Ulusal Travma Ve Acil Cerrahi Dergisi-Turkish Journal of Trauma & Emergency Surgery最新文献

Wunderlich syndrome (WS) is defined as a rare spontaneous renal hemorrhage. It mostly occurs with concomitant diseases without trauma. It usually presents with the Lenk triad and is diagnosed in emergency departments with the effective use of advanced imaging modalities such as ultrasonography, computerized tomography, or magnetic resonance imaging scanning. In the management of WS, conservative treatment, interventional radiology, or surgical procedures are decided according to the patient's condition and treated appropriately. Conservative follow-up and treatment should be considered in patients whose diagnosis is stable. If diagnosed late, the progression can be life-threatening. As an interesting case of WS, a 19-year-old patient was presented with hydronephrosis due to ure-teropelvic junction obstruction. Spontaneous renal hemorrhage without a history of trauma is presented. The patient, who presented to the emergency department with the sudden onset of flank pain, vomiting, and macroscopic hematuria was imaged by computed tomography. The patient could be followed and treated conservatively for the first 3 days, and on the 4th day, his general condition deteriorated, and he underwent selective angioembolization and then laparoscopic nephrectomy. WS is a serious, life-threatening emer-gency, even in young patients with benign conditions. Early diagnosis is mandatory. Delays in diagnosis and non-energetic approaches can lead to life-threatening situations. In hemodynamically unstable non-malignant cases, the decision for immediate treatment, such as angioembolization and surgery, should be taken without hesitation.

Background: Acute appendicitis is the leading emergency condition among surgical abdominal diseases. The treatment of choice for appendicitis is open or laparoscopic appendectomy. There are different methods for appendiceal stump closure. Laparoscopic ap-pendectomy became more applicable with hand-made endo-loop applications to close the appendiceal stump, especially in state hospi-tals where the resources were limited. This article aims to evaluate the outcomes of patients undergoing laparoscopic appendectomy with the appendiceal stump closure using a hand-made endo-loop.

Methods: Fifty patients undergoing laparoscopic appendectomy with the appendiceal stump closure using a hand-made endo-loop in the General Surgery Department of our hospital between June 2014 and December 2018 were evaluated. The ages, genders, length of stay in the hospital, complications, and histopathological investigation results of the patients were gathered retrospectively. Lapa-roscopic appendectomy was performed with three ports. The appendiceal stump was closed using two hand-made endo-loops. The loop was made with a modification of Roeder's loop whose safety was proven in the literature. The first port was introduced to the abdomen with the open method. SPSS 26.0 statistical program was used for statistical analysis.

Results: Thirty-one (62%) of patients were males and 19 (38%) of them were females. The mean age was 32.2±11.9 years. The age ranged between 19 and 74 years. The median length of stay in the hospital of the patients was 1.12±0.47 days. One of the patients was 21 weeks pregnant. A surgical site infection occurred in one patient during the post-operative period. Recovery was obtained with antibiotherapy. No leakage through the base of the appendix or cecal fistula was determined in none of the patients.

Conclusion: One of the most important parameters in the cost of laparoscopic appendectomy is the closure technique of the stump. The cost comes into question much more especially in state hospitals where the resources are limited. Appendiceal stump closure using a hand-made endo-loop is an easy, safe, and cost-effective method.

Background: This study aimed to determine the morphological differences of three-part proximal humerus fractures, the group in which plate screw fixation is most frequently used, and to evaluate the functional and radiological results of the methods applied for different subgroups.

Methods: Twenty-nine patients (6 males and 23 females) with three-part proximal humerus fractures were in the study, with an average age of 64. The patients were in three groups according to their fracture types. Group 1 included eight patients with valgus impaction fracture. Group 2 included eleven patients with easily achieved stability after reduction. Group 3 consisted of ten patients with procurvatum varus angulation, a significant displacement between fragments, and in whom medial cortical continuity was not maintained without fixation. All patients underwent surgery with a minimally invasive deltoid split approach method and locked ana-tomic plate screw osteosynthesis. In group 1 patients, the space in the area where valgization is present in the head was filled with cortico-cancellous allografts. No grafting or metaphyseal compression took place in Group 2 patients. In group 3 patients, the metaphyseal compression technique was applied to the bone defect area. Cephalodiaphyseal angles (CDA) were measured at the postoperative and final follow-up. The constant Murley score made the functional evaluation.

Results: The patients were followed for an average of 27.6 months, and the union was present in all patients for an average of 3.6 months. Early screw migration was present in three patients, and late screw migration was in one patient. There were twenty-four excellent and 5 good results. CDA decreased from 139.42° to 136.13°. A statistically significant difference was present between the values of Groups 2 and 3 in the final control CDA of the groups.

Conclusion: In this study, the functional scores of grafting stable valgus-impacted fractures and metaphyseal compression of unstable fractures with insufficient medial support were as good as stable 3-part fractures. Considering neer type 3 fractures should be evaluated with their subgroups, and fixation and stability-enhancing solutions specific to the groups are essential.

Background: The reasons for the increase in accidents involving shared stand-up e-scooters in recent years may be the wide-spread use of e-scooters among young people, especially in metropolitan areas with heavy traffic, non-compliance with traffic rules, and insufficient legal regulations. In this study, we analyzed in detail the typical features of rider-sharing e-scooter-related injuries brought to the emergency department of our hospital in the light of current literature.

Methods: The clinical and accident characteristics of 60 patients with surgical requirements who were brought to the emergency department of our hospital due to e-scooter-related accidents between 2020 and 2020 were analyzed using statistical methods ret-rospectively.

Results: The majority of the victims were university students and the number of victims of the male gender was slightly higher and the mean age was 25.3±13.0 years. Most e-scooter accidents occur on weekdays. Most of the e-scooter-related accidents happen on weekdays and are non-collision type accidents. The majority of e-scooter-related accident victims were in the minor trauma group (injury severity score <9), predominantly had extremity and soft-tissue injuries and needed radiological examination (44 patients, 73.3%), and only eight victims (13.3%) required surgical operation and also all of the e-scooter victims were discharged fully healed.

Conclusion: Among the more common collision-free e-scooter-related accidents that have a lower trauma severity score or cause minor soft-tissue injury, mono-trauma occurs more commonly than multisystem trauma; likewise, radius and nasal-weighted monofractures occur more commonly than multiple fractures, according to this study. Besides, effective measures and legal regulations should be put in place to prevent e-scooter-related accidents.

Background: The aim of this study is to compare the efficacy and complication rates of percutaneous gallbladder aspiration (PA) and percutaneous cholecystostomy (PC) in the management of AC and present the experiences of a single third-line center.

Methods: The results of 159 patients with AC who admitted to our hospital between 2015 and 2020, that underwent PA and PC procedures, because they did not respond to conservative treatment and LC could not be performed, were retrospectively analyzed. Clinical and laboratory data before and 3 days after PC and PA procedure, technical success, complications, response to treatment, duration of hospital stay, and reverse transcriptase-polymerase chain reaction (RT-PCR) test results were recorded.

Results: Out of 159 patients, 22 (8 men 14 women) underwent PA procedure and 137 (57 men 80 women) underwent PC. No significant difference was detected between the PA and PC groups in terms of clinical recovery (P: 0.532) and duration of hospital stay (P: 0.138) in 72 h. The technical success of both procedures was 100%. While 20 out of 22 patients with PA were having a noticable recovery, only one was treated with twice PA procedures and a complete recovery was observed (4.5%). Complication rates were low in both groups and were statistically insignificant (P: 1.00).

Conclusion: In this pandemic period, PA and PC procedures are effective, reliable, and successful treatment method that can be applied at the bedside for critical patients with AC who are not compatible with surgery, which are safe for health workers and low-risk minimal invasive procedures for patients. In uncomplicated AC patients, PA should be performed, and if there is no response to treatment, PC should be reserved as a salvage procedure. The PC procedure should be performed in patients with AC who have developed complications and are not suitable for surgery.

Background: It is critical to identify patients whose intubation will be difficult to ensure that necessary precautions are taken. In this study, we aimed to show the power of almost all tests used to predict difficult endotracheal intubation (DEI), and to determine which test are more accurate for this purpose.

Methods: This observational study conducted between May 2015 and January 2016 at department of anesthesiology of a tertiary hospital in Turkey (n=501). A total of 25 parameters and 22 tests used for DEI were compared according to groups formed according to the Cormack-Lehane classification (gold standard).

Results: The mean age was 49.83±14.00 years, and 259 (51.70%) patients were males. We found difficult intubation frequency to be 7.58%. Mallampati classification, atlanto-occipital joint movement test (AOJMT), upper lip bite test, mandibulohyoid distance (MHD), maxillopharyngeal angle, height-to-thyromental distance ratio, and mask ventilation test were independently associated with difficult intubation.

Conclusion: Despite comparing 22 tests, the results obtained in this study cannot definitively identify any single test that pre-dicts difficult intubation. Nonetheless, our results show that MHD (high sensitivity and negative predictive value) and AOJMT (high specificity and positive predictive value) are the most useful tests to predict difficult intubation.

Background: We aimed to determine the relationships of the trauma-specific frailty index (TSFI) and the geriatric trauma out-come score (GTOS) with 30-day mortality among geriatric trauma patients aged 65 and older.

Methods: This prospective observational study included 382 patients aged 65 years and older who were admitted to a training and research hospital due to blunt trauma. Informed consent was obtained from them and/or their relatives. In addition to patients' vital signs, information about chronic diseases and drug use was obtained on admission to the emergency service and the results of labo-ratory examinations, radiological imaging, blood replacements, length of stay in the emergency room and hospital, and mortality were recorded in case forms. Glasgow coma scale, ınjury severity score, GTOS, TSFI, and body mass index (BMI) values were calculated by the researchers. Outcome information was obtained from the patient and/or relatives by phone 30 days later.

Results: When the patients who died and those who survived were compared at the 30th day after trauma, no significant difference was found in terms of BMI or TSFI (p>0.05). It was determined that patients with a GTOS of ≥95 at admission would have higher 30-day mortality (the sensitivity was 76%, and the specificity was 72.27% (p<0.001)). When correlations were evaluated according to mortality, a correlation was found between the presence of two or more comorbid diseases and mortality (p=0.001).

Conclusion: We think that a more reliable frailty score can be obtained using these parameters as we have determined that the TSFI as calculated at admission to the emergency department is not sufficient on its own, while the lactate, GTOS, and the length of hospital stay are also effective in mortality. We suggest that it would be appropriate to use the GTOS in long-term follow-up as well as for predictive power for mortality within 24 h.

Background: Patients operated under emergency conditions have a higher risk of death and complications than those per-formed under elective conditions. Especially the patient group with high comorbidity needs to be evaluated more specifically. Accord-ing to the surgical risk and American Society of Anesthesiologists (ASA) scoring, the perioperative risk should be determined quickly, and the relatives of the patients should be informed. This study aimed to evaluate the factors affecting mortality and morbidity in patients undergoing emergency abdominal surgery.

Methods: A total of 1065 patients aged 18 years and older who underwent emergency abdominal surgery in 1 year were included in the study. The primary aim of this study was to determine the mortality rates in the first 30 days and 1 year and the variables af-fecting these rates.

Results: Of 1065 patients, 385 (36.2%) were female and 680 (63.8%) were male. The most common procedure was appendectomy (70.8%), followed by diagnostic laparotomy (10.2%), peptic ulcus perforation (6.7%), herniography (5.5%), colon resection (3.6%), and small bowel resection (3.2%). There was a significant difference between the age of the patients and mortality (p<0.05). There is no statistically significant relationship between gender and mortality. A statistically significant correlation was found between ASA scores, perioperative complication, perioperative blood product use, reoperation, intensive care unit admission, hospitalization time, periop-erative complication, and 30-day mortality and 1-year mortality. There is a significant relationship between trauma and only 30-day mortality (p=0.030).

Conclusion: The morbidity and mortality of patients operated on under emergency conditions increased compared to elective surgical operations, especially those over age 70. The 30-day mortality rate of patients who underwent emergency abdominal surgery is 3%, while the 1-year mortality rate is 5.5%. Mortality rates are higher in patients with a high ASA risk score. However, mortality rates in our study were found to be higher than the mortality rates in ASA risk scoring.

Background: Subdural empyemas (SDEs) are rare intracranial infections mostly secondary to sinusitis. Incidence of SDEs is 5-25%. Interhemispheric SDEs are even rarer, which makes their diagnosis and treatment difficult. Aggressive surgical interventions and wide-spectrum antibiotics are needed for treatment. In this retrospective clinical study, we intended to evaluate the results of surgical management supported by antibiotics in patients with interhemispheric SDE.

Methods: Clinical and radiological features, medical and surgical management and outcomes of 12 patients treated for interhemi-spheric SDE have been evaluated.

Results: 12 patients were treated for interhemispheric SDE between 2005 and 2019. Ten (84%) were male, two (16%) were female. Mean age was 19 (7-38). Most common complaint was headache (100%). Five patients were diagnosed with frontal sinusitis prior SDE. Initially, three patients (27%) underwent burr hole aspiration and ten patients (83%) underwent craniotomy. In one patient both were done in the same session. Six patients were reoperated (50%). Weekly magnetic resonance imaging and blood tests were used for follow-up. All patients received antibiotics for at least 6 weeks. There was no mortality. Mean follow-up period was 10 months.

Conclusion: Interhemispheric SDEs are rare, challenging intracranial infections that have been related to high morbidity and mor-tality rates in the past. Both antibiotics and surgical interventions play role in treatment. Careful choice of surgical approach and repeated surgeries if necessary, accompanied by appropriate antibiotic regimen, leads to good prognosis reducing morbidity and mortality.

Background: Supracondylar humerus fractures (SCHFs) are the most common types of elbow fractures in children. Closed reduction percutaneous pinning (CRPP) is the primary surgical treatment of SCHFs. In cases that cannot be managed with closed reduction, treatment with open reduction and internal fixation (ORIF) is necessary. We aimed to compare CRPP and ORIF through a posterior approach regarding clinical and functional outcomes in pediatric SCHF cases.

Methods: Patients with Gartland type III SCHF who underwent CRPP or ORIF with posterior approach at our clinic between January 2013 and December 2016 were included in this retrospective study. A total of 60 patients who underwent surgical treatment and had available data on our hospital database and no additional injuries were included in the study. We analyzed their data concerning age, gender, fracture type, neurovascular damage, and surgical treatment. In addition, we inspected the patients' anteroposterior and lateral radiographs at 1-year follow-up visits for Baumann (humerocapitellar) angle (BA) and carrying angle (CA) and checked their go-niometer assessments of elbow range of motion (ROM). The cosmetic and functional outcomes were determined using Flynn's criteria.

Results: Demographic, preoperative, and post-operative data of 60 patients between the ages of 2-15 were analyzed. 46 of these patients had CRPP, and 14 had posterior ORIF. CA, Baumann angle, and lateral capitello-humeral angle were measured for fractured elbow and contralateral elbow and compared statistically. There was no statistically significant difference between the two surgical ap-proaches in terms of CA (p=0.288), Baumann's angle (p=0.951) and LHCA (p=0.578). At the end of 1-year follow-up, elbow ROM was measured, and there was no statistically significant difference between the two groups (p=0.190). Furthermore, there is no statistically significant difference between the two surgical approaches in terms of both cosmetic (p=0.814) and functional (p=0.319) outcomes.

Conclusion: A comprehensive literature review of pediatric SCHF shows that surgeons do not frequently prefer posterior incisions in Gartland type III fracture that cannot be managed with closed reduction. However, posterior open reduction is a safe and effective method since it provides more control over the distal humerus, allows for a complete anatomical reduction involving both cortices, reduces the risk of ulnar nerve injury, thanks to the nerve exploration, and yields positive cosmetic and functional outcomes.