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

{"title":"The impact of receiving hospitals on the management and outcomes of injured patients in traffic accidents causing mass casualty incidents.","authors":"Neslihan Suzer, Gulbin Aydoğdu Umaç, Sarper Yilmaz","doi":"10.14744/tjtes.2025.04643","DOIUrl":"10.14744/tjtes.2025.04643","url":null,"abstract":"<p><strong>Background: </strong>The medical management of mass casualty incidents (MCIs) requires the strategic application of triage methods from the prehospital phase to patient discharge, ensuring the simultaneous and effective treatment of multiple injured individuals. This study aims to examine the transport processes of trauma patients to tertiary hospitals following traffic accidents that result in MCIs, and to evaluate the impact of these processes on patient outcomes.</p><p><strong>Methods: </strong>This retrospective study investigates the prehospital, inter-hospital transfer, and in-hospital processes of trauma patients injured in traffic accidents causing MCIs over a five-year period within a single province. A comprehensive analysis was conducted from multiple perspectives. A supervised artificial neural network model was employed to predict patient mortality, selected for its ability to identify complex, non-linear patterns in high-dimensional clinical data.</p><p><strong>Results: </strong>A total of 606 patients were included in the study. Of these, 212 (35.0%) underwent secondary transfer to a tertiary hospital, while 394 (65.0%) were directly admitted to a tertiary hospital following traffic accidents causing MCIs. The secondary transfer group experienced longer prehospital times (106.0 vs. 74.7 minutes, p<0.001) and received fewer correct triage decisions (75.0% vs. 92.4%, p<0.001). They also had higher rates of blood transfusion (60.8% vs. 38.8%, p<0.001), vasopressor use (43.9% vs. 22.1%, p<0.001), massive transfusion (36.8% vs. 19.0%, p<0.001), and mechanical ventilation (62.3% vs. 39.8%, p<0.001). In-hospital mortality was higher in the secondary transfer group (20.3%) compared to the direct admission group (8.1%), with an unadjusted odds ratio (OR) of 0.348 (95% confidence interval [CI]: 0.205-0.585, p<0.001). The trained neural network model demonstrated excellent predictive performance for mortality (Training area under the curve [AUC]: 0.947; 95% CI: 0.928-0.966, Testing AUC: 0.841; 95% CI: 0.782-0.899). A stratified analysis examining the impact of correct vs. incorrect triage decisions on mortality revealed that among correctly triaged patients, mortality was significantly higher in the secondary transfer group (22.6%) compared to direct tertiary admission (8.0%), with an OR of 3.38 (95% CI: 1.99-5.78, p<0.001). Overall, patients who underwent secondary transfer had a higher mortality risk compared to direct admissions (OR: 2.35; 95% CI: 1.12-5.10, p=0.0265). A direct comparison between all correctly and incorrectly triaged patients showed that correct triage significantly reduced mortality risk (OR: 4.19; 95% CI: 2.15-8.48, p<0.001).</p><p><strong>Conclusion: </strong>In the management of trauma patients following traffic accidents causing MCIs, transferring patients to hospitals that lack adequate trauma care increases mortality. Secondary transport negatively affects hemodynamic stability and leads to a greater need","PeriodicalId":94263,"journal":{"name":"Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES","volume":"31 7","pages":"627-635"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12256962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-traumatic visual sequelae from a forensic medicine perspective: A retrospective analysis of 10 years of data.","authors":"Çağdaş Savaş, Nazlıcan Aras, Tayfun Yeşilbalkan, İsmail Özgür Can","doi":"10.14744/tjtes.2025.54778","DOIUrl":"10.14744/tjtes.2025.54778","url":null,"abstract":"<p><strong>Background: </strong>Vision is one of the most fundamental functions required for a quality life. In this context, eye trauma is frequently subject to medico-legal evaluation to determine both the severity of the injury and the presence of any sequelae, and, if present, the extent of visual function loss. This study examines the medico-legal assessment process following ocular trauma. The aim is to reduce potential confusion by providing explanations that offer standardization and guidance in forensic assessments.</p><p><strong>Methods: </strong>Between January 1, 2014 and January 1, 2024, the files and reports of 210 cases (210 eyes) were retrospectively analyzed. These cases involved forensic medico-legal assessments conducted by the Department of Forensic Medicine, Dokuz Eylul University Faculty of Medicine, focusing on the severity of the injury and the presence of visual function impairment or loss following eye trauma in the context of criminal proceedings. Sociodemographic data, type and cause of trauma, initial diagnosis, classification of injury according to the Birmingham Eye Trauma Terminology System (BETTS), anatomical site of injury, injury severity, and whether visual function impairment or loss had occurred were evaluated. Statistical analysis was performed using the IBM SPSS 29.0 software package.</p><p><strong>Results: </strong>Of the 210 patients, 171 (81.4%) were male and 39 (18.6%) were female. Ocular trauma was most frequently observed in the 19-30 age group (n=62, 29.5%). There were 157 (74.8%) closed globe injuries and 53 (25.2%) open globe injuries. Subconjunctival hemorrhage (n=132, 62.9%) was the most common finding at the initial ophthalmological examination following trauma. An injury outside Zone 1 was identified as the strongest negative prognostic factor for visual impairment or loss.</p><p><strong>Conclusion: </strong>From a forensic medicine perspective, eye trauma alone is not considered a life-threatening condition. However, a multidisciplinary approach, including forensic medicine specialists and ophthalmologists, should be adopted in the assessment of visual sequelae, that is, the impairment or loss of visual function, following eye trauma related to criminal proceedings. First, it must be determined whether the healing process is complete and whether there is a causal link between the trauma and vision loss. Once healing is complete, the visual function of each eye should be assessed individually. The assessment method should be chosen based on whether visual acuity loss, visual field defects, or any other diagnoses are present in one eye alone or in both eyes.</p>","PeriodicalId":94263,"journal":{"name":"Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES","volume":"31 7","pages":"682-690"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12256963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Splenic lacerations: a retrospective analysis of management strategies and clinical outcomes.","authors":"Gürkan Değirmencioğlu, Deniz Kütük, Mehmet Hanifi Çanakcı, Muhammed Salih Süer, Ahmet Yiğit Kalelioğlu, Birkan Birben, Mustafa Özsoy","doi":"10.14744/tjtes.2025.74616","DOIUrl":"10.14744/tjtes.2025.74616","url":null,"abstract":"<p><strong>Background: </strong>Splenic injuries are among the most frequently encountered conditions in abdominal trauma. In such cases, the treatment approach must be carefully determined based on the patient's hemodynamic stability, the severity of the injury, and the presence of associated intra-abdominal pathologies, typically requiring a choice between non-operative management (NOM) and surgical intervention. The decision-making process is primarily guided by hemodynamic status, injury grade, and imaging findings. This study evaluates clinical outcomes and the factors influencing treatment decisions in patients with splenic rupture who were referred from the emergency department to the general surgery unit.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on 42 patients diagnosed with splenic injury between June 2023 and February 2025. Patients were divided into two groups: those who received NOM (n=29, 69.0%) and those who underwent operative management (OM) (n=13, 31.0%). Demographics, mechanisms of injury, hemodynamic status, laboratory results, imaging findings, transfusion requirements, length of hospital stay, and mortality rates were analyzed. Statistical comparisons were made using appropriate tests, with significance set at p<0.05.</p><p><strong>Results: </strong>The mean age of patients was 38.3±19.4 years, with 76.2% being male. The leading cause of injury was vehicular accidents (47.6%), followed by falls (21.4%) and penetrating trauma (11.9%). Operative management was more common in sharp object penetrating injuries (SOPI) (15.4%) and gunshot wounds (7.7%). Hemodynamic instability was more frequent in the OM group compared to the NOM group (30.8% vs. 10.3%, p=0.149). Splenectomy was performed in 76.9% of surgical cases (p=0.003). Computed tomography (CT) imaging revealed that Grade 1 injuries (55.2%) were predominant in the NOM group, while Grade 2 injuries (38.5%) were more common in the OM group (p=0.531). The OM group required more blood transfusions (2.6±3.0 units vs. 0.9±1.9 units, p=0.053) and had longer hospital stays (10.3±6.9 days vs. 5.7±4.9 days, p=0.042). Overall mortality was low (9.5%), with no significant difference between the groups (p=0.819).</p><p><strong>Conclusion: </strong>Non-operative management is the preferred approach for hemodynamically stable patients, offering favorable outcomes and shorter hospital stays. However, penetrating trauma and hemodynamic instability are strong predictors for surgical intervention. Early risk stratification and close clinical monitoring are essential in determining the most appropriate treatment strategy for splenic injuries.</p>","PeriodicalId":94263,"journal":{"name":"Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES","volume":"31 7","pages":"644-650"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12256966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A randomized prospective clinical study comparing wide-awake local anesthesia no tourniquet (WALANT) and spinal anesthesia in the surgical treatment of ankle fractures.","authors":"Taha Kızılkurt, Mustafa Ozkaya, Berk Nimetoglu, Muhammed Oguzhan Albayrak, Mehmet Demirel, Nur Canbolat, Halil İbrahim Balcı","doi":"10.14744/tjtes.2025.82593","DOIUrl":"10.14744/tjtes.2025.82593","url":null,"abstract":"<p><strong>Background: </strong>Ankle fractures are common injuries that often require surgical intervention to restore proper alignment and stability. Traditional anesthesia methods, such as general and spinal anesthesia, may not be suitable for patients with significant comorbidities. The wide-awake local anesthesia no tourniquet (WALANT) technique has emerged as a viable alternative, particularly for patients with cardiovascular or pulmonary conditions. This study aimed to compare the clinical outcomes of WALANT and spinal anesthesia in the surgical treatment of ankle fractures.</p><p><strong>Methods: </strong>This prospective, randomized study included patients with bimalleolar fractures who underwent surgery between June 2022 and November 2023. Patients were randomly assigned to one of two groups: the WALANT group (n=16) or the spinal anesthesia group (n=19). Preoperative demographic data, intraoperative parameters (including surgical time), and postoperative outcomes, such as pain scores assessed using the Visual Analogue Scale (VAS), patient-controlled analgesia (PCA) morphine consumption, and American Orthopaedic Foot and Ankle Society (AOFAS) scores at 12 months postoperatively, were evaluated.</p><p><strong>Results: </strong>Both groups had similar demographic characteristics (p>0.05). There was no significant difference in operating room time between the groups (WALANT: 180.47 minutes vs. Spinal: 190.94 minutes, p=0.30). Postoperative pain, assessed using VAS scores at 12 and 24 hours, did not significantly differ between groups. Morphine consumption via PCA was also similar (WALANT: 19.57 mg vs. Spinal: 22.8 mg, p=0.291). At the 12-month follow-up, AOFAS scores were similar between groups (WALANT: 80 vs. Spinal: 83.1, p=0.388). However, preoperative anxiety levels were higher in the WALANT group (p=0.001).</p><p><strong>Conclusion: </strong>The WALANT technique provides comparable postoperative pain control and functional outcomes to spinal anesthesia in ankle fracture surgery. Although preoperative anxiety was higher in the WALANT group, no significant differences were observed in postoperative pain or long-term recovery. WALANT represents a feasible and cost-effective alternative to traditional methods, especially in settings with limited access to anesthesiologists, such as during natural disasters or pandemics. It may be particularly advantageous for patients with cardiovascular or pulmonary comorbidities, helping to avoid the risks associated with systemic anesthesia.</p>","PeriodicalId":94263,"journal":{"name":"Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES","volume":"31 6","pages":"570-576"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12183486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical outcomes and management strategies in intraperitoneal rupture of hydatid cysts: A retrospective analysis.","authors":"Bilal Turan, Nurullah Bilen, Emre Teke, Serdar Acar, İsa Karaca, Sibel Yaman","doi":"10.14744/tjtes.2025.15691","DOIUrl":"10.14744/tjtes.2025.15691","url":null,"abstract":"<p><strong>Background: </strong>Hydatid cyst disease, a parasitic infection caused by Echinococcus species, primarily affects the liver and lungs, with potential for spontaneous or traumatic rupture into the peritoneal cavity. Although hydatid cyst perforation is rare, it necessitates urgent surgical intervention to prevent severe complications such as anaphylaxis, bile leakage, and secondary infection.</p><p><strong>Methods: </strong>This retrospective study analyzed 13 patients with hydatid cyst perforation who were treated in a general surgery clinic between 2017 and 2022. Data regarding clinical presentation, diagnostic methods, surgical approaches, postoperative outcomes, and follow-up were reviewed. All patients underwent emergency surgery involving cyst evacuation, peritoneal lavage with scolicidal agents, and postoperative albendazole therapy.</p><p><strong>Results: </strong>The cohort included eight male and five female patients, with a mean age of 33 years. Spontaneous perforation occurred in 12 cases, and one case was due to trauma. The liver was the most commonly affected organ (92.3%). Surgical interventions consisted of partial cystectomy with omentopexy in 12 patients. The recurrence rate was 8%. Postoperative complications were minimal, including two bile fistulas that resolved spontaneously and one case of wound infection. The average hospital stay was 9.2 days, and the mean follow-up duration was 18.8 months. One patient with cirrhosis died due to complications from portal hypertension.</p><p><strong>Conclusion: </strong>Hydatid cyst rupture is a rare but potentially life-threatening condition, particularly in endemic regions. Prompt surgical intervention, combined with postoperative albendazole therapy, is essential to reduce morbidity, mortality, and recurrence. Lifelong monitoring is recommended for patients with intraperitoneal perforations to manage potential complications of hydatidosis.</p>","PeriodicalId":94263,"journal":{"name":"Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES","volume":"31 6","pages":"562-569"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12183473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of acute traumatic coagulopathy in pediatric trauma patients.","authors":"Yavuz Selim Ayhan, Ali Korulmaz, Ali Ertuğ Arslankoylu","doi":"10.14744/tjtes.2025.28787","DOIUrl":"10.14744/tjtes.2025.28787","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate acute traumatic coagulopathy in pediatric trauma patients and to assess the effectiveness of coagulopathy-related findings in predicting prognosis.</p><p><strong>Methods: </strong>Patients aged between one month and 18 years who were admitted to our hospital due to trauma between October 2016 and January 2021 were included in the study. Demographic data, type of trauma, presence of acute bleeding, history of blood product transfusion, coagulation and hemogram parameters, as well as Glasgow Coma Scale (GCS), Injury Severity Score (ISS), Pediatric Trauma Score (PTS), Pediatric Index of Mortality 2 (PIM2), and Pediatric Logistic Organ Dysfunction (PELOD) scores were recorded. The relationship of each variable with acute traumatic coagulopathy (ATC) was statistically analyzed.</p><p><strong>Results: </strong>A total of 282 patients, including 196 males and 86 females, were included in the study. The most common injury mechanism was motor vehicle accidents (47.5%), and the most frequent type of injury was head trauma (41.8%). Acute traumatic coagulopathy was detected in 141 patients (66.8%). There were statistically significant differences between the groups with and without acute traumatic coagulopathy in terms of admission body temperature, blood product transfusion, length of stay in the pediatric intensive care unit, GCS, PTS, ISS, PIM2, and PELOD scores (p<0.05). Additionally, creatinine, aspartate aminotransferase (AST), alanine aminotransferase (ALT), pH, and HCO3 levels in blood gas analyses were significantly different between the groups (p<0.05). However, systolic and diastolic blood pressure, heart rate, urea, platelet count, and lactate levels showed no statistically significant differences between the groups (p>0.05). The mortality rate and frequency of blood product transfusion were found to be statistically significantly higher in the group with acute traumatic coagulopathy (p<0.05) Exitus was observed in 14 (19.4%) transfused patients, while no deaths were recorded among non-transfused patients.</p><p><strong>Conclusion: </strong>Trauma patients admitted to pediatric intensive care units should be closely monitored due to the risk of developing coagulopathy. The international normalized ratio (INR) can be used independently to predict the prognosis of these patients. Mortality rates are higher in patients who receive transfusions.</p>","PeriodicalId":94263,"journal":{"name":"Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES","volume":"31 6","pages":"548-555"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12183477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of rose oil on liver damage in an experimental model of obstructive jaundice.","authors":"Serdar Acar, Recep Cetin, Ismail Zihni, Ozlem Ozmen, Mehmet Zafer Sabuncuoglu, Isa Sozen, Girayhan Celik, Isa Karaca, Ece Ozkan Acar, Ceren Yaman","doi":"10.14744/tjtes.2025.96613","DOIUrl":"10.14744/tjtes.2025.96613","url":null,"abstract":"<p><strong>Background: </strong>This study investigates the effects of Turkish rose oil (Rosa damascena) on liver damage in rats with experimentally induced obstructive jaundice.</p><p><strong>Methods: </strong>A total of 40 Wistar-Albino rats were divided into three groups: Sham (control), Obstructive Jaundice (OJ), and Rose Oil treatment (RO). Obstructive jaundice was induced by bile duct ligation in the OJ and RO groups. The RO group received 100 mg/kg of oral Turkish rose oil daily for seven days.</p><p><strong>Results: </strong>Biochemical analysis showed significantly elevated levels of liver and biliary injury markers, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT), in the OJ group. These markers were significantly reduced in the RO group. Additionally, oxidative stress markers such as malondialdehyde (MDA) and myeloperoxidase (MPO) were lower in the RO group compared to the OJ group. Although levels of antioxidant enzymes, including glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD), were higher in the RO group, the differences were not statistically significant. Interestingly, C-reactive protein (CRP) levels were unexpectedly higher in the RO group than in the OJ group, possibly due to the study duration or dosing protocol. Histopathological examination revealed significant portal inflammation, bile duct proliferation, polymorphonuclear leukocyte (PMNL) infiltration, necrosis, and fibrosis in the OJ group. Conversely, the RO group showed substantial reductions in these pathological features, including milder bile duct proliferation and necrosis (p<0.001). Additionally, connective tissue expansion and collagen deposition were significantly lower in the RO group compared to the OJ group.</p><p><strong>Conclusion: </strong>The anti-inflammatory and hepatoprotective effects of Turkish rose oil, previously reported in the literature, were demonstrated in this study for the first time through oral administration. The findings highlight its potential in mitigating acute liver damage caused by obstructive jaundice. However, some unexpected biochemical results (e.g., elevated CRP and MDA levels) may be attributed to the short study duration, limited sample size, and lack of dose variation. Overall, Turkish rose oil emerges as a promising natural agent with significant hepatoprotective and anti-inflammatory properties. These results suggest that it may serve as a potential therapeutic option for liver damage associated with obstructive jaundice. Further studies are warranted to investigate varying dosages, longer treatment durations, and larger sample sizes to better understand its therapeutic potential.</p>","PeriodicalId":94263,"journal":{"name":"Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES","volume":"31 6","pages":"495-504"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12183484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rotational problems and clinical reflections after locked intramedullary nailing in diaphyseal femur fractures: A minimum follow-up of 5 years.","authors":"Onur Süer, Anıl Murat Ozturk, Ipek Tamsel, Kemal Aktuglu","doi":"10.14744/tjtes.2025.69886","DOIUrl":"10.14744/tjtes.2025.69886","url":null,"abstract":"<p><strong>Background: </strong>Rotational malalignment following intramedullary nailing (IMN) of femoral shaft fractures remains a clinically significant concern, with previous studies reporting variable incidence rates and inconsistent risk factors. This study aimed to determine the incidence of rotational malalignment after closed static-locked intramedullary nailing for adult diaphyseal femoral fractures, identify contributing etiological factors, and evaluate its clinical impact on functional capacity and quality-of-life metrics.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted involving 54 adults treated with closed static-locked IMN for diaphyseal femur fractures between 2014 and 2019. Rotational alignment was assessed using computed tomography (CT)-measured femoral anteversion (FAV) differences, with a threshold of ≥15° defined as malalignment. Multivariate logistic regression was employed to examine associations with fracture pattern, nail entry site, surgical timing (day vs. night), and coronal alignment. Functional outcomes were assessed using the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) knee, Harris hip, Lower Extremity Functional Scale, and Kujala patellofemoral scores. Receiver operating characteristic (ROC) analysis was used to determine optimal FAV thresholds.</p><p><strong>Results: </strong>Rotational malalignment (≥15° FAV difference) was observed in 33.3% of cases, with 94.4% involving internal rotation. Multivariate analysis identified no independent predictors among the following factors: fracture location (proximal 44.4% vs. middle 29.2%, p=0.625), AO classification (Type A 34.3% vs. Type C 33.3%, p=0.914), nail entry site (lateral trochanteric 40% vs. piriformis 16.6%, *p*=0.574), and surgical timing (night 26.1% vs. day 38.7%, p=0.228). Patients with malalignment demonstrated significantly poorer functional outcomes, as evidenced by higher WOMAC knee scores (12.7+-4.8 vs. 6.4+-4.8, p<0.001). ROC curve analysis identified 13.5° as the optimal FAV threshold (area under the curve, AUC: 0.78), although the 15° cutoff maintained strong clinical utility with a specificity of 83%.</p><p><strong>Conclusion: </strong>Rotational malalignment following IMN occurs in one-third of cases and has a significant negative impact on functional outcomes. However, it appears to be independent of commonly considered surgical variables such as entry site and timing. These findings support technical flexibility in IMN procedures while highlighting the need for improved intraoperative techniques to assess rotational alignment.</p>","PeriodicalId":94263,"journal":{"name":"Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES","volume":"31 6","pages":"577-586"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12183481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of chrysin on ischemia-reperfusion injury in the rat epigastric artery skin island flap.","authors":"Simay Ersahin, Nesrin Tan Baser, Narin Karagoz, Gulcin Simsek","doi":"10.14744/tjtes.2025.87041","DOIUrl":"10.14744/tjtes.2025.87041","url":null,"abstract":"<p><strong>Background: </strong>The return of oxygenated blood by reperfusion after ischemia triggers paradoxical tissue damage known as ischemia-reperfusion (I/R) injury. This study aims to investigate the effect of chrysin (C) on I/R injury in epigastric island flaps in rats.</p><p><strong>Methods: </strong>Thirty male Wistar albino rats were randomly divided into five groups (n=6): the sham control group (Group I), the flap I/R-untreated group (Group II), the I/R + C 10 mg/kg/day group (Group III), the I/R + C 50 mg/kg/day group (Group IV), and the I/R + C 100 mg/kg/day (Group V). Chrysin was administered orally for seven days before and after surgery. Flap elevation was performed on the eighth day, followed by eight hours of induced ischemia. Flap survival rate, as well as biochemical and histopathological parameters, were evaluated.</p><p><strong>Results: </strong>Oral administration of chrysin significantly reduced fibroblast activity at all treatment doses in rats subjected to I/R injury. Although improvements were observed in flap survival rate, oxidative stress index (OSI), and vascular proliferation at 10 mg/kg/day and 50 mg/kg/day doses, as well as in total oxidant status (TOS), tumor necrosis factor-alpha (TNF-α), active inflammation, chronic inflammation and ulceration across all treatment doses, these changes did not reach statistical significance. Total antioxidant capacity (TAC) values, consistent with existing literature, did not appear to influence the positive outcomes.</p><p><strong>Conclusion: </strong>This study examined the effects of chrysin treatment on ischemia-reperfusion injury using a rat inferior epigastric artery skin island flap model. Although favorable molecular changes were observed, these did not translate into significant improvements in clinical outcomes.</p>","PeriodicalId":94263,"journal":{"name":"Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES","volume":"31 6","pages":"505-515"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12183476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of Achilles tendon thickness and Kager's fat pad thickness on clinical and functional outcomes following open surgical repair of acute Achilles tendon rupture.","authors":"Bilge Kagan Yılmaz, Caglar Tuna Issı, Murat Yesıl, Furkan Kaya, Ozal Ozcan","doi":"10.14744/tjtes.2025.92998","DOIUrl":"10.14744/tjtes.2025.92998","url":null,"abstract":"<p><strong>Background: </strong>Acute Achilles tendon ruptures (ATR) are among the most common sports-related injuries. The aim of this study was to evaluate the correlation between Achilles tendon (AT) and Kager's fat pad (KFP) thickness with clinical and functional outcomes, measured using the Achilles Tendon Rupture Score (ATRS) and the Foot and Ankle Outcome Score (FAOS), in patients treated with open surgical repair for acute ATR.</p><p><strong>Methods: </strong>This retrospective study included 42 patients who underwent surgery for ATR at our institution between January 2017 and December 2021. All patients were treated using the open surgical Krackow suture technique. ATRS, FAOS, and Visual Analogue Scale (VAS) scores were recorded one year postoperatively. AT and KFP thicknesses were measured via ultrasonography by an independent radiologist at one-year follow-up.</p><p><strong>Results: </strong>The mean age of the patients was 45.38+-9.68 years, with 22 male patients (52.4%). The mean ATRS was 65.17+-24.46, the mean FAOS was 76.14+-16.75, and the mean VAS score was 3.02+-1.44. The mean AT thickness on the operated side was 15.54+-2.89 mm, compared to 14.58+-2.28 mm on the contralateral side (p=0.009). The mean KFP thickness on the operated side was 8.42+-2.99 mm, compared to 6.32+-2.67 mm on the contralateral side (p=0.005). A strong correlation was found between ATRS and FAOS (r=0.742, p<0.001). For AT thickness, there were moderate negative correlations with both ATRS and FAOS (r=-0.544, p=0.013; r=-0.451, p=0.003, respectively). For KFP thickness, a moderate negative correlation was found with ATRS (r=-0.506, p=0.001).</p><p><strong>Conclusion: </strong>AT and KFP thicknesses had no significant direct effect on ATRS and FAOS. However, ATRS and FAOS scores following open surgical repair of acute ATR were correlated with each other and with functional outcomes. Despite its specific complications, open surgical repair of acute ATR is an effective option for patients eligible for surgery.</p>","PeriodicalId":94263,"journal":{"name":"Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES","volume":"31 6","pages":"587-595"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12183480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}