BACKGROUND: Cranioplasty is the process of closing a defect after craniectomy using various materials. This procedure carries risks due to adhesions formed by fibrous scar tissue after craniectomy, which can lead to complications such as cerebrospinal fluid (CSF) fistula from dural damage and cerebral hematoma contusion from parenchymal damage, which can have serious consequences. Halofuginone, a low-molecular-weight molecule derived from Dichroa febrifuga, has demonstrated antifibrotic and anti-inflammatory properties by inhibiting type I collagen synthesis and the transforming growth factor-beta (TGF-β) signaling pathway. This study aimed to investigate the effects of halofuginone on fibrotic tissue formation following craniectomy in a rat model.
METHODS: Twenty male Wistar rats underwent bilateral frontoparietal craniectomies and were divided into two groups: a control group treated with saline and a halofuginone group receiving oral halofuginone (1 mg/kg/day) for one week post-surgery. After 30 days, histopathological and ultrastructural analyses were performed to evaluate dura mater thickness, epidural fibrosis, arachnoid involvement, and bone regeneration.
RESULTS: Halofuginone significantly reduced dura mater thickness (19.3±6.51 μm vs. 51.29±14.3 μm in controls, p<0.05) and epidural fibrosis grades, with fewer arachnoid adhesions observed in the halofuginone group (p<0.05). Electron microscopy revealed fewer active fibroblasts and thinner, disorganized collagen fibers in halofuginone-treated rats, suggesting inhibition of fibroblast activity and collagen production. No significant difference in bone regeneration was observed between the groups.
CONCLUSION: These findings indicate that halofuginone effectively reduces fibrotic tissue formation at craniectomy sites, potentially by suppressing collagen synthesis and inflammatory responses. Further studies are warranted to explore its clinical applications in preventing postoperative fibrosis.

BACKGROUND: Pediatric femoral neck fractures (PFNFs) are rare but are associated with high complication rates due to the precarious vascularity of the femoral head. Cannulated screw fixation (CSF) is the most common surgical technique, though optimal strategies remain debated. The objective of this study was to evaluate the radiological and functional outcomes of proximal femoral neck fractures (PFNFs) treated with CSF and to identify predictors of postoperative complications.
METHODS: The retrospective study was performed of 28 patients (mean age 12.4 years; range 5–18) treated with CSF between June 2020 and December 2024. Fractures were classified using the Delbet–Colonna and Garden systems. Reduction quality was assessed radiographically, and functional outcomes were measured by the Harris Hip Score (HHS). Statistical analyses included univariate and multivariate logistic regression.
RESULTS: Radiographic union was achieved in 92.9% of patients. The overall complication rate was 42.9%, including coxa vara (17.8%), avascular necrosis (AVN, 14.3%), premature physeal closure (PPC, 10.7%), and non-union (7.1%). Patients with AVN (mean HHS 72.5) and non-union (mean HHS 70.0) had the lowest functional scores, while those with coxa vara (82.0) and PPC (85.0) maintained relatively better function. Patients without complications achieved the best outcomes (mean HHS 88.5). Multivariate analysis identified higher Garden grade (OR 4.1, p=0.038) and non-anatomical reduction (OR 3.75, p=0.046) as independent predictors. PPC was significantly associated with implant removal (p=0.003). Despite the small sample, a post-hoc power analysis based on HHS indicated approximately 85% power to detect large effects.
CONCLUSION: PFNFs remain a challenging pediatric injury with high complication rates despite surgical fixation. Precise anatomic alignment is essential to minimize complications, particularly AVN and coxa vara. Close monitoring is recommended for patients with PPC, as it may necessitate implant removal and carries a risk of hip deformity or leg length discrepancy. Larger prospective studies are needed to refine surgical strategies for this rare but clinically significant injury.

BACKGROUND: To evaluate the clinical outcomes of closed reduction and crossed retrograde intramedullary Kirschner wire (K-wire) fixation in professional football players with metacarpal fractures, specifically focusing on return to play and complication rates.
METHODS: A total of 27 elite professional football athletes with metacarpal fractures were treated using closed reduction and crossed retrograde K-wire fixation. All surgeries were performed by the same orthopedic surgeon. Postoperative rehabilitation included a standardized protocol and individualized braces designed by a single hand therapist. Clinical and functional outcomes were assessed using range of motion (ROM), grip strength, Visual Analog Scale (VAS) for pain, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, time to return to training and competition, and radiographic healing.
RESULTS: The mean age of the cohort was 24 years. The fifth metacarpal was the most commonly affected site, and falling onto the pitch was the predominant injury mechanism. Mean return to training was 3.16 weeks, to competition 4.12 weeks, and to radiographic union 4.88 weeks. Mean DASH scores improved from 67.5 to 12.8, VAS from 5.78 to 0.75, MCP joint ROM from 66.75° to 89.25°, and grip strength from 44.87% to 95.55%.
CONCLUSION: Closed reduction and crossed retrograde K-wire fixation, with personalized postoperative care, appears to be a safe, reliable, and minimally invasive method in elite football athletes, enabling early return to play with excellent functional outcomes.

BACKGROUND: Injuries to the anterior cruciate ligament (ACL) are prevalent, particularly following athletic incidents. Most clinicians use MRI for diagnostic purposes and therapy assessment, but it can present challenges in terms of cost and accessibility. While ultrasound guidance (USG) is more readily available, it is inadequate for diagnosing ACL injury in isolation. Therefore, our study aimed to evaluate the effectiveness of sonoelastography, a novel method for assessing tendon injuries, in the context of anterior cruciate ligament (ACL) injuries.
METHODS: This study involved a cohort of 45 patients who fulfilled the designated inclusion criteria. We selected the patients from a cohort of 105 individuals who underwent anatomical ACL restoration at the orthopedics and traumatology clinic between 2017 and 2020. The clinical examination results and the stability and quality of the ACL in patients who underwent ACL reconstruction were compared with those from magnetic resonance imaging (MRI) and stress echo laxity (SEL) testing.
RESULTS: The study comprised 40 individuals with a mean age of 30.7±1.4 years. The patients' Lysholm scores exhibited consider-able enhancement post-operation, with a mean increase from 2.2±0.9 pre-operation to 6.1±1.6 post-operation. The Lachman, anterior drawer, and pivot-shift tests demonstrated improvements relative to the preoperative values. No substantial difference was observed in the single-leg hop test relative to the unaffected side. The SEL findings indicated that 15.6% of the healthy ACL instances were categorized as type 2a, 68.9% as type 2b, and 15.6% as type 3a. In the reconstructed ACL cohort, 17.8% were categorized as type 2a, 62.2% as type 2b, and 20% as type 3a. No substantial statistical difference was detected between the healthy ACL and the reconstructed ACL. No occurrences of type 3b or type 4 were identified in any of the patients.
CONCLUSION: We used SEL to find a torn ACL and check its stability and condition after the ligament was reconstructed with a graft. We utilize SEL, or stress sonoelastography, to monitor graft viability and evaluate the progression of ACL injuries. It is also beneficial in evaluating whether the restored ligament possesses a functional structure akin to that of a normal ligament. Moreover, considering its accessibility, cost-effectiveness, replicability, and patient preference, it may provide a more advantageous alternative to MRI.

BACKGROUND: This study aimed to compare the long-term continence outcomes of patients who underwent surgical repair for obstetric anal sphincter injuries (OASIS) and non-OASIS, based on the Jorge Wexner score. Additionally, predictive factors associated with complete continence restoration versus persistent fecal incontinence were analyzed.
METHODS: A retrospective analysis was conducted on 13 patients treated surgically for anal sphincter injuries at Erciyes University Faculty of Medicine between 2016 and 2019, with a minimum follow-up duration of five years. Patients were categorized into obstetric (n=8) and non-obstetric (n=5) groups. Functional outcomes were assessed using the Jorge Wexner score at 6 months, 1 year, and 5 years postoperatively. Continuous variables were analyzed using the Mann-Whitney U test, categorical variables with Fisher’s exact test, longitudinal changes with the Friedman test, and potential predictors of full continence were assessed via binary logistic regression.
RESULTS: The non-OASIS group exhibited significantly higher mean age (p=0.045) and longer hospital stays (p=0.006) compared to the obstetric group. Perineal examination revealed more extensive tissue loss and contamination in non-OASIS cases, often requiring fecal diversion, whereas obstetric injuries were typically cleaner and linear in nature. Although higher Wexner scores were observed in the non-OASIS group at all time points, between-group differences were not statistically significant. Wexner scores varied significantly over time within the non-OASIS group (p=0.014) but not within the obstetric group (p=0.257). No individual factor showed a significant association with complete continence restoration. The logistic regression model was statistically significant overall (p=0.027), though none of the independent predictors reached significance.
CONCLUSION: Compared with obstetric injuries, non-OASIS cases tend to involve a more prolonged recovery course and longer hospitalization. These findings suggest a more complex clinical trajectory in non-OASIS patients.

BACKGROUND: This study aimed to investigate the effects of the minimally invasive direct lateral approach, performed using standard hip surgery instruments, on operation duration, early postoperative pain, postoperative blood loss, and hospital stay in the treatment of femoral neck fractures with hemiarthroplasty (HA), compared with the standard Hardinge direct lateral approach (referred to in this study as the conventional group, CG).
METHODS: We retrospectively collected clinical data from the medical records of our hospital. Inclusion criteria were a diagnosis of femoral neck fracture resulting from low-energy trauma and treatment with HA surgery. Patients were divided into two groups based on the surgical approach: the conventional group (CG) and the mini-incision group (MG). Twenty-four patients comprised the MG (case group), while 18 patients were in the CG (control group). The average wait time for surgery was 3.8 days for the MG and 3.6 days for the CG. Statistical analyses were conducted to evaluate differences in postoperative pain scores, hospital stay, postoperative blood transfusion, operation duration, hemoglobin, and hematocrit levels between the groups.
RESULTS: There was no significant difference in age or gender distribution between the case and control groups (p>0.05). The average age of the mini-incision group was 83.8 years, while the average age of the CG was 86.9 years. In both groups, the fracture types were equally distributed between Garden type III and IV. However, the visual analog scale (VAS) scores on the first and third postoperative days were significantly lower in the case group than in the CG (p<0.05). Patients in the MG required significantly fewer postoperative blood transfusions compared to the control group. Hospitalization duration, as well as hemoglobin and hematocrit levels both preoperatively and at discharge, were comparable between the groups.
CONCLUSION: The data from this study indicate that the mini-incision technique is an effective and reliable method for treating femoral neck fractures. Compared with the conventional group, the minimally invasive direct lateral approach for femoral neck fractures significantly reduces early postoperative pain, results in less blood loss, offers better cosmetic outcomes, and maintains a similar length of hospital stay. Clinical studies with larger sample sizes and assessments of long-term postoperative outcomes are necessary.

BACKGROUND: Hemorrhagic shock is a leading cause of preventable trauma deaths, particularly within the first hours following injury. Early identification of patients requiring massive transfusion or with high mortality risk is critical to optimizing trauma management. Early identification of massive transfusion needs supports timely blood product preparation. Likewise, predicting mortality risk early can influence therapeutic planning and clinical decisions. Numerous trauma and transfusion scoring systems have been developed to guide such early decisions; however, their comparative predictive performance remains unclear. This study aimed to evaluate the effectiveness of trauma and transfusion scoring systems in predicting massive transfusion requirements and in-hospital mortality within the first four hours of trauma.
METHODS: This retrospective study included 117 trauma patients who received at least one unit of red blood cell transfusion within the first four hours of admission to a tertiary care center between 2018 and 2022. Data on demographics, trauma mechanism, clinical and laboratory findings were collected. Each patient was evaluated using 16 trauma and transfusion scoring systems. Patients were categorized based on the need for massive transfusion, defined as receiving ≥5 units of blood products within four hours. Receiver Operating Characteristic (ROC) analysis was used to assess the performance of each scoring system, and optimal cut-off values were determined using the Youden Index.
RESULTS: Massive transfusion was required in 23 patients (19.7%), with firearm injuries being the most common mechanism among these cases. All 16 scoring systems significantly differentiated patients with and without massive transfusion. The Shock Index demonstrated the highest predictive accuracy for massive transfusion (area under the curve [AUC]=0.911). For in-hospital mortality, all scoring systems except the Schreiber Score showed significant predictive ability. The Trauma Related Injury Severity Score (TRISS) achieved the highest predictive value for mortality (AUC=0.975). Several scoring systems required revised threshold values for optimal performance in this cohort, highlighting the need for population-specific calibration.
CONCLUSION: Early-phase application of trauma and transfusion scoring systems provides valuable insights for predicting clinical outcomes in trauma patients. Among the systems analyzed, the Shock Index was the most reliable predictor of massive transfusion. Separately, TRISS demonstrated superior accuracy in forecasting in-hospital mortality. These findings emphasize the importance of rapid, score-based assessment in early trauma care and support further validation of scoring systems across diverse patient populations.

Background: Earthquakes stand as the most devastating form of natural disaster. Turkey, situated within fault zone has witnessed numerous catastrophic earthquakes throughout its history. On February 6th, a powerful earthquake severely impacted eleven cities in the southeastern part of the country. The purpose of this study is to evaluate the treatment management of a specific group of patients initially advised amputation but who rejected this procedure were referred to our clinic for reconstruction.
Methods: This is single-center retrospective analysis included 15 patients (8 female, 7 male) with 17 flaps. Cases not requiring microsurgery were excluded. Data on admission conditions, time spent under debris, debridement surgeries, flap surgeries, anastomosis details, lab values, angiography, reoperations, wound closure times, complications, flap outcomes, hospitalization duration and amputations or death were collected.
Results: The average age of 15 patients was 30.67±18.51, with 5 of the patients being pediatric (33.33%). Patients spent an average of 41.77±40.68 hours under debris with an 11.40 ± 5.80-day admission delay. They underwent an average of 4.41±3.02 debridement surgeries before flap surgery, occurring around 21.06±18.24 days post-admission. Wound closure took about 37.93±37.58 days on average, with an average hospital stay of 77.33±36.67 days. 46% received hyperbaric oxygen treatment. Various flap types were used, with no failures in anterolateral thigh (ALT) or sural artery flaps. Latissimus dorsi + serratus anterior chimeric flaps were for larger defects, required more blood product replacements and fraught with difficulties. In total, 4 of the flaps were failed, 3 patients needed amputation despite all efforts, and 1 patient has died.
Conclusion: Earthquake victims with “worse than it seems” nature due vascular and infectious concerns require careful microsurgery. Proximal anastomosis, venous complication monitoring, meticulous debridement, VAC therapy and adjuvant treatments like hyperbaric oxygen therapy are crucial in managing these complex cases.

BACKGRUND: Acute appendicitis is an important clinical condition that usually occurs as a result of obstruction of the appendix lumen due to fecaloma or reactive lymphoid hyperplasia. However, rarely, various nonspecific and unusual pathologies can cause acute appendicitis or mimic this clinical condition. The aim of this study was to present patients who underwent surgery with a preliminary diagnosis of acute appendicitis and to determine the incidence of incidentally diagnosed nonspecific and unusual pathologies found during histopathological examination of the specimens.
METHODS: Data from 2633 patients who underwent appendectomy with a preliminary diagnosis of acute appendicitis in our clinic between January 2014 and June 2023 were retrospectively analyzed. Patients who underwent elective appendectomy in addition to other intra-abdominal operations were excluded. Specimens with unusual diagnoses were re-evaluated histopathologically. The data were analyzed statistically.
RESULTS: A total of 2633 patients were included in the study, 1617 (61.4%) male and 1016 (38.6%) female. The mean age was 11.32±3.66 (range: 1-18) years. All patients underwent the standard appendectomy procedure. After histopathological examination, the specimens were detected to show inflamed appendicitis in 2150 cases (81.65%), perforated appendicitis in 162 cases (6.15%), fibrous obliteration in 104 cases (3.94%) and unusual histopathological findings in 57 cases (2.16%). Of the patients with unusual histopathological findings, 40 were female and 17 were male. Enterobius vermicularis was detected in 41 patients (1.55%), appendicular carcinoid tumor in 10 patients (0.4%) and serous appendicitis in 6 patients (0.2%). Microscopic findings of acute appendicitis were not observed in 35 of these patients.
CONCLUSION: Nonspecific and unusual histopathological findings are more common in childhood appendectomy specimens than in those from adults. Careful histopathological evaluation of appendix specimens will allow early diagnosis and treatment of these rarely seen pathologies.

In cases of traumatic major extremity amputations, particularly in the lower extremity, every stage—ranging from decision-making to implementation and outcomes—remains a topic of debate. Managing major amputation cases with high mortality rates is extremely challenging both during the injury and treatment processes. We present a rare and severe case of a 30-year-old patient who sustained injuries from a concrete machine, resulting in bilateral lower extremity amputations and a unilateral proximal arm amputation. We successfully performed a replantation at the proximal ankle level on one side. In our patient, who has been followed for 14 years, we achieved a satisfactory outcome through meticulous surgical intervention, evaluated using the AOFAS and Maryland foot scores. We attained a limb with intact plantar sensation and near-complete range of motion in the ankle and toe joints. Although the clinical application of the MESS score has established criteria for replantation indications in traumatic amputation cases, we believe that there can be relative indications for limb salvage, especially in instances of multiple traumatic amputations, particularly bilateral lower extremity amputations. Therefore, in such injuries, the patient's life should be prioritized initially. Subsequently, at least one amputated extremity and its stump should be thoroughly evaluated. Rather than opting for stump closure, we advocate for attempting replantation.

Popliteal artery pseudoaneurysms are uncommon and can present as delayed complications of trauma, with clinical symptoms that may not appear until many years after the initial injury. This report describes a remarkable case of a giant popliteal artery pseudoaneurysm diagnosed 24 years following a gunshot wound. The patient, a 71-year-old male, presented with a palpable swelling and restricted movement in the left popliteal region. Notably, he had sustained a gunshot injury to the same limb more than two decades earlier, during which no immediate vascular complications were identified. Diagnostic imaging played a crucial role in this case. Doppler ultrasonography and computed tomography (CT) angiography revealed a large pseudoaneurysm measuring 12 cm in diameter, accompanied by erosion of the adjacent tibial bone. Surgical exploration confirmed the diagnosis of a popliteal artery pseudoaneurysm. The patient underwent successful vascular reconstruction using an autologous saphenous vein graft, which restored arterial continuity and limb function. This case highlights the diagnostic challenges posed by late-presenting popliteal artery pseudoaneurysms. Because symptoms can remain latent for years, these vascular abnormalities may be overlooked or misdiagnosed, particularly when there is a long interval since the initial trauma. The findings underscore the importance of prolonged and vigilant follow-up in patients who have sustained penetrating limb injuries, as pseudoaneurysms can develop decades later. Early diagnosis, facilitated by appropriate imaging modalities such as Doppler ultrasound and CT angiography, is essential for effective management. Prompt surgical intervention can prevent serious complications, including rupture, limb ischemia, and chronic pain, ultimately improving patient outcomes.

Simple renal cysts are often asymptomatic, but they can sometimes cause clinical signs when they reach a large size. In this report, we present the case of 78 a old male patient who visited the emergency department with symptoms such as nausea, vomiting, and abdominal swelling near the belly button. The patient had diabetes mellitus, which was regulated by metformin. Physical examination revealed a 5 × 5 cm umbilical swelling, abdominal asymmetry, and palpable fluctuations on the left side of the abdomen. Laboratory assessments indicated elevated white blood cell count and creatinine levels. An abdominal computed tomography scan indicated herniated segments of the small intestine emerging from the umbilical zone and a partial obstruction in the sigmoid colon, resulting from a cyst measuring 28 × 30 cm in the left kidney and a 15 × 12 cm cyst in the right kidney, and the sigmoid colon was progressively thinner in diameter. The patient underwent a surgical procedure involving unroofing of the bilateral cyst wall, aspiration of 15 liters of fluid, and mesh repair of the umbilical hernia. Discharge occurred on postoperative day six, and no complications were noted. This case highlights the potential of giant renal cysts to precipitate intestinal obstruction, and the need to consider this etiology in patients presenting with abdominal symptoms. Methods such as computed tomography, ultrasound, and magnetic resonance imaging are vital for recognizing and analyzing renal cysts and their potential complications. Therapeutic approaches include percutaneous aspiration, sclerotherapy, laparoscopic deroofing, and surgical intervention in cases with significant complications or large cysts.

Injuries to the common bile duct (CBD) have been reported in 0.4-0.5% of penetrating trauma cases across several series. Gunshot wounds pose unique challenges due to the thermal injury caused by the projectile, combined with the close anatomical proximity of the CBD, portal vein, and hepatic artery within the hepatoduodenal ligament. This proximity often results in combined injuries to these vital structures, which are associated with high perioperative morbidity or mortality. Isolated injuries to the CBD within the hepatoduodenal ligament are exceptionally rare, given the structure’s protective location and the interconnected nature of its compo-nents. The management of isolated CBD injuries remains a topic of ongoing debate. Here, we present a rare case of a gunshot wound causing an isolated CBD injury within the portal triad, accompanied by concomitant injuries to other intra-abdominal and thoracic organs.We present a 41-year-old male patient with an isolated CBD injury within the portal triad, accompanied by liver and lung injury sustained from a gunshot. Emergency computed tomography (CT) imaging revealed a bullet trajectory of 14 cm extending from liver segment 6 to segment 4B, associated with laceration and contusion. Exploration revealed thermal damage to the gallbladder wall, and the integrity of the hepatoduodenal ligament was disrupted. A cholecystectomy was performed, and dissection of the hepatoduodenal ligament revealed that approximately 70% of the CBD wall was transected. Importantly, the portal vein and hepatic artery remained intact. The proximal CBD was clamped, and complete transection of the duct was performed. Reconstruction involved a Roux-en-Y hepaticojejunostomy after preparing the jejunal segment. The patient experienced an uneventful recovery and was discharged on postoperative day 7 following drain removal. At the 6-month follow-up, the patient remained asymptomatic with no evidence of late complications.We believe that dissection of the hepatoduodenal ligament is necessary in patients with penetrating injuries near the hepatoduodenal ligament after hemostasis. Hepaticojejunostomy is an effective surgical treatment for patients with full-thickness transection of the CBD and reduces the risk of postoperative complications.