BACKGROUND: The aim of this study was to investigate whether allopurinol and oxypurinol treatment could mitigate oxidative stress and germ cell apoptosis in testicular ischemia-reperfusion (IR) injury.
METHODS: Thirty-two male rats were divided into four groups: Group 1 (Sham-Operated, n=8), in which the testicle was exposed but torsion was not performed; Group 2 (IR + Saline, n=8), in which torsion/detorsion was applied to the left testicle and 1 mL of normal saline was administered; Group 3 (IR + Allopurinol, n=8), in which torsion/detorsion was applied to the left testicle and 50 mg/kg allopurinol was administered; and Group 4 (IR + Oxypurinol, n=8), in which torsion/detorsion was applied to the left testicle and 50 mg/kg oxypurinol was administered. On postoperative day 28, left testicular tissue samples were collected, and total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) levels were measured. Additionally, the gene expression levels of Bax, B-cell lymphoma 2 (Bcl-2), endothelial nitric oxide synthase (eNOS), and vascular endothelial growth factor A (VEGF-A) were analyzed.
RESULTS: Allopurinol and oxypurinol significantly decreased OSI levels (p<0.001). Oxypurinol was found to be significantly more effective in reducing oxidative stress (p<0.001). Both allopurinol and oxypurinol significantly reduced Bax gene expression levels (p<0.001). Treatment with allopurinol (p=0.009) and oxypurinol (p=0.001) significantly increased Bcl-2 levels. Additionally, both agents significantly reduced the apoptosis index (p<0.001). Allopurinol (p1=0.007, p2<0.001) and oxypurinol (p1,2<0.001) treatments significantly increased eNOS and VEGF-A gene expression levels.
CONCLUSION: Allopurinol and oxypurinol reduce oxidative stress in the testis following IR injury, with oxypurinol demonstrating a greater antioxidant effect. Both treatments also reduce apoptosis by contributing positively to the eNOS and VEGF-A-mediated repair processes. Therefore, allopurinol and oxypurinol may serve as potential therapeutic agents for clinical application in testicular torsion.

BACKGROUND: Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are widely used to treat vertebral frac-tures. However, the standard filler material, polymethylmethacrylate (PMMA), presents significant drawbacks, including thermal dam-age, allergic reactions, and poor biocompatibility. Tetracalcium phosphate (TTCP), a calcium phosphate cement (CPC), has emerged as a promising alternative due to its superior biocompatibility, osteoconductivity, and ability to integrate with natural bone. This study aimed to evaluate the feasibility of TTCP for vertebral augmentation in a preclinical sheep model, focusing on biomechanical stability, biocompatibility, and osteogenic potential.
METHODS: Five Akkaraman sheep underwent PKP with TTCP at three lumbar vertebral levels (L2–L4). Under general anesthesia, TTCP cement was injected into cavities prepared according to the standard PKP procedure. Postoperative care included analgesia and antibiotics. Four animals were followed for 12–14 weeks, and one for 25 weeks. At the end of the study period, the animals were euthanized and vertebrae were harvested for biomechanical testing using a Shimadzu AG-IS 100 kN machine. Histological evaluation was performed to assess ossification stages according to Shapiro’s classification. Statistical analysis was conducted using paired t-tests (p<0.05).
RESULTS: One animal was euthanized prematurely due to infection, while four completed the study without complications. Biomechanical analysis demonstrated no significant difference in compressive strength between treated and untreated vertebrae (p>0.05). Histological examination revealed osteoblastic activity, progressive mineralization, and successful bone integration.
CONCLUSION: TTCP demonstrated promising biomechanical and biophysiological properties for vertebral augmentation. However, its use in infected sites and in the presence of metabolic bone disorders may be limited. Further clinical studies are required to validate its long-term efficacy.

BACKGROUND: Upper gastrointestinal bleeding (UGIB) is a significant cause of morbidity and mortality. While endoscopy is the primary treatment modality, transcatheter arterial embolization (TAE) can be an effective alternative when endoscopic treatment fails. This study aims to evaluate the safety and efficacy of empiric TAE for acute UGIB.
METHODS: This retrospective, single-center study reviewed 20 consecutive patients referred to interventional radiology for embolization due to UGIB between August 2021 and November 2024. The mean patient age was 62.3±16.2 years. Clinical success was defined as devascularization of the target area resulting in clinical cessation of bleeding and stabilization of hemoglobin levels. Technical success was defined as occlusion of the feeding vessel and/or absence of extravasation following angiography.
RESULTS: Thirteen patients (65%) had duodenal bleeding and underwent gastroduodenal artery embolization. Seven patients (35%) had gastric bleeding and underwent left gastric artery embolization. Both the technical and clinical success rates of the procedure were 100%. Rebleeding occurred in one patient (5%) and was managed surgically. There was no procedure-related mortality. One major complication (5%), coil migration, was managed conservatively. One minor complication (5%), a groin hematoma, occurred and did not require transfusion.
CONCLUSION: Empiric transcatheter embolization is an effective and safe treatment option for acute upper gastrointestinal bleeding, demonstrating high technical and clinical success rates. The procedure shows favorable outcomes in terms of hemostasis, rebleeding rates, and complication profiles compared to surgical intervention.

BACKGROUND: Infections are a frequent complication of military trauma, occurring not only in the acute phase but also during rehabilitation. However, studies specifically addressing infections in the rehabilitation setting remain scarce. This study aimed to evalu-ate the incidence, microbiological spectrum, treatment approaches, and outcomes of skin and soft tissue infections (SSTIs) and bone and joint infections (BJIs) in military trauma patients during inpatient rehabilitation.
METHODS: We retrospectively reviewed the medical records of military trauma patients hospitalized at a tertiary rehabilitation hospital between January 2020 and June 2023. Patients who developed SSTIs or BJIs during rehabilitation were included. Demographic and clinical characteristics, laboratory and imaging findings, culture results, antibiotic regimens, surgical interventions, treatment duration, and recurrence rates were analyzed.
RESULTS: Among 1,078 trauma patients, 58 (5.4%) developed SSTIs or BJIs. Stump infection was the most frequent type (44.8%), followed by graft infection (15.5%). Staphylococcus species were the predominant pathogens, while multidrug-resistant (MDR) gram-negative organisms were isolated in 24.1% of cases. β-lactam/β-lactamase inhibitor (BL-BLI) therapy was the most common mono-therapy, whereas BL-BLI plus a fluoroquinolone was the most frequently used combination regimen. Surgical intervention was required in 34.5% of patients. Recurrent infections occurred in 25.8% of cases. Treatment duration was significantly longer in non-amputee pa-tients (p<0.05), primarily due to bone and joint infections. Despite these infectious complications, most lower-limb amputees achieved ambulatory status with prosthetic devices.
CONCLUSION: Military trauma patients remain at risk for SSTIs and BJIs during rehabilitation, with stump infections being the most common. The emergence of MDR organisms underscores the need for appropriate antibiotic selection and strict infection control measures. Despite these complications, relatively favorable functional outcomes can be achieved, particularly in younger trauma populations, highlighting the value of comprehensive rehabilitation programs.

BACKGROUND: Abdominal gunshot wounds contribute significantly to trauma-related morbidity and mortality. Computed tomog-raphy (CT) can provide valuable diagnostic information but may potentially delay definitive treatment. This study aimed to evaluate the role of abdominal CT in surgical decision-making and timing among patients with abdominal gunshot injuries.
METHODS: We retrospectively analyzed patients with abdominal gunshot wounds treated at a tertiary university hospital between January 2013 and January 2023. Collected data included demographic characteristics, physiological parameters, trauma scores, CT find-ings, time intervals (from admission to CT and to surgery), and clinical outcomes. Patients were classified as hemodynamically stable or unstable based on admission parameters and their response to resuscitation. The two groups were compared.
RESULTS: A total of 74 patients were included (94.5% male; median age, 32 years). Of these, 47 (63.5%) were hemodynamically stable at presentation, while 27 (36.5%) were unstable. Abdominal CT was performed in 67 patients (90.5%), with a median time of 28 minutes from admission. The median time to CT was similar between stable (28 minutes) and unstable (30 minutes) patients (p=0.934). Based on CT findings, nonoperative management was feasible in 10 patients (13.5%). Among the unstable group, CT was performed in 7 of 11 nonresponders, of whom six (54.5%) died. Among patients who underwent surgery, the mean time to operation was significantly shorter in unstable patients compared to stable patients (60.4±36.7 vs. 93.2±76.6 minutes; p=0.034). The perioperative mortality rate was 9.3%, with all deaths occurring in hemodynamically unstable nonresponders.
CONCLUSION: Abdominal CT can aid surgical planning without causing significant delays in definitive treatment, even in initially unstable patients who respond to resuscitation. CT findings may support nonoperative management in selected cases and guide targeted surgical interventions in patients requiring operative treatment. However, these findings apply to carefully selected patients and should be interpreted cautiously, as this study does not establish the safety of CT in unselected hemodynamically unstable patients. The proximity of the CT scanner to the resuscitation area facilitated rapid imaging; therefore, the findings may not be generalizable to institutions with remotely located CT facilities.

BACKGROUND: This study aimed to investigate the factors affecting mortality in Fournier's gangrene (FG) and to establish a simplified scoring system that enables practical bedside assessment for clinicians.
METHODS: The medical records of 130 patients treated for FG between February 2012 and January 2025 were retrospectively reviewed. Survivors (Group 1, n=101) were analyzed separately from non-survivors (Group 2, n=29). The collected data included sex, age, infection spread score, Uludag Fournier’s Gangrene Severity Index (UFGSI), Fournier's Gangrene Severity Index (FGSI) scores, source of infection, presence of diabetes mellitus (DM), obesity, and other comorbidities. Additional variables included the presence of a diverting stoma, duration of vacuum-assisted closure (VAC) therapy, length of hospital stay, intensive care period (ICP), and isolated bacterial species. Associations between mortality and factors such as age, infection spread score, comorbidities other than DM and obesity (CADO), and ICP were examined.
RESULTS: A significant difference was observed between the groups in terms of age and age score. The infection spread score was significantly higher in Group 2. While 60 patients in Group 1 had CADO, all patients in Group 2 had CADO, demonstrating a statistically significant difference. ICP was also significantly longer among non-survivors. Receiver operating characteristic (ROC) analysis demonstrated that the Eğin score had a sensitivity of 96.6% and a specificity of 63.4% at a threshold value of >3.
CONCLUSION: Age, infection spread score, CADO, and ICP, which constitute the Eğin score, demonstrated significant differences between survivors and non-survivors. These parameters are crucial for predicting mortality in patients with FG.

BACKGROUND: This study aimed to compare the prognostic performance of the Fournier’s Gangrene Severity Index (FGSI) and the hemoglobin–albumin–lymphocyte–platelet (HALP) score in predicting in-hospital mortality among patients diagnosed with Fournier’s gangrene. As Fournier’s gangrene remains a life-threatening and rapidly progressive soft tissue infection, early risk stratification is critical for improving patient outcomes. Validating practical scoring systems may support timely clinical decision-making and resource allocation.
METHODS: A retrospective analysis was performed on 52 patients who underwent surgical treatment for Fournier’s gangrene at a tertiary referral center between December 2022 and June 2025. Demographic, laboratory, and clinical data were collected, and both FGSI and HALP scores were calculated at the time of admission. Receiver Operating Characteristic (ROC) curve analysis and multivariate logistic regression were used to assess the predictive value of both scores for in-hospital mortality.
RESULTS: The mean FGSI was 5.1±2.2, while the mean HALP score was 134.6±100.2. FGSI showed acceptable discrimination (AUC=0.7639; cutoff=5.0), with 72.7% sensitivity and 67.7% specificity. HALP had poor predictive ability (AUC=0.4018). In multivariate analysis, FGSI was an independent predictor (p=0.0146), while HALP was not (p=0.9474).
CONCLUSION: FGSI appears to be a reliable and independent prognostic tool in patients with Fournier’s gangrene. HALP, however, does not offer additional prognostic benefit. FGSI should be prioritized in early risk assessment to guide management strategies.

BACKGROUND: Postpartum hemorrhage is a major cause of maternal morbidity and mortality. Abdominal packing is a technique used to control bleeding when other methods fail. This study aimed to evaluate the outcomes of patients who underwent abdominal packing for postpartum hemorrhage.
METHODS: This retrospective study included 11 patients who underwent abdominal packing for severe obstetric hemorrhage (10 cases of postpartum hemorrhage and one case of second-trimester pregnancy termination complicated by severe hemorrhage) at Mersin University Faculty of Medicine Hospital between 2005 and 2023. Data were collected from medical records. The primary outcome was the successful immediate control of refractory hemorrhage and temporary stabilization of the patient's hemodynamic status. Secondary outcomes included transfusion requirements, complications, and length of hospital stay.
RESULTS: All 11 patients underwent hysterectomy for postpartum hemorrhage and subsequently required abdominal packing due to persistent bleeding. The median age was 33 years, and the median gravidity was 3. The primary causes of postpartum hemorrhage were uterine atony (54.5%), placenta previa (36.4%), and disseminated intravascular coagulation (9.1%). The median number of packs used was 3, and packs were removed after 24 hours in all cases. Abdominal packing successfully controlled persistent bleeding in all patients following hysterectomy. The median length of hospital stay was 6 days. All patients required blood transfusions. The most common complication was pulmonary edema (90.9%). All patients survived.
CONCLUSION: Abdominal packing may serve as a valuable temporary rescue measure for severe, refractory obstetric hemorrhage in selected cases where conventional methods are insufficient. Careful patient selection and close postoperative monitoring are essential.

BACKGROUND: Mortality rates are high in patients undergoing emergency surgery for obstructed colon adenocarcinoma. The etiology of mortality is multifactorial, and parameters with high predictive value are still needed. The aim of this study was to investigate the relationship between the blood urea nitrogen-to-serum albumin ratio (BAR) and short-term mortality in patients with obstructed colon cancer undergoing emergency surgery.
METHODS: This retrospective cohort study included patients with obstructed colon adenocarcinoma who underwent emergency surgery at two tertiary care centers between January 2015 and December 2024. Baseline characteristics, laboratory findings, operative details, and clinical data were collected. According to time-dependent receiver operating characteristics (ROC) analysis, the optimal cut-off value for pretreatment BAR was 0.68. Data from patients who died within the first 30 days and those who survived were compared. Univariate and multivariate Cox regression analyses were performed to evaluate the association between BAR and other factors with early mortality.
RESULTS: A total of 173 patients underwent emergency surgery, and 17 (9.8%) experienced early mortality. In multivariate logistic regression analysis, age (≥75 years), lactate level, neutrophil count, and BAR ≥0.68 (odds ratio: 7.053; 95% confidence interval: 1.728-28.785; p=0.006) were identified as significant risk factors for early mortality in patients undergoing emergency surgery for obstructed colon cancer.
CONCLUSION: Mortality in patients undergoing emergency surgery for obstructed colon cancer is high and multifactorial. BAR is a cost-effective, easily measurable, and useful predictor of early mortality.

BACKGROUND: Anal canal stenosis is a functionally disabling condition that results in impaired continence, constipation, and decreased quality of life. Although most cases arise after anorectal surgery, high-energy blast trauma (HEBT) represents a distinct etiology characterized by extensive tissue loss and neuromuscular injury. Long-term outcomes of anoplasty in this setting remain insufficiently described. This retrospective study evaluated functional and quality-of-life outcomes following flap anoplasty for anal stenosis of both postoperative and trauma-related origins.
METHODS: All patients who underwent anoplasty between 2008 and 2015 with ≥12 months of follow-up were included. Functional status was assessed preoperatively and at 12 months postoperatively using the Modified Wexner Score, Wexner Constipation Scale, and the Fecal Incontinence Quality of Life (FIQL) questionnaire. Sphincter morphology was evaluated using endoanal ultrasonography. Statistical analyses included paired tests, effect size calculations, and multivariable logistic regression to identify independent predictors of good continence (Wexner score ≤5).
RESULTS: Thirty-seven patients met the inclusion criteria: 27 with postoperative stenosis and 10 with blast-related trauma. Ano-plasty resulted in overall improvement in continence, constipation, and FIQL scores. However, functional recovery differed significantly by etiology: postoperative patients experienced substantial improvement, whereas blast-injured patients achieved only modest gains, reflecting persistent neuromuscular and fibrotic damage. Trauma cases demonstrated lower FIQL scores (14.7 vs. 16.8), higher constipation scores (8.1 vs. 7.2), and increased rates of fecal incontinence (20% vs. 11.1%). Sphincter integrity and shorter stricture length independently predicted good continence, while blast mechanism and advanced age were associated with reduced improvement.
CONCLUSION: Anoplasty provides meaningful functional benefits in patients with anal stenosis; however, recovery is significantly attenuated in survivors of high-energy trauma. These findings underscore the importance of etiology-based planning, thorough sphinc-ter evaluation, and realistic patient counseling.

BACKGROUND: Trauma during pregnancy presents unique clinical challenges due to physiological adaptations and the need to ensure fetal well-being. Although guidelines recommend a minimum period of maternal and fetal monitoring following trauma, the factors associated with prolonged emergency department (ED) observation in pregnant trauma patients remain insufficiently defined. Identifying these factors may help optimize clinical decision-making and resource utilization in emergency care settings.
METHODS: This retrospective cohort study was conducted in a tertiary-care emergency department between January 2014 and January 2024. Patients were categorized according to ED observation duration as ≤6 hours or >6 hours. Demographic characteristics and clinical variables, including Injury Severity Score (ISS), gestational age, RhD status, trauma characteristics, and consultation requirements, were recorded. Univariate and multivariable logistic regression analyses were performed to identify predictors of prolonged ED observation.
RESULTS: A total of 459 pregnant trauma patients were included in the analysis, of whom 238 (51.9%) were observed in the ED for more than 6 hours. Patients with prolonged observation had a significantly higher gestational age than those observed for ≤6 hours (median 24 weeks [interquartile range (IQR): 15–32] vs. 17 weeks [IQR: 11–23], p<0.001). In multivariable analysis, higher ISS (odds ratio [OR]: 1.20, 95% confidence interval [CI]: 1.08–1.35, p<0.001), advancing gestational age (OR: 1.07 per week, 95% CI: 1.04–1.09, p<0.001), and RhD negativity (OR: 3.84, 95% CI: 1.33–11.14, p=0.013) were independently associated with ED observation exceeding 6 hours. Although the number of consultations was significantly associated with prolonged observation in univariate analysis, it did not remain an independent predictor after multivariable adjustment.
CONCLUSION: Higher ISS, advancing gestational age, and RhD negativity were independently associated with emergency department observation lasting more than 6 hours among pregnant trauma patients.

BACKGROUND: Unintentional childhood injuries (UCIs) are a leading cause of morbidity and mortality among children globally, imposing significant clinical and economic burdens, particularly in low- and middle-income countries. Emergency Departments (EDs) serve not only as the first point of contact for such events but also as the initial entry point for non-fatal UCIs, which represent a hidden and more substantial burden on health services. The primary objective of this study is to comprehensively analyze the clinical and socioeconomic determinants and predictors of unintentional childhood injuries (UCIs) presenting to the emergency department. Based on insights from these empirical data, the study further proposes a multidisciplinary, four-dimensional framework as a conceptual model to enhance systemic prevention and intervention strategies.
METHODS: This is a prospective and cross-sectional study. Data were collected using structured forms and digital medical records, covering demographic, familial, socioeconomic, and injury-related variables. Statistical analyses were performed to examine associations among risk factors, injury mechanisms, clinical outcomes, and mortality predictors.
RESULTS: Falls were the most common cause of UCI (49.8%), followed by traffic accidents (12.4%). Injuries most frequently occurred at home(43.6%), particularly in kitchens and gardens. Male patients constituted 62.7% of the cases. Statistically significant associations were observed between low maternal education, poor economic status, and higher Injury Severity Score (ISS). Multiple trauma(MT) was more common among children aged≥12 years and those with separated parents. Elevatedserum glucose (≥153 mg/dL) and glucose/potassium ratio (≥39.48) were identified as potential clinical markers for assessing mortality risk (p<0.001). MT, abdominal and thoracic trauma, and higher ISS were associated with increased mortality.
CONCLUSION: Early identification of high-risk patients using clinical predictors such as serum glucose may improve treatment outcomes. Additionally, the frequent occurrence of head, upper, and lower extremity injuries in the ED indicates that these regions should be carefully examined for potential injuries. The tendency for thoracic and abdominal injuries to co-occur, as well as the higher prevalence of MT among patients with abdominal trauma—and the predictive value of abdominal injuries for adverse clinical outcomes—underscore the need for thorough evaluation of other systems and differentiated clinical monitoring in children identified with abdominal injury. Multidisciplinary and systematic prevention and treatment strategies that address clinical, socioeconomic, and environmental factors remain essential for reducing both the incidence and severity of such injuries. The multidisciplinary, task force-oriented approach proposed in this study—emphasizing the clear definition of roles—may offer significant improvements in this regard.

BACKGROUND: Testicular torsion is an important urologic emergency, and early identification is crucial. This study aimed to evaluate the diagnostic value of hematological parameters—particularly immature granulocytes (IGs) in differentiating epididymo-orchitis from testicular torsion in patients presenting with acute scrotal pain.
METHODS: This retrospective cohort study included 301 male patients presenting with acute scrotal pain between January 2020 and December 2024. Diagnoses were confirmed by Doppler ultrasonography or surgical exploration. Patients were classified into epididymo-orchitis (n=200), testicular torsion (n=37), and control (n=64) groups. Complete blood count parameters (WBC, neutrophil, lymphocyte, platelet, IG, NLR, PLR) were analyzed. Nonparametric tests were used for group comparisons, and ROC curve analyses were performed to determine diagnostic performance. Multivariable logistic regression adjusted for age identified independent predictors.
RESULTS: NLR (cut-off=2.19, AUC=0.644, p<0.001) and IG count (cut-off = 0.06, AUC=0.590, p=0.011) were significantly elevated in epididymo-orchitis compared with controls. No parameter showed diagnostic significance for testicular torsion. In the epididymo-orchitis vs torsion comparison, NLR (AUC=0.781, p<0.001) and IG count (AUC=0.730, p<0.001) demonstrated the best discriminative ability. Multivariable regression confirmed NLR (OR=1.17, 95% CI 1.05–1.31, p=0.005) and IG (OR=2.26, 95% CI 1.10–4.63, p=0.027) as independent predictors of epididymo-orchitis.
CONCLUSION: Immature granulocyte count and NLR are valuable and accessible hematological biomarkers that can assist in differentiating epididymo-orchitis from testicular torsion. Their integration into diagnostic evaluation may enhance clinical decision-making in the emergency management of acute scrotum.

BACKGROUND: The Kahramanmaraş earthquake that occurred in Türkiye in 2023 affected 14 million people, resulting in 53,537 deaths and more than 100,000 injuries. In large-scale disasters, it is crucial to rapidly initiate complex treatment processes in hospitals equipped with tertiary intensive care units following the initial on-site response. In this study, we aimed to retrospectively analyze the types of trauma and the associated surgical and medical treatments of patients affected by the earthquake who were admitted to our level 3 intensive care unit. Our objective was to contribute to future disaster preparedness planning in healthcare institutions and to improve intensive care treatment strategies.
METHODS: This retrospective single-center study was conducted at Mersin City Training and Research Hospital. Clinical data of patients treated in the tertiary intensive care unit were reviewed. The recorded variables included demographic characteristics, time of hospital admission, length of hospital stay, complete blood count, creatine kinase, myoglobin, albumin levels, liver and renal func-tion tests, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, type of trauma, presence of crush syndrome and acute kidney injury, surgical interventions and types of surgery, renal replacement therapy, blood transfusion, fluid therapy, nutritional support, requirement for mechanical ventilation, psychiatric support, hyperbaric oxygen therapy, mortality, and referral to another hospital.
RESULTS: A total of 80 patients were included in the study; 53.8% were female, and the mean age was 49.93 years. The overall mortality rate was 22.5%. The mean age was higher in the mortality group, and lymphocyte count was also significantly higher in this group. The proportion of patients receiving renal replacement therapy was greater in the mortality group compared to survivors (p=0.035). Eleven patients died within the first five days of admission, and 13 of the deceased patients had acute kidney injury. Mechanical ventilation and total parenteral nutrition were more frequently required in the mortality group.
CONCLUSION: Advanced age, the need for total parenteral nutrition, renal replacement therapy, and mechanical ventilation were identified as predictors of mortality among trauma patients followed in a tertiary intensive care unit.

BACKGROUND: This study aims to evaluate the effect of the type of intervention (bedside vs. operating room incision and drainage) on clinical outcomes in the treatment of perianal abscess and to identify predictive factors that may be effective in determining the type of intervention.
METHODS: A retrospective study was conducted on 213 patients who underwent incision and drainage (I&D) for cryptoglandular perianal abscess. Patients were divided into “bedside I&D” and “operating room I&D” groups according to the type of intervention. Demographic characteristics, laboratory values, abscess size, early complications, and long-term fistula development were compared. Receiver operating characteristic (ROC) analysis was performed to determine cut-off values for white blood cell count (WBC), C-reactive protein (CRP), and abscess size; subsequently, logistic regression analyses were performed using these parameters.
RESULTS: WBC count, CRP levels, and abscess size were statistically significantly higher in the operating room group (p<0.001). According to ROC analysis, cut-off values were determined as 14.68×10⁹/L for WBC, 55.7 mg/L for CRP, and 29.5 mm for abscess size. While CRP lost statistical significance in univariate regression analysis, WBC and abscess size were identified as independent predictive factors for determining the intervention site in multivariate analysis. During long-term follow-up, fistula development was observed significantly more frequently in the operating room group (p=0.002).
CONCLUSION: WBC level and abscess size may be valuable predictors in deciding the type of intervention for perianal abscess treatment. Bedside I&D can be safely performed in low-risk cases, whereas operating room intervention should be preferred in patients with high inflammatory markers and larger abscesses.

BACKGROUND: In this study, we aimed to present the management and treatment processes of patients with splenic trauma, discuss nonoperative treatment approaches, and share our institutional experience.
METHODS: A total of 244 patients hospitalized for splenic trauma between January 2010 and January 2020 were retrospectively analyzed.
RESULTS: Splenic injury was present in 22% of trauma patients who presented to the emergency department and were consulted by pediatric surgery. The most common cause of splenic injury was falls (60%). Forty-three percent of patients were of school age. Ninety percent of patients had Grade I-III splenic injuries. The mean age at presentation was 7.90 years. The mean hematocrit level was 32% and the mean hemoglobin level was 10.90. Blood transfusion was administered to 29% of patients. Additional injuries were present in 45.9% of cases, with the lung being the most frequently affected organ. The mean length of hospital stay was 6.03 days. Mortality occurred in five patients, and morbidity was observed in five patients. There was a statistically significant correlation between blood pressure, urine output, and mortality. A statistically significant association was also found between platelet-to-lymphocyte ratio, blood transfusion, hemoglobin level, Glasgow Coma Scale (GCS) score, and mortality (p<0.001). Furthermore, significant correlations were identified between GCS score, length of hospital stay, neutrophil count, and the presence of additional injuries (p<0.001). A strong negative correlation was observed between lactate levels and blood transfusion (r=-0.610), as well as between lactate levels and GCS score (r=-0.645). In the ROC analysis evaluating lactate as a predictor of additional injury, a sensitivity of 58% and specificity of 83% were identified at a cutoff value of 1.9.
CONCLUSION: We recommend nonoperative management for patients with splenic injury, as it reduces mortality, morbidity, and healthcare costs. Treatment protocols for these patients should be scientifically standardized.

BACKGROUND: Distal radius fractures (DRFs) are among the most common fractures in adults, with a significant proportion being stable, non-displaced, or minimally displaced. These fractures generally have a low risk of secondary displacement. This study aimed to compare the clinical and radiological outcomes of short-arm circular casting and volar splint application in the conservative treatment of stable distal radius fractures. Additionally, the study evaluated complication rates, patient comfort, and the feasibility of these two immobilization techniques in emergency department settings.
METHODS: This retrospective study reviewed the medical records of 170 patients diagnosed with stable, non-displaced, or minimally displaced distal radius fractures at two emergency departments between January 2020 and January 2023. Fracture stability was assessed using Lindstrom’s criteria. Among the participants, 88 patients were treated with short-arm circular casting, while 82 received volar splint application. Immobilization was maintained for four weeks, followed by a six-month follow-up period. Radiographic parameters (radial height, radial inclination, palmar tilt, and articular surface step-off) were measured at baseline and during follow-up visits. Clinical and functional outcomes were assessed using the Quick Disabilities of the Arm, Shoulder, and Hand (qDASH) and Patient-Rated Wrist Evaluation (PRWE) scales. Complication rates and patient satisfaction were also analyzed.
RESULTS: The study included 170 patients (mean age: 46.9±11.4 years). No statistically significant differences were observed between the casting and splint groups in terms of radiological parameters at baseline or six months post-treatment (p>0.05). Similarly, clinical and functional outcomes, including qDASH and PRWE scores, were comparable between the two groups (p>0.05). Complication rates were 5.7% in the cast group and 4.8% in the splint group, with no significant difference (p>0.05). The volar splint technique demonstrated advantages in terms of ease of application and patient comfort.
CONCLUSION: Short-arm circular casting and volar splinting provide equivalent clinical and functional outcomes in the management of stable distal radius fractures. Given its ease of application and greater patient comfort, volar splinting can be considered a practical alternative in emergency department settings, particularly for selected patient populations.

BACKGROUND: Vitamin D, calcium, and bone metabolism markers play a critical role in skeletal health; however, their relationship with different hip fracture types remains uncertain. This study aimed to investigate serum levels of 25(OH) vitamin D, calcium, parathyroid hormone (PTH), alkaline phosphatase (ALP), phosphorus, total protein, and albumin in elderly patients with femoral neck fractures (FNF) and intertrochanteric femur fractures (ITFF), compared to a control group.
METHODS: This retrospective study included 375 patients aged 65 years and older, comprising 117 patients with ITFF, 97 with FNF, and 161 control cases (coxarthrosis/gonarthrosis). Serum biochemical parameters were analyzed using standard laboratory methods. Fractures were classified according to the AO/OTA (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association) system by two independent observers, and interobserver agreement was assessed using Cohen’s kappa coefficient (κ=0.89). Group comparisons were performed using one-way analysis of variance (ANOVA) followed by post hoc Bonferroni tests. A p value <0.05 was considered statistically significant.
RESULTS: Vitamin D levels were significantly lower in both the ITFF and FNF groups compared to controls (p<0.01), while no significant difference was observed between the ITFF and FNF groups (p>0.05). Similarly, calcium, total protein, and albumin levels were lower in fracture groups than in controls (p<0.01). In contrast, PTH levels were significantly higher in patients with fractures (p=0.001).
CONCLUSION: Deficiencies in vitamin D and calcium were associated with an increased risk of hip fractures but did not appear to influence fracture pattern. These findings suggest that systemic biochemical parameters should be emphasized in comprehensive fracture risk assessment, underscoring the importance of preoperative evaluation and postoperative correction of metabolic deficiencies in patients with hip fractures.

BACKGROUND: The terrible triad of the elbow describes a complex injury pattern characterized by elbow subluxation or dislocation, rupture of the lateral ulnar collateral ligament (LUCL), and concomitant fractures of the radial head and coronoid process. This study aimed to evaluate and compare the clinical outcomes of patients with terrible triad injuries treated surgically at our institution, in whom coronoid fractures were managed using either screw fixation or the Tight-Rope technique.
METHODS: This retrospective cohort study included patients who underwent surgical treatment for terrible triad injuries between January 2017 and December 2023. Patients with Regan–Morrey type 2 or 3 coronoid fractures treated using the Tight-Rope technique were assigned to the Tight-Rope group, whereas those treated with screw fixation comprised the Screw group. Demographic characteristics, range of motion (ROM), visual analog scale (VAS) scores, and QuickDASH (Quick Disabilities of the Arm, Shoulder and Hand) scores at 3, 6, and 12 months postoperatively were analyzed. Patients with type 1 fractures, medial collateral ligament (MCL) injuries, follow-up <12 months, or a history of systemic infection were excluded.
RESULTS: Twenty-nine patients were included (11 in the Tight-Rope group and 18 in the Screw group). No significant differences were observed between the groups in terms of ROM or VAS and QuickDASH scores at 3, 6, and 12 months. After excluding cases requiring LUCL reconstruction and analyzing only patients who underwent LUCL repair (8 Tight-Rope, 13 Screw), the only statistically significant difference was a lower 12-month QuickDASH score in the Screw group. Complications included superficial cellulitis (1 Tight-Rope, 2 Screw) and heterotopic ossification (2 Tight-Rope, 3 Screw), all of which were managed conservatively. Post hoc power analysis based on 12-month QuickDASH scores, VAS scores, and elbow ROM (effect size d=0.77, α=0.05) demonstrated power of 77%, 71%, and 74%, respectively.
CONCLUSION: Functional outcomes were largely comparable between Tight-Rope and screw fixation techniques. These findings align with emerging evidence questioning the routine necessity of coronoid fixation and underscore the importance of individualized surgical decision-making.

BACKGROUND: Posterior malleolar fractures play a critical role in ankle fracture stability and joint congruity. While plate and screw fixation are widely used, existing literature has primarily focused on short-term functional outcomes and reduction quality. The long-term impact of the posterior malleolar fixation technique on post-traumatic ankle osteoarthritis, particularly in relation to fracture morphology, remains insufficiently explored.
METHODS: This retrospective cohort study included 91 adult patients who underwent surgical fixation of posterior malleolar fractures between 2015 and 2021, with a minimum radiological follow-up of 36 months. Patients were treated with either posterior buttress plate fixation (n=42) or posteroanterior screw fixation (n=49). Ankle osteoarthritis was assessed using the Van Dijk classifica-tion. Fracture morphology was classified according to the Bartoníček system. Functional outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) score, the Olerud–Molander Ankle Score (OMAS), and ankle range of motion (Prasad classification). Multivariable regression analyses were performed to assess the independent association between fixation method and outcomes.
RESULTS: After adjustment for age, body mass index, follow-up duration, fracture morphology, and open fracture status, screw fixation was statistically associated with a higher degree of ankle osteoarthritis compared with plate fixation (OR 11.22, 95% CI 2.17–58.04; p=0.004). However, the wide confidence intervals indicate considerable statistical uncertainty around the magnitude of this effect, likely reflecting the limited number of outcome events. Sensitivity analysis using a dichotomized osteoarthritis outcome yielded consistent results. Subgroup analyses demonstrated that the association between screw fixation and higher osteoarthritis risk was particularly pronounced in complex fracture patterns (Bartoníček types 3–4). Patients treated with plate fixation achieved significantly higher AOFAS and OMAS scores and demonstrated superior ankle range of motion at long-term follow-up. Increasing Van Dijk osteoarthritis grades were strongly correlated with worse functional outcomes.
CONCLUSION: Posterior buttress plate fixation was associated with a significantly lower risk of long-term post-traumatic ankle osteoarthritis and superior functional outcomes compared with screw fixation. These findings were especially evident in complex posterior malleolar fracture patterns, highlighting the importance of fracture morphology and fixation strategy in long-term joint preservation.

Objective
This study aims to reveal the multidimensional effects of migraine on driving by evaluating the driving habits of individuals with migraine and patients' adherence to safety strategies.
Materials and Methods
This multicenter, hospital-based, cross-sectional study was conducted between May and July 2024. Volunteers with migraine, aged 18-65 years, and with a driving history were included in the study after their consent. Detailed face-to-face interviews were conducted using a form adapted from the Driving Habit Questionnaire to assess the patients' demographic characteristics, individual driving experiences, driving preferences and habits. Finally, the impact of driving on the patients' quality of life was assessed using the Headache Impact Test-6 (HIT-6).
Results
Of the 2548 patients evaluated in our study, 1333 had driving experience; the mean age of the drivers was 36.7±9.5 years, and 64.4% were female. Patients with migraine drove approximately 4.86 days/week; 64.1% had driving experience of more than 10 years. They generally complied with safety precautions: 92.2% of participants always fastened their seat belts, and 85.2% regularly checked their rearview mirrors before driving. 28.8% of patients always wanted to be drivers, and 26.3% drove faster than the speed limit, contrary to traffic flow. Common factors related to frequent driving behaviour, higher driving speeds, and a tendency to perceive themselves as better drivers were male gender, smoking and alcohol use, longer driving experience, and lower HIT-6. The mean HIT-6 score was 62.2±7.1 in drivers with migraine.
Conclusion
Our findings suggest that migraine shapes driving behaviors by affecting driving frequency, speed preferences, and subjective driving confidence, and this should be considered in clinical assessments.

Isolated hypoglossal nerve injury is an infrequent occurrence in clinical and forensic traumatology practice. Its etiology includes trauma, malignancy, vascular events, autoimmune diseases, and complications of surgical procedures. Clinical manifestations resulting from nerve damage may present early or be delayed. We present the case of a 44-year-old woman who sustained a fracture of the third cervical vertebra following a traffic accident. An anterior approach was employed for instrumentation using an anterior plate spanning two cervical segments. The patient developed dysphagia and swallowing difficulties and subsequently underwent evaluation for disability status. Physical examination revealed significant atrophy and asymmetry of the right half of the tongue body, slight rightward deviation of the tongue apex at rest, and fasciculations. Electromyography performed 22 months after the injury demonstrated chronic axonal injury of the right hypoglossal nerve. Causality assessment favored the traffic accident as the initiating event, with postoperative edema and retraction likely contributing to progression. The condition was classified as permanent, and a 25% functional loss was assigned for tongue paralysis according to national disability criteria. This report highlights the diagnostic, prognostic, and legal complexities of delayed hypoglossal nerve palsy following cervical trauma and underscores the importance of a multidisciplinary approach in determining the etiology and prognosis of isolated hypoglossal nerve paralysis, as well as in establishing medical causality.

Objective: This study aims to highlight the clinical course of genitourinary injuries associated with pelvic fractures following motorcycle accidents and to raise awareness of these traumas.
Materials and Methods: This case report presents two young female patients who sustained pelvic fractures and genitourinary injuries as a result of motorcycle accidents. The cases are compared in terms of trauma severity, accompanying injuries, and treatment approaches.
Results: The first patient sustained a high-energy trauma resulting in severe soft tissue injuries involving the anterior vaginal wall, clitoris, and bladder neck, accompanied by active bleeding. Despite undergoing external fixation, the patient died due to multi-organ failure. The second patient had a less severe trauma, with a pelvic fracture and a superficial mons pubis laceration, which was successfully managed with conservative treatment and healed without complications.
Conclusion: These cases emphasize the importance of a thorough genital examination in female trauma patients, the necessity of a multidisciplinary approach, and the potential for timely surgical intervention to be life-saving. This report contributes to the limited body of literature on pelvic and genitourinary injuries in women caused by motorcycle accidents and highlights the need for further clinical research and documentation.