AMAÇ: Harap edici yaralanmalarda otolog sinir grefti onarýmýnýn gecikmiþ olarak yapýlmasý kaçýnýlmaz olur. Gecikmiþ veya uzamýþ onarým zamanla-rýnýn sinir greftleri üzerinde zarar verici etkileri vardýr. Sýçan uzun sinir defekti modelinde, özellikle doku kaybý olan yaralanmalarda kullanýlabilecek halka sinir grefti prefabrikasyonu ile sinir grefti onarým sürecini iyileþtirmeyi ve hýzlandýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Yirmi dört Sprague-Dawley sýçan üç gruba ayrýldý. 1.5 cm uzunluðunda peroneal sinir segmenti eksize edildikten sonra ters çevrilerek otolog sinir grefti olarak kullanýldý. Konvansiyonel interpozisyonel sinir grefti grubunda (grup 1) sinir defektleri tek seferde ona-rýldý. Halka sinir grefti prefabrikasyonu grubunda (grup 2), greftler proksimal peroneal sinir güdüðüne uç uca dikildi. Greftlerin distal uçlarý ise, ilk aþamada peroneal sinir güdüðünün uç uca onarým yapýlan bölgesinin 5 mm proksimaline uç yan dikildi. Ýkinci aþamada prefabrike greftlerin distal uçlarý transpoze edilerek defektin distal sinir güdüðüne dikildi. Aþamalý konvansiyonel interpozisyonel sinir grefti grubunda ise (grup 3), ilk aþamada greftler proksimal peroneal sinir güdüðüne uç uca dikildi. Greftlerin distal uçlarý ve sinir güdükleri birbirlerine dikilmeden ikinci aþamada yapýlacak nihai onarýma kadar çevre kaslara tutturuldu. Takip süreleri grup 2 ve 3’te her bir aþama için dörder hafta, grup 1’de ise sekiz haftaydý. Sekiz haftanýn sonunda peroneal fonksiyon indeksi (PFI), elektrofizyoloji ve histolojik deðerlendirmeler yapýldý. Ýstatistiksel analizde p<0.05 anlamlý olarak kabul edildi.
BULGULAR: Grup 1 (-22.75±5.76) ve 2 (-22.08±6) PFI sonuçlarý istatistiksel bir fark göstermedi (p>0.05). Grup 3 (-33.64±6.4) ise diðer gruplarla kýyaslandýðýnda istatistiksel bir fark gösterdi (p<0.05). Elektrofizyoloji sonuçlarý açýsýndan grup 1 (16.19±2.15 mV/1.16±0.21 ms) ve 2 (15.95±2.82 mV/1.17±0.16 ms) arasýnda istatistiksel bir fark görülmezken (p>0.05), bu iki grup grup 3 (10.44±1.96 mV/1.51±0.15 ms) ile kýyaslandýðýnda istatistiksel bir fark gözlendi (p<0.05). Akson sayýlarý grup 1 (2227±260.4) ve 3 (2194±201.1) arasýnda istatistiksel bir fark göstermezken (p>0.05), bu iki grubun, grup 2’ye (2531±91.18) kýyasla anlamlý düzeyde daha düþük akson sayýsýna sahip olduðu görüldü (p<0.05).
TARTIÞMA: Halka sinir grefti prefabrikasyonu, aksonal rejenerasyonu gecikme olmadan iyileþtirmiþtir. Halka prefabrikasyonu, gecikmiþ dönemde sinir onarýmý yapýlacak yaralanmalarda, uzamýþ rejenerasyon zamanýný kýsaltabilir. Halka sinir prefabrikasyonu ile elde edilen yüksek akson sayýlarý bu metodun ileri çalýþmalarda akut uzun sinir defekti onarýmlarýnda araþtýrýlmasýný teþvik edebilecek niteliktedir.

BACKGROUND: Delayed autologous nerve graft reconstruction is inevitable in devastating injuries. Delayed or prolonged repair time has deleterious effects on nerve grafts. We aimed improving and accelerating nerve graft reconstruction process in a rat long nerve defect model with loop nerve graft prefabrication particularly to utilize for injuries with tissue loss.
METHODS: Twenty-four Sprague-Dawley rats were allocated into three groups. 1.5 cm long peroneal nerve segment was excised, reversed in orientation, and used as autologous nerve graft. In conventional interpositional nerve graft group (Group 1), nerve defects were repaired in single-stage. In loop nerve graft prefabrication group (Group 2), grafts were sutured end-to-end (ETE) to the proximal peroneal nerve stumps. Distal ends of the grafts were sutured end-to-side to the peroneal nerve stumps 5 mm proximal to the ETE repair sites in first stage. In second stage, distal ends of the prefabricated grafts were transposed and sutured to distal nerve stumps. In staged conventional interpositional nerve graft group (Group 3), grafts were sutured ETE to proximal peroneal nerve stumps in first stage. Distal ends of the grafts and nerve stumps were tacked to the surrounding muscles until the final repair in second stage. Follow-up period was 4 weeks for each stage in Groups 2 and 3, and 8 weeks for Group 1. Peroneal function index (PFI), electrophysiology, and histological assessments were conducted after 8 weeks. P<0.05 was considered significant for statistical analysis.
RESULTS: PFI results of Group 1 (−22.75±5.76) and 2 (−22.08±6) did not show statistical difference (p>0.05). Group 3 (−33.64±6.4) had a statistical difference compared to other groups (p<0.05). Electrophysiology results of Group 1 (16.19±2.15 mV/1.16±0.21 ms) and 2 (15.95±2.82 mV/1.17±0.16 ms) did not present statistical difference (p>0.05), whereas both groups had a statistical difference compared to Group 3 (10.44±1.96 mV/1.51±0.15 ms) (p<0.05). Axon counts of Group 1 (2227±260.4) and 3 (2194±201.1) did not have statistical difference (p>0.05), whereas both groups had significantly poor axon counts compared to Group 2 (2531±91.18) (p<0.05).
CONCLUSION: Loop nerve graft prefabrication improved axonal regeneration without delay. Loop prefabrication can accelerate prolonged regeneration time for the injuries indicating a delayed nerve reconstruction. Higher axon counts derived with loop nerve prefabrication may even foster its investigation in immediate long nerve defect reconstructions in further studies.

AMAÇ: Bu çalýþmanýn amacý, asetabulumun anterior kolon posterior hemitransvers (AKPHT) kýrýk tipinin oluþturulduðu hemipelvis modelinde; arka ve ön kolon vidalarý ile desteklenmiþ infrapektineal tespit yöntemi, suprapektineal tespit yöntemi ve suprapektineal ile birlikte infrapektineal çift plak tespit yöntemlerinin biyomekanik olarak karþýlaþtýrýlmasýdýr.
GEREÇ VE YÖNTEM: Çalýþmada poliüretan köpükten özel olarak üretilmiþ 21 adet sol hemipelvis modelleri üç ayrý gruba ayrýldýktan sonra Leto-urnel-Judet sýnýflandýrmasýna göre anterior kolon posterior hemitransvers asetabulum kýrýðý oluþturuldu. Grup 1; suprapektineal yerleþimli 3.5 mm rekonstrüksiyon plak/vida tespiti ve plak üzerinden iki adet arka kolon ve bir adet ön kolon vidasý uygulamasý, Grup 2; infrapektineal yerleþimli 3.5 mm rekonstrüksiyon plak/vida tespiti ve suprapektineal alandan serbest olarak uygulanan iki arka kolon ve bir ön kolon vidasý uygulamasý, Grup 3; suprapektineal ve infrapektineal yerleþimli 3.5 mm rekonstrüksiyon plak/vida tespiti ve suprapektineal plak üzerinden iki adet arka kolon ve bir adet ön kolon vidasý uygulamasý. Çalýþma gruplarýnda uygulanan farklý tespit yöntemleri, biyomekanik olarak otomatik materyal test makinesi kullanýlarak vertikal yüklenme altýnda dayanýklýlýk bakýmýndan test edildi ve elde edilen sonuçlar istatistiksel olarak karþýlaþtýrýldý.
BULGULAR: Tüm gruplarda, sýrasý ile implant yetmezliði geliþmesine neden olan ortalama maksimum kuvvet miktarý sýrasýyla 2921 N, 2018 N ve 3658 N olarak belirlendi. Ýmplant yetmezliðine neden olan kuvvet göz önünde bulundurularak dayanýklýlýk karþýlaþtýrýldýðýnda, en dayanýklý tespitin suprapektineal ve infrapektineal tespit yönteminin birlikte uygulandýðýnda saðlandýðý, bunu sýrasýyla suprapektineal tespit ve ön ve arka kolon vidalarý ile destelenmiþ infrapektineal tespit takip ettiði belirlendi.
TARTIÞMA: Bu çalýþmada, asetabulumun AKPHT kýrýklarýnda, suprapektineal ve infrapektineal tespit yönteminin birlikte uygulanmasýnýn en stabil tespiti saðladýðýný, dayanýklýlýk açýsýndan bunu suprapektineal tespitin takip ettiðini ve arka ve ön kolon vida uygulamasý ile desteklenmiþ infrapektineal tespit’in tek baþýna yetersiz olduðunu belirledik. Asetabulumun anterior kolon posterior hemitransvers kýrýklarýnda limitli kombine yaklaþým ile uygulanan anterior ve posterior kolon vidalarý ile desteklenmiþ infrapektineal tespit hastalar için daha az invaziv olsa da yeterli stabiliteyi saðlamak için suprapektineal tespit, mutlaka cerrahi tedavi yöntemine dahil edilmelidir.

BACKGROUND: The purpose of this study is to compare biomechanical properties of suprapectineal (SP) plate fixation, in-frapectineal (IP) plate fixation, and both SP and IP plate fixation in anterior column posterior hemitransverse (ACPHT) fractures of the acetabulum using posterior and anterior column screws.
METHODS: In 21 hard plastic left hemipelvis models, ACPHT fractures of the acetabulum were created, and in three different fixa-tion groups, the methods were compared: Group 1: SP plating using a 3.5 mm reconstruction plate and cortical screw fixation, Group 2: Ýnfrapectineal plating using 3.5 mm reconstruction plate and cortical screws combined with posterior and anterior column screws, and Group 3: Combined fixation with SP and IP plating using 3.5 mm reconstruction plates and cortical screws. Maximum load to failure (strength) of these three groups was compared between groups.
RESULTS: The mean maximum load of failure for three groups was 2921 N, 2018 N, and 3658 N, respectively. When strength was compared considering the force that causing implant failure, it was determined that the strongest fixation was achieved when SP and IP fixation method were applied together, followed by SP only fixation and IP fixation supported by anterior and posterior column screws, respectively.
CONCLUSION: The combined application of SP and IP fixation provides the most stable fixation of the ACPHT acetabular frac-tures, and IP fixation does not provide comparable biomechanical stability despite reinforcement with three-column screws placed away from the plate. Although IP fixation supported by anterior and posterior column screws with the limited combined approach is less invasive approach for patients, SP fixation should be included in the surgical treatment method to ensure adequate stability.

AMAÇ: Karaciðer cerrahisinde etkili bir kanama kontrolünün saðlanamamasý ve transfüzyona baðlý problemler ameliyat sonrasý mortalite ve morbiditenin en önemli nedenleridir. Bu amaçla topikal hemostatik ajanlarý da içeren birçok kanama durdurma yöntemi uygulanmaktadýr. Bu çalýþmada, sýçanlar üzerinde oluþturulan karaciðer laserasyon modeli üzerinde Hatay’da halk arasýnda geleneksel olarak kanama durdurucu ve antiseptik olarak kullanýlan Inula viscosa ve Capsella bursa-pastoris bitkilerinin karýþýmýnýn kanama durdurucu özelliðinin araþtýrmasý amaçlandý.
GEREÇ VE YÖNTEM: Çalýþmada 30 sýçan, 10’arlý üç gruba ayrýldý ve bütün sýçanlardan ameliyat öncesi hemoglobin ölçümü için kan alýndý. Daha sonra sýçanlara standart karaciðer rezeksiyon modeli uygulandý. Rezeksiyon bölgesine 1. grupta spanç, 2. grupta Ankaferd ve 3. grupta Inula viscosa ve Capsella bursa-pastoris bitkilerinin ekstre karýþýmý üç dakika süreyle uygulandý. Ameliyat sonrasý beþinci gün bütün sýçanlarýn karaciðer örnekleri enflamasyon ve nekroz yoðunluðu açýsýndan deðerlendirildi.
BULGULAR: Ameliyat sonrasý Hb deðerleri spanç grubunda 11.0±1.1 g/dL, Ankaferd grubunda 11.9±2.0 g/dL, Ýnula grubunda 14.1±1.2 g/dL olarak saptanmýþtýr (p<0.001). Yapýlan histopatolojik incelemede Ýnula grubunda diðer gruplara göre daha az nekroz gözlenmiþ (p=0.001), spanç ve Ankaferd gruplarý arasýnda istatistiksel olarak anlamlý bir fark bulunamamýþtýr. Ýnula grubunda diðer gruplara göre daha az enflamasyon izlenirken Ankaferd grubunda diðer gruplara göre daha fazla enflamasyon izlenmiþtir (p<0.001).
TARTIÞMA: Bu çalýþmada oluþturulan sýçan karaciðer rezeksiyon modelinde Ýnula viscosa ve Capsella bursa-pastoris ekstre karýþýmýnýn Ankaferd ve spanç grubuna kýyasla daha az hemoglobin düþüþüne neden olduðu ve diðer gruplara kýyasla daha az enflamasyon ve nekroz oluþturduðu bulundu.

BACKGROUND: Failure to achieve effective bleeding control and problems related to transfusion in liver surgery are the most common causes of post-operative mortality and morbidity. Various methods/drugs including topical hemostatic agents have been em-ployed for bleeding control in liver surgery. This study was aimed to investigate the hemostatic properties of the herb mixture extract of Inula viscosa and Capsella bursa-pastoris (IvCbp) in rat liver laceration model, which have been traditionally used as antiseptic and hemostatic agents public in Hatay/Tukey.
METHODS: Thirty rats were divided into three groups equally and blood samples were taken from all rats for preoperative hemoglobin (Hb) measurements. Then, the standard liver resection model was applied to all rats. Sponge for the first rat group, Ankaferd Blood Stopper® Trend-Tech for the second rat group and IvCbp plant extract mixture for the third group were applied to resection areas for 3 minutes. Liver samples of all rats were evaluated in terms of inflammation and necrosis intensity on the 5th post-operative day.
RESULTS: Post-operative Hb values were found as 11.0±1.1 g/dL in the sponge group, 11.9±2.0 g/dL in the Ankaferd group, and 14.1±1.2 g/dL in the IvCbp herb mixture group (p<0.001). In the histopathological examination, less necrosis was observed in the herb mixture group compared to the sponge and Ankaferd groups (p=0.001). In addition, no statistically significant necrosis difference was observed between sponge and Ankaferd groups. While less inflammation was observed in the herb mixture group compared to the other groups, Ankaferd group had the highest inflammation score (p<0.001).
CONCLUSION: IvCbp herb mixture extract group provide effective hemostatic control, caused less Hb decrease and resulted in less inflammation and necrosis compared to Ankaferd and sponge groups in a rat liver resection model.

AMAÇ: Otolog kemik greftleri, kemik defekti olan olgularda kemik iyileþmesini baþlatmak ve kolaylaþtýrmak için altýn standart olarak hala kullanýl-maktadýr. Otolog kemik greftlerinin bazý dezavantajlarý nedeniyle yeni biyokompozit greftler araþtýrýlmýþtýr. Bu çalýþmanýn amacý, bir biyokompozit iskeleye yüklenen kemik iliðinden türetilen mezenkimal kök hücrelerin (BM-MSC’ler) kemik rejenerasyonunu artýrýp artýrmadýðýný araþtýrmaktý. GEREÇ VE YÖNTEM: Çalýþmamýzda sekiz adet tavþanýn sað ve sol ulnar kemiðin orta kýsmýnda 10 mm’lik osteoperiosteal segmental kemik defekti oluþturuldu. Tavþanlarýn sað ulnar defektleri (Grup 1) bir biyokompozit iskeleye (Plexur PTM, Osteotech, Eatontown, NJ, ABD) yüklenmiþ BM-MSC’ler ile tedavi edilirken, ayný tavþanlarýn sol ulnar kemiklerine (grup II) sadece biyokompozit greft ile tedavi uygulandý. Altýncý haftanýn sonunda ameliyat sonrasý olarak her bir ön ayaðýn radyografileri çekildi. Daha sonra tavþanlara histopatolojik deðerlendirme için farmakolojik olarak ötenazi yapýldý. Sonuçlar, modifiye Lane ve Sandhu puanlama sistemi kullanýlarak puanlandý.
BULGULAR: Her iki grupta da tüm defektler iyileþti. Radyolojik ve histolojik toplam skorlar grup I’de daha iyiydi, ancak istatistiksel olarak altýncý haftanýn sonunda radyolojik ve histolojik olarak iki grup arasýnda anlamlý bir farklýlýk gözlenmedi (p>0.05).
TARTIÞMA: Çalýþmamýzýn sonuçlarý, tavþan ulnar segmental kemik defekt modelinin, BM-MSC’ler içeren veya içermeyen biyokompozit greft kullanýlarak tatmin edici bir rejenerasyon elde edildiðini göstermiþtir.

BACKGROUND: The autologous bone grafts still have been used as the gold standard to initiate and facilitate bone healing in cases with bone defects. Because of some disadvantages of autologous bone grafts, the new biocomposite grafts have been researched. The purpose of the present study was to investigate whether the bone marrow-derived mesenchymal stem cells (BM-MSCs) loaded into a biocomposite scaffold enhance bone regeneration.
METHODS: In our study, a 10 mm osteoperiosteal segmental bone defect was created in the middle of the right and left ulnar bones of eight rabbits. The created defects were filled in the right ulnar bones of eight rabbits (Group I) with BM-MSCs loaded onto a bio-composite scaffold (Plexur PTM, Osteotech, Eatontown, NJ, USA) and in the other ulnar bones of the same rabbits (Group II) with only biocomposite graft. Radiographs of each forelimb were taken postoperatively at the end of the 6th week. Then, the rabbits were euthanized pharmacologically for histopathological evaluation.
RESULTS: Were scored using a modified Lane and Sandhu scoring system. All defects healed in both groups. Radiological and histo-logical total scores were slightly better in Group I, but statistical tests did not reveal any significant differences between the two groups at the end of the 6th week radiologically and histologically (p>0.05).
CONCLUSION: The results of our study demonstrated that in rabbit ulnar segmental bone defect model was obtained satisfactory regeneration with using biocomposite graft with or without BM-MSCs.

AMAÇ: Travmaya baðlý geliþen akut kalp kontüzyonu yüksek mortalite ve morbiditesi ile bilinir. Patofizyolojisinde oksidatif stres ve enflamasyonun rol oynamasý, cerrahi dýþý tedavide antioksidan ve antienflamatuvar özellikli maddelerin araþtýrýlmasýna yol açmýþtýr. Bu çalýþmada, sözkonusu iki özelliðe sahip olan rutinin akut kalp kontüzyonu üzerine etkileri araþtýrýlmýþtýr.
GEREÇ VE YÖNTEM: Albino Wistar türü 30 adet erkek sýçan, saðlýklý (HG), kontüzyon (CG) ve rutin+kontüzyon (rutin+CG) olmak üzere üç eþit gruba ayrýldý. Ýntraperitoneal yolla 60 mg/kg ketamin verilerek ve uygun aralýklarla ksilazin koklatýlarak saðlanan anestezi yoluyla CG (n=10) ve rutin+CG (n=10) grubu hayvanlarýn toraks ön duvarý üzerine 1 metre yükseklikten 200 gram aðýrlýk düþürülerek kalp kontüzyonu oluþturuldu. Kon-tüzyon iþlemi uygulandýktan 30 dakika sonra rutin+CG grubu hayvanlara oral yoldan 50 mg/kg dozunda rutin, gavajla mideye verildi. Rutin günde bir defa olmak üzere iki gün kullanýldý. Sýçanlar 48 saatin sonunda öldürüldü. Kalp dokularý çýkarýlarak biyokimyasal ve histopatolojik olarak incelendi. Sýçanlar öldürülmeden hemen önce kuyruk venlerinden alýnan kan örneklerinde troponin I (TP I) ve kreatin kinaz MB (CK-MB) ölçümü yapýldý. BULGULAR: Kontüzyon grubunda saðlýklý gruba kýyasla TP I, CK-MB, malondialdehit (MDA), total oksidan status (TOS), nükleer faktör-kappa B (NF-κB) düzeyleri artmýþ ve rutin uygulamasý bu artýþý engellemiþ; total glutatyon (tGSH) ve total antioksidan status (TAS) düzeyleri azalmýþ ve rutin uygulamasý bu azalmayý engellenmiþtir. Histopatolojik bulgular da bu bulgularý desteklemektedir.
TARTIÞMA: Rutin, kalp dokusu üzerine koruyucu etki göstermiþtir.

BACKGROUND: Acute cardiac contusion induced by trauma is known with its high mortality and morbidity. The role of oxidative stress and inflammation in its pathophysiology has led to the investigation of antioxidant and anti-inflammatory substances in non-sur-gical treatment. In this study, the effects of rutin which has these two features on acute cardiac contusion were investigated.
METHODS: Thirty male albino Wistar rats were divided into three equal groups as healthy (HG), contusion (CG), and rutin + con-tusion (rutin + CG). A heart contusion was created dropping 200 g weight from 1-m height onto anterior thorax of CG (n=10) and Rutin + CG (n=10) group animals by anesthetizing with intraperitoneal administration of 60 mg/kg ketamine and xylazine inhalation at appropriate intervals. Thirty minutes after contusion was applied, rutin at the dose of 50 mg/kg was administered orally to the stomach by gavage to the rutin + CG group animals. The rutin was used once a day for 2 days. Rats were killed at the end of 48 h. Heart tissues were removed and examined biochemically and histopathologically. Troponin I (TP I) and creatine kinase-MB (CK-MB) were measured in blood samples taken from the tail veins just before the rats were killed.
RESULTS: TP I, CK-MB, malondialdehyde, total oxidant status, and nuclear factor-kappa B levels increased in the CG when compared to the HG, and Rutin application prevented this increase, total glutathione (eGSH) and total antioxidant status levels decreased, and rutin application prevented this decrease. Histopathological findings also supported these findings.
CONCLUSION: Rutin had a protective effect on heart tissue.

AMAÇ: Travmatik beyin hasarý (TBH) olan hastalarda ciddi kan kaybý ölümcül olabilir. Þiddetli travma hastalarýnda masif transfüzyonu (MT) öngör-mek için, yaralanma þiddeti skoru (ISS), revize travma skoru (RTS), þok indeksi (SI) ve modifiye erken uyarý skoru (MEWS)’nun prognostik perfor-manslarýný analiz etmeyi ve karþýlaþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Bu geriye dönük gözlemsel çalýþmaya Ocak 2018–Aralýk 2020 tarihleri arasýnda acil servisimize baþvuran TBH’li aðýr travma hastalarý dahil edildi. Kýsa travma ölçeði 3 veya daha yüksek olduðunda TBH kabul edildi. Birincil sonuç MT idi.
BULGULAR: Toplam 1.108 hasta dahil edildi ve 92 (%8.3) hastaya MT uygulandý. MT’yi öngörmek için ISS, RTS, SI ve MEWS’nin doðruluðunu deðer-lendirmek üzere alýcý iþletim karakteristik analizleri yapýldý. ISS, SI, RTS ve MEWS’nin MT’yi tahmin etmek üzere eðri altýnda kalan alanlarý (AUC’ler) sýrasýyla 0.725 (%95 güven aralýðý [CI], 0.698–0.751), 0.676 (%95 CI, 0.648–0.704), 0.769 (%95 CI, 0.743–0.793) ve 0.808 (%95 CI, 0.784-0.831) idi. MEWS’nin AUC’si, ISS ve SI’nin AUC’lerinden önemli ölçüde farklýydý, ancak MT’yi tahmin etmek için RTS’nin AUC’sinden farklý deðildi. Çok deðiþkenli bir analizde, Glasgow Koma Skalasý (Odds oraný [OR], 0.856; %95 CI, 0.803–0.911), vücut ýsýsý (OR, 0.596; %95 CI, 0.386–0.920) ve taze donmuþ plazma (OR, 2.031; %95 CI, 1.794–2.299) baðýmsýz olarak MT ile iliþkiliydi. MEWS (OR, 1.425; %95 CI, 1.256–1.618), araya giren faktörler için ayarlama yapýldýktan sonra baðýmsýz olarak MT ile iliþkili bulundu.
TARTIÞMA: MEWS, TBH’li ciddi travma hastalarýnda MT’yi öngörmek için yararlý bir araç olabilir.

BACKGROUND: Exsanguination can be fatal in patients with traumatic brain injury (TBI). We aimed to analyze and compare the prognostic performances of injury severity score (ISS), revised trauma score (RTS), shock index (SI), and modified early warning score (MEWS) for predicting massive transfusion (MT) in severe trauma patients with TBI.
METHODS: In this retrospective observational study, severe trauma patients with TBI who visited our emergency department between January 2018 and December 2020 were included in the study. TBI was considered when abbreviated injury scale was 3 or higher. The primary outcome was MT.
RESULTS: A total of 1108 patients were included, and MT was performed in 92 (8.3%) patients. Receiver operating characteristic analyses were performed to evaluate the accuracy of ISS, RTS, SI, and MEWS for predicting MT. The area under curves (AUCs) of ISS, SI, RTS, and MEWS for predicting MT were 0.725 (95% confidence interval [CI], 0.698–0.751), 0.676 (95% CI, 0.648–0.704), 0.769 (95% CI, 0.743–0.793), and 0.808 (95% CI, 0.784–0.831), respectively. The AUC of MEWS was significantly different from the AUCs of ISS and SI but not the AUC of RTS for predicting MT. In a multivariate analysis, Glasgow Coma Scale (odds ratio [OR], 0.856; 95% CI, 0.803–0.911), body temperature (OR, 0.596; 95% CI, 0.386–0.920), and fresh frozen plasma (OR, 2.031; 95% CI, 1.794–2.299) were independently associated with MT. MEWS (OR, 1.425; 95% CI, 1.256–1.618) was independently associated with MT after adjustment for confounders.
CONCLUSION: MEWS may be a useful tool for predicting MT in severe trauma patients with TBI.

AMAÇ: Travmatik beyin hasarý özellikle geri kalmýþ ve geliþmekte olan ülkelerde önemli bir mortalite nedenidir. Serebral dokunun etkilenmesi etkilenmesi nedeniyle, kafa içi basýnç artýþý ve yaygýn ödem sonucu ciddi nörolojik disfonksiyonlarla kendini gösteren bu tabloda, dekompresif krani-yektomi cerrahi tedavi modalitesi olarak kullanýlmaktadýr. Bu çalýþmanýn amacý, travmatik beyin hasarý nedeniyle kliniðimize baþvuran ve dekompresif kraniyektomi yapýlan olgularýn ameliyat sonrasý mortalite ve morbidite oranlarýný deðerlendirmektir.
GEREÇ VE YÖNTEM: Farklý nedenlere baðlý olarak travmatik beyin hasarý geliþen 57 olgu incelendi. Olgularýn 25’i (%43.8) kadýn, 32’si (%56.1) erkek’ti. Olgularda ortalama yaþ 54.5’di (1–82). Olgularýn 14’ü (%24.5) subdural hematom, beþi (%8.7) epidural hematom, 18’i (%31.5) intrasereb-ral hematom, 13’ü (% 22.8) subaraknoid kanama ve yedisi (%2.2) de tanýmlanamayan radyolojik bulgular ile baþvurmuþtu.
BULGULAR: Elli yedi olgunun tamamýna baþvuru sonrasý en kýsa sürede dekompresif kraniyektomi yapýldý. Ameliyat sonrasý ilk üç günde 12 (%21.1), ameliyat sonrasý 3–15. günler arasýnda ise yedi (%12.2) hasta ilerleyici serebral hasar ve sekonder enfeksiyonlar nedeniyle kaybedildi. Altý (%10.5) olgu tamamen iyileþerek taburcu edildi. Ýyileþen olgularýn 32’si (%56.1) palyatif bakým klinikleri ve fizik tedavi kliniklerine nakil edildi.
TARTIÞMA: Travmatik beyin hasarýnýn tedavisinde hastanýn baþvuru anýndaki nörolojik durumunun iyiliði ve intraserebral etkilenme derecesinin yanýsýra erken dönemde yapýlan dekompresif kraniyektominin etkinliði yüksektir. Daha erken süreçte dekompresif kraniektomi yapýlan olgularda ameliyat sonrasý sonuçlar daha yüz güldürücüdür.

BACKGROUND: Traumatic brain injury (TBI) is an important cause of death, especially in underdeveloped and developing countries. Diffuse edema in the damaged cerebral tissue as a result of trauma and the subsequent increase in intracranial pressure cause signifi-cant neurological deterioration. Consequently, decompressive craniectomy (DC) is performed as the surgical treatment of TBI. The aim of this study is to evaluate the post-operative mortality and morbidity rates of patients who underwent DC for TBI in our clinic.
METHODS: The data of 57 cases of TBI were retrospectively analyzed. Clinical, radiological and surgical features of these cases were reviewed. The rates of mortality and morbidity, as well as main indicators of mortality were investigated.
RESULTS: Twenty-five (43.8%) patients were female and 32 (56.1%) were male. The mean age was 54.5 years. Fourteen (24.5%) patients were presented with subdural hematoma, 5 (8.7%) with epidural hematoma, 18 (31.5%) with intracerebral hematoma, 13 (22.8%) with subarachnoid hemorrhage, and 7 (12.2%) with other radiological findings. DC was performed in all cases as soon as pos-sible after admission. Twelve (21.1%) patients died in the first 3 days postoperatively and 7 (12.2%) patients in the postoperative 3-15 days due to progressive cerebral damage and secondary infections. Six (10.5%) patients recovered completely and were discharged. Thirty-two (56.1%) patients were transferred to palliative care clinics and physical therapy clinics after the surgical treatment.
CONCLUSION: DC, which is performed in the early period of treatment in TBI, is as important as the degree of intracerebral damage at the time of admission and the high Glasgow coma scale score. Post-operative results are more satisfactory in patients who underwent DC at an earlier stage of treatment.

AMAÇ: Çocuklarda en sýk cerrahi acillerden biri apandisittir. Bu geriye dönük klinik çalýþmada COVID-19 pandemi sürecinin, çocuk apandisit olgu-larýn da hastaneye baþvuru süresi ve hastanede yatýþ süresi üzerine olan etkilerini belirlemeye çalýþtýk.
GEREÇ VE YÖNTEM: Türkiye de ilk COVID-19 olgusunun rapor edildiði tarihten normalleþme sürecinin baþlangýcý olarak kabul edilen 01 Hazi-ran 2020 tarihine kadar yapýlan pediatrik açýk cerrahi apendektomileri; ayný gün sayýsýnda pandemi öncesi dönem çocuk apendektomilerle geriye dönük olarak yaþ, cinsiyet, hastaneye baþvuru süresi, hastane kalýþ süresi, ebeveyn eðitim düzeyi, laboratuvar deðerleri ve histopatolojik bulgularla karþýlaþtýrdýk.
BULGULAR: Çocuk apandisit hastalarýnda COVID-19 döneminde semptomlarýn baþlamasýyla hastaneye baþvuru arasýnda geçen sürede ortalama iki günlük bir artýþ mevcuttur (p=0.001). Diðer taraftan C-reaktif protein (CRP) deðeri COVID-19 döneminde istatiksel olarak anlamlý þekilde yüksek bulunmuþtur (p=0.018). Yatýþ sürelerine bakýldýðýnda ise, pandemi öncesi dönemde ortalama beþ gün iken COVID-19 döneminde ortalama dört gün olarak hesaplanmýþtýr, bu fark istatistiksel olarak önemsizdir (p=0.273). Histopatolojik bulgular açýsýndan da gruplar arasýnda anlamlý farklýlýk saptanmamýþtýr (p=0.176). Ebeveyn eðitim düzeyinin baþvuru süresi üzerinde etkisi yoktur.
TARTIÞMA: COVID-19 pandemisinde çocuk apandisitlerinde hastaneye baþvuru süreleri anlamlý þekilde uzamýþ olup bu uzamanýn etkisi histopato-lojik olarak saptanmamýþtýr. Pandemi sürecinde “evde kal” döneminde acil tedavi edilmesi gereken hastalarýn da saðlýklarýna kavuþmalarýný olumsuz yönde etkilenmiþtir. Buna karþýn hastanede kalýþ sürelerinde artýþýn olmamasý hem ailelerin hem de hekimlerin mümkün olduðunca hastanedede kalýþ süresini kýsa tutmak isteklerinden kaynaklanabileceðini düþünmekteyiz.

BACKGROUND: Appendicitis is one of the most common surgical emergencies among children. In this retrospective clinical study, we attempted to determine the effects of the COVID-19 pandemic period on hospital admission time and length of hospital stay (LOS) in pediatric appendicitis cases.
METHODS: We retrospectively compared pediatric appendectomies from the date of the first reported COVID-19 case to June 1, 2020, which is considered as the start of the normalization process, with pre-pandemic pediatric appendectomies of the same number of days in terms of age, gender, hospital admission time, LOS, parental educational level, laboratory values, and histopathological findings.
RESULTS: There was an average increase of 2 days in the time from the onset of symptoms to hospital admission in pediatric appen-dicitis patients in the COVID-19 period (p=0.001). Furthermore, C-reactive protein value was statistically significantly higher in the COVID-19 period (p=0.018). Given the LOS, it was calculated as an average of 5 days in the pre-pandemic period and 4 days in the COVID-19 period, and this difference was statistically insignificant (p=0.273). There was no significant difference between the groups in terms of histopathological findings (p=0.176). The parental educational level had no effect on the admission time.
CONCLUSION: The hospital admission time of pediatric appendicitis patients is significantly prolonged in the COVID-19 pandemic, but this prolongation had no histopathological effect. During the pandemic, the recovery of patients who required urgent treatment during the “stay-at-home” period was also negatively affected. Notwithstanding, we are of the opinion that the absence of an increase in the LOS may be due to the willingness of both families and physicians to keep the LOS as short as possible. Despite the increase in hospital admission time in pediatric appendicitis during the Covid 19 pandemic process, the lack of increase in the rate of complicated appendicitis may be an indicator of the importance of other factors in the development of complicated appendicitis.

AMAÇ: Kitlesel travma olayý, hasta sayýsýnýn saðlýk personelinin en uygun bakýmý saðlama kapasitesini geçici olarak aþtýðý bir olaydýr. Global terörizm indeksine bakýldýðýnda Ortadoðu’da terörizmden en çok etkilenen ülkelerin baþýnda Suriye gelmektedir ve kitlesel travmalara neden olabilecek terör riski devam etmektedir. Kitlesel travmaya yaklaþým denilince hasar kontrol yaklaþýmý son yýllarda öne çýkmaktadýr. Biz de çalýþmamýzda terör saldýrýlarý ve toplumsal olaylar nedeniyle kitlesel travmalarýn çok görüldüðü Suriye’nin kuzeybatýsýnda, acil ve cerrahi branþ hekimlerinin hasar kontrol cerrahisi ve resüsitasyonu konularýnda farkýndalýðýný ve eðitim etkinliðini deðerlendirmeyi amaçladýk.
GEREÇ VE YÖNTEM: Suriye’nin kuzeybatýsýndaki Çobanbey Hastanesi’nde bir travma ekibi tarafýndan “Hasar kontrol cerrahisi ve resüsitasyonu” konularýnda eðitim verildi. Bu eðitime katýlan Suriyeli hekimlere eðitim öncesi ve sonrasý hasar kontrol cerrahisi ve resüsitasyonu açýsýndan farkýndalýk anketi yapýldý.
BULGULAR: Çalýþmaya toplam 43 kiþi dahil edildi ve yaþ ortalamalarý 44.04±9.01 yýldý. Eðitime katýlan hekimlerin çoðunluðu Elbab (%23.3), Afrin (%23.3) ve Çobanbey’den (%20.9) gelmiþti. Hekimlerin ortalama mesleki tecrübesi 14 yýldý ve son bir yýlda elektif olmayan ameliyat sayýsý median 47.5’ti. Eðitim öncesi öntest toplam puan ortalamasý 67 iken, eðitim sonrasý sontest toplam puan ortalamasý 72’ye yükselmiþti ve bu farklýlýk anlam-lýydý (p=0.008). Ýntratorasik klemp yara kelepçesi yerleþtirme ve travma laporotomisi eðitimi alan ve uygulamayý yapmýþ olanlarýn ön test ve son test puanlarý eðitimi almamýþ ve uygulamamýþ olanlara göre anlamlý olarak fazla iken (p<0.05), eðitimi almayan ve uygulamayanlarýn ön test son test puanlarý arasýndaki farklýlýk anlamlýydý (p<0.05).
TARTIÞMA: Suriye’nin kuzeybatýsýnda 10 yýldan uzun süredir iç karýþýklýk ve terör eylemlerinin mevcut olduðu bilinmektedir. Bu bölgedeki hekimler için hasar kontrol stratejilerinin bilinmesi önem arz etmektedir. Bu baðlamda verdiðimiz hasar kontrol cerrahisi ve resüsitasyonu eðitimi ile hekim-lerde farkýndalýðýn arttýðý görülmüþtür. Ýnsani yardým amaçlý açýlan hastanelerde bu tarz ve benzeri ileri düzey eðitimlerin faydalý ve hayat kurtarýcý olacaðýný düþünmekteyiz.

BACKGROUND: Mass trauma is an event in which the number of patients temporarily exceeds the capacity of medical personnel to provide optimal care. Looking at the global terrorism index, Syria is one of the most terrorism-affected countries in the Middle East, and the threat of terrorist attacks that can cause mass trauma persists. When it comes to dealing with mass trauma, the damage control approach has come to the forefront in recent years. In our study, we aimed to assess the awareness and training effectiveness of emergency physicians and surgeons on damage control surgery and resuscitation in Northwest Syria, where mass trauma due to terrorist attacks and social events is common.
METHODS: A trauma team from Çobanbey Hospital in Northwest Syria conducted training on damage control and resuscitation. Syrian physicians who participated in this training were administered a damage control and resuscitation questionnaire before and after the training.
RESULTS: A total of 43 subjects were enrolled in the study, and their mean age was 44.04±9.01 years. The majority of the physicians who participated in the training were from Elbab (23.3%), Afrin (23.3%), and Çobanbey (20.9%). The average work experience of the physicians was 14 years and the average number of non-elective surgeries performed in the last year was 47.5. While the average total score (pre-test) before the training was 67, the average total score (post-test) after the training increased to 72, and this difference was statistically significant (p=0.008). While the pre-test and post-test scores of those who were trained and had practiced placing intrathoracic clamp-wound clamp and trauma laparotomy were significantly higher than those who were not trained and had not used them (p<0.05), the difference between the pre-test and post-test scores of those who were not trained and had not used them was statistically significant (p<0.05).
CONCLUSION: It is well known that there have been internal unrest and terrorist attacks in Northwest Syria for more than 10 years. It is important for physicians in this region to know the damage control strategies. In this regard, we have found that awareness among physicians has increased as a result of the training we have provided on damage control.

AMAÇ: Týbbi uygulama hatasý, doktorun standart uygulama veya bakýmdan sapmasý sonucunda hastada hasar oluþmasý durumunda ortaya çýkar. Tüm týp dallarýnda olduðu gibi göðüs cerrahlarý da týbbi uygulama hatasý iddialarýyla karþý karþýya kalabilirler.
GEREÇ VE YÖNTEM: Ýstanbul Adli Týp Kurumu Birinci Ýhtisas Dairesi tarafýndan 01/01/2010 -21/12/2015 tarihleri arasýnda karara baðlanan dosyalar arasýnda, göðüs cerrahlarý hakkýnda malpraktis iddiasý bulunan olgular geriye dönük olarak analiz edilmiþtir.
BULGULAR: Ogularýn 59’u erkek (%72.8), 22’si kadýndý (%27.2). Ortalama yaþ 51.13±18.97 ve en yaygýn yaþ aralýðý 60’ýn üzerindedir (n=35, %43.2). Týbbi uygulama hatasý 11 (%13.6) olguda doðrulanmýþtýr. Taný hatasý en yaygýn hata nedeniydi (n=7, %63.6) ve taný hatasýnýn en yaygýn nedeni zamanýnda taný koyamamaktý (n=4, %36.4). En sýk taný “travmaya baðlý yaralanmalar” (n=54, %66.7), ardýndan akciðer kanseri (n=9, %11.1) idi. Doktorlarýn %80.2’si (n=65) hastaya konsültan olarak müdahale etti. Olgularýn 48’inde (%59.3) komplikasyon geliþti. En sýk görülen komplikasyon pnömoniydi (n=7, %14.6).
TARTIÞMA: Çalýþmamýz göðüs cerrahlarý ile ilgili týbbi malpraktis iddialarýný içeren Türkiye’deki ilk çalýþmadýr. Týbbi uygulama hatasý iddialarý olan ol-gularýn incelenmesinin, hekimlere yalnýzca yanlýþ uygulama iddialarýnýn özelliklerini daha iyi anlamalarýna deðil, ayný zamanda yanlýþ uygulama iddialarýný önlemek için stratejiler geliþtirmelerine de yardýmcý olacaðýný düþünüyoruz.

BACKGROUND: Medical malpractice occurs in cases, where a patient experiences damage as a result of the doctor’s deviation from the standard practice or care. As in all medical specialties, thoracic surgeons may face medical malpractice claims.
METHODS: Among the files reviewed by the First Board of Specialization of the Council of Forensic Medicine between January 01, 2010, and December 21, 2015, cases with malpractice allegations against thoracic surgeons were analyzed retrospectively.
RESULTS: Fifty-nine of the cases were male (72.8%), and 22 were female (27.2%). The mean age was 51.13±18.97 years, and the most common age range was >60 years (n=35, 43.2%). Medical malpractice was confirmed in 11 (13.6%) of the cases. A diagnostic error was the most common cause of error (n=7, 63.6%), and the most common cause of a diagnostic error was failure to diagnose a condition on time (n=4, 36.4%). The most frequent diagnosis was “injuries due to trauma” (n=54, 66.7%), followed by lung cancer (n=9, 11.1%). It was found that 80.2% (n=65) of the doctors intervened with the patient as a consultant. Complications developed in 48 (59.3%) of the cases. The most common complication was pneumonia (n=7, 14.6%).
CONCLUSION: This was the first study in Turkey that included cases of medical malpractice claims that involved thoracic surgeons. We think that examining cases with medical malpractice claims will help physicians not only better understand the characteristics of malpractice claims but also develop strategies to prevent malpractice claims.

AMAÇ: Trafik kazalarý en sýk ölüm nedenleri arasýndadýr. Suda boðulmalarýn ise küçük bir kýsmýnýn trafik kazalarý ile iliþki bulunmaktadýr. Çalýþmanýn yapýldýðý Doðu Karadeniz Bölgesi’ndeki karayollarý deniz, akarsu ve göletlere oldukça yakýn mesafededir. Çalýþmada; 2009–2016 yýllarý arasýnda trafik kazasý sonrasýnda otopsileri yapýlan ve suda boðulma sonucu öldüðü tespit edilen olgularýn deðerlendirilmesi amaçlanmýþtýr.
GEREÇ VE YÖNTEM: 2009–2016 yýllarý arasýnda yapýlmýþ otopsilerin raporlarý geriye dönük olarak incelendi.
BULGULAR: Adli kayýtlarýn incelenmesi sonucunda 2009–2016 yýllarý arasýnda merkezimizde otopsisi yapýlan 7124 olgudan 41’inin (%0.57) ölümü-nün suda boðulma ile sonuçlanan trafik kazasý sebebiyle gerçekleþtiði görüldü. Kazaya karýþan araçlarýn %73.2’si (n=30) akarsudan, %17.1’i gölden (n=7) ve %9.7’si denizden (n=4) çýkartýldý. Otuz dokuz olgunun tamamýnda primer ölüm sebebinin “suda boðulmaya baðlý asfiksi” olduðu tespit edildi. Yedi olguda (%17.1) ölüme etki eden diðer sebepler travmatik intrakraniyal kanamalar, dört olguda (%9.7) medulla spinalis hasarý, iki olguda (%4.9) akciðer yaralanmasýydý.
TARTIÞMA: Çalýþmada trafik kazasý sonrasýnda travma ile suda boðulmanýn tipik otopsi bulgularýnýn bir arada bulunabildiði tespit edildi. Bu tip olay-larda, trafik kazasý gibi travmatik bir köken olsa da; suda boðulmalarýn tek baþýna ölüm nedeni olabileceði görüldü. Ýnceleme aþamasýnda travmatik bulgularýn yanýnda kimyasal ve mikroskobik incelemelerin, olay yeri bulgularý ve tanýk ifadeleri ile birlikte ele alýnmasýnýn gerekliliði ortaya konuldu.

BACKGROUND: Traffic accidents are among the most common causes of death. A small proportion of drownings are associated with traffic accidents. The roads in the Eastern Black Sea Region, where the study was conducted are fairly close to the seas, rivers, and ponds. This study aims to evaluate the cases who underwent autopsies after the traffic accident between 2009 and 2016 and who were found to have died as a result of drowning.
METHODS: A retrospective examination was made of the autopsy reports in the period 2009–2016.
RESULTS: As a result of the examination of forensic reports, from a total of 7124 autopsies performed in our center between 2009 and 2016, 41 (0.57%) were seen to be due to death in a traffic accident that resulted in drowning. Of the vehicles involved in the ac-cidents, 30 (73.2%) were retrieved from a river/stream, 7 (17.1%) from a lake, and 4 (9.7%) from the sea. In all 39 cases, the primary cause of death was determined as asphyxia related to drowning. Other reasons affecting death were traumatic intracranial bleeding in 7 (17.1%) cases, medulla spinalis injury in 4 (9.7%), and pulmonary injury in 2 (4.9%).
CONCLUSION: It was determined in the study that the typical autopsy results of trauma and drowning after a traffic accident could coexist. Drowning alone could be the cause of death, even though there was a traumatic origin such as a traffic accident in such cases. It was revealed that chemical and microscopic examinations should be handled together with crime scene results and eyewitness statements in addition to traumatic results during the examination phase.

AMAÇ: Depremler doðal olaylardýr ancak sebep olduklarý tahribat oldukça fazladýr. Bir depremi önlemek mümkün olmadýðý için deprem konusunda bilinçli ve duyarlý bireyler yetiþtirmek ve çözüm aramak gerekir. 2020 Elazýð depreminde kullanýlan triyaj, sarf malzemeleri, sývýlar ve ilaçlarýn sunul-masý amaçlandý.
GEREÇ VE YÖNTEM: 24 Ocak 2020 tarihinde merkez üssü Sivrice/Elazýð olan depremden sonra, etkilenen tüm maðdurlar, hastane öncesi triyaj durumu, hastanede yatýþ sýrasýnda acil durum ve diðer yatan hasta hizmetlerinin yönetimi, ameliyatlar dahil týbbi müdahaleler, sarf malzemeleri, sývýlar ve ilaçlar ilk 24 saatteki verilerle geriye dönük olarak deðerlendirildi.
BULGULAR: Elazýð’da rihter ölçeðine göre 6.6 büyüklüðünde ve 22 saniye süren depremin ardýndan toplam yaralý sayýsý 974 oldu. Otuz yedi (%3.7) kiþi hayatýný kaybederken, 18’i (%1.8) kadýndý. Enkazda 34, acil serviste üç kiþi hayatýný kaybederken, yaþ ortalamalarý 46.0±12.5 yýl idi. Ýlk 24 saatte 654 hasta kayýt altýna alýnýrken, bunlardan 30’u 112 Komuta Kontrol Merkezi’nde, 624’ü ayakta tedavi gördü. Üç yüz yirmi kiþiye kimlik bilgileri olmadýðý için geçici kayýt yaptýrýldý.
TARTIÞMA: Deprem öncesi hazýrlýklý ve organize olmak ve erken müdahale etmek afetzedelerin hayatta kalmasýnda önemli baþarý saðlayacaktýr.

BACKGROUND: Earthquakes are natural events, but the destruction they cause is quite high. Since it is not possible to prevent an earthquake, it is necessary to raise conscious and sensitive individuals about earthquakes and to seek solutions. It was aimed to present the triage, consumables, fluids, and drugs used in the 2020 Elazig earthquake.
METHODS: After the earthquake, the epicenter of which was Sivrice/Elazig on January 24, 2020, all affected victims, pre-hospital triage status, management of emergency, and other inpatient services during the hospitalization, medical interventions including sur-geries, consumables, fluids, and drugs were evaluated retrospectively with the data in the first 24 h.
RESULTS: The total number of injured after the earthquake in Elazig, which had a magnitude of 6.6 on the Richter scale and lasted for 22 s, was 974. While 37 (3.7%) people died, 18 (1.8%) of them were women. While 34 people died in the wreckage and 3 people in the emergency department, their mean age was 46.0±12.5 years. While 654 patients were registered in the first 24 h, 30 of them were by 112 Command and Control Center and 624 were outpatients. Temporary registration was provided to 320 people as they did not have their identity information.
CONCLUSION: Being prepared and organized before an earthquake, and taking early intervention will provide significant success in the survival of the disaster victims.

AMAÇ: Bu çalýþmada yüksek morbidite ve mortalite ile seyreden ve acil cerrahi giriþim gerektiren Fournier gangreninde mortaliteye etki eden risk faktörlerini belirlemeyi amaçladýk.
GEREÇ VE YÖNTEM: 2010–2020 yýllarý arasýnda anorektal orijinli Fournier gangreni nedeniyle kliniðimizde ameliyat edilen 150 hasta geriye dönük olarak incelendi. Olgular hayatta kalan ve ölen olarak iki gruba ayrýldý. Demografik, klinik, laboratuvar, tedavi verileri ve Fournier gangreni Severity Index (FGSI), simplified FGSI (SFGSI) skorlarý analiz edildi.
BULGULAR: Otuz günlük mortalite oraný %15.3 idi. Ölenlerin olduðu grupta; sigara, diyabetes mellitus, malignite ve diðer kronik hastalýklarýn oraný; ortalama yaþ, baþvuruya kadar geçen süre, debridman sayýsý, SFGSI, FGSI, lökosit ve kreatinin anlamlý ölçüde yüksek; hematokrit, serum potasyum ve albumin düzeyleri ise anlamlý ölçüde düþük bulunmuþtur (p<0.05). Bu faktörlerden yaþ (OR=1.147, CI=1.019–1.291; p=0.023), sigara (OR=0.09, CI=0.023–0.418; p=0.002), malignite (OR=0.038, CI=0.008–0.186; p=0.001) ve serum potasyum düzeyi (OR=0.141, CI=0.022–0.910; p=0.04) Fournier gangreninde mortalite ile iliþkili risk faktörleri olarak tespit edilmiþtir.
TARTIÞMA: Fournier gangreni halen yüksek mortalite ile seyreden fatal bir fasiittir. Ýleri yaþ, sigara, malignite ve hipopotasemi Fournier gangreninde mortalite için baðýmsýz prediktif risk faktörlerdir.

BACKGROUND: In the present study, we aimed to determine the risk factors for mortality in Fournier’s gangrene (FG), which has a high morbidity and mortality rate and requires urgent surgical intervention.
METHODS: A retrospective analysis was made of 150 patients who were operated on in our clinic due to FG of anorectal origin be-tween 2010 and 2020. The cases were divided into survival and non-survival groups. Demographic, clinical, laboratory, and treatment data, FG Severity Index (FGSI), and simplified FGSI (SFGSI) scores were analyzed.
RESULTS: Thirty-day mortality rate was 15.3%. In the non-survival group, rate of smoking, diabetes mellitus, malignancy and other chronic diseases, and mean age, duration of symptoms at admission, number of debridements, SFGSI, FGSI, white blood cells, and creatinine were significantly higher, while hematocrit, serum potassium, and albumin levels were significantly lower (p<0.05). Among these factors, age (OR=1.147, CI=1.019–1.291; p=0.023), smoking (OR=0.09, CI=0.023–0.418; p=0.002), malignancy (OR=0.038, CI=0.008–0.186; p=0.001), and serum potassium level (OR=0.141, CI=0.022–0.910; p=0.04) were identified as risk factors associated with mortality in FG.
CONCLUSION: FG is a fatal fasciitis still associated with high mortality. Advanced age, smoking, malignancy, and hypopotassemia are independent predictive risk factors for mortality in FG.

AMAÇ: Anstabil tibial kýrýklarýn yönetimi, proksimal ve distal metafizer bölgenin geniþ olmasý, yumuþak doku problemleri ve zayýf damarlanma nedeniyle zor olabilir. Kullanýlmýþ tübüler eksternal fiksatör sistemleri ile oluþturulan yeni tibial ortopedik redüksiyon desteði (TORS) çerçevesinin redüksiyon ve kýrýk iyileþmesinin kalitesi açýsýndan etkisini manuel traksiyon tekniði ile karþýlaþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Anstabil tibial kýrýk ile baþvuran ve intramedüller çivileme yapýlan toplam 65 hasta deðerlendirildi; 43 hastaya manuel traksiyon tekniði, 22 hastaya TORS tekniði uygulandý. Ýlk ameliyat sonrasý radyografilerde sagital ve koronal düzlem açýlanmalarý deðerlendirildi ve takip röntgenlerinde tibia kýrýklarý için radyolojik kaynama skorlarý (RUST) karþýlaþtýrýldý.
BULGULAR: Hastalarýn ortalama yaþý manuel traksiyon grubunda 43.49±19.09, TORS grubunda 43.41±16.8 yýl idi. Manuel traksiyon grubunda ortalama koronal düzlem açýlanmasý 1.84±3.16, TORS grubunda ise 1.86±4.21 idi. Manuel traksiyon grubunda ortalama sagital düzlem açýlanmasý 1.19±1.93 ve TORS grubunda 0.32±0.65 idi. Manuel traksiyon grubunda koronal ve sagital düzlem açýlanmasý >5° olanlarýn sayýsý TORS grubuna göre daha yüksekti. 6., 9. ve 12. ay kontrollerindeki ortalama RUST skorlarý TORS grubunda manuel traksiyon grubuna göre anlamlý olarak daha yüksekti. 9. ve 12. ay kontrollerinde TORS grubunda kaynama oranlarý daha yüksekti.
TARTIÞMA: TORS çerçevesi basit ve ucuz bir tekniktir ve stabil olmayan tibial kýrýklarýn intramedüller çivileme ile tedavisinde redüksiyon desteði olarak düþünülmelidir.

BACKGROUND: Management of unstable tibial fractures (UTF) can be challenging due to widening of the proximal and distal metaphyseal zone, soft tissue problems, and poor vascularity. We aimed to compare the effect of novel tibial orthopedic reduction support (TORS) frame constructed by re-used tubular external fixator systems and manual traction with regard to the quality of re-duction, and fracture healing.
METHODS: A total of 65 patients who were admitted with UTF and underwent intramedullary nailing were assessed; 43 patients un-derwent manual traction technique, and 22 patients underwent TORS technique. The sagittal and coronal plane angulations were eval-uated in initial postoperative radiographs, and radiologic union scores for tibial fractures (RUST) were compared at follow-up X-rays.
RESULTS: The mean age of patients was 43.49±19.09 years in the manual-traction group and 43.41±16.8 years in the TORS group. The mean coronal plane angulation was 1.84±3.16 in the manual traction group and 1.86±4.21 in the TORS group. The mean sagittal plane angulation was 1.19±1.93 in manual traction group and 0.32±0.65 in the TORS group. The number of coronal and sagittal plane angulations >5° was higher in manual traction group than TORS group. The mean RUST was significantly higher in the TORS group than in the manual traction group at 6th, 9th, and 12th-month controls. The union rates were also higher in the TORS group at 9th and 12th-month controls.
CONCLUSION: TORS frame is a simple and cheap technique and should be considered as reduction support in the management of UTF by intramedullary nailing.

AMAÇ: Beþinci metakarpal kýrýklarýn, özellikle Kirschner teli teknikleri kullanýlarak cerrahi tedavisi, erken el hareketini saðladýðý için son zamanlarda popüler hale gelmiþtir. Kýrýðýn baþarýlý anatomik redüksiyonu genellikle cerrahi ile saðlanmakla birlikte; anatomik bir redüksiyon her zaman elde edilemez ve 30° oblik grafilerde, kýrýk 40°’nin altýndaki dorsal açýlanma ile sabitlenir. Bu çalýþmanýn amacý, ameliyat sonrasý bu tür kýrýklarýn stabilitesini deðerlendirmek ve el ve bileðin erken hareket etmesini saðlayan iki farklý açýlanma seçeneðini karþýlaþtýrmaktý.
GEREÇ VE YÖNTEM: Beþinci metakarpal boyun kýrýðýnýn 30 ardýþýk olgusu bir Kirschner teli ile intramedüller olarak tedavi edildi. Olgular iki gruba ayrýldý: Biri anatomik redüksiyonla sabitlendi (grup 1) ve diðeri (grup 2) 30° oblik radyografiye göre apeks dorsal açýlanmada 40°’nin altýnda sabitlen-di. Quick DASH skorlarý ve kavrama kuvvetleri olarak açýlanma, kýsalma ve fonksiyonel sonuç altýncý ayda deðerlendirildi.
BULGULAR: Grup 1 için ortalama düzeltme açýsý 56.6° (30° ile 110° arasýnda) ve rezidüel açý 0° idi. Grup 2 için ortalama düzeltme açýsý 42.4° (20° ile 75° arasýnda) ve rezidüel açý 23.6° (10° ile 45° arasýnda) idi. Ortalama Quick DASH skorlarý grup 1 için 1.9 (SS: 1.7) ve grup 2 için 5.67 (SS: 2.93) idi (p<0.05). Kavrama gücü deðerleri her iki grup için benzerdi. Ortalama 4. haftada (SS: 1.4) (daðýlým, 2–6 hafta) tüm hastalar herhangi bir sýnýrlama olmaksýzýn önceki mesleklerine döndüler. Redüksiyon kaybý veya kýsalma gibi komplikasyonlar tespit edilmedi. Fizik muayenede rotasyon tespit edilmedi.
TARTIÞMA: Araþtýrmamýz, kýrýðýn kýsalmasý veya rotasyon riski olmadýðýný ortaya koydu; hastalar günlük aktivitelerine hýzla geri dönebildi.

BACKGROUND: The surgical treatment of fifth metacarpal fractures, especially using Kirschner (K) wire techniques, has recently become popular because it provides for early hand movement. Successful anatomical reduction of the fracture is often achieved with surgery; however, an anatomical reduction cannot always be achieved and, according to 30° oblique radiography, the fracture is fixed with an apex dorsal angulation below 40°. The aim of this study was to evaluate the stability of such fractures postoperatively and compare the two different angulation options that provide early movement of the hand and wrist.
METHODS: Thirty consecutive cases of neck fractures of the fifth metacarpal were treated intramedullarly with one K wire. Cases were divided into two groups: One fixed with anatomical reduction (Group 1) and the other (Group 2) fixed in apex dorsal angulation below 40°, according to 30° oblique radiography. Angulation, shortening, and functional outcome as Quick DASH scores and grip strengths were evaluated at 6 months.
RESULTS: The mean correction angle was 56.6° (between 30° and 110°) for Group 1 and the residual angle was 0°. The mean cor-rection angle was 42.4° (between 20° and 75°) for group 2 (Figs. 4 and 5) and the residual angle was 23.6° (between 10° and 45°). The mean Quick DASH scores were 1.9 (SD: 1.7) for Group 1 and 5.67 (SD: 2.93) for Group 2 (p<0.05). Grip strength values were similar for both groups. All the patients returned to their previous occupations without any limitations in an average of 4 weeks (SD: 1.4) (range 2–6 weeks). No complications such as correction loosening or shortening were detected. Rotation was not detected during physical examination.
CONCLUSION: Our investigation revealed no risk of shortening or rotation of the fracture; the patients were able to return quickly to their everyday activities.

AMAÇ: Ön çapraz bað (ÖÇB) rekonstrüksiyonuyla eþzamanlý kronik menisküs onarýmý yapýlan hastalarýn spora dönüþ oraný belirsizliðini korumaktadýr. Özellikle spora dönüþü deðerlendirme için iyi tanýmlanmýþ kriterler bulunmamaktadýr. Bu geriye dönük çalýþmanýn amacý, eþlik eden ÖÇB rekonstrüksiyonu ile kronik kilitli kova saplý menisküs yýrtýðý (BHMT) onarýmýnýn spora dönüþ baþarýsýný belirlemekti.
GEREÇ VE YÖNTEM: Bu çalýþma, en az altý haftalýk kova sapý menisküs yýrtýðý olan ve kronik ACL kopuklu 51 hastayý içermektedir. Bu olgular 2017–2020 yýllarý arasýnda artroskopik BHMT onarýmý ve ÖÇB rekonstrüksiyonu ile tedavi edildi. Spora dönüþ ile iliþkili hasta demografisi, kroniklik, preoperatif ve intraoperatif cerrahi deðiþkenler tanýmlandý. BHMT, all-inside menisküs onarýmý ve/veya kombine onarým prosedürü ile onarýldý, ardýndan femoral fiksasyon için bir süspansiyon cihazý kullanýlarak anatomik dýþtan içe ACL rekonstrüksiyonu uygulandý. Hastalara yaklaþýk dört-sekiz ayda spora dönüþ hedefi ile ayný rehabilitasyon programý uygulandý. Bu çalýþmada deðiþtirilmiþ bir spora dönüþ kriteri(SDK) uygulanmýþtýr. BULGULAR: Ortalama yaþý 27.4 (daðýlým, 18–48 yaþ) olan 51 hasta alýndý. Kilitli diz semptomlarýnýn ortaya çýkmasýndan ameliyata kadar geçen ortalama süre 10.5±4.4 haftaydý. Ortalama takip süresi 25.3±4.5 ay idi. Baþlangýçtan son takibe kadar hasta tarafýndan bildirilen tüm sonuçlarda önemli iyileþme gözlendi. Ortalama modifiye Lysholm diz skoru son takipte 45.5 puandan 91.5’e yükseldi (p<0.001). Elli bir hastanýn 43’ü (%84.3) eðlence aktivitelerine (amatör sporlara) geri dönmüþtü. Spora dönüþ süresi ortalama 5.9±0.8 (5–8) aydý.
TARTIÞMA: BHMT onarýmý ile ÖÇB rekonstrüksiyonu yapýlan hastalarýn çoðu sekiz ayda ameliyat öncesi aktivite seviyelerine döner. Kronik ÖÇB rüptürü ile birlikte tüm ihmal edilmiþ BHMT’ler, cerrahi zamandaki gecikmeye bakýlmaksýzýn menisküsün yarý düzlem-içbükey þekli korunmuþsa, tek aþamalý bir ameliyatta tamir edilmelidir.

BACKGROUND: Return to sports rate of chronic meniscus repair concurrent with Anterior Cruciate Ligament (ACL) reconstruction remains unclear, especially there is no well-defined return to sports criteria for evaluation. The purpose of this retrospective study was to determine the success rate of chronic locked bucket-handle meniscal tear (BHMT) repair with concomitant ACL reconstruction.
METHODS: This study includes 51 chronic ACL injury patients with a locked meniscal tear of at least 6 weeks who underwent surgery. All cases were treated with arthroscopic BHMT repair and ACL reconstruction between 2017 and 2020. Patient demograph-ics, chronicity, pre-operative, and intraoperative surgical variables which associated with return to sports were defined. BHMT was repaired with an all-in-side meniscus repair and/or combined repair procedure first, then an anatomic outside-in ACL reconstruction using a suspension device for femoral fixation was performed. Patients underwent same rehabilitation program with the goal of return-ing to sport at approximately 4–8 months. A modified return-to-sport criterion was performed in this study.
RESULTS: Fifty-one patients with an average age of 27.4 (range 18–48) years were included in the study. The average time elapsed from the occurrence of locked knee symptoms to surgery was 10.5±4.4 weeks. The mean follow-up time was 25.3±4.5 months. Sig-nificant improvement was observed in all patient-reported outcomes from baseline to the final follow-up. The mean modified Lysholm knee score increased from 45.5 points to 91.5 at the final follow-up (p<0.001). The 43 out of 51 patients (84.3%) were return to their recreational activities (amateur sports). The mean time to return to sport was 5.9±0.8 (5–8) months.
CONCLUSION: Majority of the patients who underwent ACL reconstruction with BHMT repair return to their pre-operative activity levels in 8 months. All neglected BHMTs with concomitant chronic ACL rupture should be repaired in a single-stage surgery if the half plane-concave shape of the menisci has been preserved regardless of the delay in time to surgery.

AMAÇ: Bu çalýþmada, eksternal fiksatör ve kilitli volar plak ile tedavi edilen distal radius kýrýklý hastalarda klinik ve izokinetik sonuçlarý karþýlaþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: AO tip C1/C2/C3 olan 50 hasta çalýþmaya alýndý. Bunlardan 23 hastaya eksternal fiksatör, 27 hastaya volar kiliti plak uygula-masý yapýldý. Kýrýk tipleri AO sýnýflandýrma sistemine göre sýnýflandýrýldý, hastalar eksternal fiksatör ve volar kilitli plak uygulamasýna göre iki guruba ayrýldý. Tüm hastalar minimum 12 ay takip edildi ve ortalama takip süresi 13.5±1.02 (12–15) ay idi. Fonksiyonel sonuçlar eklem hareket açýklýðý (ROM) ve kavrama gücü ile ölçüldü. Radyografik parametreler (radial inklinasyon, radial yükseklik, radial tilt) ve izokinetik deðerlendirmeler ameliyattan altý ay ve bir yýl sonra ölçüldü. Elbilek skorlarý DASH puanlama sistemine göre yapýldý. Tüm verilerin analizi SPSS Windows 15.0 sistemi üzerinden yapýldý. Niteliksel verilerin analizi için ki-kare testi, eþleþtirilmiþ t-test kullanýldý ve anlamlýlýk p<0.05 düzeyinde deðerlendirildi.
BULGULAR: Her iki gurup arasýnda DASH Skoru, palmarfleksiyon ve kavrama gücü gibi fonksiyonel parametrelerde altýncý ayda anlamlý fark bulunurken (p<0.05), birinci yýl sonunda fark bulunamadý (p=0.79). Ýzokinetik deðerlendirmelerde volar plaklama yapýlan hastalarda eksternal fiksatör yapýlan hastalara göre altýncý ayda pik pronasyon tork ve total work daha iyiyken (p<0.05), birinci yýl sonunda fark bulunamadý (p=0.11). TARTIÞMA: Sonuç olarak, eksternal fiksatör ve volar plaklama uyguladýðýmýz bu ileriye yönelik çalýþmada, volar plaklama yapýlan hastalarda altýncý ayda eklem hareket açýklýðý ve izokinetik deðerlendirmeler daha iyi iken birinci yýl sonunda iki grup arasýnda anlamlý fark bulunamadý. Çalýþmamýzda birinci yýl sonunda bir gurubun diðerine üstünlüðü bulunamadý.

BACKGROUND: The aim of this study was to compare the clinical and isokinetic evaluation of distal radius fractures treated by volar locking plate (VLP) and external fixator.
METHODS: The study included fifty patients with distal radius fracture type C1/C2/C3. Twenty-seven patients (12 men, 15 women; mean age 49.5±4.42) underwent open reduction and VLP fixation, and 23 patients (10 men, 13 women; 52.1±4.6) underwent closed reduction and external fixation. The follow-up period was at least 12 months and the mean following time was 13.5±1.02 (12–15) months. The functional parameters measured were range of motion (ROM) and grip strength. Radiographic parameters (radial incli-nation, palmar tilt, and radial height) and isokinetic evaluation were measured at the 6 months and at the final follow-up after surgery. The isokinetic test was done at the speed of 60º/s. The non-fractured arm was tested first and all results were also expressed as a percentage of that on the normal side. Wrist scores according to the disability of the arm, shoulder, and hand (DASH) questionnaire were used.
RESULTS: The DASH scores, grip strength, and palmar flexion were better in VLP group at the 6 months (p<0.05). However, there were no differences between two groups at the one year (p=0.79). Isokinetic evaluation of the VLP showed that peak pronation torque and total pronation work were better than external fixation at the 6 month (p<0.05). At the final of follow-up was seen no significant differences between two groups (p=0.11).
CONCLUSION: We looked at external fixation and locked volar plates in a prospective study and we found an improved range of movement and isokinetic evaluation outcome at 6 months after locked plating, but there were no differences between two groups at the final of follow-up. Our study showed no evidence for the superiority of one treatment over the other at the final follow-up.

AMAÇ: Pertrokanterik femur kýrýklarý, yaþlý popülasyonda giderek artan prevalansý ile ciddi bir saðlýk sorunudur. Muhtemel ameliyat sonrasý yoðun bakým ihtiyacý, hastalarýn daha donanýmlý hastanelere sevk edilmek zorunda kalmasýnýn yaný sýra, rezerve bir yoðun bakým yataðý ayarlanamamasý nedeniyle ameliyat zamanlamasýnda gecikmelere yol açmaktadýr. Bu çalýþmanýn amacý, pertrokanterik femur kýrýðý sonrasý cerrahi uygulanan geriatrik hastalarda ameliyat öncesi nötrofil-lenfosit oranýnýn (NLO) ameliyat sonrasý yoðun bakým ihtiyacý açýsýndan prediktif deðeri olup olmadýðýný araþtýrmaktýr. GEREÇ VE YÖNTEM: 2017–2020 yýllarý arasýnda acil servise baþvuran 65 yaþ ve üzeri 535 kalça kýrýðý tanýlý hasta retrospektif olarak tarandý. Beþ yüz otuz beþ hastadan dahil etme ve dýþlama kriterlerini karþýlayan ASA 3 skorlu 317 hasta çalýþmaya alýndý. Taranan hasta popülasyonu ameliyat sonrasý yoðun bakým ünitesinde (YBÜ) ve ortopedi ve travmatoloji servisinde takip edilenler olarak iki gruba ayrýldý.
BULGULAR: Ameliyat sonrasý ortopedi ve travmatoloji servisinde takip edilen 190 hasta (%59.9) ve ameliyat sonrasý yoðun bakýmda takip edilen 127 hasta (%40.1) mevcuttu. Tüm hastalarda ortalama ameliyat öncesi NLO 6.57 iken, ameliyat sonrasý ortopedi ve travmatoloji servisinde takip edilen has-talarýn ortalama ameliyat öncesi NLO deðeri 5.85, YBÜ’de izlenenlerin ortalama NLO deðeri 7.65 olarak bulundu. YBÜ grubu hastalarýnýn baþvuru NLO deðerlerinin ortopedi servisi grubuna göre anlamlý derecede yüksek olduðu saptandý (p<0.001). Ayrýca NLO için kestirim deðeri 6.14 olarak hesaplandý. TARTIÞMA: Yoðun bakým ihtiyacý tam olarak belirsiz olan pertrokanterik kýrýklý ortogeriatrik ASA 3 hastalar için bulduðumuz bu objektif, basit, uygun maliyetli ve hýzlý belirtecin baþka belirteçlerle kombine edilmesinin yoðun bakým ihtiyacýný öngörmede yardýmcý olabileceðine ve böylece rezerve YBÜ yataðýnýn bulunmamasý nedeniyle oluþan cerrahi gecikmelerin önlenebileceðine, dolayýsýyla bu gecikmelerden kaynaklanan mortalite ve morbiditenin azaltýlabileceðine inanýyoruz.

BACKGROUND: Pertrochanteric fractures are serious health problem with an ever-increasing prevalence in elderly population. Potential post-operative intensive care need leads to delays in the timing of surgery due to the referral of patients to better equipped hospitals as well as the inability to arrange a reserved intensive care bed. The purpose of this study is to investigate whether pre-op-erative neutrophillymphocyte ratio (NLR) has predictive value in terms of post-operative intensive care need in geriatric patients who underwent surgery following pertrochanteric fractures.
METHODS: A total of 535 patients aged 65 years and above with hip fractures who presented to the emergency service between 2017 and 2020 were retrospectively screened. Out of 535 patients, 317 patients who met the inclusion and exclusion criteria were included in the study. The screened patient population was divided into two groups as those followed in the post-operative intensive care unit (ICU) and those followed in the orthopedic ward.
RESULTS: There were 190 patients (59.9%) who were followed in the orthopedic ward postoperatively and 127 (40.1%) patients followed in the ICU postoperatively. While the mean pre-operative NLR value of all patients was 6.57, the mean pre-operative NLR of the patients who were followed up postoperatively in the orthopedic ward was 5.85, and the mean NLR of those who were followed up in the ICU was 7.65. It was found that the admission NLR values of the ICU group patients were significantly higher compared to those of the orthopedic ward group (p<0.001) and also the cutoff value of NLR was calculated as 6.14.
CONCLUSION: We believe that this objective, simple, cost-effective, and rapid marker can be used in combination with other parameters to predict ICU need to prevent surgical delays due to the lack of a reserved intensive care bed in the ASA 3 geriatric patient group with pertrochanteric fractures, whose intensive care need cannot be clarified, thereby reducing mortality and morbidity.

AMAÇ: Çalýþmanýn amacý, konservatif ve cerrahi olarak tedavi edilen deplase asetabulum kýrýklý hastalarýn fonksiyonel ve radyolojik sonuçlarýný karþýlaþtýrmaktý.
GEREÇ VE YÖNTEM: Çalýþmaya, 2000–2014 yýllarý arasýnda asetabulum kýrýklarý nedeniyle konservatif veya cerrahi olarak tedavi edilen 18 yaþ üstü yer deðiþtirmiþ asetabulum kýrýðý olan 61 hasta alýndý. Hastalar tedavi þekline göre iki gruba ayrýldý. Grup 1, 2000–2010 yýllarý arasýnda konservatif tedavi gören 31 hastadan, grup 2 ise 2010–2014 yýllarý arasýnda cerrahi tedavi gören 30 hastadan oluþuyordu. Kýrýklar Judet ve Letournel sýnýflandýrmasýna göre sýnýflandýrýldý. Hastalarýn klinik deðerlendirmesi Modifiye Merle D’Aubigne Skoru, SF-36 ve Harris Kalça Skoruna göre yapýldý. Radyolojik deðerlendirme Matta’nýn Radyolojik Deðerlendirme Kriterlerine göre deðerlendirildi. Ýstatistiksel analiz için Kolmogorov Smirnov, t-testi, Mann-Whitney U-testi ve iki Wilcoxon eþleþtirilmiþ örnek testi kullanýldý. Anlamlýlýk sýnýrý p<0.05 olarak seçildi.
BULGULAR: Ortalama takip süresi konservatif grup için 10 yýl, cerrahi grup için 5.5 yýldý. Her iki grup arasýnda fonksiyonel skorlarda istatistiksel olarak anlamlý fark yoktu (p>0.05), ameliyat edilen grupta Matta’nýn radyolojik evreleme skoru anlamlý olarak yüksekti (p=0.023).
TARTIÞMA: Radyolojik skorlar, fonksiyonel kapasite ile doðrudan iliþkili deðildir. Cerrahi grupta iyi radyolojik ve fonksiyonel skorlar elde ettik, mutlak endikasyonlar mevcut olduðunda cerrahi tedavi düþünülmelidir. Konservatif olarak yönetilen kýrýklarýn sonucu kasvetli deðildir. Yer deðiþtirmiþ asetabular kýrýklarda cerrahi tedaviye bir alternatif olduðunu ve seçilmiþ olgularda benzer fonksiyonel sonuçlarýn alýnabileceðini düþünüyoruz.

BACKGROUND: The purpose of the study was to compare the functional and radiological results of the conservatively and surgically treated displaced acetabular fractured patients.
METHODS: The study included 61 patients with a displaced acetabulum fracture over the age of 18, who have been treated con-servatively or surgically for acetabular fractures, between 2000 and 2014. Patients were divided into two groups according to their treatment type. Group 1 consisted of conservatively treated 31 between 2000 and 2010 patients and Group 2 consisted of surgically treated 30 patients between 2010 and 2014. The fractures were classified according to Judet and Letournel classification. Clinical evaluation of the patients was conducted according to Modified Merle D’Aubigne Score, SF-36, and Harris Hip Score. Radiological evaluation was evaluated according to Matta’s Radiological Evaluation Criteria. Kolmogorov–Smirnov, t-test, Mann–Whitney U-test, and two Wilcoxon paired sample tests were used for statistical analysis. The significance limit was chosen as p<0.05.
RESULTS: The mean follow-up time was 10 years for the conservative group and 5.5 years for the surgery group. There was no statistically significant difference in functional scores between both groups (p>0.05), Matta’s radiological staging score was significantly higher in the operated group (p=0.023).
CONCLUSION: Radiological scores are not directly correlated with the functional capacity. We obtained good radiological and functional scores in the surgical group, operative treatment should be considered when absolute indications are there. The outcome of conservatively managed fractures is not bleak. We think that there is an alternative to surgical treatment in displaced acetabular fractures and that similar functional results can be obtained in selected cases.

AMAÇ: Açýk tibia kýrýklarý sonrasý izlenen kaynamama çok ciddi bir komplikasyondur. Bu çalýþmada açýk tibia kýrýðý sonrasý kaynamama geliþen hastalarýn tedavisinde uygulanan indükte membran tekniðinin etkinliði incelenmiþtir.
GEREÇ VE YÖNTEM: Açýk tibia kýrýðý sonrasý kaynamama izlenen on bir erkek hasta çalýþmaya alýndý. Hastalarýn ortalama yaþý 40.7 (25–63) idi. Tüm hastalara Masquelet tarafýndan tanýmlanan indükte membran tekniði ile kemik rekonstrüksiyonu uygulandý. Ameliyatta öncelikle kemik defektler polimetilmetakrilat çimento spacer ile dolduruldu. Ameliyat sonrasý ortalama 7.3 (6–10) haftada spacer çýkarýlarak kemik graftleme uygulandý. Kaynama zamaný, tam yük verme zamaný ve oluþan komplikasyonlar deðerlendirildi.
BULGULAR: Hastalarýn ortalama takip süresi ikinci aþamadan sonra 24.6 (13–40) aydý. Radikal debridman sonrasý kemik defektlerinin ortalama uzunluðu 51 mm (25–98) idi. Dokuz hastada (%81) kýrýk iyileþmesi görüldü. Cerrahinin ikinci aþamasýndan sonra kemik kaynamasýnýn iyileþmesi için gereken ortalama süre 8.1 (8–12) hafta idi. Hastalarýn, 12 haftada tolere edebildiði þekilde tam yük vermesine izin verildi. Ýki hastada kemik kaynamasý ve enfeksiyon kontrolü saðlanamadý. Ýnatçý enfeksiyon nedeniyle bir hastada diz altý amputasyon uygulandý. Diðer hastada ise kemik kaynamamasý nedeniyle vaskülarize kemik grefti yapýldý.
TARTIÞMA: Ýndüklenmiþ membran tekniði, baþarýsýz açýk kýrýk tedavisi sonrasý oluþan tibial kaynamamalarýnýn tedavisinde güvenilir ve tekrarlanabilir bir tedavi yöntemidir. Buna raðmen büyük kemik defekti olan enfektif kaynamamýþ kemik kýrýklarýnda kaynama ve enfeksiyon kontrolü öngörülemeyebilir.

BACKGROUND: Non-union is a serious complication of open tibial fractures. This case series investigates the efficiency of the induced membrane technique in patients with tibial exposed non-union.
METHODS: Eleven consecutive male patients with non-union after an open tibia fracture were enrolled into the study. The mean age of the patients was 40.7 (25–63). Induced membrane technique described by Masquelet was performed. Operative treatment with a temporary polymethylmethacrylate cement spacer to induce membrane formation followed by spacer removal and bone grafting at 7.35 (6–10) weeks were performed. Time to union, time to full weight-bearing, and any complications were evaluated.
RESULTS: The average follow-up period of patients was 24.6 (13–40) months after the second stage. The mean length of bone defects after radical debridement was 51 mm (25–98). Fracture healing was observed in 9 patients (81%). The mean time needed to obtain bony union healing was 8.1 (8–12) weeks after second stage of surgery. Patients were allowed to full weight bearing as tolerated at 12 weeks. Two patients were failed to obtain bony union and infection control. One patient had below knee amputation due to persistant infection. Vascularized bone graft was performed for other patient due to the inability to obtain bone union.
CONCLUSION: The induced membrane technique is a reliable and reproducible treatment modality for tibial non-unions after failed open fracture treatment. However, it is unpredictable to obtain bony union and control of infection in initial infected non-unions with a large bone defect.

AMAÇ: Groove (oluk) pankreatit (GP) kronik pankreatitin daha az karþýlaþýlaþýlan ve multimodel görüntüleme yöntemleriyle yeni yeni farkýndalýðý artmakta olan nadir bir formudur. Amacýmýz GP tanýsý almýþ hastalarýn farklý tedavi yaklaþýmlarýyla orta-uzun dönem sonuçlarýný analiz etmektir. GEREÇ VE YÖNTEM: Mayýs 2013–Haziran 2019 tarihleri arasýnda elektronik hasta kayýt veri tabanýndan “groove”, “paraduodenal” anahtar kelime-leri ile bilgisayar ortamýnda arama yapýldý. GP tanýsý konulan 25 hastanýn klinik, radyolojik ve patolojik verileri elde edildi.
BULGULAR: GP hasta grubunda median yaþ 55 (25–87) ve %80 erkek cinsiyet hakimdi. Alkol ve sigara kullanýmý %40 idi. En sýk semptomlar sýrasýyla üst karýn aðrýsý(%84) ve bulantý-kusma (%40) idi. Mide çýkýþ yolu obstrüksiyonu 4 (%16) hastada görüldü. BT ve EUS hastalarýn büyük bir çoðunluðunda uygulandý. (sýrasýyla, %96 ve %92). 25 hastanýn 14’üne EUS-FNA yapýldý. Patoloji sonuçlarý sýrasýyla iki hastada atipi (%8), iki hastada adenoCA (%8) ve on hastada benign (%40) olarak geldi. EUS-FNA iþlemi ilk radyolojik deðerlendirmesi GP olarak yorumlanan iki pankreas baþý malignitesinin nihayi tanýsýnýn konulmasýnda yardýmcý oldu. Ortalama takip süresi 29 (3–71) aydý. Konservatif yaklaþým aðýrlýklý olarak tercih edilen tedavi yöntemiydi (%56). Konservatif yöntemin dýþýnda diðer tedavi stratejileri arasýnda, ERCP ile bilier stentleme, sfinkterotomi, wirsung stentleme, kolesistektomi vb. endoskopik/cerrahi giriþimler yer aldý. Tüm tedavi modaliteleri göz önünde bulundurulduðunda, groove pankreatitli 12 (%48) hastada semptomlarda iyileþme görülürken, 7 (%28) hasta tekrarlayan pankreatit ataklarýyla seyretti.
TARTIÞMA: GP, pankreatitin daha az bilinen bir formu olmasýndan ötürü taný ve tedavide klinisyenler için çeþitli zorluklarý beraberinde taþýr. Bilhassa pankreas malignitesini taklit edebilen bu form mutlaka karsinomdan ayýrt edilmelidir. EUS(±FNA), radyolojik incelemeleri tamamlayan kullanýþlý bir taný aracýdýr. Konservatif yaklaþým çoðu hastada hala ilk seçenek olarak yerini korumakla beraber, klinisyen gerekli özel durumlarda invazif endosko-pik iþlemler ve cerrahi seçenekleri göz önünde bulundurmalýdýr.

BACKGROUND: Groove pancreatitis (GP) is a rare form of chronic pancreatitis that is less common and is now gaining awareness with multimodal imaging modalities. Our aim is to analyze the mid-long term outcomes of patients diagnosed with GP with different treatment approaches.
METHODS: A computerized search from electronic patient record database between May 2013 and June 2019 with the keywords “groove”, “paraduodenal” was applied. The clinical, radiological and pathological data of 25 patients diagnosed with GP were obtained.
RESULTS: In the GP patient group, the median age was 55 (25–87) and 80% was male. Alcohol and tobacco abuse was 40% among GP patients. The most common symptoms were upper abdominal pain (84%) and nausea-vomiting (40%), respectively. Gastric outlet obstruction was observed in 4 (16%) patients. CT and EUS imaging were performed to majority of cases (96% and 92 %, respectively). EUS-FNA was done in 14 of 25 (56%) patients. It was reported as atypia, adenocarcinoma and benign in 2 (8%), 2 (8%) and 10 (40%) patients, respectively. EUS-FNA was helpful to diagnose two pancreatic head adenoCA whose preliminary radiological evaluation was GP. The mean follow-up period was 29 (3–71) months. Conservative approach was the predominantly preferred treatment (%56). Apart from conservative approach, treatment strategies included biliary stenting, sphincterotomy, wirsung stenting via ERCP, cholecystectomy etc. Considering all treatment modalities, symptoms improved in 12 (48%) patients and progressed with recurrent pancreatitis attacks in 7 (28%) patients.
CONCLUSION: Because GP is a less well-known form of pancreatitis, it presents several challenges for clinicians in diagnosis and treatment. This form, which can mimic pancreatic malignancy in particular, must be differentiated from carcinoma. EUS(±FNA) is a useful diagnostic tool complementary to imaging. Although the conservative approach remains the first choice in most patients, the clinician should consider invasive endoscopic procedures and surgical options in special cases when necessary.

Otomatik çivi tabancasýnýn neden olduðu el yaralanmalarý, bu makinelerin inþaatlarda kullanýlmasýyla yaygýn olarak ortaya çýkar. Bununla birlikte, kardiyotorasik bölge yaralanmalarý atipiktir. Bu yazýda, bir çiviyi çýkarýrken yanlýþlýkla sternumdan kalbe ulaþýlan acil cerrahi müdahale olgusunu sunmaktayýz. Yirmi dört yaþýndaki bir erkek, bir þantiyede dar bir alanda çalýþýrken, otomatik havalý çivi tabancasýnýn hava hortumuna takýlýp düþtü. Alet kiþiye doðru bakarken yanlýþlýkla tetik çekilmiþ ve sternuma bir çivi girmiþ. Göðsünde aðrý hisseden hasta, yakýndaki bir ortopedi kliniðine yürü-müþ ve ardýndan tedavi için hastanemize sevk edildi. Muayenede çivi prekordiyal göðüs orta hattýna tamamen gömülüydü. Akciðer grafisi ve toraks bilgisayarlý tomografi görüntülerinde prekordiyal bölgeden sternuma giren ve anterior mediastene ulaþan çubuk þeklinde bir çivi görüldü. Çivi ucu pulmoner arter ve aort arasýnda durmaktaydý; pulmoner arterin ana gövdesine dokunuyordu. Masif kanama ve enfeksiyon olasýlýðý düþünülerek ayný gün, 45 mm uzunluðundaki (2 mm çapýnda) çivinin çýkarýlmasý için acil cerrahi uygulandý. Yardýmcý dolaþým sistemi kullanýlmadý ve intraoperatif kan transfüzyonu gerekmedi. Hasta ayný gün ekstübe edildi. Ameliyat sonrasý yedinci günde çekilen bilgisayarlý tomografi, endiþe verici bir durum olma-dýðýný ve enfeksiyon belirtisi olmadýðýný doðruladý. Hasta ameliyat sonrasý sekizinci gün taburcu edildi ve yürüyerek evine döndü. Hasta poliklinikte altý ay takip edildi; enfeksiyon durumu veya anormal hemodinamik bulgu saptanmadý. Bu olgu, baþlangýçta önemsiz görünebilecek çivi tabancasý yaralanmalarýnýn dikkatli bir þekilde deðerlendirilmesi gerektiðini göstermektedir.

Automatic nail gun injuries to the hand commonly occur with the use of these machines in construction. However, such injuries to the cardiothoracic area are atypical. Herein, we report a case of emergency surgery to remove a nail, which was accidentally shot through the sternum and reached the heart. A 24-year-old man was working in a narrow space at a construction site, where he tripped over the air hose of an automatic pneumatic nail gun. The trigger was accidentally pulled, while the machine was facing his direction, and a nail entered his sternum. The patient felt chest pain, walked to a nearby orthopedic clinic, and then was transferred to our hospital for treatment. On examination, the nail was completely embedded in the midline of the precordial chest. Chest X-ray and computed tomography (CT) images showed a rod-shaped nail penetrating the sternum from the precordial region and reaching the anterior medi-astinum. The nail tip was located between the pulmonary artery and the aorta; it was touching the main trunk of the pulmonary artery. Emergency surgery was performed to remove the 45-mm-long nail (2 mm in diameter) on the same day, considering the possibility of massive bleeding and infection. An auxiliary circulatory system was not used, and intraoperative blood transfusion was not required. The patient was extubated on the same day. On post-operative day 7, CT confirmed that there were no issues of concern and no signs of infection. The patient was discharged on post-operative day 8 and returned home on foot. The patient was followed up for 6 months in the outpatient clinic, and there were no signs of infection or abnormal hemodynamics. This case demonstrates the need for careful assessment of nail gun injuries, which may initially appear insignificant.

De Garengeot Herni femoral herni içerisinde apendiks olmasýyla prezente olan nadir bir herni türüdür. Genellikle 7. dekatta, büyük çoðunlukta kadýn olgularda ortaya çýkan acil cerrahi gereksinimi olan klinik antitedir. Bu yazýda, 73 yaþýnda femoral herni kesesi içerisinde akut apandisit tablosu ile baþvuran olgu sunuldu.

De Garengeot hernia is a rare type of femoral hernia that presents with appendicitis. This clinical condition that usually occurs in the 7th decade, mostly in women, requires urgent surgery. Here, we present a 73-year-old patient with acute appendicitis within the femoral hernia sac.

On dört yaþýnda bir erkek çocukta dirsek çýkýðý olmaksýzýn deplase medial epikondil kýrýðýna baðlý median sinir tuzaklanmasý tespit edildi. Median sinirin tuzaklanmasý, sunumda nörolojik defisit olmasa bile, yer deðiþtirmiþ medial epikondil kýrýðýnýn potansiyel bir sonucudur. Bu durum, perkütan tedavi veya nonoperatif tedavi yerine, bu tip kýrýklarýn açýk redüksiyonu için gerekçe saðlamaktadýr. Tuzaklanan bir median sinirin erken tanýmlanmasý ve tedavisi, çocuklarda üst ekstremite sinir felcinin katastrofik sonuçlarýný önlemek ve kýrýk iyileþmesini ve geliþimini optimize etmek için zorunludur.

A 14-year-old boy with a displaced medial epicondyle fracture without elbow dislocation was found to have an entrapped median nerve. Entrapment of the median nerve is a potential consequence of a displaced medial epicondyle fracture, even when there are no neu-rologic deficits on presentation. This provides additional support for the open reduction of these fractures rather than percutaneous treatment or non-operative management. The early identification and release of an interposed median nerve are imperative to prevent the catastrophic consequences of the upper extremity nerve palsy in children, as well as to optimize fracture healing and development.