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

Background: The long-term outcomes of arthroscopic tenodesis using the onlay (groove) and inlay (groove) techniques remain debated with respect to tendon healing and graft stability. The aim of our study was to identify the optimal tenodesis strategy by comparing the effects of arthroscopic inlay and onlay techniques on postoperative complication rates, patient satisfaction, and functional recovery.

Methods: Between 2015 and 2021, the treatment outcomes of 54 patients who underwent arthroscopic biceps tenodesis using either the inlay or onlay technique for the management of superior labrum anterior-to-posterior (SLAP) lesions or biceps tendon de-generation were retrospectively evaluated. Patient demographics and clinical variables, including age, sex, side of involvement, follow-up duration, visual analog scale (VAS) score, Constant score, postoperative cramping, and complications, were recorded. Group 1 consisted of 28 patients who underwent inlay tenodesis, while Group 2 included 26 patients who underwent onlay tenodesis.

Results: Postoperatively, VAS scores improved substantially in both groups, with no significant difference between Group 1 (0.21±0.45) and Group 2 (0.18±0.37) (p=0.789). Similarly, postoperative Constant scores were high in both groups, with Group 1 at 92.73±8.23 and Group 2 at 95.47±5.12; this difference was not statistically significant (p=0.145). The mean recovery time was significantly shorter in Group 2 compared to Group 1. Specifically, the mean recovery time was 12.3±4.8 weeks in Group 1 and 8.3±3.72 weeks in Group 2 (p=0.01). Cramping was reported in 21.42% of patients in Group 1 and 7.69% in Group 2; however, this difference was not statistically significant (p=0.253). In Group 1, Popeye deformity developed in two patients (7.1%), whereas in Group 2 it de-veloped in one patient (3.8%).

Conclusion: The present study demonstrates that both inlay and onlay arthroscopic biceps tenodesis techniques are effective surgical options for managing biceps tendon degeneration and superior labrum anterior-to-posterior lesions. However, the findings suggest a potential advantage of the onlay technique, as it is associated with faster recovery and a lower risk of complications.

Background: Ischemia-reperfusion (I-R) injury associated with acute mesenteric vascular occlusion can lead to severe impairment of intestinal tissue and may become a life-threatening condition if not treated in the early clinical stages. Previous studies have suggested that fraxin may exert protective effects against I-R-induced mesenteric injury due to its antioxidant and anti-inflammatory properties.

Methods: This experimental study was conducted using healthy male Wistar albino rats. The animals were divided into four groups: a Sham group (superior mesenteric artery [SMA] isolated but not occluded), a Control group (SMA isolated and I-R induced), a 10 mg/kg Fraxin group, and a 50 mg/kg Fraxin group (fraxin administered before reperfusion). Total antioxidant status (TAS), total oxidant status (TOS), superoxide dismutase (SOD), glutathione peroxidase (GPx), and catalase (CAT) activities were evaluated. Histopathological examinations and inflammatory markers, including tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and myeloperoxidase (MPO), were also analyzed.

Results: In the Sham group, SOD activity was 135.2±10.5 U/mg protein, GPx activity was 65.3±4.7 U/mg protein, and CAT activity was 85.1±5.8 U/mg protein. In the Control group, these values were 95.4±7.9, 45.7±3.6, and 60.3±4.2 U/mg protein, respectively. In 10 mg/kg Fraxin group, SOD, GPx, and CAT activities were 115.6±8.4, 55.8±4.2, and 75.6±5.5 U/mg protein, respectively; in the 50 mg/kg Fraxin group, the corresponding values were 130.8±9.7, 60.2±4.8, and 90.4±6.3 U/mg protein. Significant decreases in TNF-α, IL-6, and MPO levels were observed in the Fraxin-treated groups (p<0.05).

Conclusion: Fraxin administration preserved tissues and improved antioxidant parameters by reducing oxidative stress and inflammation in the acute mesenteric artery ischemia-reperfusion injury (AMAIRI) model. Based on these findings, fraxin may be considered a potential therapeutic option for mesenteric ischemia-reperfusion-related injuries.

Background: This study aims to present the preliminary clinical and functional outcomes of pubic symphysis diastasis (PSD) cases treated with plate-screw fixation using the laparoscopic total extraperitoneal approach in orthopedic surgery (O-TEP).

Methods: This retrospective study included 13 patients who underwent O-TEP symphysis pubis plating for PSD between March 2022 and May 2025, all with a minimum follow-up period of 12 months. Data collected encompassed demographic characteristics, injury mechanisms, additional pathologies, and injury classifications (Young-Burgess and AO/OTA). Surgical details, including duration, blood loss, hospital stay, and postoperative follow-up, were recorded. Clinical and functional outcomes were assessed using postop-erative VAS scores, as well as Iowa Pelvic and Majeed Pelvic scores at the final follow-up. The study also evaluated implant failure, the need for revision surgery, and surgery-related complications.

Results: The mean age of the patients was 40±14.8 years (21-61). The gender distribution was 77% male and 23% female. The mean operating time was 113±36 minutes (65-175). The average blood loss was 127±67.3 ml (70-300), and the mean postoperative hospitalization period was 2.7±0.8 days (2-4). No postoperative complications, such as infection, implant failure, loss of reduction, or need for revision, were observed. Postoperative VAS scores on days 1 and 2 were 3.7±1.5 (1-6) and 2.2±1.03 (1-4), respectively. The mean follow-up period was 21.5±6.9 months (12-32), with a mean Iowa Pelvic Score of 87.1±4.7 (80-95) and a mean Majeed score of 84.9±4.01 (78-91).

Conclusion: Laparoscopic total extraperitoneal approach in orthopedic surgery (O-TEP) is an innovative minimally invasive technique that expands the available options for surgeons in the treatment of selected anterior pelvic ring injuries, providing clinically and radiologically satisfactory outcomes.

Background: Nasogastric (NG) tube decompression has traditionally been used after abdominal surgery to prevent postoperative ileus and gastric distension. The aim of this study was to evaluate the necessity of NG tube decompression following emergency repair of perforated peptic ulcer (PUP).

Methods: This retrospective study included 189 patients who underwent emergency surgery for PUP between 1999 and 2017. Patients were divided into two groups: those managed with an NG tube (Group 1, n=154) and those managed without an NG tube (Group 2, n=35). Demographic data, clinical characteristics (American Society of Anesthesiologists [ASA] scores and comorbidities), intraoperative findings, and postoperative outcomes, including length of hospital stay, time to oral intake, and complications, were analyzed.

Results: The study cohort included 189 patients, of whom 84.1% were male, with a mean age of 54.1±19.9 years. Baseline demographic and clinical characteristics, including age, comorbidities, ASA scores, and operative details, were comparable between the two groups. There were no statistically significant differences in postoperative complications or 30-day mortality. However, patients in Group 2 demonstrated a significantly earlier transition to oral feeding (3.7±0.9 vs. 4.3±1.4 days; p=0.03) and a shorter duration of hospital stay (6.6±3.1 vs. 8.1±3.8 days; p=0.04) compared to Group 1.

Conclusion: Routine NG decompression is not necessary following surgery for PUP. Avoiding routine NG tube use does not increase morbidity or mortality and is associated with earlier oral intake and a shorter hospital stay. We recommend the use of NG decompression in selected patients when clinically indicated.

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.