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

Background: This study aimed to compare the prognostic performance of the Fournier's Gangrene Severity Index (FGSI) and the hemoglobin-albumin-lymphocyte-platelet (HALP) score in predicting in-hospital mortality among patients diagnosed with Fournier's gangrene. As Fournier's gangrene remains a life-threatening and rapidly progressive soft tissue infection, early risk stratification is critical for improving patient outcomes. Validating practical scoring systems may support timely clinical decision-making and resource allocation.

Methods: A retrospective analysis was performed on 52 patients who underwent surgical treatment for Fournier's gangrene at a tertiary referral center between December 2022 and June 2025. Demographic, laboratory, and clinical data were collected, and both FGSI and HALP scores were calculated at the time of admission. Receiver Operating Characteristic (ROC) curve analysis and multivariate logistic regression were used to assess the predictive value of both scores for in-hospital mortality.

Results: The mean FGSI was 5.1±2.2, while the mean HALP score was 134.6±100.2. FGSI showed acceptable discrimination (AUC=0.7639; cutoff=5.0), with 72.7% sensitivity and 67.7% specificity. HALP had poor predictive ability (AUC=0.4018). In multivariate analysis, FGSI was an independent predictor (p=0.0146), while HALP was not (p=0.9474).

Conclusion: FGSI appears to be a reliable and independent prognostic tool in patients with Fournier's gangrene. HALP, however, does not offer additional prognostic benefit. FGSI should be prioritized in early risk assessment to guide management strategies.

Background: Posterior malleolar fractures play a critical role in ankle fracture stability and joint congruity. While plate and screw fixation are widely used, existing literature has primarily focused on short-term functional outcomes and reduction quality. The long-term impact of the posterior malleolar fixation technique on post-traumatic ankle osteoarthritis, particularly in relation to fracture morphology, remains insufficiently explored.

Methods: This retrospective cohort study included 91 adult patients who underwent surgical fixation of posterior malleolar fractures between 2015 and 2021, with a minimum radiological follow-up of 36 months. Patients were treated with either posterior buttress plate fixation (n=42) or posteroanterior screw fixation (n=49). Ankle osteoarthritis was assessed using the Van Dijk classifica-tion. Fracture morphology was classified according to the Bartoníček system. Functional outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) score, the Olerud-Molander Ankle Score (OMAS), and ankle range of motion (Prasad classification). Multivariable regression analyses were performed to assess the independent association between fixation method and outcomes.

Results: After adjustment for age, body mass index, follow-up duration, fracture morphology, and open fracture status, screw fixation was statistically associated with a higher degree of ankle osteoarthritis compared with plate fixation (OR 11.22, 95% CI 2.17-58.04; p=0.004). However, the wide confidence intervals indicate considerable statistical uncertainty around the magnitude of this effect, likely reflecting the limited number of outcome events. Sensitivity analysis using a dichotomized osteoarthritis outcome yielded consistent results. Subgroup analyses demonstrated that the association between screw fixation and higher osteoarthritis risk was particularly pronounced in complex fracture patterns (Bartoníček types 3-4). Patients treated with plate fixation achieved significantly higher AOFAS and OMAS scores and demonstrated superior ankle range of motion at long-term follow-up. Increasing Van Dijk osteoarthritis grades were strongly correlated with worse functional outcomes.

Conclusion: Posterior buttress plate fixation was associated with a significantly lower risk of long-term post-traumatic ankle osteoarthritis and superior functional outcomes compared with screw fixation. These findings were especially evident in complex posterior malleolar fracture patterns, highlighting the importance of fracture morphology and fixation strategy in long-term joint preservation.

Background: Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are widely used to treat vertebral frac-tures. However, the standard filler material, polymethylmethacrylate (PMMA), presents significant drawbacks, including thermal dam-age, allergic reactions, and poor biocompatibility. Tetracalcium phosphate (TTCP), a calcium phosphate cement (CPC), has emerged as a promising alternative due to its superior biocompatibility, osteoconductivity, and ability to integrate with natural bone. This study aimed to evaluate the feasibility of TTCP for vertebral augmentation in a preclinical sheep model, focusing on biomechanical stability, biocompatibility, and osteogenic potential.

Methods: Five Akkaraman sheep underwent PKP with TTCP at three lumbar vertebral levels (L2-L4). Under general anesthesia, TTCP cement was injected into cavities prepared according to the standard PKP procedure. Postoperative care included analgesia and antibiotics. Four animals were followed for 12-14 weeks, and one for 25 weeks. At the end of the study period, the animals were euthanized and vertebrae were harvested for biomechanical testing using a Shimadzu AG-IS 100 kN machine. Histological evaluation was performed to assess ossification stages according to Shapiro's classification. Statistical analysis was conducted using paired t-tests (p<0.05).

Results: One animal was euthanized prematurely due to infection, while four completed the study without complications. Biomechanical analysis demonstrated no significant difference in compressive strength between treated and untreated vertebrae (p>0.05). Histological examination revealed osteoblastic activity, progressive mineralization, and successful bone integration.

Conclusion: TTCP demonstrated promising biomechanical and biophysiological properties for vertebral augmentation. However, its use in infected sites and in the presence of metabolic bone disorders may be limited. Further clinical studies are required to validate its long-term efficacy.

Background: This study aims to evaluate the effect of the type of intervention (bedside vs. operating room incision and drainage) on clinical outcomes in the treatment of perianal abscess and to identify predictive factors that may be effective in determining the type of intervention.

Methods: A retrospective study was conducted on 213 patients who underwent incision and drainage (I&D) for cryptoglandular perianal abscess. Patients were divided into 'bedside I&D' and 'operating room I&D' groups according to the type of intervention. Demographic characteristics, laboratory values, abscess size, early complications, and long-term fistula development were compared. Receiver operating characteristic (ROC) analysis was performed to determine cut-off values for white blood cell count (WBC), C-reactive protein (CRP), and abscess size; subsequently, logistic regression analyses were performed using these parameters.

Results: WBC count, CRP levels, and abscess size were statistically significantly higher in the operating room group (p<0.001). According to ROC analysis, cut-off values were determined as 14.68×10⁹/L for WBC, 55.7 mg/L for CRP, and 29.5 mm for abscess size. While CRP lost statistical significance in univariate regression analysis, WBC and abscess size were identified as independent predictive factors for determining the intervention site in multivariate analysis. During long-term follow-up, fistula development was observed significantly more frequently in the operating room group (p=0.002).

Conclusion: WBC level and abscess size may be valuable predictors in deciding the type of intervention for perianal abscess treatment. Bedside I&D can be safely performed in low-risk cases, whereas operating room intervention should be preferred in patients with high inflammatory markers and larger abscesses.

Background: Vitamin D, calcium, and bone metabolism markers play a critical role in skeletal health; however, their relationship with different hip fracture types remains uncertain. This study aimed to investigate serum levels of 25(OH) vitamin D, calcium, parathyroid hormone (PTH), alkaline phosphatase (ALP), phosphorus, total protein, and albumin in elderly patients with femoral neck fractures (FNF) and intertrochanteric femur fractures (ITFF), compared to a control group.

Methods: This retrospective study included 375 patients aged 65 years and older, comprising 117 patients with ITFF, 97 with FNF, and 161 control cases (coxarthrosis/gonarthrosis). Serum biochemical parameters were analyzed using standard laboratory methods. Fractures were classified according to the AO/OTA (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association) system by two independent observers, and interobserver agreement was assessed using Cohen's kappa coefficient (κ=0.89). Group comparisons were performed using one-way analysis of variance (ANOVA) followed by post hoc Bonferroni tests. A p value <0.05 was considered statistically significant.

Results: Vitamin D levels were significantly lower in both the ITFF and FNF groups compared to controls (p<0.01), while no significant difference was observed between the ITFF and FNF groups (p>0.05). Similarly, calcium, total protein, and albumin levels were lower in fracture groups than in controls (p<0.01). In contrast, PTH levels were significantly higher in patients with fractures (p=0.001).

Conclusion: Deficiencies in vitamin D and calcium were associated with an increased risk of hip fractures but did not appear to influence fracture pattern. These findings suggest that systemic biochemical parameters should be emphasized in comprehensive fracture risk assessment, underscoring the importance of preoperative evaluation and postoperative correction of metabolic deficiencies in patients with hip fractures.

Background: Distal radius fractures (DRFs) are among the most common fractures in adults, with a significant proportion being stable, non-displaced, or minimally displaced. These fractures generally have a low risk of secondary displacement. This study aimed to compare the clinical and radiological outcomes of short-arm circular casting and volar splint application in the conservative treatment of stable distal radius fractures. Additionally, the study evaluated complication rates, patient comfort, and the feasibility of these two immobilization techniques in emergency department settings.

Methods: This retrospective study reviewed the medical records of 170 patients diagnosed with stable, non-displaced, or minimally displaced distal radius fractures at two emergency departments between January 2020 and January 2023. Fracture stability was assessed using Lindstrom's criteria. Among the participants, 88 patients were treated with short-arm circular casting, while 82 received volar splint application. Immobilization was maintained for four weeks, followed by a six-month follow-up period. Radiographic parameters (radial height, radial inclination, palmar tilt, and articular surface step-off) were measured at baseline and during follow-up visits. Clinical and functional outcomes were assessed using the Quick Disabilities of the Arm, Shoulder, and Hand (qDASH) and Patient-Rated Wrist Evaluation (PRWE) scales. Complication rates and patient satisfaction were also analyzed.

Results: The study included 170 patients (mean age: 46.9±11.4 years). No statistically significant differences were observed between the casting and splint groups in terms of radiological parameters at baseline or six months post-treatment (p>0.05). Similarly, clinical and functional outcomes, including qDASH and PRWE scores, were comparable between the two groups (p>0.05). Complication rates were 5.7% in the cast group and 4.8% in the splint group, with no significant difference (p>0.05). The volar splint technique demonstrated advantages in terms of ease of application and patient comfort.

Conclusion: Short-arm circular casting and volar splinting provide equivalent clinical and functional outcomes in the management of stable distal radius fractures. Given its ease of application and greater patient comfort, volar splinting can be considered a practical alternative in emergency department settings, particularly for selected patient populations.

Background: Infections are a frequent complication of military trauma, occurring not only in the acute phase but also during rehabilitation. However, studies specifically addressing infections in the rehabilitation setting remain scarce. This study aimed to evalu-ate the incidence, microbiological spectrum, treatment approaches, and outcomes of skin and soft tissue infections (SSTIs) and bone and joint infections (BJIs) in military trauma patients during inpatient rehabilitation.

Methods: We retrospectively reviewed the medical records of military trauma patients hospitalized at a tertiary rehabilitation hospital between January 2020 and June 2023. Patients who developed SSTIs or BJIs during rehabilitation were included. Demographic and clinical characteristics, laboratory and imaging findings, culture results, antibiotic regimens, surgical interventions, treatment duration, and recurrence rates were analyzed.

Results: Among 1,078 trauma patients, 58 (5.4%) developed SSTIs or BJIs. Stump infection was the most frequent type (44.8%), followed by graft infection (15.5%). Staphylococcus species were the predominant pathogens, while multidrug-resistant (MDR) gram-negative organisms were isolated in 24.1% of cases. β-lactam/β-lactamase inhibitor (BL-BLI) therapy was the most common mono-therapy, whereas BL-BLI plus a fluoroquinolone was the most frequently used combination regimen. Surgical intervention was required in 34.5% of patients. Recurrent infections occurred in 25.8% of cases. Treatment duration was significantly longer in non-amputee pa-tients (p<0.05), primarily due to bone and joint infections. Despite these infectious complications, most lower-limb amputees achieved ambulatory status with prosthetic devices.

Conclusion: Military trauma patients remain at risk for SSTIs and BJIs during rehabilitation, with stump infections being the most common. The emergence of MDR organisms underscores the need for appropriate antibiotic selection and strict infection control measures. Despite these complications, relatively favorable functional outcomes can be achieved, particularly in younger trauma populations, highlighting the value of comprehensive rehabilitation programs.

Background: Postpartum hemorrhage is a major cause of maternal morbidity and mortality. Abdominal packing is a technique used to control bleeding when other methods fail. This study aimed to evaluate the outcomes of patients who underwent abdominal packing for postpartum hemorrhage.

Methods: This retrospective study included 11 patients who underwent abdominal packing for severe obstetric hemorrhage (10 cases of postpartum hemorrhage and one case of second-trimester pregnancy termination complicated by severe hemorrhage) at Mersin University Faculty of Medicine Hospital between 2005 and 2023. Data were collected from medical records. The primary outcome was the successful immediate control of refractory hemorrhage and temporary stabilization of the patient's hemodynamic status. Secondary outcomes included transfusion requirements, complications, and length of hospital stay.

Results: All 11 patients underwent hysterectomy for postpartum hemorrhage and subsequently required abdominal packing due to persistent bleeding. The median age was 33 years, and the median gravidity was 3. The primary causes of postpartum hemorrhage were uterine atony (54.5%), placenta previa (36.4%), and disseminated intravascular coagulation (9.1%). The median number of packs used was 3, and packs were removed after 24 hours in all cases. Abdominal packing successfully controlled persistent bleeding in all patients following hysterectomy. The median length of hospital stay was 6 days. All patients required blood transfusions. The most common complication was pulmonary edema (90.9%). All patients survived.

Conclusion: Abdominal packing may serve as a valuable temporary rescue measure for severe, refractory obstetric hemorrhage in selected cases where conventional methods are insufficient. Careful patient selection and close postoperative monitoring are essential.

Background: Mortality rates are high in patients undergoing emergency surgery for obstructed colon adenocarcinoma. The etiology of mortality is multifactorial, and parameters with high predictive value are still needed. The aim of this study was to investigate the relationship between the blood urea nitrogen-to-serum albumin ratio (BAR) and short-term mortality in patients with obstructed colon cancer undergoing emergency surgery.

Methods: This retrospective cohort study included patients with obstructed colon adenocarcinoma who underwent emergency surgery at two tertiary care centers between January 2015 and December 2024. Baseline characteristics, laboratory findings, operative details, and clinical data were collected. According to time-dependent receiver operating characteristics (ROC) analysis, the optimal cut-off value for pretreatment BAR was 0.68. Data from patients who died within the first 30 days and those who survived were compared. Univariate and multivariate Cox regression analyses were performed to evaluate the association between BAR and other factors with early mortality.

Results: A total of 173 patients underwent emergency surgery, and 17 (9.8%) experienced early mortality. In multivariate logistic regression analysis, age (≥75 years), lactate level, neutrophil count, and BAR ≥0.68 (odds ratio: 7.053; 95% confidence interval: 1.728-28.785; p=0.006) were identified as significant risk factors for early mortality in patients undergoing emergency surgery for obstructed colon cancer.

Conclusion: Mortality in patients undergoing emergency surgery for obstructed colon cancer is high and multifactorial. BAR is a cost-effective, easily measurable, and useful predictor of early mortality.

Background: Anal canal stenosis is a functionally disabling condition that results in impaired continence, constipation, and decreased quality of life. Although most cases arise after anorectal surgery, high-energy blast trauma (HEBT) represents a distinct etiology characterized by extensive tissue loss and neuromuscular injury. Long-term outcomes of anoplasty in this setting remain insufficiently described. This retrospective study evaluated functional and quality-of-life outcomes following flap anoplasty for anal stenosis of both postoperative and trauma-related origins.

Methods: All patients who underwent anoplasty between 2008 and 2015 with ≥12 months of follow-up were included. Functional status was assessed preoperatively and at 12 months postoperatively using the Modified Wexner Score, Wexner Constipation Scale, and the Fecal Incontinence Quality of Life (FIQL) questionnaire. Sphincter morphology was evaluated using endoanal ultrasonography. Statistical analyses included paired tests, effect size calculations, and multivariable logistic regression to identify independent predictors of good continence (Wexner score ≤5).

Results: Thirty-seven patients met the inclusion criteria: 27 with postoperative stenosis and 10 with blast-related trauma. Ano-plasty resulted in overall improvement in continence, constipation, and FIQL scores. However, functional recovery differed significantly by etiology: postoperative patients experienced substantial improvement, whereas blast-injured patients achieved only modest gains, reflecting persistent neuromuscular and fibrotic damage. Trauma cases demonstrated lower FIQL scores (14.7 vs. 16.8), higher constipation scores (8.1 vs. 7.2), and increased rates of fecal incontinence (20% vs. 11.1%). Sphincter integrity and shorter stricture length independently predicted good continence, while blast mechanism and advanced age were associated with reduced improvement.

Conclusion: Anoplasty provides meaningful functional benefits in patients with anal stenosis; however, recovery is significantly attenuated in survivors of high-energy trauma. These findings underscore the importance of etiology-based planning, thorough sphinc-ter evaluation, and realistic patient counseling.