Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES最新文献

{"title":"Inattention and impulsivity in attention-deficit/hyperactivity disorder (ADHD) and pediatric extremity fractures: an association between neurobehavioral traits and trauma presentation.","authors":"Tolgahan Korkmaz, Muhammed Yusuf Afacan, Yener Ince, Mete Ozer, Fırat Öz, Mehmet Ali Talmaç","doi":"10.14744/tjtes.2026.56002","DOIUrl":"https://doi.org/10.14744/tjtes.2026.56002","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to investigate whether the severity of attention-deficit/hyperactivity disorder (ADHD) symptoms, particularly inattention and impulsivity, is associated with extremity fractures in children. Additionally, ADHD symptom scores were compared between surgically and conservatively treated fracture cases, and the relationship between trauma energy level and ADHD symptoms was evaluated.</p><p><strong>Methods: </strong>In this cross-sectional study, 160 children aged 7-17 years were evaluated. Participants were divided into three groups: children with surgically treated fractures (n=40), children with conservatively treated fractures (n=40), and fracture-free controls (n=80). ADHD symptoms were assessed using a parent-completed Screening and Assessment Scale based on the Diagnostic and Sta-tistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Sociodemographic data, trauma mechanisms, and fracture characteristics were also documented.</p><p><strong>Results: </strong>Children with fractures had significantly higher inattention scores (6.13±3.44 vs. 4.26±2.34; p<0.001), impulsivity scores (6.50±4.70 vs. 4.45±2.10; p=0.001), and total ADHD scores (12.60±6.41 vs. 8.74±3.62; p<0.001) compared with controls. No significant differences were observed between the surgical and conservative treatment groups or between low- and high-energy trauma subgroups. Sociodemographic variables and fracture history among siblings did not differ significantly between the groups.</p><p><strong>Conclusion: </strong>Higher ADHD symptom scores were significantly associated with the occurrence of extremity fractures in children. These findings suggest that assessing ADHD-related symptoms may provide useful insights during pediatric trauma evaluations. However, due to the cross-sectional design, temporality and causality cannot be established. Longitudinal studies are needed to confirm these associations.</p>","PeriodicalId":94263,"journal":{"name":"Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES","volume":"32 5","pages":"588-596"},"PeriodicalIF":1.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147848519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and radiological outcomes of callus preservation versus excision in gunshot-related distal humerus fractures.","authors":"Ali Murat Basak, Ali Aydilek","doi":"10.14744/tjtes.2026.96533","DOIUrl":"https://doi.org/10.14744/tjtes.2026.96533","url":null,"abstract":"<p><strong>Background: </strong>High-energy gunshot injuries to the distal humerus frequently result in extensive comminution, severe soft-tissue damage, and contamination, making definitive fixation both technically demanding and biologically challenging. During staged management with temporary stabilization, extra-articular callus formation may occur prior to definitive fixation, potentially influencing the surgical decision to preserve or excise this tissue. This study aimed to evaluate the clinical and radiological outcomes of a fixation strategy that preserves extra-articular callus in high-energy distal humerus fractures caused by gunshot injuries.</p><p><strong>Methods: </strong>This retrospective study included 21 male patients with Gustilo-Anderson type IIIA distal humerus fractures caused by high-velocity gunshot injuries, treated between 2016 and 2024. All patients initially underwent temporary stabilization followed by definitive fixation. Patients were stratified according to whether the extra-articular callus tissue was preserved (n=9) or excised (n=12) during surgery. Functional outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) score and the Mayo Elbow Performance Index (MEPI), and radiographic union time was recorded.</p><p><strong>Results: </strong>The mean patient age was 28 years (range, 22-43). According to the AO/OTA (Arbeitsgemeinschaft für Osteosynthe-sefragen/Orthopaedic Trauma Association) classification system, 81% of fractures were type 13C3. Nerve injury was present in five patients (23.8%), and heterotopic ossification developed in five patients (23.8%). No significant intergroup differences were observed in DASH scores, MEPI scores, range of motion, or infection rates (all p>0.05). However, union time was significantly shorter in the callus-preserved group compared with the excision group (18.0±3.1 vs. 23.5±3.3 weeks, p=0.004). Nerve injury (p=0.043) and heterotopic ossification (p=0.025) were associated with higher DASH scores, indicating poorer functional outcomes.</p><p><strong>Conclusion: </strong>A callus-preserving fixation approach may offer a biological advantage in the management of high-energy distal humerus gunshot fractures by promoting earlier bone healing without compromising functional outcomes. When extra-articular callus does not interfere with anatomical reduction, preserving it in situ may be considered as part of a staged damage-control-to-definitive fixation strategy.</p>","PeriodicalId":94263,"journal":{"name":"Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES","volume":"32 5","pages":"610-617"},"PeriodicalIF":1.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147848521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and effectiveness of nonoperative management in liver lacerations: a retrospective cohort study.","authors":"Gürkan Değirmencioğlu, Deniz Kütük, Mehmet Hanifi Çanakcı, Murat Yıldırım, Mustafa Hulusi Kurt","doi":"10.14744/tjtes.2026.73965","DOIUrl":"https://doi.org/10.14744/tjtes.2026.73965","url":null,"abstract":"<p><strong>Background: </strong>Liver trauma remains a major contributor to morbidity in patients with abdominal injuries. Although nonoperative management (NOM) is widely accepted in hemodynamically stable patients, the relationship between American Association for the Surgery of Trauma (AAST) injury grade, laboratory parameters, transfusion requirements, and the need for surgical intervention remains unclear.</p><p><strong>Methods: </strong>This retrospective observational study included 53 patients with radiologically or intraoperatively confirmed liver lacerations treated at a tertiary surgical center between October 2024 and May 2025. Data collected included demographics, vital signs, AAST injury grade, laboratory values, transfusion requirements, imaging use, and clinical outcomes. Statistical analyses were performed using analysis of variance (ANOVA), chi-square/Fisher's exact tests, and logistic regression.</p><p><strong>Results: </strong>The mean age was 41.4 years, with 67.9% of patients being male. The most common mechanism of injury was motor vehicle accidents (56.6%). On admission, 64.2% of patients had AAST grade I-II injuries, while 7.5% had grade IV injuries. NOM was successful in 81.1% of cases, with 18.9% requiring operative intervention. No in-hospital mortality was observed. Changes in hemoglobin and hematocrit levels were not significantly associated with injury grade or the need for surgery. However, transfusion requirements increased with injury severity, including erythrocyte suspension (p=0.006) and fresh frozen plasma (p<0.001). Follow-up imaging (n=25) demonstrated stable or improved findings in 96% of patients. Logistic regression analysis did not identify independent predictors of surgical intervention.</p><p><strong>Conclusion: </strong>NOM of liver lacerations is safe and effective, with excellent outcomes and no mortality observed in this cohort. Although AAST injury grade alone did not predict the need for surgery, transfusion requirements correlated with injury severity, high-lighting their value as practical indicators in clinical decision-making.</p>","PeriodicalId":94263,"journal":{"name":"Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES","volume":"32 5","pages":"574-581"},"PeriodicalIF":1.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147848526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hand trauma associated with non-professional animal slaughter during Eid al-Adha: an emergency and hand surgery experience.","authors":"Uğur Horoz, Emre Inozu, Hulda Rıfat Özakpınar, Ergin Seven, Avni Tolga Eryılmaz, Musa Kemal Keleş, Sebat Karamürsel, Ali Teoman Tellioğlu","doi":"10.14744/tjtes.2026.94145","DOIUrl":"https://doi.org/10.14744/tjtes.2026.94145","url":null,"abstract":"<p><strong>Background: </strong>Eid al-Adha is an important religious holidays celebrated annually in Muslim communities, during which the ritual of animal sacrifice is performed. The demand for butchery services rises significantly during this period; however, due to the limited availability of professional butchers, many individuals undertake the slaughter themselves. This practice is associated with an increased incidence of traumatic injuries, particularly involving the hands and upper extremities. This study aims to characterize the pattern of hand and upper limb injuries associated with non-professional animal slaughter during Eid al-Adha and to raise awareness of these preventable traumas.</p><p><strong>Methods: </strong>In this retrospective study, we evaluated patients who presented to our clinic with hand injuries requiring surgical intervention during multiple Eid al-Adha periods. The study population primarily consisted of individuals injured during animal slaughter who were admitted to the hospital for hand or upper extremity trauma. Demographic data and injury types were evaluated.</p><p><strong>Results: </strong>Over an eight-year period, a total of 259 extensor tendon injuries, 76 flexor tendon injuries, and 275 superficial soft tissue injuries related to Eid al-Adha were surgically treated at our clinic.</p><p><strong>Conclusion: </strong>This study provides a retrospective analysis of hand tendon and superficial tissue injuries observed over eight Eid al-Adha periods. The findings indicate that non-professional slaughter of sacrificial animals poses a significant risk, particularly for hand and tendon injuries. Ensuring that slaughter procedures are performed by trained individuals, along with the use of protective measures, may play an important role in reducing these preventable injuries.</p>","PeriodicalId":94263,"journal":{"name":"Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES","volume":"32 5","pages":"597-601"},"PeriodicalIF":1.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147848453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A different perspective in trauma patients: can pan-immune-inflammation value (PIV) predict mortality?","authors":"Gürkan Güneri, Kevser Dilek Andıç, Funda Çatan Inan, Kadir Çorbacı","doi":"10.14744/tjtes.2026.33746","DOIUrl":"https://doi.org/10.14744/tjtes.2026.33746","url":null,"abstract":"<p><strong>Background: </strong>Trauma is a leading cause of mortality worldwide. Accurate prognostic assessment in emergency departments and intensive care units is essential for effective triage and management. Consequently, various prognostic markers have been explored in trauma populations. The pan-immune-inflammation (PIV) is a biomarker derived from a complete blood count (CBC) and can be rapidly obtained in clinical settings. This study aimed to evaluate the role of PIV in predicting the prognosis of trauma patients.</p><p><strong>Methods: </strong>This study examined patients admitted to a tertiary-level intensive care unit due to trauma at a training and research hospital. Established prognostic parameters, including the Revised Trauma Score (RTS), Glasgow Coma Scale (GCS), and Acute Physi-ology and Chronic Health Evaluation II (APACHE II) scores, were evaluated. PIV values were calculated from laboratory data. Mortality, morbidity, and length of hospital stay were retrospectively analyzed. The predictive value of PIV for mortality was assessed using statistical methods.</p><p><strong>Results: </strong>A total of 74 patients were included. The survivor group comprised seven females (11.5%) and 54 males (88.5%), while the non-survivor group included one female (7.7%) and 12 males (92.3%). PIV, RTS, GCS, and APACHE II scores were effective in predicting mortality (p<0.001). The cut-off value for PIV was 6367.5; patients with PIV values below this threshold had a higher risk of mortality compared to those with higher values.</p><p><strong>Conclusion: </strong>Rapid and reliable prognostication is essential in emergency settings. PIV demonstrates predictive performance comparable to established prognostic scoring systems. Early assessment of PIV in trauma patients may support more effective triage and treatment planning.</p>","PeriodicalId":94263,"journal":{"name":"Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES","volume":"32 5","pages":"558-566"},"PeriodicalIF":1.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147848470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative ileus as a surgical challenge: comparative outcomes of end-to-end and side-to-side ileal anastomosis in radical cystectomy.","authors":"Fatih Sandıkçı, Muhammed Yusuf Aydın, Ahmet Emin Doğan, Alper Yavuz, Ahmet Oğuz Hasdemir, Muhammed Abdurrahim İmamoğlu","doi":"10.14744/tjtes.2026.79776","DOIUrl":"https://doi.org/10.14744/tjtes.2026.79776","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to compare the incidence of postoperative ileus (POI) between end-to-end hand-sewn and side-to-side stapled ileo-ileal anastomoses and to identify independent risk factors associated with POI.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of patients who underwent radical cystectomy with urinary diversion at Ankara Etlik City Hospital between October 2022 and October 2024. Patients were categorized according to the anastomosis technique used: end-to-end hand-sewn or side-to-side stapled. Perioperative data, including demographic characteristics, comorbidities, preoperative laboratory parameters, operative variables, and postoperative outcomes, were collected. POI was defined as intolerance to oral intake accompanied by abdominal distension and absence of flatus or stool beyond postoperative day five, requiring medical or surgical management. Univariable and multivariable logistic regression analyses were performed to identify risk factors for POI.</p><p><strong>Results: </strong>A total of 71 patients were included in the analysis. POI occurred in nine patients (23.7%) in the hand-sewn group and in four patients (12.1%) in the stapled group, indicating a significantly lower incidence in the stapled group. Multivariable analysis identified side-to-side stapled anastomosis as an independent protective factor against POI. Additional independent predictors included age ≥65 years, abnormal body mass index (BMI), preoperative constipation, hypoalbuminemia, and prolonged operative time. Receiver operat-ing characteristic (ROC) curve analysis demonstrated good predictive performance of the model.</p><p><strong>Conclusion: </strong>Side-to-side stapled ileo-ileal anastomosis is associated with a lower risk of POI compared to end-to-end hand-sewn anastomosis in patients undergoing radical cystectomy with urinary diversion.</p>","PeriodicalId":94263,"journal":{"name":"Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES","volume":"32 5","pages":"544-551"},"PeriodicalIF":1.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147848483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing and validating the Earthquake-Related Crush Syndrome Knowledge Scale using tetrachoric and Rasch analyses.","authors":"Derya Suluhan, Ecem Koyun, Dilek Yıldız, Emrah Şenel","doi":"10.14744/tjtes.2025.37646","DOIUrl":"https://doi.org/10.14744/tjtes.2025.37646","url":null,"abstract":"<p><strong>Background: </strong>A substantial proportion of earthquake-related fatalities result from severe trauma at the time of the event and entrapment under debris. Prolonged compression significantly increases the risk of developing crush syndrome, which is considered a critical determinant of mortality and morbidity. This study aimed to develop and evaluate a scale designed to assess pediatric surgical nurses' knowledge of earthquake-related crush syndrome.</p><p><strong>Methods: </strong>This methodological study was conducted between August and September 2023. The sample consisted of 77 pediatric surgical nurses working in pediatric surgery units of a city hospital who voluntarily participated in the study. Data were collected using a data collection form and a draft 30-item version of the scale. Content and construct validity were assessed to validate the instrument. Tetrachoric factor analysis was used to examine construct validity. Reliability was evaluated using the Kuder-Richardson Formula 20 coefficient and the person reliability coefficient. Rasch analysis was performed to assess item difficulty and discrimination.</p><p><strong>Results: </strong>The Content Validity Index for the Earthquake-Related Crush Syndrome Knowledge Scale was 0.99. Tetrachoric factor analysis revealed two subdimensions comprising nine items. Goodness-of-fit indices for the confirmatory two-factor model indicated an acceptable to excellent fit. The Kuder-Richardson Formula 20 reliability coefficients were 0.90 for Factor 1 and 0.88 for Factor 2. According to Rasch analysis, the scale demonstrated a two-subdimension structure comprising seven items, with factor loadings ranging from 0.59 to 0.90; the factors were interrelated. In the Rasch model, the person reliability coefficient was 0.433, indicating low reliability. The mean absolute deviation of Q3 residual correlations (MADaQ3), used to assess model fit, was 0.116, while the information-weighted fit (infit) and outlier-sensitive fit (outfit) statistics were within the acceptable range (0.5-1.5).</p><p><strong>Conclusion: </strong>Preliminary findings suggest that the scale demonstrates acceptable validity and reliability for assessing pediatric surgical nurses' knowledge of earthquake-related crush syndrome.</p>","PeriodicalId":94263,"journal":{"name":"Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES","volume":"32 5","pages":"535-543"},"PeriodicalIF":1.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147848536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Short- and long-term outcomes of surgical techniques in gastrointestinal bezoar management].","authors":"Hüseyin Kocaaslan, Sertaç Usta, Cengiz Ceylan, Mehmet Onur Gül, Zeynep Kocaaslan, Fatih Sumer","doi":"10.14744/tjtes.2026.29130","DOIUrl":"https://doi.org/10.14744/tjtes.2026.29130","url":null,"abstract":"<p><strong>Background: </strong>Bezoars are masses formed by the accumulation of indigestible food or foreign materials within the gastrointestinal (GI) tract. This study aimed to compare the outcomes of fragmentation and milking (FM) versus enterotomy in patients with bezoarinduced GI obstruction and to evaluate these findings in the context of the literature.</p><p><strong>Methods: </strong>This retrospective study analyzed data from 44 patients who underwent surgery for mechanical intestinal obstruction between 2009 and 2021 at our institution, in whom bezoars were identified as the etiological factor during the perioperative period. Demographic characteristics, comorbidities, history of previous abdominal surgery, localization of the bezoar, postoperative complications, and follow-up outcomes were evaluated. Patients with bezoars were divided into two groups: those who underwent FM and those who underwent enterotomy. Categorical variables were analyzed using the chi-square tests and are presented as frequencies and percentages. A p value <0.05 was considered statistically significant.</p><p><strong>Results: </strong>Of the patients, 25 (54.3%) were male, and the median age was 65 years (range: 56-73). Thirty patients (65.2%) underwent FM, and 16 patients (34.8%) underwent enterotomy. Severe complications (Clavien-Dindo grade IIIb-V) were observed in the enterotomy group, whereas no such complications occurred in the FM group (p=0.034). Additionally, postoperative bridal intestinal obstruction developed in six patients (37.5%) in the enterotomy group after discharge (p=0.025).</p><p><strong>Conclusion: </strong>Fragmentation and milking appears to be the preferred first-line surgical approach in patients undergoing emergency surgery for bezoar-induced gastrointestinal obstruction, as it is less invasive and associated with reduced postoperative morbidity. Furthermore, FM may decrease the risk of postoperative obstruction compared with the enterotomy technique.</p>","PeriodicalId":94263,"journal":{"name":"Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES","volume":"32 5","pages":"582-587"},"PeriodicalIF":1.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147848443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasonographic evaluation of tendon injuries in hand trauma: a crucial tool for emergency care.","authors":"Güner Yurtsever, Hüseyin Acar, Ejder Saylav Bora, Cüneyt Arıkan","doi":"10.14744/tjtes.2025.20351","DOIUrl":"https://doi.org/10.14744/tjtes.2025.20351","url":null,"abstract":"<p><strong>Background: </strong>Hand injuries, particularly tendon injuries, are a common reason for emergency department visits and may significantly impact daily functioning. Traditional diagnostic approaches may fail to detect partial tendon injuries, highlighting the need for alternative imaging techniques. Ultrasonography (USG) has emerged as a rapid, non-invasive, and effective diagnostic tool for tendon injuries, particularly in emergency settings where magnetic resonance imaging (MRI) may not be readily available. This study evaluates the diagnostic effectiveness of ultrasonography in assessing tendon injuries among patients presenting with hand trauma in the emergency department (ED). Ultrasonography findings were compared with clinical evaluations to determine its role in diagnosing tendon injuries and guiding surgical management. This prospective observational study was conducted in the ED of a single tertiary-care hospital over a one-year period and included adult patients presenting with hand injuries.</p><p><strong>Methods: </strong>Patients who met the inclusion criteria underwent both clinical evaluation and ultrasonographic examination. A total of 68 patients were included in the study. All assessments were performed by an experienced emergency medicine physician using a Philips Affinity S70 ultrasonography system (Philips Healthcare, Bothell, WA, USA). Collected data included patient demographics, injury characteristics, ultrasonographic findings, and the need for surgical intervention. Statistical analyses were performed using the chi-square test and binary logistic regression to compare the diagnostic performance of the two methods.</p><p><strong>Results: </strong>Ultrasonography demonstrated a sensitivity of 82.6% (95% confidence interval [CI]: 0.69-0.91), specificity of 90.9% (95% CI: 0.70-0.98), and an overall accuracy of 85.3% (95% CI: 0.75-0.92) in predicting the need for tendon repair. Clinical evaluation showed slightly lower diagnostic performance, with a sensitivity of 80.4% (95% CI: 0.67-0.89) and an accuracy of 80.9% (95% CI: 0.70-0.89).</p><p><strong>Conclusion: </strong>Regression analysis indicated that ultrasonography increased the likelihood of accurately diagnosing tendon injuries by 21.8 times compared to clinical assessment. Together, clinical evaluation and ultrasonography predicted 61% of all cases requiring tendon repair.</p>","PeriodicalId":94263,"journal":{"name":"Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES","volume":"32 5","pages":"567-573"},"PeriodicalIF":1.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147848226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sequential use of erector spinae plane block and thoracic epidural analgesia as multimodal regional analgesia in bilateral rib fractures: a case report.","authors":"Engin Ertürk, Merve Ölmez, Ferah Sarıca, Ali Akdoğan, Kubra Nur Kılıç","doi":"10.14744/tjtes.2026.47646","DOIUrl":"https://doi.org/10.14744/tjtes.2026.47646","url":null,"abstract":"<p><p>Effective pain management is a cornerstone in the treatment of patients with multiple rib fractures, as inadequate analgesia can impair ventilation and increase the risk of pulmonary complications. Bilateral rib fractures, in particular, can significantly compromise respira-tory mechanics, leading to hypoventilation, atelectasis, and hypoxemia. Regional analgesic techniques play a crucial role in improving respiratory function while reducing reliance on opioids and their associated adverse effects. We report the case of a patient with multiple bilateral rib fractures following thoracic trauma who presented with severe pain and compromised respiratory function. Initial management with systemic analgesic proved inadequate. Multimodal regional analgesia was therefore initiated with a bilateral erector spinae plane block, resulting in rapid pain relief and improved oxygenation. Given the limited duration of analgesia provided by a single-shot erector spinae plane block, thoracic epidural analgesia was subsequently established via epidural catheter. Continuous low-dose epidural local anesthetic infusion ensured sustained analgesia, prevented pain recurrence, and supported ongoing improvement in respiratory function throughout the clinical course. This case highlights that a multimodal regional analgesic approach, combining an erector spinae plane block followed by thoracic epidural analgesia, may represent an effective and feasible strategy for optimizing pain control and respiratory outcomes in patients with bilateral rib fractures. Such an approach may also reduce the need for systemic opioid therapy while optimizing clinical outcomes and minimizing associated risks.</p>","PeriodicalId":94263,"journal":{"name":"Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES","volume":"32 5","pages":"623-627"},"PeriodicalIF":1.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147848473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}