BACKGROUND:The aim of this study was to evaluate the clinical and radiological outcomes of posterior malleolar fractures (PMFs) treated surgically via a posterolateral approach and to investigate the prognostic value of Bartoníček-Rammelt fracture morphology in predicting functional outcome, reduction quality, and osteoarthritis development. METHODS:In this single-center retrospective study, 61 patients with PMFs who were treated surgically via a posterolateral approach between January 2020 and December 2023 and had a minimum follow-up of 24 months were included. Fractures were classified ac-cording to the Bartoníček-Rammelt classification (BRC). Clinical outcomes were assessed using the Olerud-Molander Ankle Score (OMAS), while radiological outcomes were evaluated based on articular step-off and the Kellgren-Lawrence osteoarthritis grade. Multivariable linear regression analysis was performed to identify independent predictors of functional outcome. RESULTS:The mean follow-up duration was 38.2±8.8 months. The mean OMAS was 89.9±10.2. Articular step-off was <1 mm in 82.0% of the patients. OMAS scores differed significantly among the BRC fracture types (p=0.039), with lower scores observed in more complex fracture patterns. In the adjusted multivariable regression model including fracture morphology, articular step-off, osteoar-thritis grade, syndesmotic fixation, and post-operative complications, articular step-off (p<0.001) and osteoarthritis grade (p<0.001) remained independent predictors of OMAS, whereas fracture morphology was not independently associated with functional outcome. CONCLUSION:Bartoníček-Rammelt fracture morphology was associated with functional outcome in unadjusted analyses. How-ever, after adjustment for articular reduction quality, osteoarthritis grade, syndesmotic fixation, and post-operative complications, fracture morphology was not independently associated with OMAS. Articular reduction quality and osteoarthritis grade were the strongest independent determinants of functional outcome, emphasizing the importance of achieving anatomical reduction in PMFs.
BACKGROUND:This study aimed to evaluate the epidemiological characteristics, injury mechanisms, fracture patterns, associated injuries, and early hemoglobin (Hb) changes and physiological response in pediatric patients with pelvic fractures. In addition, clinical and injury-related variables were compared according to skeletal maturity status and treatment modality. METHODS:This retrospective single-center study included 52 consecutive patients younger than 18 years who were treated for pelvic fractures between September 2022 and March 2025. Skeletal maturity was determined based on triradiate cartilage status. Fractures were classified using Torode-Zieg, Young-Burgess, and Letournel-Judet systems. Early physiological response was assessed using serial Hb measurements at admission, 24 h, and 48 h. Comparative analyses were performed according to skeletal maturity and treatment modality. RESULTS:The median age was 14 years, and 55.8% of patients were female. Pelvic ring injuries were observed in 76.9% of patients, and associated injuries were present in 67.3%. Non-operative treatment was performed in 65.4% of patients. Hb levels decreased from 12.3±1.8 g/dL at admission to 11.1±2.0 g/dL at 24 h and 10.5 g/dL at 48 h. No significant differences in Hb decline were observed according to skeletal maturity (p>0.05). Patients who underwent operative treatment had significantly lower Hb levels at 24 and 48 h (p=0.006 and p=0.005, respectively); however, the magnitude of Hb decrease did not differ significantly between treatment groups (p>0.05). CONCLUSION:Pediatric pelvic fractures are uncommon injuries typically associated with high-energy trauma and multiple concomitant injuries. Early Hb decline was modest and did not differ according to skeletal maturity. Lower Hb levels in surgically treated patients may reflect overall injury severity rather than pelvic fracture-related hemorrhage. Careful evaluation of associated injuries and close monitoring of Hb levels are essential in pediatric pelvic trauma.
This case report details a rare and potentially life-threatening injury of an initially overlooked maxillofacial trauma sustained during agricultural activity. A 19-year-old male presented to the emergency department with a headache and fatigue, 2 days following a right malar injury that had been previously sutured without advanced evaluation. A thorough clinical examination was conducted, which revealed the presence of periorbital swelling on both sides, accompanied by a right subconjunctival hemorrhage and chemosis. Radiographic imaging revealed the presence of a substantial, crescent-shaped metallic foreign body with its tip lodged just beneath the anterior skull base, penetrating the sphenoid sinus and lying inferior to the hypophysis. The base of the foreign body extended horizontally into the region adjacent to the middle nasal concha. Multislice computed tomography with angiography revealed its close proximity to critical neurovascular structures, including branches of the maxillary artery. Surgical removal was performed under general anesthesia via an extra-nasal transmaxillary approach, utilizing the trauma incision. Following meticulous dissection, the foreign body was reached and carefully extracted through an executed outward rotation technique. This case emphasizes the vital necessity for thorough clinical evaluation, detailed history-taking, and advanced imaging in the context of facial trauma, where superficially innocuous wounds may harbor latent complications. Primary closure of laceration without full diagnostic clarity risks sealing the patient in danger just millimeters from vital neurovascular structures. A detailed history, systematic examination and proper investigations are needed before primary closure of traumatic facial lacerations.
BACKGROUND:The aim of this study was to evaluate demographic and radiographic factors associated with the likelihood of open reduction in pediatric supracondylar humerus fractures (SCHF). METHODS:A total of 294 pediatric patients with SCHFs treated operatively between 2016 and 2025 were retrospectively reviewed. Patients were divided into two groups: Open reduction (OR, n=128) and closed reduction (CR, n=166). Demographic variables, including age, sex, side of injury, and surgeon experience, were recorded. Radiographic parameters assessed on preoperative anteroposterior and lateral elbow radiographs included fracture type, displacement direction, rotational deformity, diaphyseal involvement, coronal fracture pattern, sagittal fracture pattern, and coronal alignment. Variables with p<0.05 in univariate analysis were included in a multivariable logistic regression model using a backward stepwise method. RESULTS:The mean age was significantly higher in the OR group compared to the CR group (6.94±2.85 vs. 5.58±2.64 years, p<0.001). Flexion-type fractures were more frequent in the OR group (24.2% vs. 10.2%, p=0.012). Posterolateral displacement and rotational deformity were also significantly associated with open reduction. Coronal alignment differed significantly between groups, with varus and valgus malalignment more common in the OR group (p=0.003). Multivariable logistic regression analysis identified increasing age (OR=1.127, 95% confidence interval [CI]: 1.029-1.236; p=0.010), flexion-type fractures (OR=1.807, 95% CI: 1.261-2.590; p=0.001), and posterolateral displacement (OR=1.39, 95% CI: 1.010-1.926; p=0.043) as independent predictors of open reduction. In contrast, neutral coronal alignment was associated with a lower likelihood of open reduction (OR=0.681, 95% CI: 0.510-0.909; p=0.009). CONCLUSION:Several demographic and fracture-related characteristics were independently associated with the likelihood of open reduction in pediatric SCHFs. Among these, fracture-related characteristics, particularly displacement pattern and coronal alignment, showed the strongest associations with open reduction. Recognition of these associated factors may assist preoperative planning and help surgeons anticipate technically challenging reductions.
BACKGROUND:This study aimed to evaluate the demographic and clinical characteristics of adult patients presenting to the emergency department (ED) with clavicle fractures, describe the distribution of concomitant thoracic injuries, and identify factors independently associated with rib fracture and hemothorax/pneumothorax. METHODS:This single-center retrospective observational study included consecutive adult patients presenting to the ED with acute traumatic clavicle fractures between January 1, 2022, and January 1, 2025. Patients were identified through the Hospital Medical Record System using the ICD-10 code S42.0, and 687 of 828 screened ED encounters were included in the final analysis. Demographic characteristics, injury mechanisms, fracture patterns, associated injuries, treatment approaches, and ED outcomes were retrospectively reviewed. Trauma mechanisms were classified as low-energy or high-energy. Multivariable logistic regression analyses were performed to identify factors associated with rib fracture and hemothorax/pneumothorax. RESULTS:Of the 687 patients, 85.2% (n=585) were younger than 65 years. High-energy trauma mechanisms and midshaft fractures were more common in younger patients, whereas low-energy trauma with medial/lateral fractures predominated in older patients (p<0.001). Rib fracture (19.7% vs. 7.6%, p=0.005) and hemothorax/pneumothorax (12.4% vs. 3.3%, p=0.009) were significantly more frequent in male patients. Multivariable analysis revealed that increasing age (adjusted odds ratio [aOR]: 1.02, 95% confidence interval [CI]: 1.01-1.03, p<0.001), male sex (aOR: 3.08, 95% CI: 1.29-7.33, p=0.011), high-energy trauma (aOR: 3.28, 95% CI: 1.89-5.70, p<0.001), and medial (sternal) fracture location (aOR: 2.81, 95% CI: 1.11-7.10, p=0.029) were independently associated with rib frac-ture. For hemothorax/pneumothorax, increasing age (aOR: 1.03, 95% CI: 1.02-1.05, p<0.001) and high-energy trauma (aOR: 8.51, 95% CI: 3.53-20.49, p<0.001) were independently associated. CONCLUSION:Clavicle fractures demonstrated varying clinical and traumatic characteristics across different age and sex groups. Increasing age, male sex, high-energy trauma, and medial clavicle fractures were associated with rib fractures, whereas increasing age and high-energy trauma were associated with hemothorax/pneumothorax. Combined evaluation of trauma mechanism, patient characteristics, and fracture pattern may help identify patients at increased risk for concomitant thoracic injuries in the ED.
BACKGROUND:Vitamin D influences bone mineralization, yet its relationship with distal radius torus fractures in children is uncertain. This study aims to investigate the relationship between serum Vitamin D levels and distal radial torus fracture. METHODS:We compared serum 25-hydroxyvitamin D (25[OH]D) levels between children with radiographically confirmed isolated distal radius torus fractures (n=236) and laboratory-tested pediatric outpatient controls (n=505). Controls underwent serum 25(OH) D testing during routine pediatric outpatient health evaluations and were not selected because of fracture, bone pain, suspected metabolic bone disease, or delayed fracture healing. In the fracture cohort, 25(OH)D was measured at the 3rd week after injury dur-ing outpatient follow-up. Group comparisons were performed using the Mann-Whitney U and Chi-square tests. Multivariable logistic regression assessed associations with age and sex. An exploratory subgroup analysis was additionally performed. RESULTS:Median 25(OH)D was 23.0 (interquartile range [IQR] 16.8-30.3) ng/mL in the fracture patients versus 18.4 (IQR=13.1-26.6) ng/mL in controls (p<0.001). Vitamin D deficiency (<20 ng/mL) occurred of the fracture group and 55.6% of the control group, respectively. After adjustment, 25(OH)D was not independently associated with torus fracture (adjusted OR/10 ng/mL 1.08, 95% CI=0.95-1.23; p=0.262), whereas male sex strongly predicted torus fracture (adjusted OR=3.35, 95% CI=2.41-4.66; p<0.001). CONCLUSION:In this laboratory-selected case-control cohort, children with distal radius torus fractures did not have lower measured 25(OH)D levels than outpatient controls. These findings do not support routine Vitamin D testing solely on the basis of an isolated torus fracture, but screening should remain guided by individual clinical risk factors.
BACKGROUND:Ankle sprains (ASs) account for approximately 5% of emergency department visits and 40% of all sports-related injuries, causing significant pain and restriction in the range of motion (ROM). This study aims to observe the clinical outcomes of early administration of intravenously administered paracetamol, ibuprofen, and dexketoprofen, which are frequently used in emergency department practice for ASs. For this purpose, pain monitoring and ROM measurements were performed to demonstrate the effectiveness of early functional analgesia. METHODS:This prospective, randomized, double-blind study was conducted between December 2023 and May 2024 on patients diagnosed with grade 1-2 ASs in the emergency department. Patients were divided into three groups and received intravenous dexketoprofen (Group D, n=52), paracetamol (Group P, n=52), and ibuprofen (Group I, n=51). Pain assessment was performed using the numeric rating scale (NRS) and the Wong-Baker FACES Pain Scale (WBS). ROM was evaluated by measuring dorsiflexion ROM (d-ROM) and plantar flexion ROM (p-ROM) angles using a semicircular goniometer. Pre-treatment and 1-h post-treatment measure-ments were compared. RESULTS:In the post-treatment pain assessment, no significant difference was observed between the groups in terms of NRS scores (p=0.352); however, Group I had the lowest WBS scores (p<0.001). Nevertheless, in all three groups, post-treatment pain scores (NRS and WBS) were significantly lower compared to pre-treatment values (p<0.001). Regarding ROM, pre-treatment d-ROM and p-ROM values were similar among the groups (p=0.196) and p=0.287, respectively). Post-treatment measurements revealed that d-ROM was lower in Group I (p=0.034), whereas p-ROM was higher (p=0.011). However, in all groups, ROM values significantly improved after treatment compared to baseline (p<0.001). When pre- and post-treatment changes (Δ) in pain scores and ROM values were compared, no statistically significant differences were found between the groups (ΔNRS p=0.264, ΔWBS p=0.965, Δd-ROM p=0.099, Δp-ROM p=0.073). CONCLUSION:Paracetamol, ibuprofen, and dexketoprofen demonstrated similar efficacy in reducing pain and improving ankle joint ROM during the acute phase of ASs. These findings suggest that the early initiation of analgesic treatment in ASs contributes to clinical recovery.
BACKGROUND:Perforated peptic ulcer (PPU) remains a high-risk surgical emergency. Although sarcopenia has been proposed as an objective surrogate of frailty, its independent prognostic value in emergency surgery is unclear. This study evaluated sarcopenia within a multidimensional frailty framework incorporating nutritional, inflammatory, and clinical parameters. METHODS:This retrospective cohort study included adult patients who underwent emergency surgery for PPU at a tertiary center. Sarcopenia was assessed using computed tomography-derived psoas muscle area and psoas muscle index with population-specific cut-off values. Immunonutritional and inflammatory indices (hemoglobin-albumin-lymphocyte-platelet [HALP], neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], and systemic immune-inflammation index [SII]) were calculated from admission laboratory data. The primary outcome was in-hospital mortality. Multivariable logistic regression and receiver operating characteristic (ROC) curve analyses were performed to identify independent predictors and discriminatory performance. RESULTS:Ninety-seven patients were included; 30.9% were sarcopenic. Sarcopenic patients exhibited lower serum albumin, higher inflammatory markers, higher clinical severity scores, and longer intensive care unit and hospital stays (all p<0.05). However, sarcopenia was not independently associated with in-hospital mortality. In multivariable analysis, advanced age (odds ratio [OR] 1.07, p=0.010) and low serum albumin (OR 0.75, p<0.001) were the strongest independent predictors of mortality. Low HALP score and elevated NLR and PLR were significantly associated with sarcopenia. ROC analysis showed that age and albumin had superior discriminatory ability for mortality compared with morphometric muscle parameters. CONCLUSION:In PPU surgery, frailty is better characterized as a multidimensional biological phenotype rather than isolated muscle loss. While sarcopenia reflects increased vulnerability, mortality risk is more strongly driven by age and nutritional-inflammatory reserve. Integrated frailty assessment may improve risk stratification in emergency surgical patients.
BACKGROUND:The optimal nailing approach for simple distal femoral shaft fractures located below the isthmus remains controversial. A critical factor that may affect union is the residual fracture gap created during intramedullary nail insertion. This study aimed to compare antegrade and retrograde nailing techniques in terms of residual fracture gap, time to union, and functional outcomes. METHODS:This retrospective study included 50 patients (21 antegrade, 29 retrograde) with transverse or short oblique femoral shaft fractures distal to the isthmus. Residual fracture gap, union time, modified radiographic union scale for tibial fractures scores, Visual Analog Scale scores, and lower extremity functional scale were evaluated. Radiographic measurements were performed by two independent blinded observers, and statistical comparisons were conducted using appropriate parametric and non-parametric tests. RESULTS:The residual fracture gap was significantly larger in the retrograde group compared with the antegrade group on both the anteroposterior view (4.8±2.6 mm vs. 2.1±1.4 mm; p=0.006) and the lateral view (5.6±2.9 mm vs. 2.6±1.8 mm; p<0.0001). Time to radiographic union was significantly longer in the retrograde group (20.2±5.2 weeks vs. 16.0±4.6 weeks; p=0.030). However, there were no significant differences in non-union rates, functional scores, or complications. CONCLUSION:In distal femoral shaft fractures located below the isthmus, retrograde nailing was associated with larger residual fracture gaps and longer time to union. Although both techniques remain viable, attention should be directed toward minimizing distraction during retrograde nail placement to optimize healing.
BACKGROUND:Syndesmotic disruption frequently accompanies ankle fractures and requires stable fixation to restore distal tibiofibular congruence and function. Cortical screw and suture-button constructs are widely used; however, their relative superiority, particularly with respect to early recovery versus long-term outcomes, remains uncertain. METHODS:We conducted a single-center, retrospective, nonrandomized cohort study of adults with ankle fractures and radiographically confirmed syndesmotic injuries treated between 2017 and 2021. Patients underwent fixation according to surgeon preference using either screws (n=81) or suture-button constructs (n=25). The primary outcome was the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score at 12 months. Secondary outcomes included AOFAS score at 3 months, Olerud-Molander Ankle Score (OMAS) at final follow-up, tibiofibular clear space (TFCS), tibiofibular overlap (TFO), medial clear space (MCS), and complication rates. Standardized anteroposterior (AP), mortise, and lateral radiographs were obtained preoperatively and postoperatively. Median follow-up was 14 months (range: 12-19). Treatment selection was at the operating surgeon's discretion, taking into account patient age and activity level, fracture pattern and instability (including initial subluxation or dislocation), soft-tissue condition, and implant availability. RESULTS:Both groups demonstrated significant radiographic improvement in TFCS, TFO, and MCS from preoperative to post-operative assessment (all p<0.001). At three months, the suture-button group achieved higher AOFAS scores than the screw group (median, 75 vs. 70; p=0.009). However, the primary outcome of AOFAS score at 12 months and the final OMAS did not differ significantly between groups (p=0.161 and p=0.090, respectively). Interpretation of the findings is limited by baseline imbalances, including a younger patient population in the suture-button group (p=0.008) and unequal group sizes (81 vs. 25). Complication rates were low and comparable between groups. CONCLUSION:Both cortical screw and suture-button fixation provided satisfactory long-term functional and radiographic outcomes in patients with ankle fractures and syndesmotic injuries. Although suture-button fixation was associated with superior early functional recovery, this apparent advantage should be interpreted cautiously given baseline differences and potential confounding. These hypothesis-generating findings support the need for prospective randomized trials with standardized rehabilitation protocols.
BACKGROUND:Traumatic spinal cord injury (TSCI) is a catastrophic outcome frequently resulting from road-traffic crashes. We investigated whether routinely recorded pre-injury healthcare utilization patterns in electronic health records (EHRs) can serve as pragmatic warning signals for TSCI among drivers and motorcyclists. METHODS:We conducted a retrospective age- and sex-matched case-control study using national EHR data. Adults aged 18-45 years with traffic-accident-related TSCI as drivers or motorcyclists (2024-2025) were matched 1: 1 with controls (n=35 per group). Pre-index utilization during the preceding 24 months included trauma-related emergency department (ED) visits, orthopedics/traumatology department (OTD) visits, total trauma-related visits, and psychiatry visits. Between-group comparisons used Mann-Whitney U tests. Receiver operating characteristic analyses were used to summarize discriminative performance. Binary risk flags (≥1 ED visit; ≥1 psychiatry visit) were evaluated using multivariable logistic regression. RESULTS:The analytic sample included 70 participants. Compared with controls, TSCI cases had higher trauma-related ED visits (p<0.001; r=0.45), psychiatry visits (p=0.010; r=0.31), and total trauma-related visits (p=0.035; r=0.25), whereas OTD visits did not differ (p=0.920). ED visits showed the highest discrimination (area under curve [AUC]=0.726). In this sample, the ≥1 versus 0 contrast yielded sensitivity 60.0% and specificity 82.9%. Psychiatry visits showed modest discrimination (AUC=0.649). In this sample, the ≥1 versus 0 contrast yielded sensitivity 45.7% and specificity 80.0%. In multivariable analysis, ≥1 ED visit (odds ratio [OR]=8.85, 95% confidence interval [CI] 2.68-29.23; p<0.001) and ≥1 psychiatry visit (OR=4.52, 95% CI 1.34-15.20; p=0.015) were independently associated with TSCI. CONCLUSION:Traffic-related TSCI may be preceded by measurable pre-injury patterns - particularly trauma-related ED utilization and psychiatry visits - captured in routinely collected EHR data. These findings support a pragmatic risk-flagging approach that may help identify individuals who could benefit from targeted preventive education, injury-risk counseling, and psychosocial risk-reduction interventions. These findings should be interpreted with caution and require validation in larger prospective studies.
BACKGROUND:Earthquakes frequently result in high-energy extremity injuries requiring complex soft-tissue reconstruction. Performing microsurgical free-flap procedures in the acute post-disaster setting poses significant challenges due to resource limitations and logistic constraints. METHODS:This retrospective study reviewed patients who underwent free-flap soft-tissue reconstruction in our tertiary university hospital, located within the disaster zone, during the acute phase of the 2023 Kahramanmaraş earthquake (February 06-21, 2023). Of 145 patients hospitalized in our plastic and reconstructive surgery service during this period, 14 underwent free-flap reconstruction and were included. Demographics, flap types, recipient vessels, perioperative details, and outcomes were analyzed. RESULTS:Fourteen consecutive free flaps were performed over 14 days. The mean patient age was 32.8 years (range: 6-60 years); 50% were female. Twelve reconstructions (86%) involved the lower extremity, and two (14%) involved the upper extremity. The anterolateral thigh flap was the most frequently used flap (71.4%), followed by the latissimus dorsi flap (28.6%). In 75% of lower-extremity cases, the anterior tibial vessels of the injured limb were used; cross-leg anastomoses were required in three patients. Flap survival was achieved in 13/14 patients (92.8%). One total flap loss resulted in amputation. CONCLUSION:Early free-flap reconstruction can be successfully integrated into acute trauma care even under disaster conditions when resources are organized efficiently, and surgical teams are coordinated. Our results support incorporating microsurgical capability into disaster-preparedness planning.
BACKGROUND:Patients with traumatic brain injury (TBI) occupy an important place in intensive care units (ICUs) with high morbidity and mortality rates. The aim of this study was to determine the parameters predictive of mortality as the primary outcome and the distribution of these parameters as a secondary outcome in patients admitted to the ICU with TBI. METHODS:After ethics committee approval and informed consent of the patient's relatives, TBI patients over 18 years of age treated in the anesthesia and reanimation ICU of our hospital between 2021 and 2023 were retrospectively included in our cohort study. The association and distribution of 18 different parameters, including demographic and clinical characteristics of TBI patients at ICU admission, with mortality were compared. Univariate and multivariate analyses were used to estimate the odds ratio for mortality. RESULTS:Of the 194 patients included in the study, 80.4% were male, the mean age was 39.1±19.8 years, and the mortality rate was 35,1%. When comparing patients in 2 groups as survivor and non-survivor, patients in non-survivor group had a significantly lower mean Glasgow Coma Scale (GCS) score (5.7±3.1 vs. 10.1±3.1, p<0.001), revised trauma score (RTS) (5.25±2.1 vs. 10.6±2.7), the rate of surgery (33.8% vs. 53.2%, p<0.01), and the rate of epidural hematoma (EDH) (33.8% vs. 53.2%, p<0.01). The mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score (29 vs. 13, p<0.001), the estimated mortality rate based on the mean APACHE II score (55% vs. 12%, p<0.001), the stress index (SI), (62.3±29.5 vs. 42.4±19.2, p<0.001), the rate of intracerebral hematoma/hemorrhage (ICH) (52.9% vs. 30.2%, p<0.01), the rate of skull fracture (80.9% vs. 24.6%, p<0.01), and the rate of intubation (94.1% vs. 60.3%, p<0.01) were found to be higher in non-survivor group. In multivariate analysis, the significant independent predictors of mortality were high APACHE II score (OR: 1.292 [1.192-1.400, p<0.001]), high SI (OR: 0.820 [0.699-0.921], p<0.001), and the presence of concomitant skull fracture (OR: 4.982 [1.894-13.103], p<0.001). CONCLUSION:our study, high APACHE II score, high SI, presence of skull fracture, low GCS score, low RTS, intubation, and presence of ICH were associated with high mortality, while operability and presence of EDH were associated with low mortality. Therefore, we believe that these parameters should be prioritized when following TBH cases to initiate treatment earlier and prevent high mortality.
BACKGROUND:Deep second-degree burn treatment is often time-consuming and expensive, with split-thickness autografts being the current standard of care. Recently, noncultured autologous cell sprays have shown comparable efficacy. This study utilized an experimental animal model to determine the optimal donor-to-burn area ratio for this method. METHODS:Twenty-four male Wistar-albino rats were assigned to three groups (A, B, and C), each receiving two standardized second-degree burn wounds (2 cm2) on the dorsal skin. On day 5 post-injury, treatments were applied as follows: Group A wounds were left untreated or underwent tangential excision; Group B received autologous cell spray from 2 cm2 and 1 cm2 donor sites; Group C received cell spray from 0.5 cm2 and 0.25 cm2 donor sites. On day 14, all animals were sacrificed. Wound healing was assessed macroscopically (necrosis percentage) and histopathologically (ulcer size and inflammation score, 0-3). RESULTS:Necrotic area percentage in the first and second burn site of the groups A, B, and C were 15±0.15%, 13±0.1%, 6±0.05%, 6±0.05%, 17±0.15%, and 9±0.1% (mean±standard deviation [SD]), ulcer size was 1.5±2.0 mm, 0.8±1.6 mm, 0.4±0.7 mm, 0.1±0.4 mm 2.4±2.1 mm, and 1.3±1.7 mm (mean±SD), and the inflammatory response was 1.8±1.5, 1.5±1.2, 0.8±1.0, 0.5±1.1, 2.0±1.1, and 1.5±1.4 (mean±SD), respectively. All evaluated parameters were statistically significantly better in the second burn area of Group B compared to the untreated group (p=0.007, p=0.041, p=0.043). CONCLUSION:While previous research supports the use of small donor sites for extensive burns, our findings suggest that, in smaller burn injuries, a donor-to-burn area ratio of 1: 2 provides more effective wound healing than further donor site reduction. The 14-day follow-up and reliance on a single thermal burn model limit the generalizability of these results. Future studies with extended observation, varied burn etiologies, and molecular or immunohistochemical analyses are needed to validate and expand upon these findings.
BACKGROUND:Adhesive small bowel obstruction remains a common long-term complication following abdominal surgery and continues to represent a significant cause of morbidity and healthcare utilization. While several factors contributing to adhesion formation have been described, determinants influencing both the need for surgical intervention and the timing of clinical presentation are not yet fully understood. This study aimed to identify factors associated with surgical management in patients presenting with adhesive ileus after a single prior abdominal operation and to evaluate the relationship between operative duration and the timing of ileus onset. METHODS:This retrospective study included 450 patients (n=450) diagnosed with adhesive ileus at a tertiary care center between January 1, 2021 and January 1, 2026. Patients with mechanical obstruction or multiple prior abdominal surgeries were excluded. Patients were categorized into operative (n=302) and conservative (n=148) management groups. Baseline characteristics, including age, sex, and American Society of Anesthesiologists scores, were comparable between groups (p>0.05). Clinical variables such as type of prior surgery, operative duration, surgical approach, contamination status, and time to ileus presentation were analyzed. Statistical analyses included an independent samples t-test, Chi-square test, Pearson correlation analysis, and multivariate logistic regression. RESULTS:Of the 450 patients, 302 (67.1%) required surgical intervention. Operative duration was significantly longer in the operative group compared to the conservative group (4.3±1.8 vs. 3.1±1.6 h, p=0.003). Open surgery (75% vs. 52%, p=0.037) and contaminated surgical fields (78% vs. 60%, p=0.030) were more frequent in the operative group. The time to ileus presentation was significantly shorter in patients requiring surgery (5.5±1.9 vs. 6.8±2.1 months, p=0.002). A significant inverse relationship was observed between operative duration and time to ileus presentation (r=-0.32, p<0.05). CONCLUSION:Operative duration, surgical approach, and intraoperative contamination are important determinants of surgical management in adhesive ileus. The inverse relationship between operative duration and time to presentation suggests that increased surgical burden may contribute to an earlier onset of clinically significant obstruction. These findings highlight the potential value of surgical factors in risk stratification and post-operative surveillance.
BACKGROUND:Spontaneous rectus sheath hematoma (RSH) is a potentially life-threatening cause of acute abdominal pain, particularly in elderly and anticoagulated patients. While most cases are managed conservatively, a significant proportion requires interventional procedures, and mortality remains substantial. The aim of the study was to identify the predictors of interventional procedure requirements and 90-day mortality in patients with spontaneous RSH. METHODS:This retrospective study included consecutive adult patients diagnosed with spontaneous RSH at a tertiary care center between January 2017 and December 2023. Clinical, laboratory, and imaging data were collected. Multivariate logistic regression was used to identify independent predictors of interventional radiology treatment and 90-day all-cause mortality. RESULTS:The study consisted of 59 patients with a median age of 72 years, and 77.9% were females. Interventional radiology procedures were performed in 27.1% of cases, and 90-day mortality was 22.0%. Hematoma volume was independently associated with the need for intervention (odds ratio [OR]: 1.002; p=0.004). In a subgroup of patients undergoing computed tomography angiography (n=36), contrast extravasation was also a significant predictor (OR: 17.460; p=0.009). Independent predictors of 90-day mortality were advanced age (OR: 1.088; p=0.045) and greater hemoglobin decline (OR: 1.086; p=0.008). CONCLUSION:Hematoma volume and contrast extravasation are significant predictors of the need for interventional treatment, while advanced age and hemoglobin decline predict 90-day mortality in spontaneous RSH. These findings support the use of objective radiologic and laboratory parameters for early risk stratification. Prospective multicenter validation is warranted to guide standardized management strategies in this high-risk population.
BACKGROUND:Fournier's gangrene (FG) is a rare but life-threatening necrotizing fasciitis of the perineal and genital regions characterized by rapid progression, fulminant sepsis, and high mortality. Negative-pressure wound therapy (NPWT), also called vacuum-assisted closure (VAC), is becoming more commonly utilized today in the treatment of complex wounds. This study aimed to evaluate the association between NPWT/VAC and in-hospital mortality among patients with FG requiring extensive surgical debridement. METHODS:This retrospective cohort study included 95 patients treated for FG at a tertiary referral center between January 2022 and January 2025. Patients were divided into two groups according to post-operative wound management: Conventional dressing (n=31) and NPWT/VAC (n=64). Demographic, clinical, and laboratory data - including the FG severity index (FGSI), quick sequential organ failure assessment, and procalcitonin - were analyzed. Multivariable logistic regression identified independent predictors of in-hospital mortality, and model performance was evaluated using receiver-operating characteristic curves. RESULTS:Overall mortality was 20.0% (19/95). Mortality was significantly lower in the NPWT/VAC group than in the conventional group (15.6% vs. 29.0%, p<0.05). On multivariable analysis, NPWT/VAC was independently associated with lower mortality (adjusted odds ratio [OR] 0.42, 95% confidence interval [CI] 0.18-0.95, p<0.05), whereas higher FGSI (OR 1.28 per point, 95% CI 1.10-1.55, p<0.01) and procalcitonin (OR 1.95, 95% CI 1.35-2.75, p<0.01) were independently associated with higher mortality. CONCLUSION:NPWT/VAC use was associated with a lower mortality rate and may represent a valuable adjunct in the management of severe FG.
BACKGROUND:Peptic ulcer perforation (PUP) is a life-threatening complication with high mortality caused by the leakage of gastric contents into the peritoneal cavity, leading to peritonitis. Systemic inflammatory indices, such as the C-reactive protein (CRP)/lymphocyte ratio, neutrophil-to-lymphocyte ratio (NLR), and multi-inflammatory indices (MII), reflect inflammation severity. This study aimed to investigate the predictive value of the CRP/Lymphocyte ratio, NLR, platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and MII indices for estimating morbidity and mortality in patients undergoing surgery for PUP. METHODS:This retrospective analysis included 319 patients who underwent surgery for PUP between October 2012 and January 2025. Pre-operative inflammatory indices were calculated from laboratory data and correlated with post-operative complications, length of hospital stay, and mortality. RESULTS:Higher CRP/Lymphocyte ratio, PLR, MII-1, MII-2, and MII-3 values were associated with fatal outcomes (p<0.05). The MII-2 and MII-3 indices best predicted post-operative complications with superior area under the curve (AUC) values (AUC: 0.655, 0.661, respectively) (p<0.001). All analyzed markers were significantly elevated in patients with prolonged hospitalization. Notably, the MII-2 index and CRP/lymphocyte ratio showed balanced sensitivity and high specificity for predicting mortality (AUC: 0.780, 0.787, respectively) (p<0.001). CONCLUSION:The MII-2 index and CRP-to-lymphocyte ratio are strong predictors of mortality in PUP patients, whereas the MII-2 and MII-3 indices are most effective for predicting complications. Incorporating these easily calculated indices into clinical practice can enhance risk stratification and decision-making.
An ectopic spleen refers to splenic tissue or lobules located outside the normal anatomical position of the spleen and is most commonly found near the splenic hilum. Ectopic splenic tissue is typically found in characteristic anatomical locations but may rarely occur in atypical sites. Owing to its unusual localization, it can be radiologically mistaken for a variety of tumors. This case is notable because a large retroperitoneal mass requiring emergency laparotomy was ultimately diagnosed as ectopic splenic tissue. A 44-year-old man underwent emergency diagnostic laparotomy for acute abdominal symptoms. Preoperative imaging revealed a heterogeneous lesion medial to the left psoas muscle that was radiologically suggestive of a soft tissue tumor. Intraoperative frozen section examination demonstrated lymphoid tissue suggestive of splenic origin, and the diagnosis was subsequently confirmed on paraffin sections. Histopathological evaluation revealed a well-circumscribed nodular lesion composed of follicle-like lymphoid structures and sinusoidal vascular channels, consistent with ectopic splenic tissue. Unlike most reported cases, which typically occur in women aged 20-40 years and involve lesions measuring 1-3 cm, our patient was male and presented with a retroperitoneal lesion measuring 6.5×3×2.5 cm, an uncommon presentation. The unusual location and relatively large size of the lesion led to its initial radiological interpretation as a soft tissue tumor, highlighting the importance of comprehensive radiologic evaluation and histopathological examination for accurate diagnosis.
ROUND:This study aimed to evaluate the effects of silibinin, a compound with demonstrated therapeutic effects in various liver diseases, on liver healing in a rat model of blunt liver trauma. METHODS:Twenty-four Wistar albino rats weighing 250-300 g were randomly assigned to three equal groups. Group I served as the control group (CG) and received standard nutrition without trauma induction. Under general anesthesia, rats in Groups II and III underwent a blunt trauma procedure applied to the right upper abdominal quadrant. Group II, designated as the trauma group (TG), received standard nutrition only. Group III, designated as the trauma-silibinin group (T-SG), received silibinin at a dose of 100 mg/kg/day via gastric gavage for five days in addition to standard nutrition. Following the five-day observation period, blood samples were collected from inferior vena cava. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were measured in the collected blood specimens. Histopathological examination of liver tissue was performed to assess the degree of inflammation. RESULTS:Mean AST and ALT levels differed significantly among the groups (p<0.001). Although no statistically significant difference was observed in inflammation scores between the TG and T-SG groups (p=0.115), inflammation scores tended to be higher in the TG, with a moderate effect size (r=0.41). Furthermore, the risk of a high injury score was 11.7 times greater in the TG than in the T-SG. CONCLUSION:To our knowledge, this is the priority study to evaluate the effects of silibinin in a rat model of blunt liver trauma. Silibinin may represent a promising therapeutic agent for reducing inflammation following liver trauma and promoting liver healing.
