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

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: This study evaluates the safety and effectiveness of coil embolization of the superior rectal artery for both emergency and elective treatment of rectal bleeding caused by Goligher grade 4 hemorrhoids, where surgery is contraindicated.

Methods: Between 2019 and 2024, 18 patients (11 males, 7 females) with a mean age of 65±10.3 years were included in the study. Hemorrhoid grading was performed according to the Goligher classification, and rectal bleeding grading was assessed using the Paris bleeding severity score. Femoral artery access was utilized for embolization in all patients, and superior rectal artery branches were embolized exclusively with coils. All patients were treated electively except one who developed hemodynamic instability due to massive rectal bleeding while monitored in the intensive care unit. Follow-up was conducted via clinical examination and rectoscopy at 1, 3, and 6 months.

Results: All patients underwent successful treatment with 100% technical success. No procedure-related ischemic complications or femoral artery puncture-related complications were observed in any patient. All patients were classified as grade 4 according to the Goligher classification prior to treatment. The mean Paris bleeding severity score was 6.6±1.1 before treatment, 3.4±1.5 at the first month, 3.8±1.61 at the third month, and 3.6±1.29 at the sixth month. Recurrence occurred in one patient at the first month and in another at the third month. Clinical success was 95% at the first month and 85% at the third and sixth months. Re-embolization was not performed in patients with recurrence.

Conclusion: In conclusion, this study demonstrates that coil embolization of the superior rectal artery branches is a safe and effective minimally invasive procedure for both the emergency treatment of bleeding due to grade 4 hemorrhoidal disease and the elective treatment of patients unsuitable for surgical intervention.

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.