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Aim: This study aimed to compare the surgical stress and immunoinflammatory response caused by proximal femoral nail (PFN) and hemiarthroplasty (HA) in patients with unstable intertrochanteric fractures. Materials and Methods: We retrospectively evaluated 344 patients who had undergone surgery for intertrochanteric fractures. Inclusion criteria were defined as being between the ages of 65 and 80, having an ASA score of 3, and the time between fracture formation and surgery being less than 72 hours. PFN was performed in 42 of the patients whereas HA was performed in 40 patients. In the two groups, data such as age, gender, pre-operative waiting and operation times, length of hospital stay, change in hemoglobin levels, and erythrocyte suspension (ES) need were recorded. Venous blood samples were collected from all the patients at the first admission to the emergency department after fracture, 6 hours after the operation, and 3 days after the operation. neutrophil-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII) were compared between the two procedures at three different time points. Results: The age, gender distribution, and preoperative wait duration did not differ significantly (p>0.05) between the two groups. The operation duration, hospitalization duration, and number of ES use were significantly higher (p<0.05) in the HA group than in the PFN group. In both groups, NLR and SII values increased significantly (p<0.05) between the day 0 and the 3rd postoperative day. The postoperative day 0 NLR and SII values in the HA group were significantly higher than those in the PFN group (p<0.05). Conclusion: We conclude that the PFN procedure causes less surgical stress than HA; therefore, it is a safer procedure. [ABSTRACT FROM AUTHOR]

Objective: To compare the functional results and complications of open reduction-internal fixation and hemiarthroplasty performed in Neer three-part and four-part proximal humerus fractures., Methods: The retrospective study was conducted at the Istanbul Training and Research Hospital, Turkey, and comprised data of patients who were diagnosed with three-part or four-part fracture of the proximal humerus and underwent surgical procedure between January 2008 and April 2013. Those who had undergone open reduction-internal fixation using anatomical locking plates were placed in group A, and those who had undergone hemiarthroplasty were in group B. Constant-Murley shoulder outcome, University of California at Los Angeles shoulder and visual analogue scale scores were compared between the two groups. The degrees of forward flexion and abduction of the glenohumeral joint were recorded. Complications in both the groups were recorded. Data was analysed using SPSS 15.\., Results: Of the 48 patients, 30(62.5%) were in group A; 16(53.3%) males and 14(46.7%) females, with an overall mean age of 60.0±9.4 years. The remaining 18(37.5%) were in group B; 7(39%) males and 11(61%) females, with an overall mean age of 67.3±10.1 years. The mean follow-up period was 18.7±16.4 months. The mean Constant-Murley and University of California at Los Angeles shoulder scores were not significantly different between the two groups (p>0.05). The mean visual analogue scale score was significantly higher in group A compared to group B (p=0.021). In group A, heterotropic ossification was observed in 1(3.4%) patient, avascular necrosis in 3(10%), screw penetration without avascular necrosis in 4(13.2%), and non-union in 1(3.4%), while in group B, shoulder subluxation was noted in 2(11.1%) patients and malunion of the greater tubercle in 6(33.3%)., Conclusion: Although statistically non-significant, higher functional scores, forward flexion and abduction degrees were observed in patients who had undergone open reduction-internal fixation, while significantly lower visual analogue scale scores were recorded in the hemiarthroplasty group.

Aim: To examine the morphological structure of anterior lumbar spinal region., Material and Methods: Fifteen fresh human cadavers were studied in our forensic medicine institution. Within the first 24 hours after death, cadavers were subject to a routine autopsy, by which the intestines were removed and the structures adjacent to the lumbar arteries (LAs) were examined. The following characteristics of the LA were examined and recorded: diameter, number of LA, intervertebral disc, and vertebral corpus relationship, and LA anatomical variations., Results: In 14 of the 15 cadavers (93.3%), the first four LAs originated from the abdominal aorta. In one (6.7%) cadaver, the fourth LA originated from the right aortic trunk together with the median sacral artery (MSA), and this was observed only in the right side. In one cadaver, the first LAs emerged as a common trunk. Twelve cadavers did not have a fifth LA. In one cadaver (6.7%), the fifth LAs emerged as in a pair, distally from the origin of the MSA. Two cadavers (13.3%) had fifth LAs that emerged from the common trunk with the MSA and this occurred only on the right side. LAs which emerged from the right side of the abdominal aorta passed under the inferior vena cava. Of the first four LA, the third LA had the largest vessel diameter, and the first LA had the narrowest vessel diameter. Fifth LAs had one of the narrowest vessel diameters of all LAs., Conclusion: We consider that anatomical study of LAs using fresh cadavers can be useful to ensure safer anterior lumbar spinal surgeries.