Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES最新文献

Background: Mallet finger injuries, characterized by a flexion deformity caused by trauma to the extensor mechanism at the base of the distal phalanx, can lead to significant functional impairment if not treated appropriately. Surgical interventions for osseous mallet finger injuries often include techniques such as extension-block pinning and perioperative modifying plate fixation. When comparing these two methods, it is critical to assess factors such as technical ease, perioperative considerations, and postoperative outcomes. This study aims to compare these two techniques to provide valuable insights into the optimal surgical approach for treating osseous mallet finger injuries, improving patient care and outcomes.

Methods: From 2017 to 2022, a retrospective study of 89 patients with Doyle classification type IVB and IVC mallet finger injuries was conducted. The patients were divided into two groups using a surgical technique called block randomization. Group 1 included 46 patients treated with the extension-block pinning fixation technique, while Group 2 comprised 43 patients treated with the perioperative modifying plate fixation technique. Observations included nail deformities and dorsal prominence at the distal interphalangeal (DIP) joint.

Results: All patients were deemed eligible for surgical intervention due to the time elapsed since injury or ineffectiveness of prior conservative treatment. No significant differences in patient demographics were observed between the two groups. While Crawford classification and pain scores showed no significant differences between the groups (p>0.05), the Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) score and time to return to work significantly favored Group 2, which underwent perioperative modifying plate fixation (p<0.05).

Conclusion: Extension-block pinning is noted for its simplicity and favorable postoperative range of motion outcomes. In contrast, perioperative modifying plate fixation enhances stability and mechanical performance, positively impacting overall functional recovery. The choice between these techniques should consider procedural simplicity, perioperative demands, mechanical efficiency, and postoperative functional outcomes.

Background: Acute subdural hematoma (ASDH) is a critical and often fatal condition, particularly in elderly patients receiving anticoagulant therapy. With a growing global aging population, the incidence of traumatic brain injuries, including ASDH, is projected to rise, presenting significant challenges in clinical management. This study evaluates the outcomes of surgically treated ASDH in patients aged 65 years and older, comparing those who received anticoagulant therapy with those who did not. It also aims to identify the main risk factors for poor outcomes and explore preventive strategies in this vulnerable population.

Methods: A retrospective analysis was conducted on 90 patients aged 65 years and older who underwent surgery for ASDH at our institution between 2018 and 2023. Patients were categorized into two groups based on anticoagulant therapy use. Demographic data, mechanisms of injury, clinical presentations, and outcomes, including mortality and reoperation rates, were analyzed. Radiological assessments included hematoma thickness, midline shift, and the presence of residual hematoma.

Results: No significant differences were observed in hematoma thickness, midline shift, or mortality between patients receiving anticoagulant therapy and those not on anticoagulants. However, a significant association was found between anticoagulant use and the mechanism of injury; patients on anticoagulants were more likely to sustain ASDH from low-energy trauma, such as a fall from the same level (p=0.005). Despite the high mortality rates associated with ASDH in elderly patients, the multidisciplinary approach employed, including the prompt reversal of coagulopathy, likely contributed to the observed outcomes.

Conclusion: Acute subdural hematoma in elderly patients, particularly those receiving anticoagulant therapy, remains a challenging problem with a high rate of poor outcomes. This study highlights the urgent need for preventive measures to mitigate the risks associated with even minor trauma, especially in patients on anticoagulants. Our findings underscore the importance of appropriate management protocols, including the timely reversal of coagulopathy, in improving survival rates within this high-risk population. Further research is needed to develop and validate comprehensive preventive strategies and to investigate long-term outcomes in these patients.

Background: Penetrating thoracic injuries are critical conditions that significantly influence the clinical outcomes of trauma patients in the emergency department (ED). This study evaluates the prognostic value of the glucose-to-potassium ratio (GPR) in predicting mortality among patients presenting to the ED with isolated penetrating thoracic injuries caused by stabbings.

Methods: This retrospective cohort study was conducted in the emergency department of a tertiary hospital from January 1, 2021 to January 1, 2023. It includes patients diagnosed with isolated penetrating thoracic injuries resulting from stabbings. A database analysis was performed using patient records documenting demographic information, clinical findings, laboratory results, and outcomes.

Results: Among the 88 patients included in the study, categorized into deceased (14.8%, n=13) and survivors (85.2%, n=75), the median glucose level was significantly higher in the deceased group (168 [interquartile range, IQR 145-229 mg/dL]) compared to the survivor group (126 [IQR 111-151 mg/dL]) (p<0.001). Conversely, potassium levels were lower in the deceased group (3.3 [IQR 3.01-3.82] mEq/L) compared to the survivor group (3.87 [IQR 3.5-4.18] mEq/L) (p=0.007). The GPR was higher in the deceased group (51.6 [IQR 42-75.1], p<0.001) than in survivors (32.6 [IQR 29-54.8]). The area under the receiver operating characteristic (AUROC) for the GPR in predicting mortality was 0.831 (95% confidence interval [CI] 0.736-0.903). With a cutoff value of ≥40.23, the sensitivity was 84.62% (95% CI 54.6-98.1), and the specificity was 78.67% (95% CI 67.7-87.3).

Conclusion: Our findings indicate that the GPR is a valuable prognostic marker for mortality in patients with stabbing-induced penetrating thoracic injuries presenting to the ED. This highlights its potential utility in early risk stratification within this patient population.

Background: Intraabdominal adhesions increase the incidence and length of surgical complications. Many anti-adhesive agents have been used for this purpose, but no definitive solution has yet been found. Studies on the prevention and reduction of anastomotic leakage, therefore, remain up to date. This study aimed to determine the effects of Rosmarinus Officinalis extract on colon anastomosis as a surgical model, its antiadhesive activity, and its impact on wound healing in the laparotomy site simultaneously to facilitate the clinical application of Rosmarinus Officinalis extract.

Methods: The rats were divided into two groups of seven rats each. Group C (Control): Laparotomy with colon anastomosis + 2 mL isotonic solution. Group R (Rosmarinus officinalis): Laparotomy + colon anastomosis, + 2 mL of 2% rosmarinus officinalis. Macroscopic adhesion scoring was performed and recorded. The tensile strength of the wound was assessed using tissue samples obtained from the incision line. From the incision line, tissue samples were obtained for histopathological investigation and tissue hydroxyproline levels. Anastomotic burst pressure was measured from the segment of colon anastomosis.

Results: In terms of Macroscopic adhesion score, there was no statistically significant difference between Group C and Group R (p=1.000). The mean Wound tensile strength value of Group R was significantly lower than that of Group C (p=0.003). In terms of mean Anastomotic burst pressure, there was no statistically significant difference between Group C and Group R (p=0.078).

Conclusion: According to the findings of our investigation, peritoneal administration of Rosmarinus Officinalis extract in the early postoperative period may increase the risk of evisceration in the abdominal incision site.

Introduction: Gallstone may cause complications of cholecystitis, gallbladder gangrene, perforation, and related sepsis. This study aims to identify how CRP and immune cells change in patients with acute calculous cholecystitis based on the severity of disease.

Method: Patients with acute calculous cholecystitis were categorized into three main groups-mild, moderate, and severe-based on the Tokyo guidelines. CRP, neutrophil, lymphocyte, helper T cells, cytotoxic T lymphocytes, and HLA-DR expression on CD14+ monocytes were measured using flow cytometry at the time of hospitalization from all patients and whether there were any differences between the groups was evaluated.

Results: There were no significant differences in lymphocyte count, CD3+, CD4+, CD8+ cells, or CD4+/CD8+ ratios between groups. Though not significantly, lymphocyte count and CD3+ cells tended to decrease, while the CD4/CD8 ratio increased with disease severity. However, neutrophil count, Neutrophil/ Lymphocyte Ratio (NLR), CRP, and HLA-DR expression on CD14+ monocytes significantly increased with cholecystitis severity. The HLA-DR has 66.7% sensitivity and 92.9% specificity, while the CRP 78.6% sensitivity and 81.00% specificity and NLR 85.7% sensitivity and 76.2% specificity for predicting severe cholecystitis.

Conclusion: Evaluation of CRP, NLR, lymphocyte count, total CD3+ cells, CD4/CD8 ratio and HLA-DR expression on monocytes, at hospital admission, can provide clinicians with valuable information about the prognosis of the disease.

Background: There is no consensus in the literature regarding the optimal treatment method for posterior pelvic ring injuries. This study aims to compare the radiologic and clinical outcomes, as well as complications of spinopelvic fixation (SPF) and iliosacral screw fixation (ISF) in patients with posterior pelvic ring injuries.

Methods: This retrospective study analyzed 54 patients (37 females, 17 males; mean age 38.9±18.7 years) with pelvic ring injuries classified as Tile type B and type C involving the posterior pelvic ring. These patients were treated with either SPF or ISF and followed for at least one year at two centers between 2016 and 2023. Of these, 28 patients comprised the SPF group, and 26 patients were in the ISF group. Comparisons were made regarding perioperative data (hemoglobin loss, blood product replacement, hospitalization duration, intensive care unit stay, surgery time, and fluoroscopy duration) and clinical outcomes (limb length discrepancy, Majeed score, visual analogue scale (VAS) score, and Short Form-36 (SF-36) score). Radiological outcomes were assessed using Matta outcome grading. Complications were also investigated.

Results: Hemoglobin loss (median 2.2 vs. 1 g/dL; p=0.027) and surgery time (67±10.6 vs. 37.7±11.3 minutes; p<0.001) were higher in the SPF group, whereas fluoroscopy duration (median 2 vs. 51.5 seconds; p<0.001) was higher in the ISF group. Other perioperative parameters did not differ between the groups. At a minimum follow-up of one year, clinical scores (Majeed score, VAS, SF-36), limb length discrepancy, and Matta outcome grades were similar between the groups. The SPF group had higher total complication rates (46.4% vs. 19.2%; p=0.034) and infection rates (42.9% vs. 3.8%; p<0.001), while rates of neurological deficits, screw malposition, and other hospitalization complications (e.g., thromboembolic or cardiovascular events, pulmonary complications, sepsis) were not significantly different.

Conclusion: Both spinopelvic fixation and iliosacral screw fixation techniques are similarly effective in terms of clinical and radiological outcomes, with both methods demonstrating a low rate of complications. However, SPF was associated with higher infection rates and greater hemoglobin loss, while ISF required increased fluoroscopy exposure.

Background: This study aimed to compare the predictive performance of the BIG score (base deficit + [2.5 × international normalized ratio (INR)] + [15 - Glasgow Coma Scale (GCS)]) for in-hospital mortality in adult patients with multiple trauma against other scoring systems, including the Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), and Injury Severity Score (ISS).

Methods: A retrospective single-center study was conducted, including 563 adults (aged ≥18 years) with multiple trauma who were admitted to the emergency department and hospitalized between January 2022 and December 2023. Demographic and clinical characteristics, as well as trauma scoring systems (e.g., GCS, RTS, ISS, and BIG score), were analyzed between survivors and nonsurvivors to identify factors associated with in-hospital mortality.

Results: The BIG score, along with the RTS and ISS, was identified as an independent predictor of mortality in adults with multiple trauma (p<0.001 for all comparisons). A BIG score of 10.65 was determined as the mortality cut-off, with 67.7% sensitivity and 86.5% specificity (area under the curve: 0.847; 95% confidence interval: 0.808-0.886). The BIG score demonstrated higher positive predictive value (60.8%) and negative predictive value (89.6%) compared to the other trauma scoring systems. Estimated mortality risks for BIG scores of 15 and 20 were 50% and 80%, respectively.

Conclusion: The BIG score can accurately predict in-hospital mortality in adults with multiple trauma. Additionally, the BIG score was superior to the GCS, RTS, and ISS in predicting in-hospital mortality (ClinicalTrials.gov identifier: NCT06574464).

BACKGROUND Obstructive jaundice is a common surgical issue caused by obstruction in the bile ducts, which can result from factors such as stones or cancers in the main bile duct. This study aimed to investigate the effects of carvacrol, a compound known for its strong antioxidant properties, on intestinal damage, liver damage, and bacterial translocation in an animal model of obstructive jaundice. METHODS The study utilized six groups of six Wistar Albino rats each. Obstructive jaundice was induced in the rats through a surgical procedure, resulting in the enlargement of the common bile duct. Carvacrol was administered at a dose of 100 mg/kg to evaluate its therapeutic effects. Blood samples were collected for biochemical analysis, and tissue samples were obtained from the ileum and liver for histopathological examination. Additionally, samples from the spleen and mesenteric lymph nodes were collected for microbiological analysis. RESULTS The findings revealed that carvacrol did not have a significant therapeutic effect on liver and bowel damage or on bacterial translocation in the rats with obstructive jaundice. Despite carvacrol's known antioxidant properties, it failed to show benefits in this experimental model. CONCLUSION Carvacrol, while recognized for its antioxidant effects, did not demonstrate therapeutic efficacy in treating obstructive jaundice in rats. The study suggests that further research with a larger sample size may be necessary to potentially uncover positive effects and better understand carvacrol's potential role in managing obstructive jaundice.

Background: Dental trauma can cause damage to the pulp tissue in immature teeth. Revascularization therapy is a possible option in the treatment of non-vital, immature permanent teeth with a history of trauma. The aim of this prospective study was to evaluate the radiographic and clinical results of immature teeth with a history of trauma treated by regenerative endodontic procedures and mineral trioxide aggregate apexification techniques.

Methods: Forty-one patients aged between 7 and 12 years with traumatized immature permanent maxillary incisors were included in the study. These patients were divided into two groups: those who had previously received endodontic treatment and those who had not. Twenty-four patients who applied directly to the university clinic and had not received endodontic treatment before were included in the regenerative endodontic protocol group (Group 1). Seventeen patients who had previously undergone endodontic intervention on their relevant teeth were included in the mineral trioxide aggregate apexification group (Group 2). The patients were followed for a period of 24 months. Clinical success rates were evaluated, and pre-treatment and control radiographs were analyzed to calculate the percentage increase in root dentin width and root length.

Results: After 24 months of follow-up, positive periapical healing was detected in the radiographic findings in the majority of cases. In Group 1, a limited increase in root length and root dentin width was observed, while a narrowing in the apical opening was evident. The radiographic evaluation of two of the cases, which could be accessed 11 years later, emphasized the importance of long-term follow-up in assessing the effectiveness of the chosen methods.

Conclusion: The revascularization method is a treatment option that has positive results in terms of root development in teeth with necrotic pulp as a result of trauma.

Background: Acute cholecystitis (AC) is increasingly common and imposes a burden on healthcare systems, particularly in the elderly population. While laparoscopic cholecystectomy (LC) is the definitive treatment, percutaneous cholecystostomy (PC) is often preferred based on various factors. The treatment of elderly patients requires a multidisciplinary approach that carefully assesses surgical risks due to age-related changes and comorbidities. This retrospective study evaluates factors affecting mortality, morbidity, and hospital stay in elderly patients diagnosed with AC who presented to the emergency department and underwent PC.

Methods: This retrospective study, conducted between January 2013 and January 2021, included patients aged 70 years and older with grade 2 and 3 AC, as classified by the Tokyo Guidelines, who underwent PC. Data on laboratory parameters, comorbidities, and outcomes were collected and analyzed.

Results: Among the 76 included patients, complications occurred in 7.9% of cases, with catheter replacement being the most common complication. In-hospital mortality was 5.2%. Factors influencing hospital stay included intervention timing and serum albumin levels. Placement of percutaneous cholecystostomy within the first three days of hospitalization has been shown to shorten the length of hospital stay.

Conclusion: Personalized treatment strategies are essential for managing AC in elderly patients. Early placement of PC may reduce hospital stays and associated costs. Further research and updated guidelines are necessary to optimize outcomes in this demographic group.