BACKGROUND: Skeletal muscle ischemia-reperfusion injury (IRI) is a significant concern in various clinical settings. Oxidative stress and neutrophil infiltration play central roles in its pathophysiology. However, clinicians have very few therapeutic options for the prevention and treatment of IRI. The present study aimed to investigate the effects of epigallocatechin gallate (EGCG) on (i) skeletal muscle injury, (ii) oxidative stress, and (iii) markers related to neutrophil infiltration.
METHODS: This was an experimental study conducted on rats. The IRI model involved the application of an elastic rubber band for 4 + 2 hours (IRI group). In the sham control (SC) group, all procedures were identical except for the rubber band application. Saline (10 mL/kg, intraperitoneally) and EGCG (25 or 50 mg/kg, intraperitoneally) were administered 30 minutes before reperfusion (IRI-SF, IRI-25, and IRI-50 groups, respectively). Creatine phosphokinase (CPK) was the primary endpoint. Other parameters included lactate dehydrogenase (LDH), total oxidant status (TOS), total antioxidant status (TAS), myeloperoxidase (MPO), E-selectin, P-selectin, L-selectin, intercellular adhesion molecule-1 (ICAM-1), and various cytokines (interleukin-1 beta [IL-1β], IL-6, and tumor necrosis factor-alpha [TNF-α]), which were measured in serum or gastrocnemius muscle samples.
RESULTS: CPK, LDH, and TOS levels were higher in the IRI group compared to the SC group (p=0.001, p=0.0001, and p=0.005, respectively). Although not statistically significant, decreases in these parameters were observed in the IRI-50 group compared to the IRI group (p=0.628, p=0.167, and p=0.444, respectively). Regarding TAS, a noticeable decrease was observed in the IRI group compared to the SC group (p=0.054), which was significantly increased by treatment with 50 mg/kg EGCG (p=0.011). For the remaining parameters (except IL-6), there were no statistically significant increases in the IRI group compared to SC, nor decreases in the EGCG-treated groups compared to the IRI group.
CONCLUSION: We propose that EGCG possesses antioxidant activity. However, any beneficial effect related to its interaction with neutrophil infiltration markers remains only suggestive.

BACKGROUND: Cystic stump leakage is the most common cause of bile leakage following cholecystectomy, representing a significant postoperative complication that requires prompt intervention. Currently, endoscopic treatment is the preferred management approach. This study aims to identify factors influencing the success of endoscopic therapy for cystic stump leaks by analyzing cases treated at our institution.
METHODS: Thirty-seven patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for cystic stump leakage were included in this study. Patient demographics, associated complications, and length of hospital stay were analyzed.
RESULTS: All patients showed clinical improvement, with a mean hospital stay of 5.1 days. The presence of comorbidities, emergency surgery, or conversion to open surgery did not significantly impact treatment efficacy. Post-procedure, percutaneous drainage was required in 10 patients (27%). Procedure-related pancreatitis was noted in one patient (2.7%). Statistical analysis revealed that both the need for percutaneous drainage and the length of hospital stay were significantly lower in patients who had pre-existing drains (p<0.03). Additionally, early ERCP was associated with a significantly shorter hospital stay (p<0.01).
CONCLUSION: Stent placement via ERCP is a safe and effective strategy for managing cystic stump leaks. Early ERCP intervention following cystic stump leak detection is recommended. Furthermore, percutaneous drainage may be necessary in patients who do not respond adequately to initial treatment.

Objectives: The epidemiology of acute hand injuries that require surgery in children is poorly defined. The purpose of this study was to outline the epidemiological and injury characteristics of surgically treated acute traumatic hand injuries in children and offer preventive recommendations.
Methods: We performed a retrospective descriptive epidemiological study of surgically treated acute traumatic hand injuries observed between 2004 and 2024 in a tertiary university hospital. The analysis included patients under 18 years of age, and examined demographics, injury mechanisms, causes, injury characteristics, and severity using the Modified Hand Injury Severity Scale (MHISS).
Results: Two hundred ninety-five patients were enrolled in the study. Injuries were most common among males and adolescents. The most frequent mechanism of acute hand injury was laceration (78.6%). Accidental falls with glass cups in toddlers and preschool children, street glass shards in schoolchildren, and punching glass and chainsaw injuries in adolescents were the most common causes of lacerations. The Modified Hand Injury Severity Score (MHISS) indicated that most hand injuries were moderate (35.9%). Complex injuries accounted for 39.7% of all cases, and 10.8% of patients required additional surgeries.
Conclusions: The main cause of acute traumatic hand injuries requiring surgery in children is laceration due to glass, motorized and non-motorized farming equipment, cutting machines, knives, and various sharp objects. Raising parental awareness and educating the community can help to reduce the incidence of these injuries.

BACKGROUND: The Modified 5-Factor Frailty Index (mFI-5) has been shown to predict complications following treatment in geriatric patients. However, few studies have compared the mFI-5 with other trauma scoring systems in cases involving multiple injuries. This study aimed to evaluate the Relationship Between mFI-5, Injury Severity Score (ISS), and Geriatric Trauma Outcome Score (GTOS) and their association with mortality in geriatric trauma patients.
METHODS: This retrospective cohort study included patients aged 65 and older who were admitted to the emergency trauma unit of a tertiary care hospital. Data collected included laboratory parameters, imaging results, blood transfusion requirements, hospitalization status, intensive care unit admission, surgical intervention, ISS, GTOS, mFI-5 scores, and mortality outcomes.
RESULTS: A total of 241 patients were included, with a mean age of 78.12 (±8.34) years. Falls were the most common cause of trauma (n=142, 58.9%). Thoracic injuries were the most frequently observed (n=86, 53.7%). Patients who died within the first 24 hours of admission had significantly higher ISS (14.1 vs. 26.33), GTOS (119.02 vs. 157.33), and mFI-5 (2.53 vs. 3.33) scores (p=0.001, p=0.001, and p=0.017, respectively). Similar trends were noted for one-month and three-month mortality (p=0.001 for all).
CONCLUSION: Scoring systems are essential for early mortality prediction in geriatric trauma patients. ISS, GTOS, and mFI-5 scores have shown similar effectiveness in predicting comorbidities, intensive care unit admission, and mortality in geriatric trauma patients. ISS involves a complex calculation, while GTOS, although specifically designed for geriatric patients, requires additional computations based on the ISS. In contrast, mFI-5 may be more practical in emergency settings because it is easy to calculate.

BACKGROUND: This study aimed to investigate the relationship between trauma severe enough to cause physical injury and subsequent hearing loss in military personnel exposed to blast events.
METHODS: A retrospective review was conducted on 95 patients aged 30-39 who were admitted between 2015 and 2018 due to blast-related injuries and acoustic trauma. A control group of 51 military personnel without complaints was included. Patients were categorized based on the location of trauma, the energy level of the explosion, and the presence of tympanic membrane perforation. Hearing thresholds and clinical characteristics were compared between groups to evaluate the relationship between trauma patterns and auditory outcomes.
RESULTS: Patients with head-related injuries had significantly worse air and bone conduction thresholds at multiple frequencies compared to those with injuries in other body regions (p<0.05). Tympanic membrane perforation was significantly associated with eye injuries (p=0.004) and elevated air conduction thresholds (p<0.05), but not with bone conduction thresholds. Exposure to medium and high-energy blasts was associated with elevated hearing thresholds across all frequencies compared to controls (p<0.001).
CONCLUSION: Blast-related acoustic trauma is associated with hearing loss across a range of frequencies. Tympanic membrane perforation contributes to air conduction hearing loss. Eye injury may be anatomically related to tympanic membrane damage. Hearing assessment should be integrated into the multidisciplinary care of trauma patients in war zones.

BACKGROUND: This study aims to evaluate traumatic injuries resulting from wounding crimes from a forensic medical perspective, determine the demographic characteristics of the victims, and characterize injury patterns.
METHODS: A retrospective review was conducted on 2,164 forensic reports prepared between January 1, 2023 and June 30, 2024 at the Department of Forensic Medicine, Gülhane Training and Research Hospital. Data including gender, age, marital status, educational level, type of assault, nature of the forensic traumatic event, traumatic injuries, affected body regions, and injury characteristics were analyzed using IBM SPSS Statistics 26.0. The results were evaluated statistically.
RESULTS: Of the victims, 72.8% were male and 27.2% female. Injuries occurred most frequently in the 21-30 age group (30.4%). A significant decrease in the incidence of injuries was observed with increasing education levels (p<0.05). The fact that 22.1% of victims were university graduates suggests that higher education may serve as a protective factor against victimization. The most common cause of trauma was assault (54.6%), followed by traffic accidents (35.9%). Injuries often involved multiple body regions (39.3%), with the head-neck region (30.6%) and upper extremities (13.4%) being most commonly affected. It was determined that 66.6% of the injuries were mild enough to be treated with simple medical interventions, while 6.9% were life-threatening. Traffic accidents were significantly associated with fractures and dislocations (23.6%). Additionally, facial injuries due to assaults occurred frequently and were statistically significant (68.6%; p<0.05).
CONCLUSION: This study highlights the demographic distribution of assault-related crimes and the forensic implications of traumatic injuries, emphasizing the importance of preventive measures and the necessity for multidisciplinary collaboration.

BACKGROUND: On February 6, 2023, Türkiye experienced two devastating earthquakes with epicenters in Pazarcık and Elbistan, measuring 7.7 and 7.6 on the Richter scale. These earthquakes resulted in over 50,000 deaths and widespread destruction of infrastructure. The disaster triggered a large-scale humanitarian crisis, presenting significant medical and psychological challenges. Understanding the scientific response to such events is crucial for enhancing future disaster preparedness and management.
METHODS: A systematic search was conducted in the Web of Science database using the terms "Kahramanmaraş earthquake," "Pazarcık earthquake," "Elbistan earthquake," and "Türkiye earthquake 2023." The search covered literature published from February 6, 2023 onward, and focused on medical publications. A total of 371 articles were initially identified; after excluding geological, engineering, and social science studies, 350 articles were included. Bibliometric analysis was performed using the Bibliometrix package in R Studio and visualized with Biblioshiny. Key indicators analyzed included publication volume, citation count, author collaboration, and thematic clustering.
RESULTS: The analysis identified 350 articles published in 173 journals, with contributions from 1,739 authors. The average number of co-authors per document was 6.03, indicating a high level of collaboration. However, only 5.429% of the studies involved international authors. The annual growth rate of publications was -11.11%, suggesting a projected decline in research activity. The most cited article was Emergency Medicine Association of Turkey Disaster Committee Summary of Field Observations of February 6th Kahramanmaraş Earthquakes, which emphasized the challenges faced in emergency response. Psychological studies were more numerous; however, publications related to emergency response and trauma care received higher citation counts. Keyword analysis revealed a focus on trauma care, post-traumatic stress disorder (PTSD), surgical management, and public health. Notable clinical advancements included the SAFE-QUAKE (Seismic Activity Forecasting and Evaluation–QUAKE) scoring system for predicting dialysis needs and the Mangled Extremity Severity Score (MESS) for amputation triage.
CONCLUSION: The research response to the Kahramanmaraş earthquakes followed a clear progression: an early focus on emergency response and public health, followed by injury and surgical management, and a later emphasis on psychological recovery. Despite a strong domestic research effort, low international collaboration hindered broader knowledge exchange. Sustained funding, enhanced global partnerships, and integrated mental health and trauma care strategies are essential for improving future disaster preparedness and healthcare system resilience.

Objectives: In this study, our objective was to investigate the factors that affect 1-year mortality in patients over 65 years of age who were hospitalized due to hip fracture.

Methods: This retrospective cohort study is based on data from our clinical archives collected between January 2013 and December 2021. All consecutive patients over 65 years of age with hip fractyres admitted to our hospital were considered for inclusion in the study.
Results: During the period from January 2013 to December 2021, 834 patients met the inclusion criteria. The one-year mortality rate was 33.5 % (279/834). The mean surgery time was 5.64 days in patients with 1-year mortality; and 4.50 days in patients who lived longer than one year (P = 0,001). The mean values of hemoglobin, creatinine, lymphocyte count, and albumin of patients in the one-year mortality group were 11.47 g/dL, 1.33 mg/dL, 1.10x103/μL and 3.42 g/L, respectively. The same values of those who survived for more than a year were 11.93 g/dL, 1.12 mg/dL, 1.35x103/μL and 3.68 g/L, respectively (P= 0.006, 0.002, 0.001 and 0,000, respectively).
Conclusions: We found that older patient age, delayed surgery, low albumin level, low total lymphocyte count, and high creatinine levels at hospital admission are associated with increased mortality after hip fracture. Comorbidities, number of comorbidities, transfusions, and ICU requirements were not associated with increased mortality, unlike the literature

BACKGROUND: Femoral neck fractures are a serious health concern, particularly among the elderly. The aim of this study is to diagnose and classify femoral neck fractures from plain pelvic X-rays using deep learning and machine learning algorithms, and to compare the performance of these methods.
METHODS: The study was conducted on a total of 598 plain pelvic X-ray images, including 296 patients with femoral neck fractures and 302 individuals without femoral neck fractures. Initially, transfer learning was applied using pre-trained deep learning models: VGG-16, ResNet-50, and MobileNetv2.
RESULTS: The pre-trained VGG-16 network demonstrated slightly better performance than ResNet-50 and MobileNetV2 for de-tecting and classifying femoral neck fractures. Using the VGG-16 model, the following results were obtained: 95.6% accuracy, 95.5% sensitivity, 93.3% specificity, 95.7% precision, 95.5% F1 Score, a Cohen’s kappa of 0.91, and the Receiver Operating Characteristic (ROC) curve of 0.99. Subsequently, features extracted from the convolution layers of VGG-16 were classified using common machine learning algorithms. Among these, the k-nearest neighbor (k-NN) algorithm outperformed the others and exceeded the accuracy of the VGG-16 model by 1%.
CONCLUSION: Successful results were obtained using deep learning and machine learning methods for the detection and clas-sification of femoral neck fractures. The model can be further improved through multi-center studies. The proposed model may be especially useful for physicians working in emergency departments and for those not having sufficient experience in evaluating plain pelvic radiographs.

BACKGROUND: Non-articular dorsally angulated distal radius fractures (DRFs) are often managed conservatively, yet the optimal cast design remains debated. Dorsoradial (DR) casting leaves the ulnar border open, potentially better accommodating swelling and reducing early cast-related interventions.
METHODS: A single-center retrospective cohort study included adults with AO-23-A2/A3 DRFs treated between May 2019 and May 2023. Patients received either a DR cast (n=88) or a conventional circular cast (CC) (n=122) for a standard five-week immobilization. Primary outcomes included functional (Patient-Rated Wrist Evaluation, PRWE) and clinical (Gartland-Werley, GW) scores, along with radiographic alignment (volar tilt, radial inclination, radial height) at a median follow-up of 118.5 weeks. Secondary outcomes were early cast revisions (release or reinforcement) and complications. Statistical tests included Mann-Whitney U, χ²/Fisher, with Bonferroni-adjusted α=0.017.
RESULTS: Baseline characteristics were similar across groups: mean age 60±11 years, 87% female, comparable AO subtype distribution, and osteoporosis status. Early revision: DR 22.7% vs. CC 36.1% (absolute risk reduction 13% points; odds ratio: 0.51, p=0.038), primarily due to fewer cast releases for swelling/pain (12.5% vs. 32.8%, p=0.001). Function: PRWE scores were 34±18 (DR) vs. 36±18 (CC), p=0.435; GW scores were good-excellent in 79.5% vs. 77.8%, p=0.508. Radiographic outcomes: final volar tilt and radial height were similar (both p>0.08). DR casts better preserved radial inclination (median change 0°, p=0.057) compared to CC casts, which lost 1.3° (-6%, p<0.001); however, the net 1.2° intergroup difference is below the 5° minimal clinically important difference (MCID) and is clinically negligible. No cases of compartment syndrome or acute carpal tunnel occurred.
CONCLUSION: Dorsoradial casting delivers functional and radiographic outcomes equivalent to circular casting while reducing early revision rates by one-fifth. By lowering unplanned cast adjustments and follow-up visits, the DR technique represents a pragmatic alternative for centers with limited monitoring capacity treating dorsally angulated extra-articular DRFs.

BACKGROUND: Cervical pedicle screws offer biomechanical advantages over other stabilization systems. However, their placement carries a relatively high risk of vascular or neurological injury due to individual differences and the complex structure of the cervical spine. Therefore, understanding patient-specific anatomy is crucial for the safe and accurate placement of pedicle screws. In this study, we present our single-center case series over a seven-year period involving cervical pedicle screw placement in subaxial cases.
METHODS: We retrospectively analyzed patients who underwent cervical subaxial pedicle screw placement between 2017 and 2024. A freehand surgical technique was employed, using a mini-laminotomy approach to ensure safe screw placement. During the procedure, the medial, superior, and inferior borders of the pedicle were palpated.
RESULTS: A total of 70 cases were analyzed retrospectively. Fifty patients were male, and 20 were female. The patients ranged in age from 20 to 89 years (median age: 64 years). Fifty-seven patients (81.5%) had cervical stenosis as the surgical indication. Of the remaining cases, 11 patients had fractures and two had tumors. Among the 468 pedicle screws placed, 434 were graded as 0-1. The correct placement rate was 92.7%. Thirty-four screws were malpositioned (grade 2-3), representing a rate of 7.3%.
CONCLUSION: In our case series, the accuracy of cervical subaxial pedicle screw placement was high. We believe that achieving this level of accuracy requires a strong understanding of anatomy, three-dimensional spatial awareness, and surgical experience.

Background: Bony mallet finger is a common injury of the distal phalanx that often requires surgical fixation when fracture displacement disrupts joint congruity. Extension-block Kirschner wire fixation, originally described by Ishiguro, is a minimally invasive method with high reported success rates. This study aimed to evaluate the clinical and radiological outcomes of patients with acute bony mallet finger treated with the extension-block technique using Kirschner wires.
Methods: A retrospective review was conducted on 76 patients treated surgically between October 2020 and December 2023. Radiographic union, extension lag, Crawford classification scores, and complications were analysed. Fractures were also categorised according to the Wehbé and Schneider classification. Statistical analyses included the Shapiro–Wilk test, Wilcoxon signed-rank test, and Chi-square or Fisher’s exact tests as appropriate.
Results: The mean patient age was 34.4 ± 11.6 years. The median injury-to-surgery interval was 3 days, and the median follow-up duration was 18.5 months. Union was achieved in 97% of cases. The median preoperative DIP joint extension lag improved significantly from 8.8° (IQR 5.8–14.2) to 2.1° (IQR 0–4.8) at final follow-up (p < 0.001, r = 0.72). According to the Crawford classification, 80.2% of patients achieved excellent results, 13.2% good, 1.3% satisfactory, and 5.3% poor outcomes. Complications were limited to two non-unions and one malunion (3.9%).
Conclusion: Extension-block Kirschner wire fixation provides excellent functional and radiographic outcomes in the treatment of acute bony mallet finger when performed early. The technique is safe, effective, and minimally invasive, with low complication rates and high union success.

Intestinal perforation may occur, albeit rarely, following blunt abdominal trauma. However, there is insufficient data in the literature regarding late-onset intestinal ischemia and perforation observed during hospitalization in patients rescued from under the rubble after earthquakes. The intestinal perforations that occurred in this patient group were defined as “stress-related intestinal ischemia.” After the two earthquakes measuring 7.8 and 7.5 on the Moment Magnitude Scale that occurred in Türkiye on February 6, 2023, a total of 1261 patients were treated at our hospital. Among these patients, delayed intestinal perforation developed in three cases (0.23%) during their hospitalization for various reasons. Two of the patients had a history of hemodialysis due to acute kidney injury, while one patient had undergone continuous renal replacement therapy. No mesenteric injury was detected in any patient, and the median time between the earthquake and the development of intestinal perforation was 30 days. Two patients underwent small bowel resection and anastomosis, while the other patient underwent subtotal colectomy with end colostomy. The median length of stay in the general surgery ward following abdominal surgery was 12 days, and the median total hospital stay for treatment was 67 days. All patients were successfully discharged after completion of their postoperative treatment. In conclusion, delayed intestinal perforations may occur in multi-trauma patients after earthquakes, especially in those with risk factors such as hemodialysis, major surgeries, and prolonged hospitalizations. Stress-induced intestinal necrosis should be considered in the differential diagnosis of acute abdominal conditions that may develop during extended hospital stays.

This report describes the successful treatment (without hepatectomy) of a patient who underwent laparotomy and bullet removal for a gunshot injury to the liver at another institution. The patient was later referred for hemobilia and was found to have an un-recognized tangential injury to the right portal vein branch, resulting in portal vein thrombosis, diagnosed on the twelfth day after injury. The patient subsequently developed severe cholangitis. Hepatic arteriography did not identify the source of hemobilia. Fol-lowing thrombectomy of the main portal vein and its left branch, along with portal vein repair, bilateral external biliary drainage from the common hepatic duct was performed. Hemobilia ceased after portal revascularization. A low-volume biliary fistula developed in the early postoperative period but resolved within 17 days with gradual removal of abdominal drains. The patient experienced no further complications during six months of follow-up. Standard biochemical blood tests remained within normal limits, except for slightly elevated alkaline phosphatase (167 U/L: 40-129) and gamma-glutamyl transpeptidase (100 U/L: 8-61) levels. Follow-up contrast-enhanced computed tomography scans on postoperative day 10 and at six months confirmed patency of the main portal vein and its left branch. Additionally, right lobe atrophy and left lobe hypertrophy were observed. In conclusion, applying principles from elective hepatopancreatobiliary surgery to trauma care, and avoiding major hepatectomy in the setting of severe cholangitis, played a crucial role in achieving a successful outcome.

In conflict-affected regions such as Somalia, injuries resulting from terror-related explosions impose a substantial public health burden. Shrapnel injuries are frequently encountered and often lead to multiple trauma, with penetrating thoracic injuries among the most clinically significant. Although rare, cardiac trauma presents considerable diagnostic and therapeutic challenges for emergency physicians and trauma surgeons. While surgical intervention is typically indicated in hemodynamically unstable patients, the optimal management for retained intracardiac foreign bodies (FBs) in stable patients remains an area of clinical uncertainty. The decision between surgical removal and conservative observation is influenced by several factors, including hemodynamic stability, the presence of cardiac complications, and the characteristics of the retained object. We present a case of a hemodynamically stable patient in Somalia with a retained intracardiac shrapnel fragment following a terror-related explosion. Imaging studies, particularly transthoracic echocardiography, revealed a foreign body within the pericardial space, without evidence of tamponade or myocardial injury. Given the stable clinical course and absence of acute cardiac pathology, a non-operative strategy with close clinical and echocardiographic monitoring was adopted. The patient remained complication-free and was successfully managed. This case underscores the feasibility of conservative treatment in selected hemodynamically stable patients with intracardiac FBs and highlights the necessity of an individualized, multidisciplinary clinical approach in complex trauma scenarios.