BACKGROUND: Acute cholecystitis (AC) is a common hepatobiliary condition that requires surgical intervention. The Tokyo Guidelines 2018 (TG18) recommend early laparoscopic cholecystectomy (LC) for moderate AC (Grade II) and percutaneous transhepatic gallbladder drainage (PTGBD) for high-risk patients. However, the optimal timing for LC following PTGBD remains controversial.
METHODS: This retrospective study analyzed data from 432 patients with Grade II AC treated at a high-volume center between January 2022 and February 2024. Patients were divided into two groups: early LC (n=131) and delayed LC following PTGBD (n=43). Clinical outcomes, postoperative complications, and length of hospital stay were compared using statistical analyses, including linear regression modeling.
RESULTS: No significant differences were observed between the groups in conversion to open surgery (4.7% vs. 9.9%, p=0.27), postoperative bleeding (6.9% vs. 1.5%, p=0.006), or biliary tract complications (4.7% vs. 3%, p=0.638). However, postoperative systemic inflammatory response syndrome (SIRS) occurred significantly more frequently in the PTGBD group (23.3% vs. 6.9%, p=0.003). Linear regression analysis identified conversion to open surgery, postoperative SIRS, and biliary complications as independent predictors of prolonged hospital stay, whereas PTGBD itself was not associated with increased hospitalization duration (p=0.304).
CONCLUSION: Early LC is a feasible approach for most patients with Grade II AC, with outcomes comparable to those of PTGBD followed by delayed LC. PTGBD remains a valuable alternative for high-risk patients. Further large-scale prospective studies are needed to refine treatment strategies and determine the optimal timing for LC following PTGBD.

BACKGROUND: Gastroduodenal perforation is a life-threatening surgical emergency associated with substantial postoperative morbidity and mortality. In the emergency setting, rapid and objective preoperative risk stratification remains challenging. This study aimed to evaluate the prognostic value of the hemoglobin, albumin, lymphocyte, and platelet (HALP) score for predicting postoperative outcomes in patients undergoing emergency surgery for gastroduodenal perforation.
METHODS: This retrospective cohort study included 115 adults who underwent emergency surgery for gastroduodenal perforation at a tertiary referral center between January 2021 and December 2025. The HALP score was calculated using laboratory values obtained at admission before surgery. The primary endpoint was a composite adverse outcome defined as postoperative mortality, reoperation, or prolonged hospital stay (≥8 days). Clinical, laboratory, and operative variables were compared between patients with and without the composite outcome. Predictive performance was assessed using receiver operating characteristic (ROC) curve analysis.
RESULTS: Postoperative mortality occurred in five patients (4.3%). Non-survivors were older and had higher American Society of Anesthesiologists (ASA) classification than survivors (p<0.05). Patients who experienced the composite adverse outcome had significantly lower HALP and prognostic nutritional index (PNI) values and higher inflammatory indices on univariate analysis (p<0.05). In ROC analysis, the HALP score demonstrated modest discriminatory ability for predicting the composite adverse outcome (area under the curve [AUC] 0.619, 95% confidence interval [CI]: 0.511–0.719). Increasing age was associated with adverse outcomes, whereas a multivariable model incorporating age, ASA classification, and HALP score demonstrated improved discrimination (AUC 0.748).
CONCLUSION: The HALP score is an inexpensive and readily available preoperative marker that reflects both inflammatory and nutritional status. In this cohort, lower HALP values were associated with adverse postoperative outcomes on univariate analysis. Although HALP was not identified as an independent predictor in multivariable analysis, it may provide complementary information regarding patients’ immunonutritional vulnerability when interpreted alongside established clinical risk factors. Further prospective multicenter studies are needed to validate its prognostic utility and establish clinically relevant cutoff values.

BACKGROUND: Preoperative identification of complicated acute appendicitis (CAA) is important for reducing morbidity. We assessed the diagnostic value of immature granulocyte (IG) count and percentage (IG%) for predicting CAA and histopathologically confirmed perforation in adults presenting to the emergency department.
METHODS: We retrospectively reviewed consecutive adults (≥18 years) with histopathologically confirmed appendicitis admitted to a tertiary care center between January 1, 2025 and January 1, 2026. Cases were classified as CAA or non-complicated acute appendicitis (NAA). Perforation was analyzed as a separate secondary endpoint. Diagnostic performance was assessed using receiver operating characteristic (ROC) analysis, the Youden index, and multivariable logistic regression.
RESULTS: A total of 891 patients were included (58.6% male; median age, 35 years [IQR 25–47]); 466 (52.3%) had CAA and 105 (11.8%) had perforation. For discrimination of CAA, the highest area under the curve (AUC) was observed for the neutrophil-to-lymphocyte ratio (NLR) (0.547; 95% confidence interval [CI]: 0.508–0.586), whereas the AUC for IG% was 0.519 (95% CI: 0.479–0.556). Among patients with perforation, lymphocyte counts were lower (p=0.032) and NLR values were higher (p=0.018). Although IG% was numerically higher and demonstrated a small-to-moderate effect size (Cohen’s d=0.257), the difference did not reach statistical significance (p=0.116). In multivariable analysis, IG% did not reach independent statistical significance for perforation (adjusted odds ratio [aOR]=1.66; 95% CI: 0.99–2.76; p=0.053), although the point estimate suggested a possible positive association.
CONCLUSION: IG count and IG% did not provide clinically meaningful discrimination between CAA and NAA. The non-significant association observed for IG% in the multivariable perforation model should be considered hypothesis-generating rather than confirmatory. These findings challenge the high diagnostic performance reported in previous smaller studies and do not support the use of IG count or IG% as standalone preoperative biomarkers in adult acute appendicitis.

Background:
Adhesive small bowel obstruction (ASBO) remains a common surgical emergency, yet distinguishing patients who will fail conservative management continues to be difficult. Although many clinical and radiologic predictors have been proposed, their accuracy is inconsistent, and simple objective tools are still lacking.
Methods:
A retrospective cohort study was conducted including adults admitted with CT-confirmed ASBO between 2020 and 2024. Demographics, comorbidities, laboratory values, PNI, PLR, radiologic parameters, and Antoine Béclère (AB) scores were collected. Predictors of surgery were examined using univariate and multivariable logistic regression. Diagnostic accuracy of the AB score was assessed using receiver operating characteristic (ROC) analysis.
Results:
A total of 106 patients were included, of whom 51 (48.1%) required operative management. PNI and PLR did not differ significantly between operative and non-operative groups. Older age, higher comorbidity burden, and higher AB scores were associated with surgery. An AB score ≥2 predicted operative need in 82.4% of cases (p < 0.001). In multivariable analysis adjusted for age and Charlson index ≥4, an AB score ≥2 remained an independent predictor (OR 4.20). ROC analysis showed moderate discriminative ability for the AB score, with an AUC of 0.71, sensitivity of 82%, and specificity of 66.
Conclusion:
The AB score helped identified patients unlikely to respond to conservative treatment, with a score ≥2 strongly associated with operative need. Its performance was not influenced by nutritional or inflammatory status. These findings highlight the clinical utility of simple, reproducible indicators in guiding early management of ASBO.

BACKGROUND: This study aimed to evaluate the diagnostic approaches, treatment modalities, and clinical outcomes of patients presenting to the emergency department following razor blade ingestion.
METHODS: Hospital records of patients who presented to the emergency department with razor blade ingestion and were referred to the General Surgery Clinic between 2021 and 2024 were retrospectively reviewed. Data collected included demographics, presenting symptoms, time to presentation, number of ingested razor blades, imaging findings, treatment approaches, complications, and clinical outcomes.
RESULTS: A total of 72 patients with complete medical records were included. All patients were male and incarcerated. The mean age was 31.2 years, and the mean time to presentation was 8 hours. The mean number of ingested razor blades was 1.4. Endoscopic intervention was performed in seven patients (10%) in whom imaging localized the razor blade to the stomach; all presented within 6 hours of ingestion. Successful endoscopic removal was achieved in two patients, while no razor blade was visualized in the stomach in five patients. Surgical intervention was required in two patients (3%). A total of 63 patients (87%) recovered without intervention with outpatient conservative management and follow-up. Successful endoscopic removal was achieved in patients who presented within the first 2 hours. No morbidity or mortality was observed.
CONCLUSION: A conservative management is safe and effective in most cases of razor blade ingestion. Early endoscopy may decrease the likelihood of surgical intervention.

BACKGROUND: Fournier’s gangrene (FG) is an aggressive form of necrotizing fasciitis associated with high mortality despite advances in critical care and surgical management. Early identification of high-risk patients is essential to enable timely intervention. This study aimed to evaluate established prognostic indices and to develop a novel model for mortality prediction.
METHODS: We retrospectively reviewed the medical records of 69 patients diagnosed with FG and treated at the General Surgery Clinic of Kocaeli University Hospital between January 2017 and January 2022. Demographic, clinical, laboratory, radiological, and treatment-related data were collected. Disease severity was assessed using the Fournier’s Gangrene Severity Index (FGSI), Uludağ FGSI (UFGSI), and the American Society of Anesthesiologists (ASA) score. The UFGSI was calculated by combining the FGSI physiological score with additional age and dissemination scores derived from radiological extent grading. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to identify independent predictors of mortality and to develop the Kocaeli Fournier Gangrene Severity Index (KFGSI).
RESULTS: The mean age was 58.6±13.5 years (range: 36–89), with 52 (75.4%) males and 17 (24.6%) females. The overall in-hospital mortality rate was 40.6% (n=28). On univariate analysis, admission parameters significantly associated with mortality included pulse rate, respiratory rate, body mass index (BMI), serum lactate level, radiological extent grade, body temperature, and FGSI score (all p<0.05). Intensive care unit (ICU) length of stay was also associated with mortality in exploratory analyses, reflecting the downstream clinical course. ROC analysis demonstrated strong prognostic performance for pulse rate (area under the curve [AUC] 0.935; 95% confidence interval [CI] 0.848–0.980) and radiological extent grade (AUC 0.898; 95% CI 0.797–0.966), as illustrated in Figure 1. The UFGSI also showed good discrimination (AUC 0.858; 95% CI 0.748–0.967), with 96.4% sensitivity and 73.2% specificity at the Youdenderived cut-off (≥10). The newly developed admission-based KFGSI, incorporating five admission parameters (pulse rate, respiratory rate, body mass index, serum lactate level, and radiological extent grade), demonstrated superior discrimination compared with FGSI in this derivation cohort (AUC 0.943; 95% CI 0.860–0.985; sensitivity 92.9%; specificity 85.4% vs. FGSI AUC 0.860; 95% CI 0.755– 0.932). ICU length of stay was not included in the admission-based KFGSI model.
CONCLUSION: The KFGSI demonstrated excellent prognostic accuracy for mortality prediction in FG and outperformed FGSI in this derivation cohort. However, external validation in multicenter populations is required. Early application of the KFGSI may enhance clinical risk stratification and support timely decision-making regarding triage and management. Prospective multicenter studies are needed to confirm its validity and establish its clinical utility.

BACKGROUND: This study aimed to identify prognostic factors in patients undergoing pars plana vitrectomy (PPV) following open globe injury (OGI) and to evaluate surgical outcomes of PPV in eyes with no light perception (NLP) at presentation after OGI.
METHODS: We retrospectively reviewed the medical records of patients who underwent primary repair for severe ocular trauma, subsequently required PPV due to posterior segment damage, and had a minimum follow-up of 6 months. Patients were divided into two groups based on initial best-corrected visual acuity (BCVA): Group 1, no light perception (NLP); and Group 2, light perception (LP) or better. Clinical characteristics, as well as final anatomical and visual outcomes, were compared between the groups. Additionally, the role of PPV was specifically evaluated in eyes that were most severely affected by trauma and presented with NLP after primary repair.
RESULTS: A total of 47 eyes from 47 patients were included. Twelve eyes had NLP after primary repair for OGI. Among these, five eyes remained NLP, two (16.7%) improved to light perception (LP), three (25.0%) to hand motion, one (8.3%) to counting fingers, and one (8.3%) achieved a visual acuity of 20/60 at final follow-up. Final anatomical success was achieved in 39 of 47 eyes (82.9%). Visual improvement was observed in 91.4% of eyes (32/35) with preoperative visual acuity of at least LP, and in 58.3% of eyes (7/12) with NLP prior to vitrectomy. No eyes required enucleation. Retinal detachment (p<0.001), retinectomy (p=0.01), silicone oil use (p=0.001), and the need for a second vitrectomy (p=0.019) were associated with poor prognosis.
CONCLUSION: In patients with loss of LP secondary to severe ocular trauma, PPV can achieve high rates of anatomical success, with a significant proportion regaining ambulatory vision when appropriate surgical techniques are employed.

BACKGROUND: Anticoagulant and antiaggregant drugs (commonly referred to as blood thinners) are widely used for various clinical indications. The most significant complication associated with these medications is hemorrhage. In this study, we evaluated patients receiving blood thinners who developed spontaneous chest wall hematomas.
METHODS: Between January 2016 and December 2024, a total of 13 patients with a history of blood thinner use who developed spontaneous chest wall hematoma were referred to our clinic. The analysis included radiological findings, demographic characteristics, underlying pathologies, and treatment modalities.
RESULTS: Nine of the 13 patients had no history of major chest wall trauma but presented with large or progressively enlarging hematomas, and therefore underwent surgical intervention with hematoma evacuation. Intraoperatively, no active bleeding source was identified; the hematomas were localized between the muscle fascia and were successfully evacuated. These patients were discharged with full recovery. During the course of medical treatment and follow-up, two of the four patients, who had poor overall clinical status, died.
CONCLUSION: Bleeding is the most significant adverse effect of blood thinner medications. Spontaneous chest wall hematoma is a rare clinical entity. Repetitive microtrauma, particularly in elderly or mobility-limited patients supported at the axillary or pectoral regions during positioning or mobilization, may contribute to hemorrhage and hematoma formation under the effects of anticoagulant therapy. Surgical drainage, when appropriately indicated, provides symptomatic relief and may help prevent secondary complications such as infection.

BACKGROUND: Fournier’s gangrene (FG) is a rapidly progressive, life-threatening necrotizing fasciitis of the perineal and genital region. Despite advances in surgical and medical management, morbidity remains high. Early identification of disease severity and prognosis is essential for timely intervention. This study aimed to evaluate the prognostic value of routinely available inflammatory and metabolic markers—particularly C-reactive protein (CRP) and white blood cell (WBC) count—and to establish clinically applicable admission cut-off values for predicting clinical outcomes, including prolonged hospitalization and surgical burden.
METHODS: This retrospective single-center study included 40 patients diagnosed with and treated for FG at Niğde Ömer Halisdemir University Training and Research Hospital between 2022 and 2025. Demographic, laboratory, and clinical data were reviewed. Laboratory parameters, including WBC count, CRP, glucose, and derived indices such as the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), were recorded at three time points: admission, post-first debridement, and pre-discharge. Patients were stratified according to diabetes mellitus (DM) status, antibiotic regimen, and surgical complexity. The primary outcome was prolonged hospitalization (>14 days), and the secondary outcome was the need for multiple debridements (≥3 procedures). Statistical analyses included the Friedman test for repeated measures, Spearman correlation analysis, logistic regression, and receiver operating
characteristic (ROC) analysis.
RESULTS: The mean age was 56.8±17.9 years, and 40% of patients had DM. The most common etiology was scrotal abscess (57.5%). Serial laboratory assessment demonstrated significant reductions in WBC count (median: 13.1→8.2 ×10³/µL, p<0.001) and CRP level (median: 90.4→34.6 mg/L, p<0.001) following serial debridements. Admission CRP and WBC levels showed positive correlations with both length of hospital stay (ρ=+0.46 and +0.41, respectively) and number of debridements (ρ=+0.39 and +0.36, respectively). In multivariate regression analysis, CRP was the only independent predictor of prolonged hospitalization (odds ratio=1.07, 95% confidence interval: 1.02–1.14; p=0.009). ROC analysis identified a CRP threshold of ≥128 mg/L (area under the curve=0.86) as the optimal cut-off value for predicting prolonged hospitalization. No mortality occurred during the study period.
CONCLUSION: CRP and WBC count are practical, inexpensive, and reproducible markers of disease severity and treatment response in patients with Fournier’s gangrene. Serial monitoring of these parameters may facilitate early risk stratification, guide decisions regarding repeat debridement, and support optimization of antibiotic and surgical management. Incorporation of these readily available inflammatory markers into standardized treatment protocols may improve clinical decision-making and patient outcomes in FG.

BACKGROUND: Although conventional and metastatic femoral neck fractures (FNF) represent distinct patient populations in routine clinical practice, treatment management is generally similar for both groups. Systematic treatment approaches for FNF are currently used and supported by clinical guidelines; however, patients with metastatic FNF are generally managed according to treatment protocols developed for conventional FNF. The aim of this study was to determine whether the treatment strategy for conventional FNF is effective for patients with metastatic FNF.
METHODS: This retrospective study included 185 patients diagnosed with conventional FNF and 71 patients with metastatic FNF who underwent endoprosthetic reconstruction at a nationwide tertiary orthopedic oncology center. The primary outcome measures were patient- and hospital-related factors potentially affecting survival in the two groups. Secondary outcomes included complications such as thrombotic events, decubitus ulcers, and erythrocyte transfusion requirements.
RESULTS: Patients with metastatic FNF had significantly lower survival rates (p=0.021), higher rates of complications including thrombotic events (p=0.030) and decubitus ulcers (p=0.029), longer operative times (p<0.001), greater perioperative blood loss (p<0.001), and increased erythrocyte transfusion requirements (p<0.001). Compared with the conventional FNF group, metastatic FNF patients also had longer preoperative and postoperative hospital stays (p<0.001) and delayed postoperative mobilization (p=0.017).
CONCLUSION: Although treatment management for conventional femoral neck fractures has been standardized in orthopedic practice through established algorithms, these protocols do not adequately address the needs of patients with metastatic femoral neck fractures, who experience higher complication rates and lower survival.

BACKGROUND: The importance of glenoid version in glenohumeral instability (GHI) has become increasingly recognized. However, it remains unclear whether three-dimensional (3-D) correction of magnetic resonance imaging (MRI) scans provides more accurate glenoid version measurement in patients with GHI. The primary hypothesis of this study was that a statistically significant difference would exist between glenoid version values measured on standard two-dimensional (2-D) axial slices and those measured on 3-D–corrected axial slices.
METHODS: A retrospective analysis of glenoid version measurements was performed in 54 patients (22 females, 32 males) with glenohumeral instability. Measurements were obtained using the Friedman method on standard 2-D axial MRI slices and 3-D–corrected axial MRI slices. Two observers performed each measurement twice. Measurements obtained by each observer were compared using paired t-tests. Measurement reliability was evaluated using intraclass correlation coefficients (ICC).
RESULTS: For observer 1, mean glenoid version values were −0.69°±3.95° and −1.24°±3.94° on standard and 3-D–corrected axial MRI slices, respectively (p=0.16). For observer 2, corresponding values were −2.97°±4.48° and −2.81°±4.92°, respectively (p=0.66). Interobserver reliability was good for both techniques (ICC=0.87 for 2-D and 0.83 for 3-D measurements). Intraobserver reliability was excellent for measurements performed on 2-D slices (ICC=0.95 and 0.97) and ranged from good to excellent for measurements performed on 3-D–corrected slices (ICC=0.86 and 0.98).
CONCLUSION: The findings of this study suggest that 3-D correction may not be necessary for glenoid version measurements performed on MRI in patients with glenohumeral instability. Multicenter studies with larger patient populations should be conducted to enhance the clinical relevance of these findings.

BACKGROUND: The role of intermediate screws in long-segment posterior fixation for thoracolumbar fractures remains controversial. This study aimed to evaluate their effectiveness in improving alignment, maintaining correction, and reducing complications.
METHODS: This retrospective comparative study included 91 patients with unstable thoracolumbar burst fractures (T11–L2) treated between 2014 and 2022. Patients were divided into two cohorts: Group A (n=61), who underwent long-segment fixation with intermediate screws inserted at the fracture level, and Group B (n=30), who received conventional fixation. Radiological outcomes, including vertebral compression angle (VCA) and anterior/posterior vertebral body height (ABH/PBH), intraoperative parameters (operative time and fluoroscopy use), clinical pain scores assessed using the Visual Analog Scale (VAS), and complications were analyzed. Statistical comparisons were performed using t-tests and chi-square tests.
RESULTS: Both groups demonstrated significant postoperative improvements in VCA and vertebral body height (p<0.0001). Group A achieved superior early correction of VCA compared with Group B (4.78°±3.47 vs. 6.82°±4.02, p=0.014), and this difference remained significant at the two-year follow-up (5.67°±3.08 vs. 8.59°±3.76, p=0.0005). Although correction loss was lower in Group A (1.22°±1.13 vs. 1.95°±2.12, p=0.122), the difference was not statistically significant. Group A required longer operative times (160.25±19.4 vs. 150.17±26.9 minutes, p=0.044) and greater fluoroscopy exposure (26.38±2.3 vs. 20.00±2.13, p<0.001). No significant differences were observed between groups in preoperative or follow-up VAS scores (p>0.05).
CONCLUSION: Placement of intermediate screws in long-segment constructs was associated with significantly enhanced restoration and maintenance of radiographic alignment in patients with thoracolumbar fractures, although it required longer operative time and increased fluoroscopy use. Clinical pain outcomes were comparable between groups. These findings suggest that intermediate screw placement may provide biomechanical and radiographic advantages in selected cases where optimal anatomical restoration is prioritized. This technique was associated with improved initial and long-term radiographic alignment, at the cost of longer operative time and greater radiation exposure, but did not improve pain outcomes. However, the non-random assignment of patients according to surgeon preference should be considered when interpreting these results.

Introduction:
Distal femur fractures in the geriatric age group have a one-year mortality rate similar to hip fractures. Like hip fractures, treatment should focus on early mobilization to reduce morbidity and mortality. Nail-Plate Combination (NPC) and Double-Plate Combination (DPC) are suggested to allow early mobilization with low mechanical complication rates. This study aimed to compare the clinical and radiological outcomes of NPC and DPC in elderly patients with distal femur fractures.

Methods:
After the inclusion and exclusion criteria, 28 patients treated with NPC and 24 patients treated with DPC were included in the study. The clinical records and radiological images of these patients were evaluated using a standardized form. Operative time, intraoperative blood loss, range of motion (ROM), and Lysholm scores were obtained from the medical records of the patients. From the radiological records, findings of radiological union and measurements of the Anterior Lateral Distal Femur Angle (aLDFA) and the Anterior Posterior Distal Femur Angle (aPDFA) were obtained.

Results:
In the NPC group, the operative time was 120 (±22.5) minutes, and in the DPC group, it was 155 (±23.75) minutes (p<0.001). In the NPC group, the amount of blood loss was 422.5 (±115) mL, while in the DPC group, it was 640 (±237.5) mL (p<0.001). At the 3rd month, the ROM was 100 (±17.5) degrees in the NPC group and 80 (±10) degrees in the DPC group (p<0.001). The Lysholm score at the 3rd month was 70 (±12.5) in the NPC group and 68.5 (±10) in the DPC group (p<0.001). The radiological union time was 12 (±2) weeks in the NPC group and 12 (±3.5) weeks in the DPC group (p=0.290). There was no significant difference between the two groups in terms of aLDFA measurements (81 [±4.75] vs. 81 [±1.75], p=0.356), while the aPDFA was 85.5 (±4) in the NPC group and 83 (±2) in the DPC group (p<0.001).

Discussion:
Immediate weight-bearing after surgery is crucial in elderly patients. Dual-implant systems aim to enable early mobilization, but full weight-bearing is often delayed with DPC. NPC patients could bear full weight earlier, likely contributing to better early ROM and clinical outcomes.

Conclusion:
NPC showed several advantages over DPC, including less blood loss, shorter operative time, immediate full weight-bearing, better early ROM, and improved clinical scores. Complication and union rates were similar, but the benefits of NPC may be clinically meaningful.

BACKGROUND: Traumatic spinal injuries (TSI) are a major public health concern associated with substantial morbidity. As the first study to provide a regional forensic medicine perspective, this study aimed to retrospectively evaluate the clinical characteristics, etiological factors, injury patterns, and long-term sequelae of traumatic spinal fractures among patients presenting to Department of Forensic Medicine, Atatürk University between 2020 and 2022.
METHODS: Medical records of 12,029 cases evaluated at the Department of Forensic Medicine, Atatürk University between 2020 and 2022 were reviewed. A total of 277 cases with confirmed spinal fractures were included. Demographic characteristics, etiology, Injury Severity Score (ISS), fracture levels, associated injuries, and treatment methods were analyzed. Long-term sequelae were assessed in 174 patients with at least 12 months of follow-up.
RESULTS: Among the patients, 74.1% were male (male-to-female ratio: 2.85), and the mean age was 40.1±16.69 years. The most common etiology was vehicle occupant motor vehicle accidents (VO-MVA) (56.3%), followed by motor vehicle accidents involving vulnerable road users (VRUs-MVA) (15.5%) and high-energy falls (HEF) (13.4%). A statistically significant association was found between age and etiology (p=0.001); VO-MVA predominated in the 18–44-year age group, whereas VRU-related injuries increased among individuals aged ≥65 years. Injuries resulting from VRUs-MVA and HEFs were significantly associated with major trauma (ISS ≥16) (p=0.044) and multiple vertebral fractures (p=0.001). The thoracolumbar junction (T11–L2) was the most frequently affected region (31.8%). A significant association was identified between head/facial trauma and cervical fractures (odds ratio [OR]=3.59; 95% confidence interval [CI]: 1.89–6.82), and between intra-abdominal organ injuries and sacral fractures (OR=6.47; 95% CI: 2.40–17.39). Permanent sequelae were observed in 50% of patients with follow-up data; the most common were restricted spinal mobility (46.8%) and spinal cord injury (13.5%).
CONCLUSION: Although vehicle occupant traffic accidents are the most common cause of spinal fractures, accidents involving vulnerable road users and high-energy falls are associated with greater injury severity and multiple fractures. Clinicians should maintain a high index of suspicion for cervical fractures in patients presenting with head trauma and sacral fractures in those with abdominal injuries. Rapid triage and careful evaluation are essential, particularly in cases involving high-energy mechanisms and associated organ injury. These findings highlight the substantial long-term morbidity associated with traumatic spinal fractures and underscore the importance of multidisciplinary follow-up.

Seatbelt-related breast trauma is an uncommon consequence of motor vehicle collisions. Most injuries present as localized contusion or hematoma, whereas progressive breast hematomas requiring surgical intervention are exceedingly rare, particularly in patients without coagulation abnormalities. Obesity may further alter trauma biomechanics and influence hematoma progression. A 49-yearold woman with obesity (Body Mass Index: 38 kg/m2) presented to the emergency department one hour after a motor vehicle collision with left breast swelling, firmness, and ecchymosis. Body temperature, blood pressure, and heart rate were within normal limits. Contrast-enhanced computed tomography (CT) demonstrated a 62×52 mm breast hematoma without evidence of arterial extravasation. Conservative treatment with compression therapy was continued for three days; however, pain and breast tension progressively increased, and ultrasonography demonstrated mild enlargement of the hematoma. On the fourth day, minimally invasive surgical evacuation was performed, yielding a large volume of organized hematoma. Postoperatively, symptoms improved rapidly. At two-week follow-up, breast symmetry was fully restored with no residual deformity. This case represents a rare presentation of seatbelt-related breast trauma: a progressive breast hematoma without active bleeding that ultimately required surgical evacuation. Obesity may have contributed to the failure of conservative management and earlier clinical progression. Early recognition of symptom worsening is essential to optimize cosmetic and functional outcomes.