BACKGROUND: Ischemia-reperfusion (I-R) injury associated with acute mesenteric vascular occlusion can lead to severe impairment of intestinal tissue and may become a life-threatening condition if not treated in the early clinical stages. Previous studies have suggested that fraxin may exert protective effects against I-R–induced mesenteric injury due to its antioxidant and anti-inflammatory properties.
METHODS: This experimental study was conducted using healthy male Wistar albino rats. The animals were divided into four groups: a Sham group (superior mesenteric artery [SMA] isolated but not occluded), a Control group (SMA isolated and I-R induced), a 10 mg/kg Fraxin group, and a 50 mg/kg Fraxin group (fraxin administered before reperfusion). Total antioxidant status (TAS), total oxidant status (TOS), superoxide dismutase (SOD), glutathione peroxidase (GPx), and catalase (CAT) activities were evaluated. Histopathological examinations and inflammatory markers, including tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and myeloperoxidase (MPO), were also analyzed.
RESULTS: In the Sham group, SOD activity was 135.2±10.5 U/mg protein, GPx activity was 65.3±4.7 U/mg protein, and CAT activity was 85.1±5.8 U/mg protein. In the Control group, these values were 95.4±7.9, 45.7±3.6, and 60.3±4.2 U/mg protein, respectively. In 10 mg/kg Fraxin group, SOD, GPx, and CAT activities were 115.6±8.4, 55.8±4.2, and 75.6±5.5 U/mg protein, respectively; in the 50 mg/kg Fraxin group, the corresponding values were 130.8±9.7, 60.2±4.8, and 90.4±6.3 U/mg protein. Significant decreases in TNF-α, IL-6, and MPO levels were observed in the Fraxin-treated groups (p<0.05).
CONCLUSION: Fraxin administration preserved tissues and improved antioxidant parameters by reducing oxidative stress and inflammation in the acute mesenteric artery ischemia–reperfusion injury (AMAIRI) model. Based on these findings, fraxin may be considered a potential therapeutic option for mesenteric ischemia-reperfusion-related injuries.

BACKGROUND: This study aimed to compare the analgesic efficacy of the transversus abdominis plane block (TAPB) and the erector spinae plane block (ESPB) following cesarean delivery under spinal anesthesia. The primary endpoint was the proportion of patients requiring rescue analgesia within the first 24 hours postoperatively. Secondary outcomes included time to first rescue analgesia, Numerical Rating Scale (NRS) scores at predefined time points (30 minutes, 4, 8, 12, 16, and 24 hours), and the incidence of persistent postsurgical pain at two months.
METHODS: This single-center, prospective, randomized controlled study included patients undergoing cesarean section under spinal anesthesia. Participants were randomly allocated into two groups: TAPB and ESPB. Postoperative pain and vital signs were assessed 30 minutes after block application and at 4, 8, 12, 16, and 24 hours postoperatively. Pain intensity was measured using the NRS (0=no pain, 10=worst imaginable pain). Rescue analgesia was administered when the NRS score was ≥4. Diclofenac sodium 75 mg intramuscularly (IM) was given for NRS scores of 4–5, while intravenous (IV) morphine sulfate 0.05 mg/kg was administered for NRS scores ≥6.
RESULTS: A total of 94 patients were analyzed: 48 received ESPB and 46 received TAPB postoperatively. The TAPB group had a significantly higher proportion of patients requiring rescue nonsteroidal anti-inflammatory drug (NSAID) analgesics compared to the ESPB group (58.70% vs. 27.08%, p=0.002). NRS scores at 30 minutes, 12 hours, and 16 hours postoperatively were significantly lower in the ESPB group (p=0.03, p=0.003, and p=0.023, respectively).
CONCLUSION: For postoperative analgesia following cesarean section under spinal anesthesia, ESPB resulted in a significantly lower proportion of patients requiring rescue analgesia within the first 24 hours compared to TAPB. In addition, ESPB demonstrated a faster onset and longer duration of effective analgesia, suggesting it may be a more favorable option for postoperative pain management in this clinical setting.

BACKGROUND: Despite efforts toward early diagnosis, approximately 25% of patients with colorectal cancer are still operated on under emergency conditions. The aim of this study was to investigate the risk factors associated with morbidity and mortality in emergency colorectal cancer resections.
METHODS: Emergency colorectal cancer resections performed at a single center were included in this retrospective study. Baseline, operative, and tumor-related data were examined. Morbidity was defined as a complication of Clavien Dindo grade ≥3. Risk factors for both morbidity and mortality were evaluated using univariate analyses and multivariable logistic regression.
RESULTS: The study included 188 patients, of whom 119 (63.3%) were men. In the multivariate analysis, factors associated with increased morbidity risk were age (odds ratio [OR]=3.02, p=0.009), American Society of Anesthesiologists (ASA) score (OR=2.04, p=0.049), duration of surgery (OR=1.01, p=0.001), and presence of perforation (OR=3.24, p=0.004). Multivariate analysis for mortality demonstrated significant effects of age (OR=3.23, p=0.017), ASA score (OR=5.92, p=0.009), duration of surgery (OR=1.01, p=0.007), and presence of perforation (OR=3.01, p=0.013).
CONCLUSION: This study highlights several key risk factors—including advanced age (≥70 years), higher ASA scores (≥3), longer operative times, and the presence of perforation—that significantly impact morbidity and mortality in emergency colorectal cancer resections. Early recognition of these factors may improve risk stratification and guide more effective perioperative care strategies for high-risk patients.

BACKGROUND: Logging is widely recognized as one of the most hazardous industries. Despite the prominence of this sector in Türkiye’s Eastern Black Sea region, comprehensive forensic investigations of logging-related deaths are limited.
METHODS: This retrospective study examined 102 logging-related fatalities identified among 4,878 forensic autopsies performed between 2013 and 2023 by the Recep Tayyip Erdoğan University. Demographic, occupational, environmental, seasonal, and medical response characteristics were extracted from autopsy reports and supplemented with information from police and judicial records.
RESULTS: The victims were predominantly male (93.1%) with an average age of 57.4 years. Two-thirds of them were unregistered workers, and 5.9% were foreign nationals. Tree-strike injuries were the leading cause of death (51.0%), followed by falls from trees (30.4%). Fatalities most frequently occurred in the fall (32.4%), with cranial trauma predominating in the summer and thoracic inju-ries in the spring. Autopsy findings revealed extensive polytrauma, including pelvic and extremity fractures (71.6%) and intracranial hemorrhage (53.9%). Most incidents were witnessed (78.4%); however, unwitnessed deaths occurred disproportionately among older informal workers on private lands. Female victims (6.9%) primarily died while performing auxiliary tasks and frequently lacked medical intervention (83%).
CONCLUSION: This study represents the first comprehensive medico-legal evaluation of logging-related fatalities in the Eastern Black Sea region. The findings highlight the pivotal role of unregulated labor, hazardous seasonal working conditions, and limited emergency response capacity in shaping mortality patterns. Targeted interventions, including stricter enforcement of occupational safety regulations, training for informal workers, and improved access to rural emergency services, are urgently needed to reduce preventable deaths in forestry and logging activities.

BACKGROUND: Nasogastric (NG) tube decompression has traditionally been used after abdominal surgery to prevent postoperative ileus and gastric distension. The aim of this study was to evaluate the necessity of NG tube decompression following emergency repair of perforated peptic ulcer (PUP).
METHODS: This retrospective study included 189 patients who underwent emergency surgery for PUP between 1999 and 2017. Patients were divided into two groups: those managed with an NG tube (Group 1, n=154) and those managed without an NG tube (Group 2, n=35). Demographic data, clinical characteristics (American Society of Anesthesiologists [ASA] scores and comorbidities), intraoperative findings, and postoperative outcomes, including length of hospital stay, time to oral intake, and complications, were analyzed.
RESULTS: The study cohort included 189 patients, of whom 84.1% were male, with a mean age of 54.1±19.9 years. Baseline demographic and clinical characteristics, including age, comorbidities, ASA scores, and operative details, were comparable between the two groups. There were no statistically significant differences in postoperative complications or 30-day mortality. However, patients in Group 2 demonstrated a significantly earlier transition to oral feeding (3.7±0.9 vs. 4.3±1.4 days; p=0.03) and a shorter duration of hospital stay (6.6±3.1 vs. 8.1±3.8 days; p=0.04) compared to Group 1.
CONCLUSION: Routine NG decompression is not necessary following surgery for PUP. Avoiding routine NG tube use does not increase morbidity or mortality and is associated with earlier oral intake and a shorter hospital stay. We recommend the use of NG decompression in selected patients when clinically indicated.

BACKGROUND: Proximal femur fractures are a common injury in elderly patients and are associated with high morbidity and mortality worldwide. Recent data indicate that the age-standardized incidence of hip fractures in adults over 55 years has increased significantly. We aimed to identify radiographic stability parameters and patient- or procedure-related factors associated with clinical fixation success following intramedullary nailing of proximal femur fractures.
METHODS: In this retrospective study, we evaluated 373 patients aged ≥35 years who underwent proximal femoral nail (PFN) implantation for intertrochanteric, pertrochanteric, subtrochanteric, or reverse-oblique femur fractures at our tertiary center between 2012 and 2024. Fractures were classified preoperatively using the Evans classification system, and the quality of reduction was graded as good, fair, or poor according to the standard radiographic Modified Baumgaertner criteria. Radiographic variables, including proximal lag screw tip-head distance (ApLAG1), distal lag screw tip-head distance (ApLAG2), ApLAG2-calcar distance, lesser trochanter-calcar distance, lateral lag screw tip-apex distance (LatTAD), and normal-side lesser trochanter-calcar distance, were measured postoperatively. Clinical outcomes were categorized into two groups: success or failure.
RESULTS: The cohort (mean age: 78.06±12.79 years; 66.5% female) included 262 (70.2%) standard PFNs, 79 (21.2%) integrated intertrochanteric antegrade nails (InterTAN) PFNs, and 32 (8.6%) single-screw PFNs. Overall, 359 patients (96.2%) had successful fixation and 14 (3.8%) experienced failure. No significant differences were found in radiographic parameters between the success and failure groups. PFN type did not influence radiographic measurements except for ApLAG2-related variables, in which InterTAN and single-screw nails differed from standard PFNs (p<0.001). Univariate analysis revealed that only poor reduction quality was significantly associated with failure (χ²=36.298; p<0.001).
CONCLUSION: Quality of fracture reduction emerged as the sole independent predictor of PFN fixation success, whereas patient demographics, Evans classification, and implant design did not significantly affect outcomes. Surgeons should prioritize achieving nearanatomic alignment and stable implant positioning to minimize mechanical failure

BACKGROUND: In tibial plateau fractures, achieving anatomical restoration of the articular surface and preventing postoperative collapse are critical for successful outcomes. Bone grafting is still commonly used to fill subchondral voids after reduction; however, it carries risks such as donor-site morbidity and technical difficulties. To address these issues and enhance subchondral stability, sub-chondral raft techniques have been developed. Although various screw and plate configurations have been investigated in the litera-ture, there is still no clear consensus regarding the most effective method. We aimed to evaluate the effectiveness of our modified technique using free 5.5-mm cannulated compression screws in preventing postoperative collapse and improving functional recovery in tibial plateau fractures.
METHODS: A total of 21 patients were included based on the following criteria: age ≥18 years, presence of >10 mm depression in the lateral tibial plateau, and no history of previous surgery on the affected knee. A subchondral raft construct was established without grafting using free 5.5-mm cannulated compression screws. Postoperative evaluation at 12 months included radiological and functional assessments using the Rasmussen Clinical Score (RCS) and Rasmussen Radiological Score (RRS).
RESULTS: The mean preoperative articular depression was 14.7 mm, improving to 1.1 mm at the one-year follow-up. Mean condylar widening decreased from 5.3 mm preoperatively to 0.7 mm postoperatively. The average postoperative hospital stay was 3.7 days, and the mean time to return to work was 3.5 months. At one year, radiological and functional outcomes were favorable, with a mean RCS of 26.6 and a mean RRS of 16.6.
CONCLUSION: The modified raft technique using 5.5-mm cannulated compression screws is a simple and effective option for managing depressed tibial plateau fractures, preventing articular collapse and facilitating faster recovery.

BACKGROUND: The long-term outcomes of arthroscopic tenodesis using the onlay (groove) and inlay (groove) techniques remain debated with respect to tendon healing and graft stability. The aim of our study was to identify the optimal tenodesis strategy by comparing the effects of arthroscopic inlay and onlay techniques on postoperative complication rates, patient satisfaction, and functional recovery.
METHODS: Between 2015 and 2021, the treatment outcomes of 54 patients who underwent arthroscopic biceps tenodesis using either the inlay or onlay technique for the management of superior labrum anterior-to-posterior (SLAP) lesions or biceps tendon de-generation were retrospectively evaluated. Patient demographics and clinical variables, including age, sex, side of involvement, follow-up duration, visual analog scale (VAS) score, Constant score, postoperative cramping, and complications, were recorded. Group 1 consisted of 28 patients who underwent inlay tenodesis, while Group 2 included 26 patients who underwent onlay tenodesis.
RESULTS: Postoperatively, VAS scores improved substantially in both groups, with no significant difference between Group 1 (0.21±0.45) and Group 2 (0.18±0.37) (p=0.789). Similarly, postoperative Constant scores were high in both groups, with Group 1 at 92.73±8.23 and Group 2 at 95.47±5.12; this difference was not statistically significant (p=0.145). The mean recovery time was significantly shorter in Group 2 compared to Group 1. Specifically, the mean recovery time was 12.3±4.8 weeks in Group 1 and 8.3±3.72 weeks in Group 2 (p=0.01). Cramping was reported in 21.42% of patients in Group 1 and 7.69% in Group 2; however, this difference was not statistically significant (p=0.253). In Group 1, Popeye deformity developed in two patients (7.1%), whereas in Group 2 it de-veloped in one patient (3.8%).
CONCLUSION: The present study demonstrates that both inlay and onlay arthroscopic biceps tenodesis techniques are effective surgical options for managing biceps tendon degeneration and superior labrum anterior-to-posterior lesions. However, the findings suggest a potential advantage of the onlay technique, as it is associated with faster recovery and a lower risk of complications.

BACKGROUND: This study aimed to compare the clinical, radiological, and cost-related outcomes of early spica casting performed without anesthesia in the emergency department and spica casting performed under general anesthesia in the operating room for the treatment of femoral shaft fractures in children under five years of age.
METHODS: One hundred eleven patients who underwent closed reduction and spica casting for femoral shaft fractures between 2020 and 2024 were retrospectively reviewed. Patients were divided into two groups according to where the spica cast was applied: Emergency Department Group (ED group, n=71) and Operating Room Group (OR group, n=40). The groups were compared in terms of age, sex, fracture type, radiological alignment, and treatment costs.
RESULTS: No statistically significant differences were found between the two groups regarding age, sex, fracture pattern, or final radiological alignment. However, treatment costs were significantly lower in the emergency department group. Complication rates were also similar between the groups.
CONCLUSION: Early spica casting performed in the emergency department without general anesthesia provides radiological out-comes comparable to those achieved in the operating room while offering a significant cost advantage. With appropriate patient selec-tion, this method represents a safe and effective treatment option.

BACKGROUND: This study aims to present the preliminary clinical and functional outcomes of pubic symphysis diastasis (PSD) cases treated with plate-screw fixation using the laparoscopic total extraperitoneal approach in orthopedic surgery (O-TEP).
METHODS: This retrospective study included 13 patients who underwent O-TEP symphysis pubis plating for PSD between March 2022 and May 2025, all with a minimum follow-up period of 12 months. Data collected encompassed demographic characteristics, injury mechanisms, additional pathologies, and injury classifications (Young-Burgess and AO/OTA). Surgical details, including duration, blood loss, hospital stay, and postoperative follow-up, were recorded. Clinical and functional outcomes were assessed using postop-erative VAS scores, as well as Iowa Pelvic and Majeed Pelvic scores at the final follow-up. The study also evaluated implant failure, the need for revision surgery, and surgery-related complications.
RESULTS: The mean age of the patients was 40±14.8 years (21–61). The gender distribution was 77% male and 23% female. The mean operating time was 113±36 minutes (65–175). The average blood loss was 127±67.3 ml (70–300), and the mean postoperative hospitalization period was 2.7±0.8 days (2–4). No postoperative complications, such as infection, implant failure, loss of reduction, or need for revision, were observed. Postoperative VAS scores on days 1 and 2 were 3.7±1.5 (1–6) and 2.2±1.03 (1–4), respectively. The mean follow-up period was 21.5±6.9 months (12–32), with a mean Iowa Pelvic Score of 87.1±4.7 (80–95) and a mean Majeed score of 84.9±4.01 (78–91).
CONCLUSION: Laparoscopic total extraperitoneal approach in orthopedic surgery (O-TEP) is an innovative minimally invasive technique that expands the available options for surgeons in the treatment of selected anterior pelvic ring injuries, providing clinically and radiologically satisfactory outcomes.

BACKGROUND: The role of traction radiographs in the preoperative evaluation of intertrochanteric femur fractures remains controversial, with inconsistent evidence regarding their impact on fracture classification, stability assessment, and surgical decisionmaking. This nationwide simulation-based study aimed to investigate how orthopedic trauma surgeons use and interpret traction radiographs and to determine their influence on surgical planning across different levels of clinical experience.
METHODS: A nationwide, cross-sectional simulation-based study was conducted among actively practicing orthopedic and trauma surgeons between October 14 and November 15, 2025, using a structured questionnaire containing simulated cases. The questionnaire included demographic characteristics, clinical experience, perceptions of traction radiographs, and case-based assessments of 15 AO Foundation/Orthopaedic Trauma Association (AO/OTA)-classified intertrochanteric fractures (31-A1, 31-A2, 31-A3). A total of 133 surgeons participated, yielding 1,995 individual case evaluations. Changes in surgical decisions before and after traction radiographs were analyzed using McNemar tests, while independent predictors were identified using generalized estimating equations (GEE).
RESULTS: Traction radiographs were requested in 59.5% of all assessments, with significantly higher request rates in unstable patterns (31-A2: 75%; 31-A3: 68.2%) compared with 31-A1 fractures (30%). Overall, traction imaging resulted in a 12.4% change in surgical planning, increasing to 21% among cases in which traction radiographs were obtained. Decision changes were most common in 31-A2.3 (14.9%) and 31-A3.3 (16.9%) patterns. The most frequent implant transition was from short to long proximal femoral nail (PFN) (40.8%), followed by conversion to arthroplasty (18.8%). GEE analysis demonstrated that both fracture type and requesting traction radiographs were independent predictors of surgical plan modification (odds ratio [OR]=1.55–2.40 for unstable fracture types; OR=1.60 for traction radiograph request; p<0.05 for all). Surgeon title, institutional setting, years of experience, and case volume were not associated with decision changes.
CONCLUSION: Traction radiographs provide clearer visualization of fragment configuration and medial and lateral wall integrity, leading to improved recognition of fracture instability and a measurable shift toward more durable fixation strategies. Their impact on surgical planning is most pronounced in complex or borderline-unstable fracture patterns and remains consistent across experience levels. As a low-cost and readily accessible adjunct, traction radiography represents a valuable tool in the preoperative assessment of intertrochanteric fractures. Routine use is recommended, particularly when instability is suspected or when standard radiographs provide insufficient clarity.

Although congenital variations of the biceps brachii are relatively common, agenesis of the long head is exceedingly rare. Due to the absence of clinical symptoms and notable physical examination findings, its diagnosis is challenging. The absence of the long head repre-sents one such variant, although it has only rarely been reported in arthroscopic and imaging studies. As this anomaly does not result in functional impairment, congenital biceps agenesis is often incidentally detected on shoulder magnetic resonance imaging performed for other reasons. In this case report, we present a 42-year-old industrial worker with a two-year history of persistent pain who under-went rotator cuff repair, during which an absent long head of the biceps tendon was incidentally identified. Current evidence suggests that the absence of the long head of the biceps tendon is not a risk factor for rotator cuff rupture or labral pathology. Additionally, when evaluating patients with an absent long head of the biceps tendon, it is essential to consider any previous surgical interventions. If the long head cannot be identified, the distal portion of the tendon should be carefully assessed, as the most common cause of its ab-sence near the shoulder is not a congenital condition but rather a complete tear causing the tendon to retract downward. This condi-tion represents an incidental anatomical variation and does not contribute to the functional impairment observed in these conditions.

Endovascular aneurysm repair (EVAR) is a treatment method that has become increasingly popular for abdominal aortic aneurysms (AAA) due to its ease of application, reduced hospital stay, and its suitability as an alternative for patients who cannot tolerate open surgery. Although the early outcomes of EVAR are better than those of open surgery, complications such as endoleak, migration, thrombosis or kinking of the endograft limbs, graft infection, and secondary rupture may occur. In this study, we present a patient who underwent EVAR at another institution approximately 10 years earlier and was admitted to our clinic with complaints of deterioration in general condition, fever, and melena. Laboratory examination of 73-year-old man revealed a white blood cell (WBC) count of 17,100, hemoglobin level of 9.5 g/dL, and C-reactive protein (CRP) level of 261 g/L. Computed tomography (CT) revealed thrombosis within the EVAR graft, free air surrounding the graft, fractures in the graft stents, and displacement of the right limb beyond the aorta at the level of the iliac bifurcation. The endograft was observed to have migrated toward the duodenum and formed a fistula. The pa-tient, who presented with sepsis, underwent emergency surgery. Initially, a left axillofemoral bypass was performed to relieve ischemia in the left leg. Subsequently, a laparotomy was performed with the joint participation of the general surgery and cardiovascular surgery departments. Intra-abdominal fecal contamination and rupture of the sigmoid colon were observed. The abdomen was lavaged, the sigmoid colon and rectum were excised, and a colostomy was created. An aortotomy was then performed, and the main body of the graft and its left limb were removed. The duodenum was opened, and the fistulized right limb of the endograft was also removed. No additional vascular intervention was required due to abdominal contamination, adequate collateral circulation in the right leg, likely due to the chronic nature of the process, and the absence of ischemia. The aorta was ligated at the infrarenal level, and the patient, who required high-dose inotropic support, was transferred to the intensive care unit. The patient died in the eighth postoperative hour. To our knowledge, this case represents a rare and unique complication that has not been previously reported in the literature. By presenting this case, we aim to draw attention to the long-term complications of EVAR and emphasize the importance of open surgery in patients with a high life expectancy.

Subacute post-traumatic ascending myelopathy (SPAM) is a rare but devastating complication of spinal cord injury (SCI). It is character-ized by progressive neurological deterioration extending several segments above the primary lesion within days to weeks after trauma. The underlying pathophysiology remains uncertain, and treatment strategies are not standardized. A 38-year-old man sustained trau-matic C6–7 spondylolisthesis with bilateral facet dislocation following a motorcycle accident. Initial magnetic resonance imaging (MRI) demonstrated cord contusion and edema extending from C5 to C7. After traction and reduction, the patient underwent anterior C6 corpectomy with placement of an expandable cage and C5–7 plating, followed by C5–6 total laminectomy and C4–7 posterior in-strumentation. Postoperatively, partial neurological recovery was observed. However, on postoperative day 10, the patient developed quadriparesis rapidly progressing to quadriplegia, accompanied by spinal shock and respiratory failure requiring mechanical ventilation. Imaging studies excluded hematoma and implant failure, although postoperative MRI was limited by metallic artifacts. Differential diagnoses, including pulmonary embolism, cardiac dysfunction, and sepsis, were ruled out. Based on the clinical progression and exclu-sion of alternative causes, a diagnosis of ascending myelopathy was established. Despite intensive supportive care, the patient died on the fourth day of mechanical ventilation. SPAM remains an unpredictable and fatal complication of SCI. Limitations in postoperative imaging, particularly metal-related artifacts, may hinder diagnosis, underscoring the importance of correlating clinical and radiological findings. Vigilant monitoring and continued reporting of cases are essential to improve recognition, refine diagnostic strategies, and guide management of this rare entity.