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

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.

Background: Osteoporosis is characteristically defined as a decrease in bone density and mass, accompanied by the deterioration of bone structure, which increases bone fragility and the risk of fractures. Osteoporosis frequently develops with age. In high-risk populations, oxidative damage is a common pathological condition. Oxidative stress plays a critical role in the development of osteoporosis and the formation of osteoporosis-related fractures. This study aimed to investigate the role of oxidative stress and antioxidants in bone tissue metabolism among elderly individuals with osteoporotic hip fractures, specifically intertrochanteric femur fractures and femoral neck fractures, who presented to our department.

Methods: Based on power analysis, 24 patients over the age of 65 who presented with hip pain following a fall, were diagnosed with hip fractures (intertrochanteric or femoral neck fractures) on X-ray, were hospitalized in the Orthopedics and Traumatology Department, and underwent surgery were included in the study. A control group consisting of 24 healthy individuals matched for age and gender, with no history of fractures and meeting the same exclusion criteria, was also included. Levels of oxidative stress and antioxidant parameters, including total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), and paraoxonase-1 (PON-1), were measured in serum samples using spectrophotometric methods.

Results: The TAS (p=0.189) and OSI (p=0.110) levels in the patient group were significantly lower compared to the control group. Conversely, the TOS (p=0.002) and PON-1 (p=0.013) levels in the patient group were significantly higher than those in the control group.

Conclusion: The data indicate that oxidative balance is disrupted due to increased oxidative load and the resulting antioxidant deficiency. A better understanding of the pathophysiology of the disease, along with the development of alternative treatment approaches and disease markers, will contribute to the literature.

Background: Degeneration of the spine may affect pelvic parameters and hip mobility. This study aimed to evaluate the effects of degenerative scoliosis and spinopelvic parameters on hip hemiarthroplasty dislocations.

Methods: A retrospective analysis was conducted on patients who underwent hemiarthroplasty for intracapsular hip fracture over a twenty-year period. Demographic data, dislocation incidence, degenerative scoliosis (DS) status, type of hemiarthroplasty, surgical intervention to the hip, femoral head size, cement use, American Society of Anesthesiologists (ASA) score, body mass index (BMI), and in-hospital mortality were evaluated. The Cobb angle (CA), pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), and thoracic kyphosis (TK) angles were measured and analyzed.

Results: A total of 284 patients were evaluated, with a mean age of 79.07 (±8.21) years. The frequency of hemiarthroplasty dislocation was 13% (n=37). Degenerative scoliosis was detected in 25.4% of the cases and was significantly more common in patients with degenerative scoliosis (p=0.001). Advanced age, higher BMI, higher ASA score, unipolar and cementless hemiarthroplasty, smaller femoral head size, and the posterior approach significantly increased dislocation frequency (p=0.004, p=0.001, p=0.03, p=0.001, p=0.001, and p=0.026, respectively). The mean PI, SS, PT, LL, and TK angles were significantly reduced in patients with dislocation and degenerative scoliosis (dislocation: p=0.001, p=0.001, p=0.001, p=0.003, p=0.048; degenerative scoliosis: p=0.001, p=0.001, p=0.001, p=0.001, p=0.001; respectively).

Conclusion: The presence of degenerative scoliosis and low pelvic incidence, sacral slope, pelvic tilt, thoracic kyphosis, and lumbar lordosis angles may increase the frequency of hemiarthroplasty dislocations. The posterior approach and small femoral head size may also elevate the risk of posterior dislocation.

Background: Acute appendicitis is a common surgical emergency that causes acute abdominal pain and affects approximately 7-8% of the population during their lifetime. The closure of the appendix stump during laparoscopic appendectomy is one of the most critical steps of the surgery to prevent life-threatening complications such as postoperative fistula, peritonitis, and sepsis. The mate-rial chosen for appendix stump closure must be effective, safe, and economical. However, there is still no consensus on the optimal method for stump closure. In this study, we aimed to compare the advantages and reliability of three different methods used for appendix stump closure.

Methods: At Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Department of General Surgery, cases that underwent laparoscopic appendectomy for acute appendicitis between January 2022 and April 2024 were retrospectively analyzed using the hospital's data system. The patients' demographic data, laboratory values, pathology reports, surgical notes, duration of hospital stay, duration of surgery, total hospital costs, complications related to the surgery within 30 days postoperatively, and the management of these complications were examined.

Results: The study included a total of 150 individuals, with 83 (55.33%) males and 67 (44.67%) females. The average age of the participants was 38.45±14.48 years. In terms of the materials used for stump closure, endoloop was used in 82 (54.67%) cases, Hem-o-lok clip in 30 (20.00%) cases, and endostapler in 38 (25.33%) cases. In 144 (96%) cases, no Clavien-Dindo (CD) complications were observed, while complications occurred in six (4%) cases. These six complications included two intra-abdominal abscesses (CD Grade 3), two wound infections (CD Grade 1), one case of bleeding (CD Grade 2), and one pulmonary embolism (CD Grade 4).

Conclusion: The use of endoloop, polymeric clips, and endostapler in laparoscopic appendectomy is safe and effective for appendectomy. All three methods can be successfully applied without an increase in intraoperative or postoperative complications. However, due to the higher treatment costs associated with endostapler, its use should be reserved for situations where securing the appendix stump cannot be achieved with endoloop or Hem-o-lok clip.

In this case report, we presented to a 90-year-old female with multiple comorbidities presented to the emergency department of our hospital three weeks following a fall from standing height. Upon arrival, the patient exhibited a Glasgow Coma Scale (GCS) 12, blood pressure of 100/60 mmHg, heart rate of 117 beats/min, respiratory rate of 24 breaths/min. Examination revealed atrophy, skin color change, sensory disturbance, or motor palsy in the left upper extremity. Chest X-ray showed a fractured left clavicle, with its free fragment dislocated toward the thorax. She was diagnosed with a displaced midshaft clavicle fracture, Arbeitsgemeinschaft für Osteosynthesefragen (AO) type 15.2B2. On doppler ultrasound examination, flow loss secondary to compression was observed in the proximal left subclavian artery (SA). No flow was observed in the axillary, brachial, radial and ulnar arteries. Due to the patient's high number of comorbid diseases and poor general condition, disarticulation was performed from the shoulder joint, which is the proximal region of arterial occlusion. No other symptoms of circulatory dysfunction were observed at the 3 months follow-up. This case report emphasizes that delayed clavicle fracture can lead to catastrophic consequences. Trauma surgeons should also consider surgical treatment of clavicle fractures, depending on the patient's condition.

Background: Lateral condyle fractures are the second most common peri-elbow fractures in children aged 6-10 years, following supracondylar fractures. In treating these fractures, either open or closed reduction fixation can be performed. However, it is not yet completely clear which type of fracture should be treated and how. The Song classification has been increasingly used by orthopedic surgeons for these fractures in recent years. A review of the literature reveals few studies comparing closed reduction and percutaneous pinning (CRPP) and open reduction and internal fixation (ORIF) in lateral condyle fractures (LCFs) with displacements of 2 mm or more. Based on this, we compared Song stage 4 and 5 fractures operated with open or closed reduction methods in our clinic in terms of radiological and clinical aspects.

Methods: Patients who underwent surgery in our clinic for Song type 4 and 5 lateral condyle fractures between 2011 and 2016 were included in the study. After obtaining approval from our ethics committee (ID: 00171379117), we retrospectively evaluated the medical records of the patients. Between 2011 and 2016, 213 patients underwent surgery for LCF in our hospital, 24 patients were lost to follow-up, and 78 patients had other types of Song fractures. Our study evaluated 111 patients, who were divided into two groups: the CRPP group and the ORIF group.

Results: A total of 111 patients were included in our study, with 52 undergoing CRPP and 59 undergoing ORIF. There was no difference between the groups in terms of age, gender, side of injury, mechanism of trauma, and follow-up time (p=0.962, p=0.198, p=0.706, p=0.526, p=1.000, p=0.708, respectively). There was also no significant difference in the displacement amounts between the patients (p=0.233). In the postoperative radiological comparison, a lateral spur was observed in 12 patients (23%) in the CRPP group and 28 patients (47.5%) in the ORIF group. Hardacre's criteria were evaluated as excellent in 46 (88.4%) of the patients who underwent CRPP and 50 (84.7%) of the patients who underwent ORIF. No significant result was found between both groups (p=0.769). There was no difference in complications between the groups (p=1.000).

Conclusion: This study demonstrates that in pediatric patients with lateral condyle fractures displaced by 2 mm or more, the choice between open or closed reduction has minimal impact on medium and long-term outcomes. Since there are not many studies on this subject in the literature, we believe that our results will provide valuable guidance for treatment decisions.

Background: This study aimed to elucidate the diagnostic significance of changes in periappendiceal fat density observed on computed tomography (CT) in patients with acute appendicitis (AA).

Methods: Patients who underwent surgery with a diagnosis of AA based on CT findings from January 1, 2020 to December 31, 2020 were included in the study. Patients were divided into three grades. In Grade 1, the periappendiceal tissue appears hypoechoic, indicative of normal tissue. In Grade 2, the periappendiceal tissue is slightly hyperechoic but confined to the periappendiceal area. In Grade 3, dense hyperechoic areas are present not only in the periappendiceal tissue but also extend into surrounding organs and deeper tissues. The groups were compared in terms of clinical, laboratory, and pathological outcomes.

Results: A total of 195 patients-131 males and 64 females-were included in the study. A correlation was identified between grade and several factors: appendix diameter, appendix wall thickness, incidence of lymphadenopathy, and duration of symptoms onset (p<0.001). Conditions such as appendicolitis, free air, and intra-abdominal abscesses were more frequently observed in Grade 3 patients compared to Grade 1 and Grade 2 patients (p=0.002, p<0.001). Both operative time and length of hospital stay were highest in Grade 3 patients (p<0.001). The rate of patients found to have a normal appendix upon pathological examination was significantly higher in Grade 1 than in Grade 2 (p=0.03).

Conclusion: In cases where the diagnosis is uncertain, the hyperechogenicity in periappendiceal tissue observed on CT strengthens the diagnosis of AA. Additionally, cases of AA become increasingly complex as echogenicity in periappendiceal tissue increases.

We present a challenging case at our facility involving a 70-year-old female with a history of hypertension who was diagnosed with malignant ovarian neoplasia. Preoperative imaging revealed a 6 x 6 x 2.5 cm mass in liver segment 6, initially suspected to be metastatic disease. The patient had undergone a laparoscopic cholecystectomy 11 years prior. Despite repeated biopsies and a high fluorodeoxy-glucose (FDG) uptake value of 9.87 on positron emission tomography-computed tomography (PET-CT), the exact nature of the mass remained undetermined. However, during a total abdominal hysterectomy and bilateral salpingo-oophorectomy, an excisional biopsy of the liver lesion identified it as an abscess formed around a gallstone, presumably spilled during the previous cholecystectomy. This case highlights a rare but significant diagnostic challenge, wherein a gallstone shed during gallbladder surgery mimicked a metastatic liver mass. It underscores the importance of considering a patient's surgical history in differential diagnoses, especially when encountering atypical abdominal masses.

Brachial plexus injuries are the second most common perioperative peripheral nerve injuries. Malposition is a significant predisposing factor to these injuries. Additionally, some drugs, including tacrolimus, are known to predispose individuals to peripheral neuropathy. Herein, we present the electroneuromyography (EMG) findings within the first 48 hours for a patient who has been under tacrolimus treatment for five years due to liver transplantation and developed compression-induced reversible brachial plexopathy. Through this case, we highlighted that brachial plexus injury may not always result in axonal involvement and discussed the findings that may be encountered in early neurophysiological examinations.

Background: Although the ankle clonus test is a pathological finding in neurological examination, it may temporarily occur in neurologically intact individuals during awakening from anesthesia. Some studies suggest it as a marker indicating neural tract integrity in pediatric spinal deformity surgery. This study aims to investigate the consistency of the ankle clonus test under different anesthesia protocols in pediatric patients with spinal deformities.

Methods: A total of 39 patients diagnosed with Adolescent Idiopathic Scoliosis or Scheuermann Kyphosis were enrolled to this prospective study. Patients were divided into three groups based on the anesthesia protocol used. In Group I and Group II, two different anesthetic agents (pentothal vs. propofol) were administered, while Group III received Total Intravenous Anesthesia. All patients underwent surgery with pedicle screw constructs using a standard posterior approach. The presence of clonus was recorded during awakening.

Results: Bilateral ankle clonus was observed in 10 patients (76.9%) in Group 1, six patients (46.1%) in Group II, and seven patients (53.8%) in Group III. Clonus was absent in 16 patients (41%) across all groups. There was no significant association between the presence of ankle clonus and factors such as group assignment, duration of surgery, level of instrumentation, or blood loss. No neurological deficits were observed in any patient during the postoperative period.

Conclusion: The ankle clonus test is not a reliable method for monitoring neurological deficits during spinal surgery. It is not exactly known how such myoclonic contractions occur or how the pathway is inhibited or activated.