p-ISSN: 1306-696x | e-ISSN: 1307-7945
Volume : 20 Issue : 3 Year : 2025

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Turkish Journal of Trauma and Emergency Surgery - Ulus Travma Acil Cerrahi Derg: 20 (3)
Volume: 20  Issue: 3 - May 2014
EXPERIMENTAL STUDY
1. Captopril protects against burn-induced cardiopulmonary injury in rats
Esra Saglam, Ahmet Ozer Sehirli, Emine Nur Ozdamar, Gazi Contuk, Sule Cetinel, Derya Ozsavcı, Selami Suleymanoglu, Goksel Sener
PMID: 24936835  doi: 10.5505/tjtes.2014.96493  Pages 151 - 160
BACKGROUND: This study was designed to determine the possible protective effect of captopril treatment against oxidative damage in heart and lung tissues induced by burn injury.
METHODS: Under ether anesthesia, the shaved dorsum of Wistar albino rats was exposed to 90°C water bath for 10 seconds. Captopril was administered intraperitoneally (10 mg/kg) after the burn injury and repeated twice daily. In the sham group, the dorsum was dipped in a 25°C water bath for 10 seconds. At the end of the 24 hours, echocardiographic recordings were performed, then animals were decapitated and heart and lung tissue samples were taken for the determination of tumor necrosis factor-α (TNF-α) as a pro-inflammatory cytokine, malondialdehyde and glutathione levels and myeloperoxidase, caspase-3, and Na+,K+-ATPase activity in addition to the histological analysis.
RESULTS: Burn injury caused significant alterations in left ventricular function. In heart and lung tissues, TNF-α and malondialdehyde levels and myeloperoxidase and caspase-3 activities were found to be increased, while glutathione levels and Na+, K+-ATPase activity were decreased due to burn injury. Captopril treatment significantly elevated the reduced glutathione level and Na+, K+-ATPase activity, and decreased cytokine and malondialdehyde levels and myeloperoxidase and caspase-3 activities.
CONCLUSION: Captopril prevents burn-induced damage in heart and lung tissues and protects against oxidative organ damage.

2. The effect of hyperbaric oxygen therapy on fracture healing in nicotinized rats
Abdullah Demirtaş, Ibrahim Azboy, Mehmet Bulut, Bekir Yavuz Ucar, Celil Alemdar, Ulas Alabalik, Veysi Akpolat, Ismail Yildiz, Savas Ilgezdi
PMID: 24936836  doi: 10.5505/tjtes.2014.52323  Pages 161 - 166
BACKGROUND: The aim of the present study was to investigate the effect of hyperbaric oxygen therapy on fracture healing in nicotinized rats.
METHODS: Thirty-two rats were divided as follows: nicotinized group (1), hyperbaric oxygen group (2), nicotinized + hyperbaric oxygen group (3), and control group (4). For 28 days, nicotine was administered in Groups 1 and 3. Then, a standard shaft fracture was induced in the left femur of rats. Groups 2 and 3 underwent hyperbaric oxygen therapy for 21 days. At the end of the experiment, fracture site, left femur and whole body bone mineral content and density were measured.
RESULTS: The radiological and histopathological scores of Group 1 were statistically significantly lower compared to Groups 2, 3 and 4, and there was no statistically significant difference between the Groups 2, 3 and 4. In a comparison between the groups, no statistically significant difference was found in terms of bone mineral content and density values measured at the fracture site, left femur and whole body.
CONCLUSION: The negative effects of nicotine on fracture healing are eliminated with hyperbaric oxygen therapy, but hyperbaric oxygen alone does not cause significant changes in healing (radiologically and histopathologically).

3. Effectiveness of hyperbaric oxygen and ozone applications in tissue healing in generated soft tissue trauma model in rats: an experimental study
Ali Osman Yıldırım, Mehmet Eryılmaz, Ümit Kaldırım, Yusuf Emrah Eyi, Salim Kemal Tuncer, Murat Eroğlu, Murat Durusu, Turgut Topal, Bülent Kurt, Serkan Dilmen, Serkan Bilgiç, Muhittin Serdar
PMID: 24936837  doi: 10.5505/tjtes.2014.09465  Pages 167 - 175
BACKGROUND: Soft tissue trauma is a type of acute traumatic ischemia. We investigated in this study whether the edema, inflammation and ischemia caused by the trauma could be affected positively by hyperbaric oxygen (HBO) and ozone therapy.
METHODS: Soft tissue trauma was generated in a total of 63 adult male Sprague-Dawley rats. Subsequently, rats were divided into three groups. The first group was treated with ozone, the second group with HBO, and the third group served as controls. Tissue and blood samples were taken at the end of the procedures. Tissue lipid peroxidation (LPO), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), inducible nitric oxide synthase (iNOS), heme oxygenase (HO)-1, and hypoxia-inducible factor (HIF)-1 levels were detected. Hematoxylin-eosin staining was used to determine the inflammation and edema histopathologically.
RESULTS: We also detected HIF-1 activity, which decreases when the oxygen concentration increases, HO-1 activity, which has anti-inflammatory effects, and iNOS activity, which releases in any type of acute case. We determined a statistically significant reduction in iNOS and LPO levels in both the HBO and Ozone groups. A significant decrease in inflammation was detected in both the Ozone and HBO groups compared with the Control group, and a significant decrease in edema was detected in all three groups.
CONCLUSION: We think that HBO and Ozone therapy have beneficial effects on biochemical and histopathological findings. Related clinical trials will be helpful in clarifying the effects.

ORIGINAL ARTICLE
4. Psychiatric disorders and their association with burn-related factors in children with burn injury
Gul Karacetin, Turkay Demir, Semih Baghaki, Oguz Cetinkale, Mine Elagoz Yuksel
PMID: 24936838  doi: 10.5505/tjtes.2014.49033  Pages 176 - 180
BACKGROUND: The aim of this study was to assess psychiatric disorders and their association with burn-related factors in a population of Turkish children with burns.
METHODS: Thirty-one children admitted to the Cerrahpasa Medical Faculty Burn Unit between January 2013 and August 2013 were first assessed by the plastic surgeon, and then those with psychological symptoms were referred to a child psychiatrist, and the records were analyzed retrospectively.
RESULTS: The percentage of burned area to Total Body Surface Area (TBSA) ranged between 2-60% (mean, 17.3%). Nineteen patients (61.3%) had a psychiatric diagnosis, which included acute stress disorder (ASD) (n=15), depression (n=3), posttraumatic stress disorder (n=2, comorbid with depression), and delirium (n=1). The percentage of burned area to TBSA was associated with the presence of psychopathology and ASD. Further, psychopathology was associated with the number of burned major body regions.
CONCLUSION: Pediatric burn patients are at risk of developing psychopathology. The children with a greater percentage of burned area to TBSA and more burned body regions have the greatest risk of psychopathology. Surgeons have an important role in patient referral for psychiatric interventions, so that psychiatric disorders can be prevented as early as possible.

5. Traumatic wound dehiscence after penetrating keratoplasty
Baki Kartal, Baran Kandemir, Turan Set, Süleyman Kuğu, Sadullah Keleş, Erdinç Ceylan, Berkay Akmaz, Aytekin Apil, Yusuf Özertürk
PMID: 24936839  doi: 10.5505/tjtes.2014.36589  Pages 181 - 188
BACKGROUND: We aimed to evaluate the risk factors, clinical features and outcomes of surgery for traumatic wound dehiscence (TWD) following penetrating keratoplasty (PK).
METHODS: Twenty-six patients with TWD following PK were evaluated retrospectively in terms of factors related to the trauma, types of reconstructive surgery, final graft clarity, and visual acuity.
RESULTS: There were 26 patients with a mean age of 40.7±19.6 years. In 12 (46.1%) patients, the better eye was affected by the trauma. The most frequent type of trauma was blunt trauma by various objects (9). In all cases, the dehiscence was at the graft host junction. The mean extent of detachment was 135.4°±57.6°. Crystalline or intraocular lens damage was present in 42.3% of cases. Median follow-up time after the reconstructive surgery was 36 months. The graft remained clear in 13 (50%) patients, whereas graft insufficiency/graft rejection developed in 13 (50%) patients. Final visual acuity was over 20/200 in 13 (50%) patients.
CONCLUSION: TWD may occur at any time after PK, most frequently within the first postoperative year. Low visual acuity in the other eye seems to be a major risk factor. In patients without major complications such as posterior segment damage, visual outcomes and graft survival can be favorable.

6. Comparison of intramedullary nail and plate fixation in distal tibia diaphyseal fractures close to the mortise
Umut Yavuz, Sami Sökücü, Bilal Demir, Timur Yıldırım, Çağrı Özcan, Yavuz Selim Kabukçuoğlu
PMID: 24936840  doi: 10.5505/tjtes.2014.92972  Pages 189 - 193
BACKGROUND: In this study, we aimed to compare the functional and radiological results of intramedullary nailing and plate fixation techniques in the surgical treatment of distal tibia diaphyseal fractures close to the ankle joint.
METHODS: Between 2005 and 2011, 55 patients (32 males, 23 females; mean age 42 years; range 15 to 72 years) who were treated with intramedullary nailing (21 patients) or plate fixation (34 patients) due to distal tibia diaphyseal fracture were included in the study. The average follow-up period was 27.6 months (range, 12-82 months). The patients were evaluated with regard to nonunion, malunion, infection, and implant irritation. The AOFAS (American Orthopaedic Foot and Ankle Society) scale was used for the clinical evaluation.
RESULTS: No statistically significant difference was found between the two surgical methods with respect to unification time, AOFAS score, accompanying fibula fracture, material irritation, and malunion. Nine patients had open fractures, and these patients were treated with plate fixation (p=0.100). Nonunion developed in three patients who were treated with plates. Infection occurred in one patient. Anterior knee pain was significantly higher in patients who were treated with intramedullary nails. There was no malunion in any patient.
CONCLUSION: As the distal fragment is not long enough, plate fixation technique is usually preferred in the treatment of distal tibia diaphyseal fractures. In this study, we observed that if the surgical guidelines are followed carefully, intramedullary nailing is an appropriate technique in this kind of fracture. The malunion rates are not significantly increased, and it also has the advantages of being a minimally invasive surgery with fewer wound problems.

7. A new, simple technique for gradual primary closure of fasciotomy wounds
Mustafa Özyurtlu, Süleyman Altınkaya, Yahya Baltu, Güzin Yeşim Özgenel
PMID: 24936841  doi: 10.5505/tjtes.2014.54077  Pages 194 - 198
BACKGROUND: The aim of this study was to demonstrate a new, easy and safe technique, which has not been defined in the literature previously, that enables the gradual primary closure of fasciotomy wounds using barbed sutures.
METHODS: The technique was performed on five patients who presented with fasciotomy wounds on both upper and lower extremities, varying in size, observed after compartment syndrome due to different causes. The average width of the defects for which primary closure was planned was 8.8 cm. Following the fasciotomy incision, absorbable barbed sutures were inserted through the dermal tissue around the wound similar to that of a subcuticular closure, but left loose, after which closed dressing was applied. During the clinical follow-up, with the decrease in tissue edema and tightness around the wound, the barbed suture was tightened at bedside every 48-72 hours.
RESULTS: At the end of this gradual closure, all the fasciotomy defects were primarily closed within an average of 8.6 days. All the patients had complete and uncomplicated primary closure with the exception of one with high-voltage electrical burn injury, who developed necrosis in the distal part of the defect, and was treated by secondary healing.
CONCLUSION: The gradual fasciotomy closure technique with barbed suture seems to be an easy, rapid and effective method.

8. The results of autologous bone graft and titanium headless cannulated compression screw for treatment of scaphoid nonunion
Güzelali Özdemir, Özgür Çiçekli, Turgut Akgül, Sinan Zehir, Ferit Yücel, Deniz Eşkin
PMID: 24936842  doi: 10.5505/tjtes.2014.92255  Pages 199 - 204
BACKGROUND: We aimed to present the clinical and radiological results of patients treated with debridement, iliac bone graft and titanium headless compression screw for scaphoid nonunion.
METHODS: We retrospectively evaluated 24 patients (23 males, 1 female) who underwent this technique between 2009 and 2012, with a minimum of 12 months’ follow-up. Nonunion was determined as no union evidence within eight weeks on radiological view. Scaphoid fracture was classified according to Herbert classification and anatomical location. Functional evaluation was performed using the Mayo wrist scoring system.
RESULTS: According to the Herbert classification system, there were 20 D1 and 4 D2 fractures. Anatomical location included 1 distal, 6 proximal and 17 corpus. Fracture union was achieved in all but 2 patients, with a mean union time of 9.5 weeks (6-15). Scapholunate angle and radiolunate angle were measured as a mean 32° (39°-50°) and 7° (4°-10°) at the latest follow-up radiographic examination. There was a statistically significant correlation between the length of the pseudoarthrosis period and union time (p=0.003). Union time of proximal fractures was longer than of the others (p=0.004). Mayo wrist score was 86 (80-95).
DISCUSSION: Autologous iliac bone graft and titanium headless cannulated compression screw combination via volar approach is safe and effective for scaphoid nonunion.

9. Results of arthroscopic repair of triangular fibrocartilage complex peripheral tears (Palmer type 1B)
Fatih Kabakas, İsmail Bülent Ozcelik, Meriç Uğurlar, Berkan Mersa, Memet Yazar, Metin Uzun
PMID: 24936843  doi: 10.5505/tjtes.2014.63933  Pages 205 - 210
BACKGROUND: Triangular fibrocartilage complex (TFCC) injury is the major cause of wrist pain on the ulnar side. In this study, treatment outcomes of arthroscopically repaired peripheral TFCC tears (Palmer type 1B) were evaluated retrospectively.
METHODS: Thirty-eight patients (30 males, 8 females; mean age 27.6; range 19 to 42 years) with TFCC tears (Palmer type 1B) who were treated arthroscopically between February 2007-July 2012 were evaluated retrospectively. The data were collected by Mayo wrist evaluation form and by preoperative and postoperative visual analogue scale (VAS).
RESULTS: The results of the data collected by the Mayo wrist evaluation forms were perfect in 30 patients and good in 8 patients. Preoperative VAS was 6.53 (range: 4.5-8.2) and postoperative VAS was 1.48 (range: 0.3-3.1).
DISCUSSION: With the arthroscopic technique, TFCC tears can be repaired with minimal harm and better visualization, and evaluation of all the structures of the wrist can be done. Outside-to-inside suturing technique, which is performed through the portal opened 1 cm inferior to the 6R portal, is the least traumatic technique and does not carry the risk of injury to the superficial branch of the ulnar nerve. With this technique, the complaints of preoperative pain can be eliminated significantly.

CASE REPORTS
10. Supraventricular tachycardia due to blunt chest trauma in an adolescent
Hayrullah Alp, Tamer Baysal, Sevim Karaarslan
PMID: 24936844  doi: 10.5505/tjtes.2014.90337  Pages 211 - 213
Blunt chest trauma and its associated complications represent a rare cause of cardiac arrest in a healthy child, although an increasing number of these events have been reported. Victims are most often diagnosed in ventricular fibrillation or tachycardia. However, cardiac conduction abnormalities are also reported. In this report, a healthy adolescent with supraventricular tachycardia associated with blunt chest trauma due to a football is presented. This is the first report in the literature of atrial arrhythmia in these cases with chest trauma.

11. Are blank cartridge guns really harmless?
İsmail Gülşen, Hakan Ak, Enver Sosuncu, Mehmet Deniz Bulut
PMID: 24936845  doi: 10.5505/tjtes.2014.90868  Pages 214 - 216
Blank cartridge guns are devices that discharge sound and gas, but no bullet or shot. These devices are very similar to real guns in the form of their external design and the sound generated during their firing. Although it is widely held in society that these devices are harmless, reports from Turkey and the world have shown that these guns are not entirely innocent. Herein, we present a 26-year-old male with a head injury due to gunshot from a blank cartridge. The purpose of this presentation is to emphasize that these devices are not harmless, contrary to common public opinion.

12. Successful emergency department thoracotomy for traumatic cardiac rupture: effective utilization of a fret sternum saw
Tsukasa Nakamura, Koji Masuda, Eiji Hitomi, Yoshio Osaka, Toshimasa Nakao, Norio Yoshimura
PMID: 24936846  doi: 10.5505/tjtes.2014.60598  Pages 217 - 220
Mortality following blunt chest injury and cardiac rupture remains high despite advances in the care of traumatic injuries. Indeed, most patients succumb to these injuries even prior to reaching a hospital. However, timely recognition and surgical intervention can save lives. We present the case of a 40-year-old woman who presented to our emergency department in cardiac arrest due to rupture of her left atrium following a major motor vehicle collision. The patient underwent emergency department thoracotomy with successful repair of the cardiac rupture. Emergency department thoracotomy, when indicated and performed by trained surgeons, can be the only life-saving procedure available. Rapid median sternotomy using a cost-effective fret sternum saw does not require significantly more time than a left lateral thoracotomy or clamshell incision in an emergency situation. It can be an effective and alternative method of thoracic entry in the emergency department. Prognosis of cardiac rupture depends largely on the mechanism of injury, location of injury, signs of life: vital signs, and availability of timely intervention. When indicated, hesitation should be avoided. Expedient cardiac exposure is essential and leads to better results with improved survival rates in patients with blunt cardiac rupture.

13. An unusual entry site for a nasal foreign body: a neglected trauma patient
Selçuk Mülazımoğlu, Emre Ocak, Süha Beton, Ozan Bağış Özgürsoy
PMID: 24936847  doi: 10.5505/tjtes.2014.56805  Pages 221 - 223
Burunda yabancı cisim özellikle çocuklarda sıkça karşılaşılan bir durumdur. Literatürde burunun değişik bölgelerinde çok çeşitli yabancı cisim bildirilmiştir. Yabancı cisimin giriş yolu sıklıkla burun delikleridir. Bu yazıda, ihmal edilmiş bir travma hastasında, burunda yabancı cisim için sıradışı bir giriş yolu sunuldu. Çocuklarda penetran yüz yaralanması sonrasında yabancı cisimden şüphelenilmeli ve detaylı aranmalıdır.

14. Occipital condyle fractures: A case report
Cem Dinç, Mehmet Erhan Türkoğlu, Cengiz Tuncer, Ömer Aykanat, Derya Özçelik, Gamze Özkan
PMID: 24936848  doi: 10.5505/tjtes.2014.22747  Pages 224 - 226
Occipital condyle fractures are rare, and conservative treatment is sufficient for many cases. Surgical treatment may be required if the condyle fracture is accompanied by atlantooccipital dislocation. Unfortunately, condyle fracture generally cannot be diagnosed with X-ray in the emergency department. Recently, computed tomography scans have been used more frequently, and enable easier diagnosis of these types of fractures. In this report, we describe a patient who admitted to our emergency department after a major trauma. She complained of neck pain, and maxillofacial trauma was more evident. Her cervical X-rays were normal, but cervical computed tomography revealed unilateral occipital condyle fracture.