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

Subacute post-traumatic ascending myelopathy (SPAM) is a rare but devastating complication of spinal cord injury (SCI). It is character-ized by progressive neurological deterioration extending several segments above the primary lesion within days to weeks after trauma. The underlying pathophysiology remains uncertain, and treatment strategies are not standardized. A 38-year-old man sustained trau-matic C6-7 spondylolisthesis with bilateral facet dislocation following a motorcycle accident. Initial magnetic resonance imaging (MRI) demonstrated cord contusion and edema extending from C5 to C7. After traction and reduction, the patient underwent anterior C6 corpectomy with placement of an expandable cage and C5-7 plating, followed by C5-6 total laminectomy and C4-7 posterior in-strumentation. Postoperatively, partial neurological recovery was observed. However, on postoperative day 10, the patient developed quadriparesis rapidly progressing to quadriplegia, accompanied by spinal shock and respiratory failure requiring mechanical ventilation. Imaging studies excluded hematoma and implant failure, although postoperative MRI was limited by metallic artifacts. Differential diagnoses, including pulmonary embolism, cardiac dysfunction, and sepsis, were ruled out. Based on the clinical progression and exclu-sion of alternative causes, a diagnosis of ascending myelopathy was established. Despite intensive supportive care, the patient died on the fourth day of mechanical ventilation. SPAM remains an unpredictable and fatal complication of SCI. Limitations in postoperative imaging, particularly metal-related artifacts, may hinder diagnosis, underscoring the importance of correlating clinical and radiological findings. Vigilant monitoring and continued reporting of cases are essential to improve recognition, refine diagnostic strategies, and guide management of this rare entity.

Background: In tibial plateau fractures, achieving anatomical restoration of the articular surface and preventing postoperative collapse are critical for successful outcomes. Bone grafting is still commonly used to fill subchondral voids after reduction; however, it carries risks such as donor-site morbidity and technical difficulties. To address these issues and enhance subchondral stability, sub-chondral raft techniques have been developed. Although various screw and plate configurations have been investigated in the litera-ture, there is still no clear consensus regarding the most effective method. We aimed to evaluate the effectiveness of our modified technique using free 5.5-mm cannulated compression screws in preventing postoperative collapse and improving functional recovery in tibial plateau fractures.

Methods: A total of 21 patients were included based on the following criteria: age ≥18 years, presence of >10 mm depression in the lateral tibial plateau, and no history of previous surgery on the affected knee. A subchondral raft construct was established without grafting using free 5.5-mm cannulated compression screws. Postoperative evaluation at 12 months included radiological and functional assessments using the Rasmussen Clinical Score (RCS) and Rasmussen Radiological Score (RRS).

Results: The mean preoperative articular depression was 14.7 mm, improving to 1.1 mm at the one-year follow-up. Mean condylar widening decreased from 5.3 mm preoperatively to 0.7 mm postoperatively. The average postoperative hospital stay was 3.7 days, and the mean time to return to work was 3.5 months. At one year, radiological and functional outcomes were favorable, with a mean RCS of 26.6 and a mean RRS of 16.6.

Conclusion: The modified raft technique using 5.5-mm cannulated compression screws is a simple and effective option for managing depressed tibial plateau fractures, preventing articular collapse and facilitating faster recovery.

Background: Logging is widely recognized as one of the most hazardous industries. Despite the prominence of this sector in Türkiye's Eastern Black Sea region, comprehensive forensic investigations of logging-related deaths are limited.

Methods: This retrospective study examined 102 logging-related fatalities identified among 4,878 forensic autopsies performed between 2013 and 2023 by the Recep Tayyip Erdoğan University. Demographic, occupational, environmental, seasonal, and medical response characteristics were extracted from autopsy reports and supplemented with information from police and judicial records.

Results: The victims were predominantly male (93.1%) with an average age of 57.4 years. Two-thirds of them were unregistered workers, and 5.9% were foreign nationals. Tree-strike injuries were the leading cause of death (51.0%), followed by falls from trees (30.4%). Fatalities most frequently occurred in the fall (32.4%), with cranial trauma predominating in the summer and thoracic inju-ries in the spring. Autopsy findings revealed extensive polytrauma, including pelvic and extremity fractures (71.6%) and intracranial hemorrhage (53.9%). Most incidents were witnessed (78.4%); however, unwitnessed deaths occurred disproportionately among older informal workers on private lands. Female victims (6.9%) primarily died while performing auxiliary tasks and frequently lacked medical intervention (83%).

Conclusion: This study represents the first comprehensive medico-legal evaluation of logging-related fatalities in the Eastern Black Sea region. The findings highlight the pivotal role of unregulated labor, hazardous seasonal working conditions, and limited emergency response capacity in shaping mortality patterns. Targeted interventions, including stricter enforcement of occupational safety regulations, training for informal workers, and improved access to rural emergency services, are urgently needed to reduce preventable deaths in forestry and logging activities.

Although congenital variations of the biceps brachii are relatively common, agenesis of the long head is exceedingly rare. Due to the absence of clinical symptoms and notable physical examination findings, its diagnosis is challenging. The absence of the long head repre-sents one such variant, although it has only rarely been reported in arthroscopic and imaging studies. As this anomaly does not result in functional impairment, congenital biceps agenesis is often incidentally detected on shoulder magnetic resonance imaging performed for other reasons. In this case report, we present a 42-year-old industrial worker with a two-year history of persistent pain who under-went rotator cuff repair, during which an absent long head of the biceps tendon was incidentally identified. Current evidence suggests that the absence of the long head of the biceps tendon is not a risk factor for rotator cuff rupture or labral pathology. Additionally, when evaluating patients with an absent long head of the biceps tendon, it is essential to consider any previous surgical interventions. If the long head cannot be identified, the distal portion of the tendon should be carefully assessed, as the most common cause of its ab-sence near the shoulder is not a congenital condition but rather a complete tear causing the tendon to retract downward. This condi-tion represents an incidental anatomical variation and does not contribute to the functional impairment observed in these conditions.

Background: The terrible triad of the elbow describes a complex injury pattern characterized by elbow subluxation or dislocation, rupture of the lateral ulnar collateral ligament (LUCL), and concomitant fractures of the radial head and coronoid process. This study aimed to evaluate and compare the clinical outcomes of patients with terrible triad injuries treated surgically at our institution, in whom coronoid fractures were managed using either screw fixation or the Tight-Rope technique.

Methods: This retrospective cohort study included patients who underwent surgical treatment for terrible triad injuries between January 2017 and December 2023. Patients with Regan-Morrey type 2 or 3 coronoid fractures treated using the Tight-Rope technique were assigned to the Tight-Rope group, whereas those treated with screw fixation comprised the Screw group. Demographic characteristics, range of motion (ROM), visual analog scale (VAS) scores, and QuickDASH (Quick Disabilities of the Arm, Shoulder and Hand) scores at 3, 6, and 12 months postoperatively were analyzed. Patients with type 1 fractures, medial collateral ligament (MCL) injuries, follow-up <12 months, or a history of systemic infection were excluded.

Results: Twenty-nine patients were included (11 in the Tight-Rope group and 18 in the Screw group). No significant differences were observed between the groups in terms of ROM or VAS and QuickDASH scores at 3, 6, and 12 months. After excluding cases requiring LUCL reconstruction and analyzing only patients who underwent LUCL repair (8 Tight-Rope, 13 Screw), the only statistically significant difference was a lower 12-month QuickDASH score in the Screw group. Complications included superficial cellulitis (1 Tight-Rope, 2 Screw) and heterotopic ossification (2 Tight-Rope, 3 Screw), all of which were managed conservatively. Post hoc power analysis based on 12-month QuickDASH scores, VAS scores, and elbow ROM (effect size d=0.77, α=0.05) demonstrated power of 77%, 71%, and 74%, respectively.

Conclusion: Functional outcomes were largely comparable between Tight-Rope and screw fixation techniques. These findings align with emerging evidence questioning the routine necessity of coronoid fixation and underscore the importance of individualized surgical decision-making.

Background: Abdominal gunshot wounds contribute significantly to trauma-related morbidity and mortality. Computed tomog-raphy (CT) can provide valuable diagnostic information but may potentially delay definitive treatment. This study aimed to evaluate the role of abdominal CT in surgical decision-making and timing among patients with abdominal gunshot injuries.

Methods: We retrospectively analyzed patients with abdominal gunshot wounds treated at a tertiary university hospital between January 2013 and January 2023. Collected data included demographic characteristics, physiological parameters, trauma scores, CT find-ings, time intervals (from admission to CT and to surgery), and clinical outcomes. Patients were classified as hemodynamically stable or unstable based on admission parameters and their response to resuscitation. The two groups were compared.

Results: A total of 74 patients were included (94.5% male; median age, 32 years). Of these, 47 (63.5%) were hemodynamically stable at presentation, while 27 (36.5%) were unstable. Abdominal CT was performed in 67 patients (90.5%), with a median time of 28 minutes from admission. The median time to CT was similar between stable (28 minutes) and unstable (30 minutes) patients (p=0.934). Based on CT findings, nonoperative management was feasible in 10 patients (13.5%). Among the unstable group, CT was performed in 7 of 11 nonresponders, of whom six (54.5%) died. Among patients who underwent surgery, the mean time to operation was significantly shorter in unstable patients compared to stable patients (60.4±36.7 vs. 93.2±76.6 minut±es; p=0.034). The perioperative mortality rate was 9.3%, with all deaths occurring in hemodynamically unstable nonresponders.

Conclusion: Abdominal CT can aid surgical planning without causing significant delays in definitive treatment, even in initially unstable patients who respond to resuscitation. CT findings may support nonoperative management in selected cases and guide targeted surgical interventions in patients requiring operative treatment. However, these findings apply to carefully selected patients and should be interpreted cautiously, as this study does not establish the safety of CT in unselected hemodynamically unstable patients. The proximity of the CT scanner to the resuscitation area facilitated rapid imaging; therefore, the findings may not be generalizable to institutions with remotely located CT facilities.

Isolated hypoglossal nerve injury is an infrequent occurrence in clinical and forensic traumatology practice. Its etiology includes trauma, malignancy, vascular events, autoimmune diseases, and complications of surgical procedures. Clinical manifestations resulting from nerve damage may present early or be delayed. We present the case of a 44-year-old woman who sustained a fracture of the third cervical vertebra following a traffic accident. An anterior approach was employed for instrumentation using an anterior plate spanning two cervical segments. The patient developed dysphagia and swallowing difficulties and subsequently underwent evaluation for disability status. Physical examination revealed significant atrophy and asymmetry of the right half of the tongue body, slight rightward deviation of the tongue apex at rest, and fasciculations. Electromyography performed 22 months after the injury demonstrated chronic axonal injury of the right hypoglossal nerve. Causality assessment favored the traffic accident as the initiating event, with postoperative edema and retraction likely contributing to progression. The condition was classified as permanent, and a 25% functional loss was assigned for tongue paralysis according to national disability criteria. This report highlights the diagnostic, prognostic, and legal complexities of delayed hypoglossal nerve palsy following cervical trauma and underscores the importance of a multidisciplinary approach in determining the etiology and prognosis of isolated hypoglossal nerve paralysis, as well as in establishing medical causality.

Objective This study aims to reveal the multidimensional effects of migraine on driving by evaluating the driving habits of individuals with migraine and patients' adherence to safety strategies. Materials and Methods This multicenter, hospital-based, cross-sectional study was conducted between May and July 2024. Volunteers with migraine, aged 18-65 years, and with a driving history were included in the study after their consent. Detailed face-to-face interviews were conducted using a form adapted from the Driving Habit Questionnaire to assess the patients' demographic characteristics, individual driving experiences, driving preferences and habits. Finally, the impact of driving on the patients' quality of life was assessed using the Headache Impact Test-6 (HIT-6). Results Of the 2548 patients evaluated in our study, 1333 had driving experience; the mean age of the drivers was 36.7±9.5 years, and 64.4% were female. Patients with migraine drove approximately 4.86 days/week; 64.1% had driving experience of more than 10 years. They generally complied with safety precautions: 92.2% of participants always fastened their seat belts, and 85.2% regularly checked their rearview mirrors before driving. 28.8% of patients always wanted to be drivers, and 26.3% drove faster than the speed limit, contrary to traffic flow. Common factors related to frequent driving behaviour, higher driving speeds, and a tendency to perceive themselves as better drivers were male gender, smoking and alcohol use, longer driving experience, and lower HIT-6. The mean HIT-6 score was 62.2±7.1 in drivers with migraine. Conclusion Our findings suggest that migraine shapes driving behaviors by affecting driving frequency, speed preferences, and subjective driving confidence, and this should be considered in clinical assessments.

Background: This study aimed to investigate the factors affecting mortality in Fournier's gangrene (FG) and to establish a simplified scoring system that enables practical bedside assessment for clinicians.

Methods: The medical records of 130 patients treated for FG between February 2012 and January 2025 were retrospectively reviewed. Survivors (Group 1, n=101) were analyzed separately from non-survivors (Group 2, n=29). The collected data included sex, age, infection spread score, Uludag Fournier's Gangrene Severity Index (UFGSI), Fournier's Gangrene Severity Index (FGSI) scores, source of infection, presence of diabetes mellitus (DM), obesity, and other comorbidities. Additional variables included the presence of a diverting stoma, duration of vacuum-assisted closure (VAC) therapy, length of hospital stay, intensive care period (ICP), and isolated bacterial species. Associations between mortality and factors such as age, infection spread score, comorbidities other than DM and obesity (CADO), and ICP were examined.

Results: A significant difference was observed between the groups in terms of age and age score. The infection spread score was significantly higher in Group 2. While 60 patients in Group 1 had CADO, all patients in Group 2 had CADO, demonstrating a statistically significant difference. ICP was also significantly longer among non-survivors. Receiver operating characteristic (ROC) analysis demonstrated that the Eğin score had a sensitivity of 96.6% and a specificity of 63.4% at a threshold value of >3.

Conclusion: Age, infection spread score, CADO, and ICP, which constitute the Eğin score, demonstrated significant differences between survivors and non-survivors. These parameters are crucial for predicting mortality in patients with FG.