BACKGROUND: The treatment of unstable intertrochanteric fractures in elderly is still controversial. The purpose of this study is to present treatment strategies for unstable intertrochanteric fractures with hemiarthroplasty using standard uncemented collared femoral stems and at the same time preserving the fractured calcar fragment. METHODS: Fifty-four patients aged 75 years or older with unstable intertrochanteric fractures were included in this prospective cohort study. All patients were treated with calcar preserving hemiarthroplasty using cementless collored femoral stems. Fractured calcar fragment was stabilized either by compaction between the implant and femur or fixed with cable grip system. Follow-up evaluations were performed at least 24 months and later. Palmer and Parker mobility score and visual analogue scale (VAS) pain score were assessed. We also analyzed radiographs of the operated hip at each follow-up visit. RESULTS: The patients were 15 males and 39 females with a mean age of 81.3 years (range, 75 to 93 years). The average operative time was 86.6 minutes. The mean transfused blood units were 1.2 units. The average duration of hospital stay was 5.3 days. The preoperative mean mobility score was 6.20. This score was found to be 4.96 on postoperative third day and 5.90 at 24 months postoperatively. The results of the statistical analysis revealed significant increase in the mobility scores at each follow-up after three days. Radiological interpretation revealed no loosening in the cable-grip systems, and no significant subsidence (> 5 mm) of prosthesis was observed. CONCLUSIONS: Calcar preservation arthroplasty is a good option for elderly patients with severe osteoporosis, frail constitution and the patients who are at higher risk for second operation due to unstable intertrochanteric fractures.
Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip/adverse effects/*methods ; Female ; Femur/pathology/radiography/surgery ; Hemiarthroplasty/adverse effects/*methods ; Hip/pathology/radiography/surgery ; Hip Fractures/physiopathology/radiography/*surgery ; Humans ; Male ; Pain Measurement ; Postoperative Complications ; Prospective Studies

PURPOSE: Although there are several surgical methods for treatment of sacrococcygeal pilonidal sinus, there is no widespread consensus. In this study, we aimed to compare primary closure, Limberg, and modified Limberg flap techniques, with each performed by each of 3 surgeons. METHODS: A total of 802 patients who were operated on for pilonidal sinus disease were included in this retrospective cohort study. Patients were evaluated in 3 groups: group 1 (limited excision + primary closure), group 2 (large excision + Limberg flap technique), and group 3 (large excision + modified Limberg technique). Development of early or late period complications was accepted as primary outcome. RESULTS: Mean patient age was 28.1 ± 6.7 years. Operation time in group 1 was 44.0 ± 14.5 minutes, and was shorter in comparison to other 2 groups (P < 0.001). One or more complications developed in 171 patients (21.3%) within study group. Highest complication rate was in group 1, with a rate of 30.7% (P < 0.001). Rate of wound dehiscence and recurrence in group 1 were differed significantly from other groups (P < 0.001 and P = 0.001, respectively). CONCLUSION: Based on the same technique-the same surgeon approach, comparison of surgical methods for treatment of pilonidal sinus showed that modified Limberg and Limberg techniques are superior to primary closure technique in terms of general complication, wound dehiscence, and recurrence rates.
Cohort Studies* ; Consensus ; Humans ; Pilonidal Sinus* ; Postoperative Complications ; Recurrence ; Retrospective Studies* ; Surgeons ; Surgical Flaps ; Wounds and Injuries

The aim of this study was to determine the presence and prevalence of larval stages of Dicrocoelium dendriticum and Brachylaima sp. in the first intermediate host, a species of land snail, Helix aspersa, in Turkey. A total of 211 snails were collected in April-May 2014 from pastures in Mersin District. Larval stages of D. dendriticum were identified under a light microscope. Hepatopancreas from naturally infected H. aspersa snails were examined histologically. The prevalence of larval stages of D. dendriticum and Brachylaima sp. in H. aspersa snails was found to be 2.4% and 1.9%, respectively, in Mersin, Turkey. Cercariae were not matured in sporocysts at the beginning of April; however, it was observed that cercariae matured and started to leave sporocysts by early-May. Thus, it was concluded that H. aspersa acts as an intermediate host to D. dendriticumin and Brachylaima sp. in Mersin, Turkey. A digenean trematode Brachylaima sp. was seen for the first time in Turkey.
Animals ; Hepatopancreas/*parasitology ; Larva/anatomy & histology ; Microscopy ; Snails/*parasitology ; Trematoda/anatomy & histology/classification/*isolation & purification ; Turkey