BACKGROUND: Bicortical screws (lag and positional) or miniplates with monocortical screws are generally used for the rigid fixa-tion of the sagittal split ramus osteotomy (SSRO) in maxillofacial surgery. However, in this osteosynthesis method, the plate must be perfectly adapted to the bone to prevent misalignment of the bone segment and occlusal changes. In addition, it is necessary to prevent the position of the condyle in the mandibular fossa from changing after fixation. In recent years, locked miniplate systems have been used to overcome these complications.
METHODS: The aim of this study is to compare the commonly used 2.0 mm standard miniplate/screw systems and 2.0 mm locking miniplate/screw systems in fresh sheep jaws with Obwegeser-Dal Pont (OD) and Hunsuck-Epker (HE) modifications, by evaluating standard parameters.
RESULTS: Our study consists of two main groups and two subgroups. 40 sheep hemimandibulae were randomly divided into two main groups. Each group was randomly divided into two subgroups. There are ten hemimandibulae (n=10) in each subgroup. Linear force test was applied using 4-hole standard miniplate and 4-hole locking miniplate systems on sheep jaws with 5 mm advancement by applying OD and HE techniques, which are two frequently preferred modifications in SSRO. For statistical analysis SPSS® 16.0 (Sta-tistical Package for the Social Sciences, SPSS Inc. Chicago, Illinois, USA) package program was used. It was statistically compared with the 95% confidence interval using the Pearson coefficient, and p<0.05 was interpreted as significant. The values of the loading forces applied to the samples in the groups were subjected to analysis of variance (ANOVA) to confirm the normality of the sample. Multiple comparisons were made between groups using the Tukey test. The mean loadings in the groups were analyzed by one-way ANOVA.
CONCLUSION: In general, as the strength of the force increases, the displacement values increase in all groups, but although it was observed that the locked miniplate/screw system was more stable than the standard miniplate/screw system, no statistically significant difference was found.

BACKGROUND: This study aimed to investigate the possible protective effects of melatonin (MEL) against the damage to testicular tissue in rats caused by polymicrobial sepsis as a result of cecal ligation and perforation (CLP).
METHODS: In this study, 21 male Wistar albino rats were used. The rats were randomly divided into three groups (n=7): Sham Control (Group 1), CLP (Group 2), and CLP + MEL (Group 3). Sepsis was created using the CLP method. MEL was administered intraperitoneally in two equal doses of 10 mg/kg at 30 min before and 6 h after perforation. Tissue sections taken from paraffin blocks were stained with hematoxylin and eosin (H and E) and examined histopathologically under a light microscope. Intracellular H2O2 and apoptosis evaluations were carried out using the flow cytometric method.
RESULTS: Sepsis caused a significant reduction in all sperm parameters. There was a significant decrease in sperm density, motility and cell numbers with normal morphology (p<0.05). Intracellular H2O2 level and apoptotic cell percentages increased in sperm cells in the CLP group. MEL treatment was found to significantly reduce sperm abnormalities, testicular damage, intracellular H2O2 levels, and apoptosis.
CONCLUSION: This study showed that melatonin administration could be a potential treatment option to reduce acute testicular tissue damage due to sepsis.

BACKGROUND: The aim of the present study is to investigate the efficiency of roflumilast and ibuprofen in an experimental rat testicular ischemia reperfusion injury model in the light of histological and biochemical data.
METHODS: A total of 32 prepubertal male rats were randomly divided into four groups as G1: Control Group (testicular torsion/detorsion + saline (0.9% of 2 ml) was applied). G2: Sham Group only right scrotal incision was performed; G3: Ibuprofen Group (tes-ticular torsion/detorsion + ibuprofen administration); and G4 Roflumilast Group (testicular torsion/detorsion + roflumilast adminis-tration). Oxidative markers such as malondialdehyde (MDA), myeloperoxidase (MPO), total sulfhydryl (TSH), and nitrite (NO) levels as well as histopathological changes were analyzed.
RESULTS: Tissue MPO, MDA, and NO levels were significantly higher and TSH levels significantly lower in control group compared to sham group (p<0.001). The histopathologic scores of drug groups (Groups 3 and 4) were significantly lower than group 1 (p<0.001). In comparison of Group 3 and Group 4 with each other, the mean values of MPO and MDA were statistically significantly lower in Group 4 (p<0.001). A higher mean value of TSH was found in Group 3 without statistically significance (p=0.32). There was also an insignificant decrease in mean NO values of Group 3 compared to Group 4 (p=0.44). In comparison of drug groups, Group 4 had statistically insignificant better scores.
CONCLUSION: Our results indicate that administrating ibuprofen and roflumilast reduced testicular ischemia reperfusion injury in rat testis torsion model. In comparison, roflumilast is found to be more beneficial.

BACKGROUND: Traumatic brain injuries cause damages in the brain in several ways, which include cell death because of edema, disruption of the blood–brain barrier, shear stress, and ischemia. In this study, we investigated the effects of adrenomedullin (AM) on oxidative stress and inflammation after head traumas in a rat model.
METHODS: Eighteen male adult Wistar albino rats were randomized into three groups (n=6). No traumas were applied to the con-trol (C) group. Traumas were applied in line with Marmarau trauma model in the trauma group. The rats in the AM treatment group were treated with post-traumatic 12 μg/kg i.p. AM in addition to the trauma group. The rats were followed for 7 days in all groups and were then sacrificed. Brain tissues and blood samples were taken.
RESULTS: In the trauma group, both tissue and serum MDA, TNF-α, and IL-6 levels were significantly increased compared to the control group (p<0.05). In the AM-treated group, serum TNF-α levels were significantly decreased compared to the trauma group (p<0.05). In the trauma group, both tissue and serum GSH levels were significantly decreased compared to the control group (p<0.05). In the trauma group, serum Vitamin D3 levels were significantly decreased compared to the control group (p<0.05). In the AM-treated group, both tissue and serum GSH levels were significantly increased compared to the trauma group (p<0.05).
CONCLUSION: These results indicate that AM has neuroprotective effects on traumatic brain injury in a rat model.

BACKGROUND: The most common cause of intra-abdominal adhesion (IAA) is previous abdominal surgery and mortality. IAA can cause serious complications such as chronic abdominal pain, ileus, and infertility. Approximately 3% of all laparotomies are related to adhesions. IAA reduces the quality of life of the patient, causes morbidity, and increases health expenditures. In this study, we aimed to investigate the preventive effect of fucoxanthin (Fx) on IAA in the intra-abdominal surgical adhesion model that experimentally created in rats.
METHODS: This study used 21 Sprague-Dawley rats divided into three groups. After anesthesia, the abdomen was opened, the cecum and right abdominal wall were damaged with a sterile toothbrush until petechiae bleeding was seen. No additional action was taken to the control group. In the sham group, 5 cc saline solution was released into the peritoneum before the abdomen was closed. In the Fx group, 35 mg/kg Fx was instilled intraperitoneally and the abdomen was closed. On the 21st post-operative day, all subjects were anesthetized with standard anesthesia. Macroscopic adhesions were quantitatively evaluated according to the Mazuji classifica-tion. The cecum anterior wall and parietal peritoneum were excised for pathological sampling. A pathologist, unaware of the groups, evaluated inflammation, fibroblastic activity, and vascular proliferation. In addition, serum tumor necrosis factor-alpha (TNF-α) and interleukin-10 levels were measured.
RESULTS: No rat was lost during the study period. Congenital adhesion was not observed in any of the subjects at the first laparo-tomy. Adhesion was significantly less macroscopically in the Fx group compared to the control and sham group (p<0.001 and p<0.001). Fibroblastic activity was found to be significantly less in the Fx group compared to the sham and control groups (p<0.001 and p<0.001). Vascular proliferation was found to be significantly less in the Fx group than in the sham and control groups (p<0.001 and p<0.001). The inflammation score was significantly lower in the Fx group compared to the other two groups (p<0.001 and p<0.001). The inflam-mation score in the sham group was lower than the control group and was statistically significant (p<0.001). TNF-α level was found to be statistically significantly lower in the Fx group compared to the sham and control groups (p<0.001 and p<0.001).
CONCLUSION: As a result of experimental study, we can say that Fx is effective in preventing IAAs and decreases the level of TNF-α, a pro-inflammatory cytokine.

BACKGROUND: The aim of the study was to investigate the clinical variations of Systemic Inflammatory Response Index (SIRI), Systemic Inflammation Index (SII), and Alvarado Score during the COVID-19 pandemic period.
METHODS: Between March 2019 and March 2021, 161 consecutive patients who had surgery due to acute appendicitis were ret-rospectively recruited from Trakya University in Edirne, Turkey. Group I included patients who had surgery during the COVID-19 pandemic and Group II included patients who had surgery before the COVID-19 pandemic period. A total of 80 patients volunteered for Group I and 81 patients for Group II. The neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio, and lymphocyte/monocyte ratio were calculated. SII was calculated by the formula: platelet (P) × neutrophil (N)/lymphocyte (L). NLR was calculated by dividing the neutrophil count by the number of lymphocytes. SIRI was defined as follows: SIRI = (neutrophil × monocyte/lymphocyte). The Alvarado score was also calculated by using patient history, clinical examination, and laboratory findings.
RESULTS: There was a significant difference between the two groups in terms of displacing pain, nausea/vomiting, right lower quad-rant tenderness, rebound, hyperthermia, leukocytosis, and total Alvarado score (p<0.001). There was a significant difference between two groups in comparison of C-reactive protein, SIRI, and SII values (p<0.001). Group I patients had higher values of these parameters than Group II.
CONCLUSION: Based on the results obtained from this study, we conclude that COVID-19 pandemic has caused an increase in patients with acute appendicitis admitted to the hospital. This late diagnosis of acute appendicitis caused more complications during COVID-19 pandemic. Alvarado score, SIRI, and SII can be used as a marker to indicate whether complications of acute appendicitis occurred pre- or post-operatively. Therefore, Alvarado score, SIRI, and SII are directly proportional to the complication of acute appendicitis.

BACKGROUND: The effects of the COVID-19 infection on the world’s health system began to be reported in a short time, with the spread of the infection all over the world and it gained a global acceptance as a pandemic. It was predicted that patients who require urgent surgical procedures may not be able to access appropriate treatment during this period and may suffer from this process. In this process, we planned to report the effects of the pandemic process to this patient group by evaluating patients with acute appendicitis, which is the most common cause of acute abdomen among general surgery emergencies.
METHODS: In our study, we compared the patients who applied to the Training and Research Hospital we collaborated, whose clinics were compatible with acute appendicitis, between March 11, 2020, and May 21, 2020, with those applied within the same time period with the year before. We evaluated clinical and pathological findings of the patients and the treatment applied.
RESULTS: In this study, there were 103 patients diagnosed with acute appendicitis before pandemic and 61 in pandemic period. We found that during the pandemic period, patients with acute appendicitis were admitted to the hospital less often, and in a later period, and more complicated clinical pictures were determined. Complicated appendicitis patients were higher in pandemic period compared with previous year (33.96% vs. 8.00% of patients, respectively; p<0.05).
CONCLUSION: We emphasized that diseases that need to be treated urgently should not be left behind during the pandemic. Furthermore, we shared our clinical practice to ensure early discharge of patients with acute appendicitis during the pandemic process.

BACKGROUND: Upper gastrointestinal system bleeding (UGIB) that occurs with the effect of coagulopathy due to COVID-19 disease itself and drugs such as LMWH and steroids used in the treatment negatively affects the outcomes. In this study, we aimed to examine the frequency of gastrointestinal system bleeding in COVID-19 patients, risk factors, effect on outcomes, and management.
METHODS: Institutional center (a third-level pandemic center) database was searched for patients hospitalized for COVID-19 between March 11, 2020, and December 17, 2020, retrospectively. Patients with UGIB symptoms/signs were included in the study. Age, gender, body mass index (kg/m2), hospital department where bleeding was diagnosed, previous bleeding history, comorbidities, and medication were steroid, anticoagulant, low weight molecule heparin, and proton-pomp inhibitor, endoscopic findings/treatment, transfusion, and mortality rates were evaluated. Patients were divided into two groups as survivors and non-survivors and parameters were compared.
RESULTS: Forty-five of a total 5484 patients under COVID-19 treatment had upper gastrointestinal bleeding (0.8%). The average age of the patients was 70.1 years and 73% bleeders were male. Nineteen patients (44%) underwent endoscopy. The most common etiologies of bleeding were gastric/duodenal ulcer (n=9), erosive gastritis (n=4), and hemorrhagic gastritis (n=3). Active bleeding re-quiring intervention was detected in only one patient; therapeutic band ligation was applied to only 1 (2%) of all patients. The most common etiologies of bleeding were gastric/duodenal ulcer (n=9), erosive gastritis (n=4), and hemorrhagic gastritis (n=3). In terms of statistical significance, it was observed that the rate of steroid treatment (77% vs. 39%) and the number of days of steroid treatment were higher in non-survivor group.
CONCLUSION: UGIB is less common in COVID-19 patients compared to other hospitalized patients. However, it significantly increases mortality. Mortality risk increases even more in patients using steroids. These risks should be considered in patients under COVID-19 treatment. The majority of the bleeding patients does not require endoscopic treatment and should be managed conser-vatively. It is worth considering reducing unnecessary endoscopies in the pandemic.

BACKGROUND: While a life-threatening course is observed in 2–3% of patients with acute pancreatitis (AP), mortality can be up to 50% in severe AP. In our study, we research relationship between calcium level and Modified Balthazar (MB) score.
METHODS: 354 patients who were followed up with a diagnosis of AP between 2013 and 2019 were included in our study. Serum calcium level was measured within the first 24 h. Abdominal computed tomography (CT) was performed in all patients in the first 12 h and between 3 and 7 days. The severity of AP was determined according to the MB classification. The correlation between calcium level and MB classification was examined.
RESULTS: 206 (58.2%) of the patients were women. Mean age was 54.8±17.9 years (range: 18–100). It was observed that the rate of severe AP was significantly higher in the low calcium group compared to the MB classification in which tomographies taken at ad-mission and 72 h after were evaluated (p<0.05). Furthermore, progression was higher in low calcium group (p<0.05). The cutoff value was 9.35 mg/dl for the ROC analysis performed to distinguish mild pancreatitis from moderate-severe pancreatitis according to the MB classification performed by CT obtained after 72 h based on the Ca values. For the cutoff value of 9.35 mg/dl (AUC: 0.581, p=0.018, 95% Cl: 0.514–0.649), the sensitivity was 57.4% and the specificity was 53.1%.
CONCLUSION: Since there is a correlation between the initial calcium level and the severity of the disease according to the CT-scan obtained later, the calcium level gives us an idea of the course of the disease.

BACKGROUND: The use of antitrombotic (antiaggregant and anticoagulant) drugs is increasing all over the world and in our coun-try. About 12.6% of patients who underwent gastrointestinal tumor surgery receive antitrombotic therapy for various reasons, and in this study, we aimed to demonstrate the safe feasibility of elective or emergency gastrointestinal tumor surgery with the correct perioperative antitrombotic therapy management.
METHODS: The patients who were planned for gastrointestinal tumor surgery under antitrombotic treatment were analyzed in three groups as those whose pre-operative treatment management treatment was discontinued, those who underwent bridging treat-ment, and those whose treatment continued. Anti-embolic stockings or intermittent pneumatic compression devices were applied to all patients preoperatively and postoperatively as mechanical prophylaxis. Post-operative complications, especially post-operative bleeding and thrombosis, were evaluated using the Clavien–Dindo post-operative complication classification.
RESULTS: When patients who were under antithrombotic therapy, whose therapy was discontinued, and who underwent surgery under bridging therapy, no significant difference was found between the three groups in terms of bleeding complications.
CONCLUSION: In tertiary centers with high clinical experience, elective and emergency gastrointestinal system tumour surgery can be safely performed under antitrombotic therapy without increasing the thromboembolic risk.

BACKGROUND: There are several factors affecting trauma cases in mass gatherings (MG). Event type, mood of the crowd, age, gender and educational background are among these factors. It is to identify the relationship between the event types of trauma cases and temperature variables observed in MG.
METHODS: It is a descriptive epidemiological study. The universe of the research consists of 112 emergency medical service records (ambulance) in organizations such as Çanakkale Victory and Martyrs’ Memorial Day (ÇVMMD), Zeytinli Rock Fest, Deaflympics, and European Youth Olympic Winter Festival (EYOF). For the statistical evaluations of the study, frequency analysis, Chi-square test, and logistic regression were used.
RESULTS: Within the scope of the research, 474 emergency medical service cases were examined. About 49.5% (n=235) of the cases took place at the DEAFOLIMPICS. About 57.6% (n=273) of the cases are male. The age average of the cases is 30.3±16.5 (Min: 0, Max: 92). When the pre-diagnosis range at the ÇVMMD is examined, it is seen that 27.7% (n=20) of the cases are trauma cases while 72.2% (n=52) are non-trauma cases. Among the trauma cases, the most frequently observed ones are soft-tissue trauma, multi-trauma, lower limb injury, and head trauma. When the other cases are examined, the most common ones are angina pectoris, nausea-vomiting, asthma, and ache. In the research, 38.3% (n=90) of the cases at the DEAFOLIMPICS are trauma cases, while 61.7% (n=145) are non-trauma cases. While the trauma cases mostly consist of soft-tissue injury and lower limb injury, the non-trauma cases include nausea-vomiting and upper respiratory infections. While the trauma cases were caused by multi-trauma, sharp object injury, soft-tissue injury, and head trauma, the pre-diagnosis of the non-trauma cases mainly included mental confusion and behavioral disorder due to use of alcohol; conversion; behavioral changes due to use of substance and drug use; hypotension; and allergic reaction.
CONCLUSION: As a consequence of the logistic regression modeling, the trauma cases were found to be 1.6 times (p<0.05) higher in men than women and 9.5 times more in those who participated in the EYOF event than those who participated in the ÇVMMD event (p<0.05).

BACKGROUND: For prediction of mortality and clinical course, various scoring systems had been developed. We choose four well known burn specific scoring systems and a general scoring system that using in Intensive Care Units. The primary outcome of this study was evaluate the predictive performances of this models and define the optimal one for our patient population.
METHODS: Variables analyzed were age, gender, burn type, total burned surface area (TBSA), total partial thickness burn area, total full thickness burn area, inhalation injuries, mechanical ventilation supports, blood products usage, total scores of Abbreviated Burn Severity Index (ABSI), revised Baux, Belgian Outcome in Burn Injury, Fatality by Longevity, Acute Physiology and Chronic Health Eval-uation II (APACHE II) score, Measured Extent of burn and Sex (FLAMES) and APACHE II, and their relations with mortality.
RESULTS: In our study, a statistically significant relationship was found with mortality between age, TBSA, full thickness burn percent-age, inhalation injury, burn type, and it was similar to literature. Female gender was found to be a significant risk factor for mortality.
CONCLUSION: We compared several burn mortality scoring systems and their predictional mortality rates. ABSI scores of patients for estimated mortality rates were similar to our mortality rate. Consequently, it was thought that ABSI was included all mortality-re-lated parameters.

BACKGROUND: Intimate partner violence (IPV) is an important human rights problem faced by one in three women worldwide. The aim of this study is to evaluate the demographic, trauma, and radiological characteristics of patients admitted to a tertiary emer-gency department due to IPV.
METHODS: Sociodemographic characteristics (age, gender, education level, and marital status), trauma characteristics (severity, type, and location), radiological imaging findings (radiography, computed tomography, and magnetic resonance imaging) of patients diagnosed with IPV were evaluated.
RESULTS: In the study, 1225 patients were evaluated, and 98.7% of them were women (mean age 35 [IQR: 17] years). Of the pa-tients, 63.1% were high school and university graduates. The rate of married women was 74.6%. No relationship was found between gender, age, educational status, and marital status (p>0.05). Most of the traumas were minor (85.4%) and blunt (81.9%) trauma, and the most common types of trauma were kicking (49.9%) and punching (47.3%). It was found that the most frequently affected areas of the patients were the head and neck (76.7%), and the frequency of pelvic trauma was high in male patients (p<0.05). The most com-mon bone fracture was nasal (40.5%) followed by ulna fractures (14.5%). The left-sided diaphyseal fractures were the most common in patients exposed to IPV. In our study, the frequency of mortality was 12.9%, and it was found to be significantly higher in males (p<0.05).
CONCLUSION: Female patients are more frequently exposed to IPV. Specific injury characteristics can be detected in patients diagnosed with IPV and old fractures detected in these patients should alert the clinician about IPV.

BACKGROUND: Supratentorial midline epidural hematoma is rare but challenging in diagnosis and management. Indication for surgery can arise even following hospital admission. Being familiar to the presentation and watching out for direct and indirect signs on axial computed tomography (CT) such as suture diastasis or fracture traversing midline are essential to plan multi-planar CT enabling exact diagnosis including form and mass effect of hematoma.
METHODS: Nine patients with midline epidural hematoma including two pediatric patients underwent surgery between 2013 and 2018. Pre-operative and post-operative patient status, radiological features, and surgical technique were analyzed.
RESULTS: Four patients had deteriorating consciousness levels and two patients had paraparesis. All had fractures traversing midline and epidural hematomas with significant mass effect. They were operated through separated craniotomies around the midline and midline bone strip was used for dural tenting and as support for natural closure of bone flaps. No post-operative complications were developed. All patients were discharged with Glasgow Outcome Score of 5.
CONCLUSION: Because of the rarity of the lesion and small number of patients, definitive conclusions may be misleading but we think that, in experienced hands, midline epidural hematomas can safely be operated on and, preservation of midline bone strip pro-vides easier bleeding control.

BACKGROUND: The study was to investigate the role of mobility and frailty in predicting the prognosis of elderly burns along with the burn severity.
METHODS: In this retrospective study, 67 patients aged 65 and over who were hospitalized between October 1, 2017, and Septem-ber 30, 2020 in our burn center are included in the study. The demographic data, etiological data, clinical variables, the percentage of burned total body surface area (TBSA), Abbreviated Burn Severity Index (ABSI), Functional ambulation classification (FAC) scores, and Clinical frailty scale (CFS) scores are evaluated.
RESULTS: Mean age of the study population was 71.58±7.4 years and most of the patients were female (65.7%). The percentage of TBSA was 11.34±12.2. The flame burns were the most common etiology (87.5%) of deaths (n=8), whereas 52.5% of the survivors were scalds. Most of the survived patients were functional ambulatory (93.2%). On the other hand, only 25% of patients who died were functional ambulatory (p<0.001). Also, 83% of the survivors were normal according to CFS scoring, whereas 25% of the patients who did not survive were vulnerable and 75% was frail (p<0.001).
CONCLUSION: The percentage of elderly burns is low, yet the mortality is high in these patients which emphasize the importance of elderly burns. The ABSI is of great help, but ambulation status and comorbid diseases should be taken into consideration in terms of elderly burns. The current study demonstrated that FAC and CFS will be helpful to better predict the outcomes of elderly burn patients along with ABSI.

BACKGROUND: Gallbladder gangrene and perforation are an important complication of acute calculous cholecystitis and are dif-ficult to detect preoperatively. Therefore, in this study, we aimed to evaluate whether serum inflammatory parameters are predictive factors for complicated cholecystitis (CC).
METHODS: In the present study, histopathological findings of 250 patients who were operated on with the diagnosis of acute chole-cystitis (AC) in the emergency department between 2014 and 2019 were evaluated and the cases were divided into two groups as AC and CC. Parameters, including age, gender, body mass index, white blood cell (WBC) count, C-reactive protein (CRP), neutrophil-to-lym-phocyte ratio (NLR), mean platelet volume (MPV), and platelet distribution width (PDW), were examined for their ability to predict CC.
RESULTS: The findings obtained in this study showed that WBC, CRP, and NLR were significantly higher in the CC group (p<0.05). WBC >9.000 cells/ml, CRP >29.0, and NLR >4.3 were the factors that could predict CC. There was no significant difference between the two groups concerning MPV and PDW (p>0.05). CC was observed more frequently in patients over 65 years of age, but there was not a statistically significant difference (p=0468).
CONCLUSION: WBC, CRP, and NLR are valuable biochemical markers in predicting complicated AC. Advanced age may be a help-ful predictive factor for CC. These factors may be helpful in making an early cholecystectomy decision.

BACKGROUND: The aim of the study is to evaluate the relationship between plate-screw density (PSD), functional results, and complication rates in the treatment of proximal humerus fractures (PHFs) with proximal humerus locking anatomical plate (PHLAP).
METHODS: Consecutive 43 patients (22 females and 21 males) who underwent PHLAP for the treatment of PHF between 2010 and 2016 were evaluated. AO classifications were used for the classification of fractures. Based on the biomechanical stability the-ory of Erhardt et al., the patients were divided into two groups as <60% and >60% according to the number of screws fixed to the humeral head for the determination of PSD. The patients were divided into two groups as PSD <60% (n=21) and PSD>60% (n=22) according to the number of screws fixed to the humeral head for the determination of PSD. Functional results were evaluated using the Constant-Murley shoulder score (CMS). Radiological evaluation was performed with collodiaphyseal angle (CDA), varus-valgus angulation, avascular necrosis (AVN), and arthrosis. The groups were compared in terms of demographic characteristics, functional results, radiological scores, and complications.
RESULTS: The mean age was 54.47±17.43 years and the mean follow-up time was 19.51±5.27 months. Although the CMS scores of patients with a PSD of over 60% were higher than those below 60%, the CMS score did not differ statistically. In groups, the mean CDA of the operated shoulder was significantly lower than that of the non-injured side (p=0.002). Eight patients had varus angulation, whereas two patients had humerus head AVN. No significant relationship was observed between PDS and functional scores, radiolog-ical results, and complications.
CONCLUSION: Functional results of PSD >60% are higher than PSD <60% group but there is no statistical difference between groups according to functional, radiological results, and complications.

BACKGROUND: Hip fractures (HF) are among the most common fractures present in the emergency department and are very painful. Pericapsular nerve group block (PENG) is a new regional anesthesia technique developed for analgesia in total hip arthroplas-ties. We aimed to determine the effectiveness of PENG block used to reduce pain in patients with HF in the emergency department.
METHODS: This single-center, randomized, and prospective study was carried out in the emergency department. The patients in-cluded in the study were selected according to the suitability of the personnel who will perform the procedure. The sealed envelope system was used for randomization.
RESULTS: Statistical analysis was performed with 39 patients (18 patients in the PENG group, 21 patients in the control group). Thir-teen (33.3%) of the patients were female and 26 (66.7%) were male. The mean age was 75.3. At rest post-procedure, the mean Numeric Rating Scale (NRS) scores of the patients at the 30th min, 2nd, 6th, and 24th h were 1.78±1.83, 0.00±0.00, 0.00±0.00, and 1.28±1.41 in the PENG group. On the other hand, it was 3.38±1.86, 0.05±0.22, 2.86±2.37, and 4.95±1.47 in the control group, respectively. The mean NRS scores of the patients at 15° elevation of the leg at the 30th min, 2nd, 6th, and 24th h were 3.06±1.80, 0.06±0.24, 0.22±0.43, and 2.44±1.50 in the PENG group and it was 5.24±1.81, 1.05±0.92, 4.29±2.35, and 7.14±1.24 in the control group, respectively.
CONCLUSION: PENG block can reduce pain and the need for systemic analgesics as a practical option in patients with HF.

BACKGROUND: The aim of this study is to compare open double-button (DB) and hook plate (HP) techniques in the treatment of acromioclavicular joint dislocation (ACJD) in terms of clinical and radiological outcomes and to determine which method is superior.
METHODS: This retrospective comparative study included patients with ACJDs (Rockwood Type III/V) who were treated with one of these implants (22 patients with HP, 21 patients with DB) between June 2014 and February 2018.
RESULTS: A total of 43 patients (39 men and 4 women) with a mean age of 41.8±17.4 years have participated in this study. The mean follow-up time was 20.6±7.5 months. Mean times of fluoroscopy, operation, and return to work were shorter in the DB group. Compli-cation rates were 23.8% and 54.6%, reoperation rates (including mandatory implant removals [IR]) were 4.8% and 77.3%, mean constant scores were 92.1±3.4 and 88.3±4.2, and mean Visual Analog Scale scores were 0.8±1.0 and 1.5±1.0 for the DB and HP groups, respec-tively. IR was the main reason for reoperations in the HP group, whereas the DB group’s only reoperation was caused by a coracoid cutout (due to coracoid tunnel malposition) leading to redislocation. AC joint arthritis (36.4%) and subacromial osteolysis (31.9%) were com-monly encountered in the HP group. The most frequent complication of the DB group was malreduction (initial undercorrection) (9.6%).
CONCLUSION: DB was superior to HP in functional outcome, post-operative pain, complication and reoperation rates, operation and fluoroscopy times, and time to return to work. Besides, reoperation (for IR) was needed in most of the HP patients. Therefore, the open DB technique should be preferential to the HP procedure.

BACKGROUND: C-reactive protein-to-lymphocyte ratio (CLR), C-reactive protein/albumin (CRP/ALB), and CRP are prognostic factors for outcome and survival in oncology and digestive surgery. CLR has not been studied for the prediction of mortality in hip fracture. The aim of this study is to investigate whether there is an association between pre-operative CLR, CRP/ALB, and CRP levels in patients with hip fracture and patient survival.
METHODS: The medical reports of the patients who underwent surgery with a diagnosis of hip fracture in our hospital between January 2016 and December 2019 were retrospectively reviewed. The patients were divided into two groups (Group E: Those who died within 1 month and Group S: Those who died after the 1st month or those who survived). A total of 19 parameters, namely, included “ blood parameters including hemoglobin, C-reactive protein, albumin, lymphocytes, neutrophils, monocytes, platelets, PLR, NLR, LMR, CLR CRP/ALB ratios, gender, American Society of Anesthesiologists, Charlson Comorbidity Index, delirium, infections, repeated surgeries, and type of anesthesia were evaluated preoperatively and on the post-operative 2nd and 5th days and 1 month.
RESULTS: A total of 165 patients with the mean age of 83.09±8.52 years who met the inclusion criteria were studied. The pre-op-erative means of CRP, neutrophil count, CLR ratio, and CRP/ALB ratio were statistically significantly higher in Group E than in Group S (p=0.016, p=0.023, p=0.035, and p=0.044, respectively). The univariate regression analysis showed that age, pre-operative Hb level, CRP, and CRP/ALB ratio were significant predictors of the 1-month mortality (ß=−0.335, p=0.049; ß=0.411, p=0.028; ß=3.632, p=0.007; and ß=−3.280, p=0.008; respectively). When we performed the ROC curve analysis, the CRP/ALB ratio had the highest AUC, with the highest sensitivity and specificity. The cutoff value of CRP/ALB ratio was found to be 12.42.
CONCLUSION: We found that the pre-operative CRP/ALB ratio is an important parameter for predicting the first 30-day mortality in elderly patients with intertrochanteric femur fractures. For this reason, we recommend that CRP and albumin be checked in prepa-ration for routine pre-operative anesthesia.

BACKGROUND: The aim of the study was to investigate the relationship between the interpedicular distance increase ratio and the ratio of canal compromise in thoracolumbar burst fractures.
METHODS: Thirty-one patients (18 male and 13 female) with an average age of 30.8 (14–57) who had been treated for thoraco-lumbar burst fractures in the Department of Orthopaedics and Traumatology were included in the study. The initial anteroposterior radiographs of the patients were used to calculate the increase ratio of interpedicular distance (both from medial-to-medial and from center-to-center). The area measurements from the computerized tomography or magnetic resonans images were used to calculate the canal compromise. The relationship between the increase ratio of interpedicular distance and the ratio of canal compromise was investigated by correlation and linear regression analysis.
RESULTS: There was a “very good” correlation between the from medial-to-medial and from center-to-center measurements of interpedicular distance (Pearson correlation coefficient: 0.89, p<0.001). The correlation between the ratio of canal compromise and from medial-to-medial and from center-to-center measurements of interpedicular distance was “good” with Pearson correlation coef-ficients of 0.60 and 0.63, respectively (p<0.001). No statistically significant relationships were found between the fracture levels, types, neurologic status of the patients, and the increase ratio of interpedicular distance or the ratio of canal compromise.
CONCLUSION: Depending on the correlation coefficients which were obtained in this study: To predict the canal compromise from the ratio of interpedicular distance increase is not a reliable method for all of the patients.

Trauma with prolonged shock can cause systemic capillary leak syndrome regardless of the site of injury and a transfusion can aggravate it. The systemic capillary leak induces both an abdominal compartment syndrome and pulmonary edema, and a transfusion can aggra-vate these sequelae within hours. In our case, 21-year-old man with a penetrating injury in his left thorax experienced delay in rescue and definitive surgery. To manage life-threatening shock, massive blood transfusion and crystalloids had been infused. Cardiopulmonary cerebral resuscitations were performed 2 times during the surgery. Massive amount of pulmonary secretions emitted from his airways with severe hypoxia along with development of massive ascites causing abdominal compartment syndrome, while the surgery was underway. After temporary abdominal closure, he was moved to the intensive care unit and underwent venovenous extracorporeal membranous oxygenation. He recovered without any notable complications. It is important to prevent and correct the shock rapidly by appropriate rescue, controlling the source and infusing less amount of crystalloid and transfusion.

Many flap designs for coverage of soft-tissue defects of the posterior elbow have been reported, and the lateral arm flap is considered reliable. With the advantages of less donor site morbidity and preservation of the continuity of the source artery, perforator flaps have taken the place of lateral arm flap recently. The lateral arm perforator flaps for elbow soft-tissue coverage have a propeller design. In this report, we describe a case of posterior elbow defect that was reconstructed with posterior radial collateral artery perforator island advancement flap. Lateral arm perforator island advancement flap is a good alternative for a propeller flap for coverage of soft-tissue defects of the posterior elbow.

The arteriovenous fistulas (AVFs) of the vertebral artery are usually caused by iatrogenic and penetrating traumas. Vertebral AVF is rarely seen after blunt cervical trauma. A 65-year-old male patient applied to the emergency clinic due to falling from a height of about 3 m. In his neurological examination, he had weakness in the left upper limb and tinnitus in the left ear. The cervical computed tomog-raphy examination showed a Hangman’s fracture, a C3 vertebra corpus compression fracture, and a C1 anterior arch fracture. There was a separation on the C1-2 transverse foramen due to the fracture, and there was a fracture in the left C3-4 transverse foramen. In cervical magnetic resonance imaging (MRI), the presence of a contusion in the spinal cord at the C2 corpus level was observed. Through an MRI angiography examination of the vertebral artery, it was determined that the left vertebral artery had developed an AVF at the V2-3 segment level. Stabilization surgery was performed with a posterior approach for unstable vertebrae. Then, vertebral AVF was then closed endovascularly using a stent coil. Improvement in neurological deficit was seen after surgery and endovascular treatment. There were no complications related to the procedure. Transverse foramen should be carefully evaluated, especially in the upper cervical trauma. Vertebral artery imaging should be performed before instability surgery in the presence of a separation in the fracture line to determine whether the damage to the vertebral artery is iatrogenic.

Isolated proximal and distal interphalangeal joint (DIPJ) dislocations are widely seen as a result of sporting injuries and major trauma. The combination of dorsal dislocation of the DIPJ in the same finger concomitant to traumatic dorsal dislocation of the proximal interphalangeal joint (PIPJ) is a rarely seen injury. The case is, here, presented of a 65-year-old female patient with proximal and DIPJ dislocation of the right-hand ring finger accompanied by volar and dorsal plate injuries in the proximal and distal joints. With this case, it was aimed to introduce a new term of “floating phalanx” into medical literature. The treatment was applied to the patient of closed reduction under peripheral block and the application of an aluminium finger splint in semiflexion. In a 24-month follow-up period, the 4th finger of the patient was observed to be stable and has pain-free range of movement. This case is an uncommon case of volar and dorsal plate avulsion fractures with PIPJ and DIPJ dorsal dislocation treated successfully with closed reduction and conservative treat-ment with excellent functional results.

Peutz-Jeghers Syndrome (PJS) is a rare autosomal dominant disorder which is characterized by hyperpigmentation in mucocutaneous membranes and hamartomatous polyps in the gastrointestinal tract (GIT). Common complications reported in patients with PSJ are bleeding and mechanical intestinal obstruction due to the hamartomatous polyps. There is also an increased risk of gastrointestinal and extra-intestinal malignancies in patients with PJS. A 28-year-old female patient was admitted to the emergency service with complaints of abdominal pain and vomiting. In addition to distention and tenderness on abdominal examination, revealed hyperpigmented lesions on her lips. An abdominal examination did not reveal any scar from the previous abdominal operation. The patient with suspected mechanical intestinal obstruction at pre-diagnosis demonstrated intussusception in the distal jejunal loops on abdominal tomography. In the diagnostic laparoscopy observed intussusception in jejunal loops. After a minimal suprapubic incision, small intestine loops were checked through alexis with bidigital palpation and no other intraluminal mass were detected. Laparoscopy-assisted jejunojejunal re-section and anastomosis was performed for the intussusception segment, where the polyb is located. It has been recommended that endoscopic polyps removal should be performed to avoid multiple surgical resections, which lead to short bowel syndrome. It has been recommended that endoscopic polyps removal should be performed to avoid multiple surgical resections, which lead to short bowel syndrome. By the nature of the disease, there may be multiple polyps simultaneously in the GIT and the associated risk of recurrent intussusception attacks in patients with PJS. To prevent short bowel syndrome and intra-abdominal adhesions due to repeated, laparo-tomies treatment with combined endoscopy and laparoscopic/laparoscopy-assisted surgery should be preferred in patients with PJS.