income Level on Pediatric Upper Extremity Fracture Rate

Objective: The aim of the study was to compare the sociodemographic characteristics of children with upper extremity fractures with those of children without upper extremity fractures. Materials and Methods: A total of 161 participants (age:11.24±2.95, female:53, male:108), 100 of whom were admitted to the orthopedics and traumatology clinic in 2022 with upper extremity fractures and 61 without upper extremity fractures, were included in the study. Participants; age, height, weight, mother's education level, mother's age, father's education level, father's age and monthly income of the family were recorded. Fracture and recurrent fracture rates of the participants who were members of a family whose monthly income was below the minimum wage and those who were included in a family with a monthly income above the minimum wage were compared. Results: The age, height and weight of the participants without upper extremity fractures were greater than those with upper extremity fractures (p<0.01). The body mass index of those with upper extremity fractures was lower than those without upper extremity fractures (p=0.001). While the number of upper extremity fractures in the participants who were members of families with a monthly income below the minimum wage was 79 (63.70%), the number of fractures in the participants who were members of families with an income above the minimum wage was 21 (56.80%) (p=0.44). In addition, when those with upper extremity fractures were evaluated independently from those without upper extremity fractures; While the number of recurrent upper extremity fractures was 7 (33.3%) in the participants who grew up in families with an income above the minimum wage, the number of recurrent upper extremity fractures was 11 (13.9%) in the participants who grew up in families with an income above the minimum wage (p= 0.04). Conclusion: Low body mass index may increase the rate of upper extremity fractures in children. For this reason, families should be informed about the possibility of physical development of children at risk for upper extremity fractures. In addition, the rate of recurrent upper extremity fractures is higher in children of families with a relatively high monthly income. Families with relatively high incomes should be made aware of the safety measures to be taken against accidents in their living spaces.

Prostate Cancer Screening Behaviors and Health Beliefs Regarding Prostate Cancer Screening of Individuals Over 50 Years of Age: A Descriptive, Cross-Sectional Study

Purpose: This descriptive cross-sectional study was conducted to assess the prostate cancer screening behaviors and health beliefs related to prostate cancer screening among individuals aged 50 and over. 
 Material and Methods: The study sample consisted of 72 men aged 50 and over receiving treatment at the orthopedics and traumatology clinic of a university hospital. Data were collected using a "Personal Information Form" and the "Prostate Cancer Screening Health Belief Model Scale." 
 Results: The mean age of the participants in the study was 61.59±8.51 years. It was found that 22.2% of the participants had undergone Prostate-Specific Antigen testing, 73.6% had no knowledge about prostate cancer, and 75% had no knowledge about early detection tests for prostate cancer. Furthermore, participants who had knowledge about prostate cancer and early detection, had a family history of prostate cancer, and considered undergoing prostate examination had a higher rate of undergoing Prostate-Specific Antigen testing. Those who had never undergone a prostate examination, had no knowledge about prostate cancer and early detection tests, and did not plan to undergo prostate examination within the next six months had higher scores on the barrier perception scale, while those who had undergone Prostate-Specific Antigen testing and planned to undergo prostate examination within the next six months had higher scores on the health motivation perception scale. 
 Conclusion: The study revealed a low rate of Prostate-Specific Antigen testing for early detection of prostate cancer, and participants' knowledge and health beliefs and perceptions related to prostate cancer and early detection tests were identified as key factors influencing prostate cancer screening behaviors.

PERCEPTION OF NURSING CARE AND SATISFACTION LEVELS OF ORTHOPEDICS AND TRAUMATOLOGY PATIENTS

Introduction: Aging adversely impacts the functioning of the organs of the human body and the musculoskeletal system. Orthopedics and traumatology clinics are a speciality area where services are provided for health issues requiring long-term care and multi-disciplinary teamwork. Consequently, patient–nurse interaction occurs for an extended period. Materials and Metod: This descriptive study aimed to determine the perception of nursing care and satisfaction levels of orthopedics and traumatology patients. The data were collected after face-to-face interviewswith patients who had applied to an orthopedics and traumatology clinic between May 2022 and April 2023 and had undergone surgical procedures. The patient information form, Newcastle Nursing Care Satisfaction Scale, and Patient’s Perception of Nursing Care Scale were used for data collection. Results: The mean age of the study participants was 65.83±15.90 and 47.6% (n=137) of the participants were catagorized as elderly. The mean score on the Newcastle Nursing Care Satisfaction Scale was 85.01±16.85 and on the Patient’s Perception of Nursing Care Scalewas 64.47±13.26. There was a moderate positive significant relationship between the scores on the Newcastle Nursing Care Satisfaction Scaleand Patient’s Perception of Nursing Care Scale (r_s=.391; p<.01). Conclusion: Patients’ satisfaction with nursing care and perception of care were positive. Additionally, as the patients’ satisfaction with nursing care increased, their perception of nursing care also increased. Keywords: Nursing; Perception; Personal Satisfaction; Orthopedics; Patients.

Investigation of hospitalization costs in orthopedics and traumatology clinic

The aim of the study was to analyze inpatient costs in the Orthopedics and Traumatology clinic of a public hospital. The hospitalizations in the Orthopedics and Traumatology clinic of the 525-bed AII group hospital in 2019, 2020 and 2021 were retrospectively evaluated. The study was planned as a cross-sectional descriptive study and data were obtained from the Hospital Management Information System. There were 27,330 inpatients in 2019, 18,604 in 2020 and 21,709 in 2021. The average number of days of hospitalization was 4.07 days in 2019, 2.99 days in 2020 and 2.34 days in 2021. The total annual inpatient cost of Orthopedics and Traumatology service was realized as 3,761,369.20 $ (21,326,963.36 TL) in 2019, 2,061,248.96 $ (14,428,742.72 TL) in 2020 and 1,231,753.09 $ (10,937,967.44 TL) in 2021. The average hospitalization cost of inpatients was 137.63 $ (780.36 TL) in 2019, 110.80 $ (775.60 TL) in 2020 and 56.71 $ (503.58 TL) in 2021. The decrease in total inpatient costs and average cost per patient over the years is a result of the Covid-19 pandemic. In calculating costs for cost control in hospitals, it is important to investigate the reasons for the change in costs over time as well as revealing the current situation. It is recommended to investigate the sources of changes in costs in future research.

Combinations of pulmonary artery valve stenosis with other congenital heart defects in dogs

The paper presents statistical results of identifying combinations of various congenital heart defects in dogs of different breeds diagnosed with pulmonary artery valve stenosis. The study was retrospective, conducted on the basis of the Department of General, Private and Operative Surgery, as well as in the veterinary clinic of neurology, traumatology and intensive care. The total sample amounted to 100 animals. All animals underwent a complete physical examination. The morphofunctional state of the heart was evaluated. Diagnosis was made by echocardiography using Doppler. Each congenital heart defect was evaluated and studied separately, noting its individual features and hemodynamic changes in the combination of several congenital anomalies of heart development. The study was conducted before performing surgical treatment of pulmonary artery valve stenosis by balloon plasty of the pulmonary artery valve. This study included animals with other cardiac anomalies in addition to obstructive right ventricular outflow tract disease. Among 100 dogs examined, the most frequent combined heart defect was Fallot's tetrad. This pathology was singled out separately, as its mechanism of development differs significantly from a simple combination of several anomalies of heart development. It is believed that this is one heart defect consisting of several components. In addition, atrial septal defect, mitral or tricuspid valve dysplasia, open ductus arteriosus, and aortic valve stenosis were found in combination with pulmonary valve stenosis. Combined heart defects were most common in French Bulldog dogs in this study, as this is the most common breed of dog diagnosed with pulmonary valve stenosis.

Evaluation of malnutrition in the orthopedics and traumatology clinic hospitalized patients

Evaluation of malnutrition in the orthopedics and traumatology clinic hospitalized patients