Background: Infertility and organ loss are possible outcomes of testicular torsion, a urological emergency. This study aimed to demonstrate the impact of lupeol on testicular ischemia/reperfusion damage.
Methods: Thirty adult male Spraque–Dawley rats were randomized into five groups: Control (C), Lupeol (L), Ischemia (Isc), Treatment 1 (T1), and Treatment 2 (T2). In the study groups, detorsion was applied to the left testicles by creating a 720-degree testicular torsion for 2 h. Additionally, in the T1 and T2 groups, 100 mg/kg of lupeol was injected intraperitoneally 30 minutes before and immediately after detorsion. At the sixth hour,aBACKGROUND: Infertility and organ loss are potential consequences of testicular torsion, a urological emergency. This study aimed
to evaluate the impact of lupeol on testicular ischemia-reperfusion damage.
METHODS: Thirty adult male Sprague-Dawley rats were randomly assigned to five groups: Control (C), Lupeol (L), Ischemia (Isc),Treatment 1 (T1), and Treatment 2 (T2). In the study groups, detorsion was applied to the left testicles following the induction of 720-degree testicular torsion for two hours. In the T1 and T2 groups, 100 mg/kg of lupeol was administered intraperitoneally 30 minutes before and immediately after detorsion. At the sixth hour, blood and testicular tissue samples were collected from each rat. Measurements included serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α), tissue glutathione (GSH), malondialdehyde (MDA), and caspase-3 levels. Histopathological analysis was performed to assess the Johnsen Tubular Biopsy Score (JTBS).
RESULTS: Levels of caspase-3 (2.74±0.32), MDA (1.71±0.26), IL-6 (4.92±0.57), and TNF-α (113.18±29.77) were elevated in Group Isc compared to Group C and showed a significant reduction in Group T2 (2±0.67, 1.16±0.36, 3.95±0.17, and 106.13±12.49, respectively) and particularly in Group T1 (1.65±0.50, 0.95±0.143, 80±0.35, and 104.86±8.42, respectively) (p=0.001). However, while TNF-αlevels decreased in both treatment groups, the difference was not statistically significant (p=0.768). GSH levels decreased in Group Isc(140.63±25.71) but increased in Group T2 (211.58±95.05) (p=0.753) and particularly in Group T1 (219.9±48.21)(p=0.078). The JTBS
was lowest in Group Isc (7.67±0.25). However, improvements were observed in both treatment groups (8.93±0.16 and 8.82±0.22, respectively) (p=0.001).
CONCLUSION: This study, the first to use lupeol in an experimental testicular torsion model, demonstrated its antioxidant, antiinflammatory, anti-apoptotic, histopathological damage-reducing, and protective effects. blood and testicular tissue samples were obtained from each rat. Serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α), tissue glutathione (GSH), malondialdehyde (MDA), and caspase-3 measurements were also obtained. Histopathological analysis was used to evaluate the Johnsen Tubular Biopsy Score (JTBS).
Results: Caspase-3 (2,74±0,32), MDA (1,71±0,26), IL-6 (4,92±0,57), and TNF-ɑ (113,18±29,77) values increased in Group Isc compared to Group C and significantly decreased in T2 (2±0,67, 1,16±0,36, 3,95±0,17, and 106,13±12,49) and particularly T1 groups (1,65±0,50, 0,95±0,143, 80±0,35, and 104,86±8,42) (p=0.001). However, TNF-α levels decreased in both treatment groups, with no statistically significant difference (p=0.768). GSH levels decreased in Group Isc (140,63±25,71) but increased in T2 (211,58±95,05) (p=0.753) and particularly in T1 groups (219,9±48,21) (p=0.078). JTBS was lowest in Group Isc (7,67±0,25). Improvement was observed in both treatment groups (8,93±0,16 and 8,82±0,22) (p=0.001).
Conclusion: This study, which is the first to use lupeol in an experimental testicular torsion model, demonstrated its antioxidant, anti-inflammatory, antiapoptotic, and histopathological damage-reducing and protective effects.

We evaluated the protective effects of melatonin against skeletal muscle ischemia-reperfusion injury, a significant
cause of skeletal muscle damage. Ischemia-reperfusion (I/R) injury occurs due to a temporary restriction of blood flow (ischemia) followed by its restoration (reperfusion), triggering oxidative stress, inflammation, and cell death. Although current treatments are limited, melatonin's antioxidant and anti-inflammatory properties suggest potential benefits.
METHODS: We studied 30 male mice divided into five groups: control, melatonin control, I/R, melatonin + I/R, and dimethyl sulfoxide control. After the designated treatments, we assessed muscle tissue for antioxidant capacity (total antioxidant status [TAS]), oxidative stress markers (total oxidative status [TOS] and malondialdehyde [MDA]), inflammation (myeloperoxidase [MPO]), and cell death (terminal deoxynucleotidyl transferase dUTP nick-end labeling [TUNEL] assay and histological analysis).
RESULTS: Melatonin significantly increased antioxidant capacity (TAS) compared to all other groups. Conversely, oxidative stress (TOS) was significantly lower in the melatonin + I/R group compared to the I/R group alone. Histological analysis revealed greater necrosis, edema, inflammation, and cell death in the I/R group compared to others. Interestingly, the melatonin + I/R group exhibited significantly less damage than the I/R group, highlighting melatonin's protective effect.
CONCLUSION: This study demonstrates that exogenous melatonin effectively reduces oxidative stress, inflammation, and cell death in skeletal muscle tissue subjected to I/R injury. These findings suggest that melatonin may be a promising therapeutic agent for mitigating I/R-induced complications in skeletal muscle injury.

BACKGROUND: In the rat sepsis model, the protective effect of dexmedetomidine (Dex) in sepsis-induced tissue injuries by reducing inflammation is still unclear, and research is ongoing to determine whether Dex modulates sepsis-induced tissue injury. To investigate the effect of Dex on liver injury in sepsis rats histopathologically and immunohistochemically.
METHODS: In this study, sepsis was induced in rats by 10 ml/kg E. coli injection and the protective efficacy of Dex against liver damage was investigated with histopathological and immunohistochemical findings by intraperitoneal administration of 100 𝜇g/kg Dex.
RESULTS: In our results, the most striking and basic morphological changes in the liver tissues of sepsis group rats were neutrophil leukocyte infiltrations in and around the vessels. In Dex-treated groups, neutrophil leucocyte infiltrations were more prominent and marked dilatations were observed in the vessels. The fact that inflammatory reactions were more prominent in the Dex-treated groups was thought to be related to the increase in vascular permeability due to Dex's vasodilation effect.
CONCLUSION: according to the histopathological and immunohistochemical findings obtained in the present study, we conclude that Dex did not alleviate sepsis-induced liver inflammation in a rat sepsis model.

BACKGROUND: Relaparotomy following abdominal trauma surgery is a critical intervention associated with significant morbidity and mortality. However, data on relaparotomy in trauma patients remain limited. This study aimed to evaluate the impact of relaparotomy-related factors on prognosis in patients undergoing relaparotomy after abdominal trauma surgery.
METHODS: This retrospective study analyzed adult patients who underwent relaparotomy following abdominal trauma surgery at a single center between December 2016 and December 2022. Demographic characteristics, trauma-related features, and perioperative clinical findings were recorded. Statistical analyses were conducted to identify factors associated with in-hospital mortality.
RESULTS: Among 300 patients who underwent abdominal trauma surgery, 106 (35.3%) required relaparotomy. The in-hospital mortality rate was 9.4%. Major indications for relaparotomy included hemorrhage control, hemodynamic instability, and intestinal leaks. Factors significantly associated with increased mortality included age ≥50 years (p=0.020), female sex (p=0.031), blunt trauma (p=0.020), multiple relaparotomies (p=0.023), active hemorrhage during relaparotomy (p<0.001), and fresh frozen plasma transfusion (p=0.046). Additionally, non-survivors demonstrated significantly lower blood pressure (p<0.001) and higher heart rates (p<0.001). They also presented with decreased levels of hemoglobin (p=0.015), platelet counts (p=0.001), and albumin (p<0.001), along with elevated international normalized ratio (INR) (p<0.001) and lactate levels (p<0.001).
CONCLUSION: This study highlights key factors associated with mortality in patients undergoing relaparotomy after abdominal trauma surgery. Early recognition and optimization of risk factors, along with the management of active hemorrhage, careful monitoring of vital signs and laboratory parameters, and special attention to high-risk groups such as older patients and those with blunt trauma, may improve outcomes in this vulnerable population.

BACKGROUND: This study aims to analyze the demographic, ultrasonographic, and laboratory findings as well as the outcomes of patients with ectopic pregnancy (EP) who underwent life-saving urgent surgery.
METHODS: A retrospective cross-sectional study was conducted at the Tersiyer Referral Hospital between January 01, 2016 and January 01, 2020. The study included 469 cases of EP. Data for these patients were extracted from hospital records and patient files. For the analysis of life-saving urgent surgeries, only patients presenting with severe signs and symptoms during hospital admission, follow-up, or after methotrexate (MTX) therapy were included.
RESULTS: The mean age of the patients was 31.2 (±5.65) years, with the youngest being 15 years old and the oldest 49 years old. A history of EP was noted in 15.1% of patients, and 29.4% were smokers. The reasons for consulting a doctor included no complaints in 37 patients (7.9%), delayed menstruation in 37 patients (7.9%), abdominal pain in 128 patients (27.3%), abdominal pain with vaginal bleeding in 108 patients (23.0%), and only vaginal bleeding in 159 patients (33.9%). In four patients (0.9%), the ectopic focus could not be identified via ultrasound, while in 255 patients (54.3%) the ectopic focus was located in the right adnexal area. The mean preoperative hemoglobin level was 12.4 (±1.33) g/dL, with a median hemoglobin value of 12.6 (range: 7.2-14.7 ) g/dL. A comparison of demographic data, ultrasound findings, and pre- and postoperative laboratory results between patients who underwent surgery
without MTX therapy and those who underwent surgery following MTX therapy revealed significant differences in terms of age, parity, maximum diameter of the ectopic focus, preoperative hemoglobin levels, preoperative white blood cell counts, presence of free fluid in the abdomen, and contraceptive methods.
CONCLUSION: EP holds a significant place among gynecological emergencies. Any delay in diagnosis can lead to life-threatening conditions, where the only viable treatment at this stage is life-saving urgent surgical intervention.

BACKGROUND: Dupuytren’s contracture is characterized by the thickening of the palmar fascia. Although extensive literature exists on this disease, changes in lifestyle necessitate the re-evaluation of its epidemiology, etiology, and clinical features. This study aims to revise the current characteristics of Dupuytren’s contracture and to explore potential relationships between these characteristics and recurrence.
METHODS: Patients who underwent surgery for Dupuytren’s contracture between January 2014 and December 2016 were included in this study. Electronic health records were reviewed to collect data on gender, age at surgery, age at the first signs of the disease, dominant hand, profession, cigarette and alcohol consumption, comorbidities and their treatments, the affected hand and digit, operative technique, type of anesthesia, degree of joint contracture severity, and presence of recurrence. Patients with and without recurrence were compared.
RESULTS: A total of 69 patients were included (60 males, nine females) with a mean age of 68.4 years (range: 51-90 years). Unilateral hand involvement was significantly more common. Recurrence occurred in seven patients (six males, one female). Comparison between patients with and without recurrence revealed that involvement of the first ray was significantly associated with recurrence. Partial palmar fasciectomy was the most commonly performed surgical procedure for recurrence treatment. No other significant differences were observed between the groups. The initial contracture angles of the metacarpophalangeal joints were higher compared to those observed in recurrence, whereas the proximal and distal interphalangeal joints were similar.
CONCLUSION: No new recurrence-independent epidemiological, etiological, or clinical factors were identified for Dupuytren’s contracture. However, first ray involvement was significantly associated with recurrence. Partial palmar fasciectomy was the primary surgical approach for treating recurrence. Metacarpophalangeal recurrence was less severe than the initial disease, while proximal and distal interphalangeal recurrences were similar in severity.

BACKGROUND: This study aimed to retrospectively examine the prehospital and emergency department processes of burn cases to evaluate process effectiveness, establish regional data, and identify factors affecting mortality in burn patients.
METHODS: The study included 784 burn cases treated by Ankara 112 Emergency Health Services and transferred to Ankara Bilkent City Hospital Emergency Department between January 1, 2019 and December 31, 2023. Demographic data, burn characteristics, response times of 112 emergency health services, and patient outcomes were retrospectively analyzed.
RESULTS: The mean age of the patients included in the study was 23.4±20.7 years, with 36.7% being female. The most common type of burn was hot liquid burns (49.9%) and 73.7% of cases involved second-degree burns. The overall mortality rate was 5%. Logistic regression analysis identified advanced age (odds ratio [OR]: 1.02), presence of inhalation burns (OR: 3.33), and burn percentage as independent risk factors for mortality. Receiver operating characteristic (ROC) analysis showed that age >44 years (38.5% sensitivity, 83.8% specificity) and burn surface >16% (89.7% sensitivity, 77.5% specificity) were predictive thresholds for mortality.
CONCLUSION: Advanced age, extensive burn surface area, residence in rural areas, and inhalation injuries are key predictors of mortality in burn patients. Enhancing prehospital emergency services, implementing community education programs, and adopting a multidisciplinary approach are critical for preventing and effectively managing burn injuries.

BACKGROUND: Emergency surgical pathologies constitute a significant portion of general surgery practice. Small bowel obstructions are a common cause of surgical emergencies in general surgical practice. This study aimed to investigate the predictive role of the Systemic Immune-Inflammation Index and Pan-Immune-Inflammation Value in determining the need for operative treatment in adhesive small bowel obstructions. These obstructions are significant in general surgery, yet clinicians lack consensus on treatment selection and clinical follow-up. This study also seeks to address controversial questions surrounding this topic.
METHODS: The study included patients with small bowel obstruction caused by adhesions during the postoperative period who were treated and followed up in our General Surgery Clinic. Patients' age, demographic information, and clinical data from January 2017 to January 2024 were retrospectively reviewed and recorded using the hospital information management system (HIMS) and patient records. Statistical analyses were performed using SPSS version 22.0.
RESULTS: A total of 341 patients with postoperative adhesive small bowel obstruction were included in the study. The mean age was 59.6±17.4 years (range: 18-93 years), with a male-to-female ratio of 1.4: 1. The median duration of symptoms was 2 days (range: 1-30 days). Operative treatment was performed in 19.6% of cases. The most frequently used operative technique was explorative laparotomy and bridectomy (70.1%). Intensive care unit (ICU) admission was required for 16.1% of patients, and the in-hospital mortality rate was 4.1%. The predictive roles of the Systemic Immune-Inflammation Index (SII), Pan-Immune-Inflammation Value (PIV), and other markers for operative treatment were evaluated. Receiver operating characteristic (ROC) analysis revealed that SII (area under the curve [AUC]=0.601, p=0.009) and PIV (AUC=0.596, p=0.010) were determinants for operative treatment.
CONCLUSION: SII and PIV values may assist in determining the need for operative treatment or non-operative follow-up in patients with adhesive small bowel obstruction (ASBO). By utilizing these markers, unnecessary operative interventions may be avoided. The management strategies for ASBO, a significant component of general surgical emergency practice, remain to be fully clarified. There are ongoing debates in the literature on this subject. We believe further studies with prospective, homogeneous, and broader populations should be conducted to address this issue.

BACKGROUND: Primary spontaneous pneumothorax (PSP) is a common condition encountered in emergency departments, typically
affecting young, otherwise healthy individuals. Identifying patients at risk for recurrence is critical for optimizing management
strategies and preventing complications. This study aimed to evaluate the predictive value of the Haller index in determining the risk
of recurrence in patients diagnosed with PSP.
METHODS: A retrospective analysis was conducted on patients diagnosed with PSP between January 1, 2019 and January 1, 2024,
in the emergency department of a tertiary care hospital. Patients were categorized into two groups: those experiencing a single PSP
episode and those with recurrent pneumothorax. Propensity score matching was employed to control for confounders, including age,
gender, smoking status, and body mass index (BMI). The Haller index was calculated from chest computed tomography (CT) scans, and
its predictive accuracy for recurrence was evaluated using Receiver Operating Characteristic (ROC) curve analysis.
RESULTS: A total of 182 patients were included in the study, with 91 patients in each group after propensity score matching. The
Haller index was significantly higher in the recurrent pneumothorax group (2.72±0.47) compared to the single pneumothorax group
(2.15±0.34), with a mean difference of 0.56 (95% confidence interval [CI]: 0.44-0.69, p<0.001). ROC analysis demonstrated an area
under the curve (AUC) of 0.830 (95% CI: 0.768-0.882), with a Youden index of 0.50, sensitivity of 72.53%, and specificity of 76.92%
for a cutoff value of >2.38.
CONCLUSION: The Haller index is a strong predictor of recurrent pneumothorax in patients with PSP. Its integration into clinical
assessments can help identify patients at elevated risk of recurrence, enabling tailored treatment strategies.

BACKGROUND: Acute calculous cholecystitis (ACC) is a significant cause of acute abdominal pain, accounting for 90-95% of
gallbladder inflammations caused by gallstones. Its clinical presentation ranges from nonspecific abdominal pain to septic conditions
associated with an acute abdomen. Timely and accurate diagnosis is critical in patient management, as delayed diagnosis or inadequate
treatment can result in increased morbidity and life-threatening complications such as perforation or biliary peritonitis. This study aims
to identify factors influencing the severity of ACC by analyzing the relationship between laboratory findings, radiological imaging, and
pathology results in cases managed in the emergency department.
METHODS: This retrospective study was conducted at the emergency department of Etlik City Hospital, a tertiary care center.
Patients diagnosed with acute cholecystitis were included in the study, while those under 18 years of age and those with choledocholithiasis
were excluded. Patients’ radiological findings, laboratory parameters, and pathological results were analyzed.
RESULTS: A total of 230 patients were included in the study. Patients with pericholecystic fluid exhibited significantly thicker gallbladder
walls (p=0.002). A significant association was found between elevated white blood cell (WBC) counts and gallbladder wall thickness
(p=0.035). However, no significant relationship was observed between liver function test results and gallbladder wall thickness.
CONCLUSION: This study evaluated the diagnostic and management parameters utilized by clinicians in cases of acute calculous
cholecystitis. The association between increased gallbladder wall thickness and pericholecystic fluid was highlighted as a key factor in
diagnosis and follow-up. Although laboratory and imaging modalities provide supportive roles in diagnosis, their necessity may vary
depending on the individual case. The study emphasizes the importance of a holistic approach that integrates clinical, laboratory, and
radiological findings to optimize patient outcomes in the emergency department, avoid unnecessary interventions, and prevent delays
in surgical treatment.

BACKGROUND: Pediatric gunshot injuries present significant challenges to emergency care, highlighting the need for precise strategies
in the management of high-volume incidents. This study aims to assess pediatric gunshot injuries presenting to the emergency
department in clusters and their outcomes, contributing to the development of a more detailed high-volume incidents classification
based on patient numbers.
METHODS: A retrospective analysis was conducted at a level-one trauma center, focusing on pediatric gunshot admissions. Patients
were segmented by admission type: single versus multiple simultaneous admissions from the same incident. Further analysis distinguished
between incidents involving three or more victims and those with fewer victims to assess the impact on emergency care outcomes.
RESULTS: This study included 182 pediatric patients with gunshot injuries, with a median age of 16 years (IQR 13.75–17). Patients
were analyzed using two grouping methods: the first divided patients into single admissions (n=103, 56.6%) and multi-victim presentations
(n=79, 43.4%). In this comparison, multi-victim presentations had a lower rate of blood transfusions (RR: 0.58, 95% CI:
0.35–0.95) but similar mortality rates (RR: 0.88, 95% CI: 0.31–2.44). The second grouping method classified incidents with three or
more victims (n=35, 19.2%) versus fewer victims (n=147, 80.8%). This analysis showed that incidents with three or more victims had
a higher mortality rate (RR: 2.81, 95% CI: 1.08–7.31). The average ED stay was shorter for multi-victim presentations (54.1±22.5
minutes) compared to solo presentations (65.2±48.8 minutes).
CONCLUSION: Findings indicate that pediatric gunshot incidents with three or more simultaneous victims, regardless of triage category,
significantly affect mortality and ED stay lengths in a center with a single trauma team. This highlights the necessity of defining MCIs
based on such patient volumes to optimize emergency care responses and improve outcomes. Establishing objective, outcome-focused
criteria for high-volume incidents classification is crucial for enhancing patient care and resource allocation in these critical situations.

BACKGROUND: The aim of this study is to characterize the sociodemographic, epidemiological, and clinical characteristics of ocular injuries in a secondary-level public hospital in Türkiye, identify the risk factors in the region, raise awareness on this issue, and propose solutions for injury prevention.
METHODS: This hospital-based retrospective cross-sectional study was conducted using data from patients who were followed up and treated for ocular trauma between January 2021 and January 2023 in a secondary-level public hospital located in the Middle Black Sea region of Türkiye. All patients, regardless of age, diagnosed with eyeball, eyelid, and orbital trauma were included. The age and gender of the patients, the situation or object that caused the injury, the location where the injury occurred, the type of injury according to the Birmingham Eye Trauma Terminology System (BETTS), initial and final visual acuities, and treatment outcomes were analyzed.
RESULTS: Medical records of 83 patients aged between two and 93 years were evaluated. Ocular trauma predominantly occurred in individuals aged 18 to 35 years (35%), with males comprising the majority (74.6%). Closed globe injury was the most common type of injury (73.5%), while injuries without globe involvement accounted for 18.1%, and open globe injuries comprised 8.4%. The most common cause of ocular injuries was falling (22.9%), with 47.3% of the patients in this group being 60 years of age or older. The most frequently implicated object in open globe injuries was wood, accounting for 42.8%. It was observed that injuries occurred most frequently on the streets (38.6%), followed by incidents at home (31.3%) and in the workplace (22.8%). Perforating injuries and ruptures
were associated with the worst prognosis for final outcome.
CONCLUSION: Falls in older adults were the most common cause of trauma. Preventive measures should be implemented to address the causes and risk factors of fall-related eye injuries in the elderly. Raising awareness among society and authorities about the causes and consequences of eye injuries is essential. By doing so, these injuries can be effectively prevented.

BACKGROUND: Distal tibial fractures are among the most common injuries in childhood. The treatment of distal tibial physeal
fractures presents significant challenges for orthopedic surgeons, and potential complications are a major concern. The aim of this
study is to evaluate the mid- and long-term outcomes of patients who underwent surgery for a distal tibial physeal fracture.
METHODS: This retrospective study included 46 patients who underwent surgery for a distal tibial physeal fracture between 2008
and 2022. Patients were evaluated based on the trauma that caused the fracture, the type of fracture (Salter-Harris classification), the
type of reduction performed (open or closed), the type of implant used (K-wire or cannulated screw), the location of the fracture in
the joint (intra-articular or extra-articular), and the presence of complications. The American Orthopaedic Foot and Ankle Society
(AOFAS) score was used for clinical assessment.
RESULTS: The median age of the patients was 12 years (interquartile range [IQR] 10-14). The median follow-up time was 67 months
(IQR 50.5-107). Postoperative anatomical reduction was achieved in 45 patients (97.8%), while 1 patient (2.2%) failed to achieve anatomical
reduction. The median AOFAS score for all patients was 100 (IQR 90-100). Patients treated with K-wire fixation had a median
score of 90 (IQR 86.5), while those treated with cannulated screws had a median score of 100 (IQR 92.5-100). Although the score for
cannulated screws was statistically significantly higher (p=0.024), both groups demonstrated excellent clinical outcomes.
CONCLUSION: Distal tibial physeal fractures are one of the most common childhood fractures and can lead to severe complications.
The mid- and long-term outcomes of surgical treatment of distal tibial physeal fractures are favorable. The method of reduction
(open or closed), the choice of implant (K-wire or cannulated screw), and the location of the fracture (intra-articular or extra-articular)
do not affect outcomes or complications in patients with these injuries. The crucial factor in the treatment of distal tibial physeal
fractures is achieving anatomical reduction.

BACKGROUND: Complex tibial plateau fractures present significant challenges due to severe articular comminution and soft tissue
complications. There is still no consensus in the current literature regarding the optimal treatment for these fractures. This study
aims to evaluate the clinical and radiological outcomes of complex tibial plateau fractures treated with Ilizarov external fixation with
or without minimal internal fixation.
METHODS: This retrospective study analyzed 62 patients with Schatzker type V or VI tibial plateau fractures, with a minimum
follow-up duration of three years. Patients were divided into two groups: one treated with circular external fixation (Ilizarov method)
combined with minimal internal fixation and the other treated with circular external fixation alone. Clinical, functional, and radiological
outcomes were assessed, including knee range of motion (ROM), Knee Society Score (KSS), Kujala Score, and Visual Analog Scale
(VAS) score.
RESULTS: At the latest follow-up, Group 1 demonstrated better functional and clinical outcomes compared to Group 2. The mean
knee range of motion in Group 1 was 116.56° versus 97.83° in Group 2 (p<0.05). Group 1 also had higher KSS scores (92.43 vs.
79.06) and Kujala Scores (94.75 vs. 90.6) and lower VAS scores (1.13 vs. 3.33) (all p<0.05). Flexion contracture and extension lag were
significantly less prevalent in Group 1, with fewer cases and lower severity. Circular external fixators were removed earlier in Group 1
(120.43 days) compared to Group 2 (157.06 days) (p<0.05), with a lower incidence of delayed union in Group 1. Varus malalignment
was also less frequent and less severe in Group 1. No major complications, such as neurovascular injuries, septic nonunion, or deep
venous thrombosis, were reported in either group. Both groups exhibited similar rates of minor complications, primarily pin tract
infections, which resolved with appropriate treatment.
CONCLUSION: Ilizarov external fixation, with or without minimal internal fixation, is an effective treatment method for complex
tibial plateau fractures. However, patients in whom the joint was anatomically reduced demonstrated better anatomical reduction, improved
range of motion, earlier weight-bearing, and enhanced functional recovery, highlighting the superiority of this approach. These
findings support the recommendation of this combined technique as the preferred treatment for such challenging fractures.

A popliteal pseudoaneurysm following total knee arthroplasty is a rare but potentially life-threatening complication. The most critical
step in diagnosing popliteal pseudoaneurysms is maintaining a high level of suspicion and conducting a clinical assessment. The presence
of a pulsatile mass in the popliteal region, edema, ecchymosis in the leg, unusual and persistent posterior knee pain, swelling, and
paresthesia are diagnostically valuable indicators for popliteal pseudoaneurysms. Lower extremity venous Doppler ultrasonography
and computed tomographic angiography are valuable diagnostic tools for identifying pseudoaneurysms. This case report describes a
patient who presented with clinically inconsistent pain on the first postoperative day following primary total knee arthroplasty and was
subsequently diagnosed with a popliteal pseudoaneurysm. Additionally, a review of the literature on this topic is provided. An 81-yearold
woman with a history of nocturnal knee pain and significant impairment in daily activities underwent total knee arthroplasty. On
the first postoperative day, she reported discomfort in the lower extremities and posterior knee pain that did not align with her clinical
presentation. Palpation of the distal pulses revealed no abnormalities, and no additional symptoms were observed. Venous Doppler
ultrasonography of the patient's left lower extremity identified a spherical, low echogenic structure with pulsation, approximately 3.5
× 2.5 cm in size, located near the prosthesis and adjacent to the popliteal artery. This finding confirmed the diagnosis of a pseudoaneurysm.
Following a comprehensive assessment and given the evidence of a neck size exceeding 5 mm and the potential for dissection
in the vicinity of the pseudoaneurysm, the decision was made to implant a covered stent. In cases of severe pain that is inconsistent
with the clinical and postoperative period, popliteal pseudoaneurysms should be considered.