Amaç: Generalize peritonit olgularýnda hala, laparoskopik giriþimlerle ilgili kuþkular devam etmektedir. Bu çalýþmamýzda, deneysel peritonit oluþturulan ratlarda, karbondioksit pnömoperitoneumun inflematuar cevap ve peritonit þiddeti üzerine etkilerinin araþtýrýlmasý amaçlandý.
Gereç ve Yöntem: Çalýþmada 21 Wistar-Albino rat kullanýldý. Ratlar, control (grup 1), bakteriyel peritonit oluþturulan grup (grup 2) ve peritonit + karbondioksit pnömoperituan oluþturulan grup (grup3) olmak üzere 3 gruba ayrýldý. Ýkinci ve üçüncü gruptaki ratlara intraperitoneal Escherishia coli verilerek peritonit oluþturuldu. Üçüncü gruptaki ratlarda karbondioksit insuflasyonu ile pnömoperitoneum oluþturuldu. Ratlar 24 saat sonra sakrifiye edildi. Ratlardan kan ve karýn duvarýndan periton örneði alýndý. Tüm gruplarda peritonit þiddet skoru, C-reaktif protein düzeyi ve kanda beyaz küre sayýsý deðerlendirildi.
Bulgular: Peritonit þiddet skoru, C-reaktif protein düzeyi ve kan beyaz küre sayýsý, ikinci ve üçüncü gruplarda, birinci gruba göre istatistiksel olarak anlamlý düzeyde yüksek bulundu ( p<0.05). Üçüncü grupta deðerler, ikinci gruptan anlamlý düzeyde düþük bulundu (p<0.05).
Sonuç: Çalýþmamýzýn sonuçlarý, karbondioksit pnömoperitoneumun Escherishia coli ile peritonit ve sepsis oluþturulan ratlarda peritonit þiddetini ve sistemik enflematuar yanýtý azalttýðýný göstermiþtir.

Background: There are still some suspects regarding the reliability of laparoscopic interventions in the presence of generalized peritonitis. The aim of the present experimental study was to investigate the effects of carbondioxyde pneumoperitoneum on inflammatory response and peritonitis severity score in experimental peritonitis.
Methods: Twenty-one Wistar Albino rats were taken under the study. The rats were distributed into tree group; the control group (group 1, n=7), the bacterial peritonitis-induced group (group 2, n=7) and peritonitis + carbondioxide pneumoperitoneum-induced group (group 3, n=7). In group two and three, peritonitis was induced by intraperitoneally injected Escherishia coli. In group three, pneumoperitoneum was induced by giving CO2 insufflations. The rats were sacrificed after 24 hours. Five cc of blood was sampled and peritoneum tissue excised from the abdominal region of the rats. Peritonitis severity score, C-reactive protein level and white blood cell count were assessed in all groups.
Results: Peritonitis severity score, C- reactive protein level and white blood cell count were significantly higher in group 2 and 3 than group 1 (both, p<0.05), while significantly lower in group 3 than group 2 (p<0.05).
Conclusion: The results of this study shown that carbondioxyde pneumoperitoneum decreases the peritonitis severity and systemic inflammatory response in experiments with Escherishia coli peritonitis and sepsis.

Objective: Burns are an important health problem in our country and in the world. In our study, we aimed to epidemiologically analyze the patients who were hospitalized in the burn unit serving 3 million individuals in Middle Anatolia.
Material and Method: Records of 457 patients who had been hospitalized in burn unit between 2008-2010 were retrospectively analyzed. Patients were asseseed in terms of gender, age, burn area, burn depth, admission time to the health center, burn region, factors causing burns.
Results: Majority (44.6%) of the patients was in 0-5 age group. Burn surface area was detected as 11.6±8.5%. Patients had reached health center in 252.8±892.5 minutes. While 82.7% of the patients had 2. degree of burns, 17.3% had 3. degree of burns. Most burns were on extremities (39.6%). The most common burn agent was scalds with hot liquids (54.1%).
Conclusion: In our study, children in 0-5 age group was found to be the most commonly affected group from indoor burns. Basic factor for this is children’s spending more time in the house and being more active. Scalding burns may be prevented by taking care when using hot liquids that may lead to indoor burns. Informing parents is of first priority for this issue.

Amaç: Ýnhalasyon yanýðý olgularýnda,klinik,radyolojik ve bronkoskopik bulgular temelinde inhalasyon hasarýný,pulmoner komplikasyonlarý ve mortalite ile iliþkili faktörleri ortaya koymak.Gereç ve yöntem: 2009 Ocak-2010 Ocak tarihlerinde,hastanemiz yanýk merkezi yoðun bakým ünitesinde yatan,bronkoskopi ile inhalasyon yanýðý tanýsý konulan olgular dahil edildi.Hastalarýn demografik bulgularý,yanýk þekli,yanýk yüzdesi,klinik ve laboratuvar özellikleri,1.ve 5.yatýþ günündeki akciðer grafisi bulgularý ve bronkoskopik lezyon türleri dosyalarýndan elde edildi.Bronkoskopik bulgular sýnýflandýrýldý,her hastadaki bronkoskopik skor hesaplandý.Kaybedilen hastalar ile iyileþerek taburcu olan hastalardaki klinik,laboratuar,radyolojik bulgularýn özellikleri ve sýklýðý,yoðun bakýmdaki yatýþ süresi,bronkoskopik skorlar birbirleriyle karþýlaþtýrýlarak mortalite iliþkili olabilecek faktörler araþtýrýldý.Ýstatistiksel deðerlendirmeler için ki-kare, fisher exact test ve Mann Whitney-U testi kullanýldý.Bulgular: Yaþ ortalamalarý 40.1±3.4 olan,4’ü kadýn toplam 29 hasta çalýþmaya alýndý.Hastaneye yatýþ gününde olgularýmýzýn %41.3’ünde,yatýþýn 5.gününde ise %65.5’inde radyolojik anormallik saptanmýþtýr.Bronkoskopi,olgularýn %100’ünde taný koydurucu olmuþtur.Bronkoskopik bulgular deðerlendirildiðinde 29 olgunun 25’inde hiperemi,ödem,erozyon,ülserasyon,nekroz gibi mukozal lezyonlar,7’sinde ise trakeobronþial aðaçta karbon partikülü(is) birikimi saptanmýþtýr.Çalýþmamýzda bronkoskopiye baðlý komplikasyon görülmedi.Kaybedilen 24 hasta ile iyileþen hastalar karþýlaþtýrýldýðýnda kaybedilen hastalarda yanýk yüzdesinin daha yüksek(%20.4-%48.5,p=0.003),yoðun bakým yatýþ süresinin daha uzun(ort.7.0–13.7 gün,p= 0.037)olduðu saptanmýþtýr.Kaybedilen hastalarda 5.günde radyolojik anormallik ve ARDS %79.1 ve %50 oranýnda görülürken,iyileþen hastalarýn hiçbirinde ARDS ve 5.gün akciðer grafisinde patoloji olmadýðý saptanmýþtýr(p<0.05).Sonuç: Kutanöz yanýk olgularýnda birlikte var olan inhalasyon yanýðý yüksek oranda pulmoner komplikasyonlara neden olmakta ve mortaliteyi arttýrmaktadýr.Taný için erken dönemde bronkoskopi yapýlmasý ve bu hastalarýn yakýn takibi gereklidir.

Aim: To introduce inhalation injury,pulmonary complications and mortality related factors on the basis of clinical,radiological and bronchoscopic findings at patients with inhalation burns.Material-method: Between January2009-January2010,patients hospitalized at intensive care unit of burn center,who were diagnosed as inhalation burn and bronchoscopy was performed were included.Demographic findings,burn type,burn percentage,clinical-laboratory features,chest x-ray findings on the first and fifth day,bronchoscopic lesions were obtained from files.Bronchoscopic findings were classified,bronchoscopic score for each patient was calculated.Clinical,laboratory,radiological findings,length of stay at intensive care unit,bronchoscopic score of patients who were discharged and were exitus were compared with each other and mortality related factors were investigated.Results: 29patients with mean age of 40.1±3.4were included.Radiological abnormalities were found at 41.3% and 65.5% of patients at first day and fifth day of hospitalization,respectively.There were no complications related to bronchoscopy. Percentage of burn and duration of stay in intensive care were higher at patients who were died than discharged patients;(%20.4-%48.5,p=0.003)(mean: 7.0-13.7days,p=0.037),respectively.Patients who were died showed 79.1% radiological abnormality and 50% ARDS on fifth day of hospitalization.There were no pathologic findings on chest x-ray and ARDS wasn’t observed on fifth day at patients who were discharegd(p<0.05).Conclusion: Inhalation burns existing in patients with cutaneous burns, causes high percentage of pulmonary complications and increases mortality.Bronchoscopy has to be performed early for diagnosis and close follow-up of these patients is necessary.

Amaç: Türkiye’nin Batý Karadeniz bölgesindeki göz yaralanmalarýnýn klinik özelliklerini ve görsel prognozunu belirlemek; ulusal istatistiklere veri oluþturmak.
Gereç ve Yöntem: Zonguldak Karaelmas Üniversitesi Hastanesi Acil Servisi’ne 2001-2010 yýllarý arasýnda baþvuran 281 göz yaralanmasý olgusu geriye dönük olarak incelendi.
Bulgular: Göz yaralanmalarýnýn büyük kýsmý (%42.7) 30 – 50 yaþlarý arasýnda meydana gelmiþti. Yaralanmalarýn en sýk (%28.8) nedeni kýrsal alanda ahþap kaynaklý maddelerle yaralanmalar iken, 30 – 50 yaþ arasý erkeklerde en sýk neden iþyeri yaralanmalarýydý. Kornea-skleral kesiler ilk ve son görme keskinliði açýsýndan en ciddi yaralanma olarak belirlendi.
Sonuç: Göz yaralanmalarý hala sýk ve önlenebilir bir körlük sebebidir. Alýnacak basit tedbirler ve halkýn eðitimi sayesinde; iþ gücü kaybý, ekonomik kayýp ve psikolojik sorunlara yol açan bu önemli problemin önüne geçilebilir. Trafikte emniyet kemeri takýlmasý, iþ yerlerinde ve kýrsal alanda çalýþýrken koruyucu gözlük takýlmasý konusunda halkýn bilinçlendirilmesi alýnacak tedbirlerin baþýnda gelmektedir.

Background: To investigate clinical aspects, the visual prognosis in eye injury and to constitute datum to national statistics, in the West Black Sea Region, in Turkey
Methods: A retrospective analysis of 281 eye trauma cases admitted to the emergency department of Zonguldak Karaelmas University Hospital between 2001 and 2010 was performed.
Results: A majority of eye injuries (42.7%) affected individuals between the ages of 30 and 50 years. The most frequent cause of injury was wooden objects in rural areas. The most frequent cause of injury was work site injuries in males between the ages of 30 and 50 years. Corneal-scleral lacerations were found to be the most serious injuries with regard to initial and final visual acuities.
Conclusion: Eye injuries are still the most common and preventable cause of blindness. Simple precautions and public education might prevent this health problem which causes loss of labor force, economic loss and psychological problems. One of the basic precautions would be raising public awareness on wearing seat belt inside the car and protective eyeglasses at the work site and while working in rural areas.

AMAÇ
Bu çalýþmada, yetiþkin kafa yaralanmalý olgularda hasta kayýt sistemimizden elde edilebilen verilerin sonuç üzerine etkisi araþtýrýldý.

GEREÇ VE YÖNTEM
Trakya Üniversitesi Hastanesi Beyin ve Sinir Cerrahisi Anabilm Dalý ve Yoðun Bakým Ünitelerine yatýrýlan 356 KY tanýlý yetiþkin olgunun kayýtlarý incelendi. Elde edilen veriler istatistiksel olarak incelendi.

BULGULAR
Yaþ (p=0,012), havayolu tüplenmesi (p<0,001), olay yeri ve Acil Birimde saptanan GKÖ deðerleri (p<0,001), kümelen sistolik ve diastolik TA deðerleri (p<0,001, eþlik eden göðüs (p=0,001) ve karýn (p=0,041) yaralanmasý, anizokori (p=0,001), IR (p<0,001), kafatasý içi radyolojik bulgulardan SDK (p<0,001), BE (p=0,006), ySAK (p<0,001), yBÝK (p=0,005) ve BÖ (p<0,001), cerrahi giriþim yapýlmasý (p<0,001) ve hastane infeksiyonu varlýðý (p<0,001) verilerinin sonuç üzerinde anlamlý farklýlýk oluþturduðu saptandý.

SONUÇ
Kafa yaralanmalarýna baðlý ölümlerin azaltýlmasýnda temel amaç kaza oluþumunun azaltýlmasý olmalý, ayrýca ilk müdahale ve hastane bakým þartlarý yaralanmalý olgular için iyileþtirilmelidir.

BACKGROUND
In this study, the data that can be obtained from our patient record system is investigated to effect on the outcome in the adult head injured patients.

METHODS
The records of 356 adult head injured patients hospitalized in Trakya University Hospital, Department of Neurosurgery and Intensive Care Unit have been examined. Result of the obtained data has been analyzed by statistically.

RESULTS
Age (p=0.012), using airway tube (p<0.001), values of GCS was detected on injury side and Emergency Unit (p<0.001), clustered systolic and diastolic TA values (p<0.001, accompanied by chest (p=0.001) and abdominal (p=0.041), injury, anisocoria (p=0.001), pupillary ligth responce (p<0.001), intracranial radiologic findings such as; SDH (p<0.001), brain contusion (p=0.006), traumatic SAH (p<0.001), traumatic ICH (p=0.005) and brain edema (p<0.001), doing surgical procedure (p<0.001) and presence of nosocomial infection (p<0.001) make significant differences on the outcome were found.

CONCLUSION
Main aim must be reducing the formation of an accident at reducing of death due to head injuries; additionally, emergency and hospital care facilities should be developed injury cases.

Amaç: Bu çalýþmada, ürogenital bölgeyle iliþkili travma nedeniyle acil servise baþvuran hastalarýn özellikleri, morbidite ve mortalite ile iliþkili durumlarýn belirlenmesi amaçlanmýþtýr.
Gereç ve Yöntem: Bu prospektif, kesitsel tanýmlayýcý çalýþmada, ürogenital bölgeyle iliþkili travmasý olan hastalarýn demografik özellikleri, travma þekilleri, tetkik sonuçlarý, yatýþ iþlemleri ve sonuçlarý deðerlendirildi.
Bulgular: Çalýþmaya toplamda 153 majör travmasý olan hasta alýndý. Bunlarýn 108 (%70.6)' i erkek, 45 (%29.4)' i bayandýr. 23 (%15.03)' ü penetran, 130 (%84.96)' u künt travmadýr. 79' u trafik kazasý, 42' si yüksekten düþme, 12' si ateþli silah yaralanmasý, 10' u delici-kesici alet yaralanmasýdýr. Hastalarýn 60' ýnda pelvis kýrýðý, 35' inde böbrek, 4' ünde mesane yaralanmasý saptanmýþtýr. Hastalarýn 21' i herhangi bir nedenle opere edilmiþtir, toplamda 17 hastada ölüm gerçekleþmiþtir. Ölüm gerçekleþen hastalarýn hiçbirinde ölüm nedeni ürogenital yaralanma deðildir. Ýdrar tetkiki yapýlabilen iki mesane yaralanmasýnda da gross hematüri görülmüþtür, ayrýca hematüri varlýðý ile böbrek yaralanmasý arasýnda anlamlý iliþki bulunmuþtur.
Sonuç: Ürogenital yaralanmalar sýklýkla diðer organ yaralanmalarýyla birliktedir ve kaybedilen hastalarýn ölüm nedenleri genellikle diðer organ yaralanmalarýna baðlýdýr. Ayrýntýlý klinik deðerlendirme ile zamanýnda taný konulup müdahale edilmesi ürogenital bölge yaralanmalarýna baðlý ölüm olaylarýný önlemede önemlidir. Yaralanma mekanizmasýný düþünülerek fizik muayene yapýlmalý ve tanýsal görüntüleme ve laboratuar tetkikleri uygulanmalýdýr.

Background: The aim of this study is to investigate the characteristics of the patients admitted to the emergency department with the urogenital system trauma and the factors effecting mortality and mortality.
Methods: In this prospective, cross-sectional descriptive study, the demographic characteristics, trauma types, laboratory and radiologic results, hospitalization states and the outcome of the patients with urogenital trauma were investigated.
Results: A total of 153 patients with major trauma were included in this study. 108 (%70.6) of them were male. 23 (%15.03) of them were penetrating trauma and 130 (%84.96) of them were blunt trauma. 79 of them were presented with motor vehicle accidents, 42 of them were falls, 10 of them were gunshot wounds, 10 of them were stab wounds. There were pelvic fractures at 60 patients, renal injuries at 35 patients, bladder injuries at 4 patients. 21 of the patients underwent surgery for any reason and 17 patients dead. There was a significant relationship between hematuria and renal injury.
Conclusion: The urogenital injuries are frequently seen with other system injuries and deaths generally occur due to other system injuries. The timely identification and management of genitourinary injuries with a deep clinical evaluation is important for preventing deaths due to urogenital region trauma.

Background: Falls from height are one of the leading causes of death from unintentional injuries.
Materials and methods: We reviewed cases of musculoskeletal trauma due to fall from height, over one year, at a tertiary care hospital in Delhi for demographic data, site of accident, circumstances and location of fall, approximate height of fall, season, landing surface, details of skeletal and other injuries and duration of hospital stay.
Results: Of 1451 admissions during the period, 138 were injured due to fall from height. Thirty seven cases were excluded. Mean age of patients was 31.3 years. The mean height of fall was 4.54 meters (range 0.6-12 meters). A total of 126 fractures occurred in 101 patients, 55 in the upper limbs, 50 in lower limbs, 14 in spine and seven in pelvis. Associated injuries included head (n=17), chest (n=9) and abdominal injuries (n=6). Ninety patients (89%) needed surgical intervention for fracture management. Eleven of these 101 (10.8%) injuries were fatal.
Conclusion: Fall from height is a potentially preventable cause of skeletal injuries as most of the injuries sustained due to fall from height were domestic injuries and occurred due to poor dwelling units.

Amaç: Travmatik femur cisim kýrýðý tanýsý nedeniyle oymasýz kilitli intramedüller çivi kullanýlarak biyolojik tespit yapýlan hastalarýn sonuçlarý deðerlendirildi.
Çalýþma planý: Uludað Üniversitesi Týp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalý’nda, Ocak 1997 – Aralýk 2007 tarihleri arasýnda travmatik femur cisim kýrýðý tanýsý ile oymasýz kilitli ÝMÇ kullanýlarak biyolojik tespit yapýlan 25 (29 kýrýk) eriþkin hasta çalýþmaya dahil edildi. Olgularýn yaþ ve cinsiyetleri, yaralanma nedenleri, kýrýk tipleri, ameliyata alýnma zamanlarý ve ameliyat süreleri, kanama miktarlarý, skopi kullaným süreleri, erken ve geç dönem komplikasyonlarý, kaynama zamaný ve fonksiyonel sonuçlarý deðerlendirildi. Fonksiyonel sonuçlar Klemm-Börner, Thoresen sistemi ile SF-36 genel saðlýk ölçütü kriterlerine göre deðerlendirildi.
Sonuçlar: Olgularýn ortalama takip süresi 65,1±31,6 (26-138) ay idi. Basit ve kompleks kýrýklar arasýnda ameliyat süresi, kanama miktarý ve kaynama süresi açýsýndan istatiksel olarak anlamlý fark olmadýðý saptandý (p>0,05). SF-36’ya göre aðrý skorlarý arasýnda istatiksel olarak anlamlý fark saptanmadý (p>0,05).
Çýkarýmlar: Femur cisminin basit ve çok parçalý kýrýklarýnýn oymasýz ÝMÇ ile tespiti; endosteal ve periosteal kan dolaþýmýný bozmamasý, derin enfeksiyon riskinin az olmasý, yüksek kaynama oraný ve fonksiyonel sonuçlarýnýn iyi olmasý nedeniyle özellikle çoklu yaralanmalý, pulmoner ve kardiyovasküler sistemi risk altýnda olan hastalarda tercih edilmesi gerektiði sonucuna varýlmýþtýr.

Anahtar sözcükler: Femur cisim kýrýðý, biyolojik tespit, oymasýz kilitli intramedüller çivi.

Objectives: We evaluated the results of patients with traumatic femur diaphyseal fracture who had undergone biologic fixation with unreamed intramedullary nailing.
Methods: 25 adults with 29 traumatic femur diaphyseal fracture who had undergone unreamed intramedullary nailing at Uludag University School of Medicine Department of Orthopedics and Traumatology were included in the study. Gender, age, cause of injury, fracture type, operation length, time lapse till surgery, blood loss, fluoroscopy duration, early and late complications, time till union and functional results were noted. Founctional results are evaluated with Klemm-Börner, Thoresen and SF-36 health survey questions.
Results: mean follow-up of the patients was 65,1±31,6 months (26-138). There was no statistically significant difference between operation length, blood loss and time till union of simple and complex fractures (p>0,05). Also, SF-36 questionnaire revealed no statistically significant difference between pain scores (p>0,05).
Conclusion: We state that sparing of the endosteal and periosteal circulation, low infection and high union rates and good functional outcomes of unreamed intramedullary nailing fixation make it the treatment of choice for simple and comminuted fractures of the femur shaft, especially for multi-trauma patients and patients with cardiopulmonary co-morbidities.

Key words: Femur shaft fractures, biologic fixation, unreamed intramedullary nail.

Amaç: Bu çalýþmada, allogreft ya da otogreft ile ön çapraz bað (ÖÇB) rekonstrüksiyonun klinik sonuçlarý araþtýrýldý.
Yöntem: Anterior tibial tendon (ATT) allogreft (n=52) ya da dörtlü hamstring (DHT) otogreft (n=30) ile ön çapraz bað (ÖÇB) rekonstrüksiyonun uygulanan 82 hastanýn sonuçlarý geriye dönük olarak deðerlendirildi. Hastalar son kontrolde; IKDC (International
Knee Documentation Committee) diz skoru ve Lysholm skoru, fonksiyonelite (tek bacak zýplama) ve laksite (öne çekmece,pivot shift,lahman) testleri ile deðerlendirildi.
Bulgular: Ýki grup arasýnda yaþ ve cinsiyet daðýlýmý, ameliyat edilen taraf, ameliyat öncesdi süre ve eþilik eden yaralanmalar açýsýndan farklýlýk yoktu (p>0.05). IKDC,lysholm,fonksiyonellik, laksite bakýmndan her iki grupta da sonuçlar tatmin ediciydi ancak gruplar arasýnda anlamlý istatistiksel fark yoktu (p>0.05). Fakat ATT alogreft grubunda DHT otogreft grubuna göre daha fazla effüzyona rastlandý.
Sonuç: Bu çalýþmanýn sonuçlarý ATT allogreft ya da DHT otogreft ile ÖÇB rekonstrüksiyonunun klinik sonuçlarýnýn bezer olduðunu göstermektedir. Bununla birlikte allogreftlerde görülen immun yanýta çözümler geliþtirilmesiyle ÖÇB rekonstrüksiyonunda iyi bir greft alternatifi olabiliceðini düþünüyoruz.

Objectives: We investigated clinical outcome that allograft or autograft with anterior cruciate ligament (ACL) reconstructions.
Methods: We retrospectively evaluated 82 patients who underwent arthroscopic ACL reconstruction with anterior tibial tendon (ATT) allograft (n=52) or quadrupled hamstring tendon (DHT) otograft (n=30). The patients were assessed using the IKDC (International Knee Documentation Committee) and Lysholm knee scores,functional(one leg hop) and laxity (pivt-shift,lahman,anterior drawer) tests.
Results: The two groups were similar with respect to age and sex distribution, operated side, preop preiod and associated injuries (p>0.05). Results were satisfactory in both groups, but there is no statistically significant difference between groups that respect to IKDC, lysholm score,functýonality and ligament laxity. However, were found in effusions DHT group than in the ATT group.
Conclusion: Our results suggest that differences graft options of the ACL reconstructions tunnel fixation have no effect clinical outcome. Allografts with to be developed solutions to immune response may be a good alternative in ACL reconstruction.

Amaç: Eriþkin radius alt uç kýrýklarýnda volar yaklaþýmla kilitli ve kilitsiz plak uygulamalarýnýn sonuçlarý deðerlendirildi.
Çalýþma planý: Distal radius kýrýðý nedeni ile cerrahi tedavi uygulanan 14'ü kadýn, 20'si erkek, yaþ ortalamasý 48.5±17.9 olan toplam 34 hasta retrospektif olarak incelemeye alýndý. Kýrýklarýn tipi AO sýnýflamasýna göre %17.6 B3, %11.8 C2 ve %70.6 C3 olarak daðýlým göstermekteydi. Klinik sonuçlar Gartland ve Werley deðerlendirme skalasý, Görsel analog ölçüt (VAS), Kol omuz el sorunlarý anketi (DASH) ile, radyolojik deðerlendirme ise Stewart deðerlendirme ölçütleri ile yapýldý.
Sonuçlar: Hastalarýn ortalama takip süresi 24±16.3 aydý. Gartland-Werley deðerlendirme skalasýna göre %29.4 hastada mükemmel, %55.9 hastada iyi, %11.8 hastada orta ve %2.9 hastada kötü sonuç alýndý. Ortalama VAS skoru 0.5±1.1, ortalama DASH subjektif sorgulama puaný 26.1 olarak bulundu. Stewart skoruna göre %44.1 mükemmel, %52.9 iyi, %2.9 orta sonuç elde edildi. Olgularýn kavrama gücü geri kazanýmlarý saðlam tarafa göre %43.1 olarak bulundu. Ýki hastada kompleks rejyonel aðrý sendromu, bir karpal tünel sendromu ve bir tenosinovit görüldü.
Çýkarýmlar: Radius distal uç kýrýklarýnýn tedavisinde volar plak ile tespit etkin ve iyi bir yöntemdir. Plak özenli yerleþtirilmeli ve ameliyat sonrasý rehabilitasyon ihmal edilmemelidir.

Objective: To evaluate results of volar locking and unlocking plate fixation of adult distal radius fractures.
Methods: 34 patients (14 female and 20 male, the mean age was 48.5±17.9) who were treated for distal radius fractures,retrospectively investigated. The fractures were distirubuted as follows; 17.6% AO type B3, 11.8% AO type C2 and 70.6% AO type C3. The patients were evaluated clinically (Gartland and Werley scale, Visual analog score (VAS), Disabilites of the arm shoulder and hand score (DASH)) and radiographically (Stewart score).
Results: The mean follow-up of patients were 24±16.3 months. According to Gartland-Werley scale, the results were excellent in 24.9% of patients, good in 55.9% of patients, moderate in 11.8% of patients and poor in 2.9% of patients. The mean VAS score was 0.5±1.1, and the mean DASH score was 26.1. According to Stewart criteria, 44.1% of patients rated as excellent, 52.9% of patients rated as good and 2.9% of patients rated as moderate. 2 patients had complex regional pain syndrome, one patient had carpal tunnel syndrome and one patient had tenosynovitis.
Conclusions: Volar plate fixation is a good and an effective treatment for distal radius fractures. Plate should be inserted properly and physiotherapy should not be ignored.

Amaç: Bu çalýþmada beþinci metakarp boyun kýrýklarýnýn konservatif tedavisinde sýklýkla uygulanan tespit yöntemlerinden dördü deðerlendirildi.
Hastalar ve Yöntem: 2008-2009 yýllarý arasýnda kliniðimize baþvuran ve konservatif yöntemlerle tedavi edilen hastalar ileriye dönük olarak deðerlendirildi.Altmýþ erkek hastayý kapsayan bu çalýþmada uygulanan tespit yöntemleri; Metakarpofalangeal eklemler ekstansiyonda iken distal interfalangeal ekleme kadar uzanan sirküler alçý, MF eklemler semifleksiyonda iken DIF ekleme kadar uzanan sirküler alçý, el bileðinden DIF eklemin distaline kadar uzanan adeziv bandaj ve 4- 5. MF, proksimal ve DIF eklemleri semifleksiyonda içine alan “U”alçý ateli idi. Yerleþtirme öncesi ve sonrasý dönemde radyografilerle takip edilen hastalarýn açýlanmalarý ile metakarp uzunluklarý ölçüldü. Hastalarýn eklem hareketleri ve kavrama güçleri mukayeseli olarak ölçüldü ve istatistiksel deðerlendirmede yapýldý.
Sonuçlar: 52 hasta çalýþmayý tamamladý. Tedavi öncesi arka-ön ve oblik radyografilerde sýrasýyla; 17̊ (SD: 11), 46̊ (SD: 11. 7) olan açýlanmasý olan kýrýklar, 4 hafta sonunda 5̊̊ (SD: 5.9), 27̊ (SD: 10.5) açýlanmalý olarak kaynadý(p<0.0001). Kontrol grafilerinde beþinci metakarp boyunda 1.6(SD: 1.4) mm kýsalma bulundu. Saðlam tarafa göre kavrama güçlerinde %16, MP eklem hareketlerinde %5 azalma bulundu. DASH ve PEM anketlerinin sonuçlarý sýrasýyla 3(SD: 1.4), 24(SD: 3) puan oldu. Ýstatistiksel olarak tedavi gruplarý arasýnda anlamlý bir fark gözlenmedi(p>0.05).
Tartýþma: Beþinci metakarp kýrýklarýnýn konservatif yöntemlerle tedavisinde uyguladýðýmýz tespit yöntemleri arasýnda sonuç bakýmýndan istatistiksel anlamlýlýkta fark bulunamadý.

Aim: We evaluated four distinctive fixation methods for conservative treatment of neck fractures of fifth metacarp.
Patients and Methods: Patients who have been treated with non-surgical methods following closed reduction in our clinics between 2008 and 2009 were evaluated prospectively.In study that consists of 60 male patients, the following were the fixation methods applied for 4 weeks; circular cast extending from the wrist to the distal interphalangeal joint (Group A), circular cast covering semiflexed metacarpophalangeal and DIP from the wrist to the distal interphalangeal joint (Group B), circular self-adherent wrap (Coban™) covering metacarpal bones II–V, from wrist to DIP joint (Group C) and ulnar gutter splint covering semiflexed 4-5.MP, proximal and distal IP joints (Group D). In patients who were followed up with AP and oblique radiography, angulations and metacarpal lengths of patients were measured before and after reduction
Results: 52 patients with an average age of 30(SD: 9) completed the studyFractures with radiographical angulation of 17˚ (SD: 11) and 46˚(SD: 11.7) before treatment, union achieved with an angulation of 5˚(SD: 5.9) and 27̊ (SD: 10. 5) after 4 weeks (p0.05).
Conclusion: No statistically significant difference was found between the applied non-surgical treatment methods of fifth metacarpal fracture.

Adrenal injuries following blunt abdominal trauma are uncommon. Adrenal hemorrhage in children associated with multiple organ injury, has received little attention in the past, and is an increasingly recognized phenomenon in modern trauma centers with the wide-spread use of abdominal computed tomography (CT). Adrenal trauma occurs in the setting of multisystem organ injury. Isolated adrenal injury is exceedingly rare. We report two children with blunt adrenal trauma (one with isolated and one with associated injuries), who were admitted to our pediatric surgery department after abdominal trauma during the last two years. We determined the prevalence, management and general prognosis of blunt adrenal injury in pediatric population. Traumatic adrenal hemorrhage appears to be an incidental and unsuspected finding that resolves on follow up imaging.

Diaphragmatic rupture is a potential life threatening clinical situation. It occurs as a result of high velocity blunt or penetrating injury to abdomen and thorax. Acute traumatic rupture of diaphragm may go undetected and there is often delay between the injury and diagnosis. Right sided rupture is less common due to hepatic protection and increased strength of right hemidiaphragm. A systematic review of literature by Rashid F et al has revealed 13 cases of right sided diaphragmatic rupture, while herniation of liver occurred only in six cases. We report a case of 28 year old man who was admitted with breathlessness to our hospital 72 hours after trauma. Since clinical signs and symptoms were non-specific, helical computed tomography was done which revealed diaphragmatic rupture with hepatothorax. Emergency thoracotomy was done to repair diaphragmatic rent. Postoperative period was uneventful and patient was discharged from hospital after three weeks.

Yüksekten düþme sonucu 10 ve 11. torakal vertebralarda burst fraktürü, parapleji ve akut aort transeksiyonu saptanan otuzsekiz yaþýndaki erkek hasta, transeksiyon tedavisi amacýyla merkezimize sevk edildi. Eþlik eden ciddi yaralanmalar nedeniyle cerrahi tamir yüksek riskli bulundu. Transeksiyon endovasküler yöntemle, 30X100 mm Vailant torasik endogreft, sol karotis arter ostiyumunun hemen distaline yerleþtirilerek tamir edildi. Hasta olaðan seyreden servis takibinin ardýndan nöroþirurji servisine, parapleji tedavisinin devamý amacýyla geri gönderildi. Akut transeksiyon tedavisinde endovasküler yöntemler cerrahi tamire oranla morbidite ve mortalitede önemli avantajlar saðlamaktadýr. Ancak torasik endogreftlerin uzun dönem sonuçlarý halen bilinmemektedir. Orta dönemde elde edilen umut verici neticeler uzun dönemde de saðlanabilirse, endovasküler tamir altýn standart haline gelebilir.

A thirty-eight year old, male patient who suffered from 10th and 11th thoracal vertebrae fractures, paraplegia and acute traumatic aortic transection because of accidental fall was referred to our hospital. Open surgical repair had a very high risk due to severe coexisting injuries. Transection was treated with 30x100 mm Vailant thoracic endograft which was deployed just distal to the ostium of the left carotid artery. Patient was transfered to neurosurgery clinic for treatment of paraplegia after uneventful recovery. Endovascular repair of acute transection confers substantial advantages in mortality and morbidity according to surgical repair. But the long-term durability of thoracic endografts is still unknown. If the long-term results are satisfactory just like promising mid-term results, this technique may become a gold standart approach for treatment of acute transection.

Penetrating landmine injuries are the unavoidable consequences of military conflicts. They are potentially life-threatening conditions. The mortality rates in the literature range from 23% to 92% and are considerably higher in patients that admitted with poor neurologic state. Penetrating craniocerebral injuries require early surgical management designated to prevent infection and remove foreign objects, necrotic tissue, and complicating blood clots, as well as to minimalize post-traumatic sequelae. We reported an interesting case of penetrating intracerebral injury with shrapnel due to landmine in a 20-year-old young man.

Künt göðüs travmasý ile iliþkili kardiyak etkilenme, literatürde çocuklarda genellikle vaka sunumlarý þeklinde bildirilmiþtir ve travmaya baðlý interventriküler septum rüptürü geliþmesi oldukça nadirdir. Çocuklarda göðüs kafesi yapýlarýnýn esnek olmasý nedeniyle görünür bir travma belirtisi olmadan da interventriküler septum rüptürü geliþebilmektedir. Makalemizde trafik kazasý sonrasý sol ön inen koroner arter zedelenmesine baðlý mid-müsküler bölgede interventriküler septum rüptürü ve sol ventrikülde psödoanevrizma geliþen 7 yaþýnda bir erkek vaka sunulmuþtur. Künt göðüs travmasý sonrasýnda fizik muayenede üfürüm tespit edilen hastalarda kardiyak zedelenme olabileceði düþünülmeli ve elektrokardiyografide iskemi bulgularý saptananlarda koroner arterlerin de etkilenmiþ olabileceði unutulmamalýdýr.

Cardiac response associated with blunt chest trauma in children was generally reported as case reports in the literature and interventricular septum rupture due to trauma is quite rare. Interventricular septum rupture can be developed even in the absence of visible signs of a trauma because of the flexibility of the chest structure in children. In the present report; a 7 year-old boy with interventricular septum rupture at mid-muscular region and left ventricle pseudo aneurysm developed due to the injury of the left anterior descending coronary artery after a traffic accident was reported. The patients with cardiac murmur detected on physical examination after a blunt chest trauma must be considered as cardiac injury and in those detected the signs of ischemia on electrocardiography, it should not be forgotten that coronary artery may be affected.

Kimyasal yanýklar, yanýk ünitelerine baþvurularýn çok az bir yüzdesini oluþturmaktadýr. Islak çimentoyla temasýn kimyasal yanýk oluþturabileceði bilinmemektedir. Ýnþaat sektörünün giderek büyümesiyle birlikte, bu maddeyle temas etme ve zararlý etkilerine maruz kalma ihtimalide artmaktadýr. Uzun süren temas sonucu ýslak çimento ciddi yanýklara neden olabilmekte ancak maalesef bu özelliði profesyonel kullanýcýlar arasýnda bile yeterince bilinmemektedir.
Bu maddenin yol açabileceði potansiyel tehlikeler hakkýnda yeterince bilgi sahibi olunmamasý, kimyasal yanýk için ciddi bir risk faktörü olarak düþünülmesini dahada önemli hale getirmektedir. Bu maddeyle çalýþanlarýn gerekli koruyucu önlemleri almasý konusunda bilinçlendirilmeleri, bu tip kimyasal yanýklarýn önlenmesinde son derece etkili olacaktýr.

Chemical burns account for a small percentage of admissions to burn units. Wet cement is a poorly recognized cause for a chemical burn. As the construction industry is growing, it becomes more likely to get in contact with this material and be more prone to its harmful effects. Wet cement can cause severe full-thickness burns with prolonged contact but this property is not well-known among professional users.
Lack of information about its potential hazards makes it an important problem which must be taken into consideration more seriously as a risk factor for a chemical burn. Increasing public knowledge about taking necessary preventive measures is crucial for avoiding this type of chemical burn injuries.

Çocukluk çaðýnda birden fazla mýknatýs yutulmasý durumunda acil tedavi gerektiren klinik tablolar gözlenebilir. Bir mýknatýsýn yutulmasý durumunda çoðunlukla barsak pasajý ile atýlýrken, birden fazla mýknatýs veya mýknatýslanabilen metal cisimler yutulduðunda, yabancý cisimlerin bir araya gelmesine baðlý olarak önemli intestinal komplikasyon oluþturabilmektedir. Burada çoklu mýknatýs ve metal maddeler yutulmasý sonrasýnda geliþen multiple intestinal perforasyon olgusu sunulmaktadýr.
Olgu Sunumu:
Sekiz yaþýnda kýz hasta karýn aðrýsý ve kusma þikayeti ile baþvurdu. Baþvuru sýrasýnda batýn hassasiyeti ve defansý mevcuttu. Düz grafide hava-sývý seviyeleri ve metalik cisimler gözlendi. Grafide görülen metalik cisimler tanýsal yönden dikkate alýnmadý. Batýn USG’de akut apandisit lehine rapor edildi. Eksplorasyonda appendiks normal olarak görüldü fakat çekum ve ileum sýký bir þekilde yapýþýk bulundu. Diseksiyon sonrasýnda çekumda, çekumun 15 ve 45 cm proksimalinde internal fistüller yapan intestinal perforasyonlar gözlendi. Belirgin intestinal kaçak ve buna baðlý peritonit bulgusu yoktu. Bu alandaki yapýþýklýklar ayrýldýðýnda mýknatýs parçalarý ve metal cisimler görüldü. Ýntestinal yaralanmalarýn birinde wedge rezeksiyon, diðerlerinde primer tamir uygulandý. Postoperatif sorun yaþanmadý, hasta 5. gün þifa ile taburcu edildi.
Sonuç:
Çocuk cerrahlarý olarak çoklu mýknatýs yutulmasý ve buna baðlý geliþebilecek komplikasyonlardan haberdar olunmalýdýr. Yabancý cisim yutulmasý hikayesi mevcut olgularda abdominal düz grafilerle hasta takibi yapýlmalý, beraberinde mýknatýslanabilen metal cisim veya çoklu mýknatýs yutulmasý durumunda muhtemel komplikasyonlarý önlemek için cismin lokalizasyonuna bakýlmadan çýkarýlmalýdýr.

Multiple magnet ingestion during childhood may result in emergency situations. A single magnet may be discharged with intestinal peristalsis, but multiple magnets might stick together and cause significant intestinal complications. Here we present a case with intestinal perforation due to ingestion of multiple magnets and metal pieces.
Case report:
An eight years old girl was presented with abdominal pain and vomiting. She had abdominal tenderness and defense at examination. Abdominal x-ray showed air and fluid levels. Metallic images were not considered firstly as important in diagnosis. Abdominal ultrasonography was reported as acute appendicitis. At abdominal exploration, appendix was normal, but there were dense adherences around ileum and cecum. After adhesiolysis, intestinal perforations were seen in cecum and 15 and 45 cm proximal to cecum. Magnet and metal pieces were present in perforated segments. Wedge resection and primary repair was performed. There were no postoperative complications and she was discharged on postoperative 5th day.
Conclusion:
Pediatric surgeons should be aware of the complications of multiple magnet ingestions. If the patient has the complaint of multiple magnet ingestions, follow-up with daily abdominal x-rays should be done and in cases where magnets seem to cluster together or if acute abdominal signs develop, surgical exploration should be considered.