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Background: Minimally invasive percutaneous plate osteosynthesis (MIPO) and intramedullary nailing (IMN) are the two most commonly used methods for distal tibial extra-articular fractures; however, the ideal treatment is still on debate. The aim of this study was to compare MIPO and IMN in the treatment of distal tibial extra-articular fractures in terms of cost analysis according to health insurance records in Turkey., Methods: The data of patients who underwent either MIPO or IMN for the treatment of distal tibial extra-articular fractures between 2013 and 2018 were analyzed in this retrospective study. Patients' clinical data, as well as the overall expenses from the first admission until return to work including hospitalization, and all outpatient controls had been reviewed from the hospital's billing department. The total amount of money paid per month by Turkish National Social Security Institution to the patient until the patient's returns to work were also recorded., Results: 118 consecutive patients (35 female-83 male) with the mean age of 37.2±13.4 were participated to the study. IMN group consisted of 57 patients with a mean age of 36.7±12.8 years, and MIPO group consisted of 61 patients with a mean age of 37.8±13.6 years. No significant differences were observed between study groups in terms patients' age, gender, fracture classification (AO/OTA: Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association), soft-tissue injury (Tscherne classification), presence of type 1 open fracture, and presence of accompanying fibula fracture. There was no statistical difference between two groups in terms of pre-operative hospital stay (p=0.713). However, the mean length of hospital stay was significantly higher in the MIPO group (p=<0.001). The means of number of total outpatient controls, time to union, and return to work were also significantly higher in the MIPO group (p=0.005, p<0.001 and p<0.001, respectively). The mean hospital cost until discharge and the mean total cost until return to work were significantly higher in the MIPO group (p=0.001 and 0.001, respectively). The mean total costs of hospital stay and outpatient controls were also significantly higher in the MIPO group (p=0.001 and 0.004, respectively). The mean implant costs did not significantly differ between groups (p=0.179)., Conclusion: According to the results acquired from the present study, IMN is a better option compared to MIPO for the treatment of extra-articular distal tibial fractures in terms of costs paid by the national health insurance in Turkey.

Introduction: The purpose of this prospective randomised study is to compare in the elderly the functional results of intertrochanteric femur fractures treated either with closed reduction and internal fixation with proximal femoral nailing or cemented hemiarthroplasty., Materials and Methods: The study included patients above the age of 75 who were diagnosed with intertrochanteric femur fracture and admitted to the Department of Orthopaedics and Traumatology, Ege University Hospital between October 2006 and December 2012. After informed consent was obtained from the patients, they were randomised via sealed opaque envelops into two groups. Patients in Group 1 were internally fixated utilizing proximal femoral nail, whilst the patients in Group 2 were treated with a cemented hemiarthroplasty. Complications were recorded and functional results were evaluated using the Harris Hip score. The mean time of follow up was 31.72 months (min. 18-max. 47, std. dev. ±10.68)., Results: A total of 54 patients were included in the study. 21 of them (38.9%) received a proximal femoral nail whilst 33 (61.1%) were treated with hemiarthroplasty. Average age of the patients was 82.24 (min. 75-max. 97). Average age in Group 1 was 79.57 (min. 75-max. 91), whilst it was 83.94 in Group 2 (min. 75-max. 97). Harris Hip score analysis revealed that the difference between the patients treated with hemiarthroplasty and proximal femoral nailing was statistically significant in favour of the hemiarthroplasty group within the first 3 months. However, this difference diminished at the 6th month time point, and even reversed as of the 12th month postoperatively., Discussion and Conclusions: Although cases with hemiarthroplasty achieved a better level of activity in the beginning, cases with proximal femoral nailing reached a comparable level of activity within a short period of time, faster than those treated with hemiarthroplasty, displaying a better level of activity in the end., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: We evaluated the results of patients with traumatic femur diaphyseal fracture who had undergone biologic fixation with unreamed intramedullary nailing., Methods: Twenty-five adults with 29 traumatic femur diaphyseal fractures who had undergone unreamed intramedullary nailing at Uludag University School of Medicine, Department of Orthopedics and Traumatology were included in the study between January 1997 and December 2007. Gender, age, cause of injury, fracture type, operation length, time lapse till surgery, blood loss, fluoroscopy duration, early and late complications, time until union, and functional results were noted. Functional results were evaluated with Klemm-Börner and Thoresen systems and Short Form (SF)-36 health survey questions., Results: The mean follow-up of the patients was 65.1 +/- 31.6 months (26-138). There was no statistically significant difference between operation length, blood loss and time until union of simple and complex fractures (p > 0.05). Furthermore, the SF-36 questionnaire revealed no statistically significant difference between pain scores (p > 0.05)., Conclusion: Sparing of the endosteal and periosteal circulation, low infection and high union rates, and good functional outcomes of unreamed intramedullary nailing fixation make it the treatment of choice for simple and comminuted fractures of the femur shaft, especially for multi-trauma patients and patients with cardiopulmonary comorbidities.

Objectives: We evaluated the results of treatment with Ender nails in intertrochanteric fractures of the femur in patients exceeding the age of 65 years., Methods: Thirty-three patients (18 women, 15 men; mean age 78 years; range 65 to 98 years) were treated with Ender nails for non-pathological fractures of the intertrochanteric part of the femur. The right hips were involved in 17 patients and the left in 15 patients. One patient had bilateral involvement. Serious complicating diseases existed including cardiovascular disease (n=12), pulmonary disease (n=11), and others (n=10) such as diabetes mellitus. According to the Evans-Jensen classification, there were 14 type 1, five type 2, four type 3, four type 4, and seven type 5 fractures. The mean follow-up was 20 months (range 5 to 78 months)., Results: The mean length of hospital stay was 15 days (range 9 to 18 days). Mortality was encountered in 10 patients (30.3%) within the first postoperative year, two of whom (6%) died during hospitalization. Twelve patients were alive on final follow-ups, of these eight patients were ambulatory without any significant problem. Postoperatively, one patient developed electrolyte imbalance, and another had urinary infection. Due to migration problems, one of the three nails had to be removed in the early period in one patient, and all nails in five patients after the union was obtained. Union was obtained in all patients within a mean of eight weeks (range 6 to 18 weeks)., Conclusion: Ender nailing may be appropriate in stable, non-displaced intertrochanteric fractures in the elderly, as it is associated with lower mortality in the early period.