abstracts of the international congress of trauma 2021

I C O T R A U M A 2 0 2 1

International Congress of Trauma 2021 - ICOTRAUMA-2021, Nov 20th – 21th, 2021, Virtual Event

Abstracts of the International Congress of Trauma 2021

ICOTRAUMA 2021

Nov 20-21, 2021, Virtual Event

www.icotrauma.org

Scientific Programme Committee Chair(s):

Professor Fevzi Toraman Anesthesiology and

Reanimation Acıbadem Mehmet Ali Aydınlar University

Assoc

Prof

Ahmet Şen Anesthesiology and

Reanimation

University of Health Sciences, Trabzon

Medical Faculty

Organizational Board

Professor Fatih Özkan Algology Ondokuz Mayis University

Professor Ferda Kahveci Anesthesiology and

Reanimation

Bursa Uludağ University Medical Faculty

Professor Fevzi Toraman Anesthesiology and

Reanimation

Acıbadem Mehmet Ali Aydınlar University

Professor Mehmet Derya

Demirağ

Rheumatology Health Sciences University, Samsun

Training and Research Hospital

Professor Mustafa

Kemal Atilla

Urology Health Sciences University, Samsun


Professor Mustafa Süren Anesthesiology and

Reanimation

Health Sciences University, Samsun


Professor Remzi İşçimen Anesthesiology and

Reanimation

Bursa Uludağ University Medical Faculty

Professor Uğur Arslan Cardiology Health Sciences University, Samsun


Professor Zekeriya

Alanoğlu

Anesthesiology and

Reanimation

WUSTL School of Medicine

Assoc

Prof

Ahmet Şen Anesthesiology and

Reanimation

University of Health Sciences, Trabzon

Medical Faculty

Assoc

Prof

Başar

Erdivanlı

Anesthesiology and

Reanimation

Recep Tayyip Erdoğan University

Assoc

Prof

Enes Emre

Başar

Marketing Anadolu University, Faculty of Business

Administration

Assoc

Prof

Ersin Köksal Anesthesiology and

Reanimation

Ondokuz Mayis University

Professor Kemalettin

Koltka

Anesthesiology and

Reanimation

Istanbul University

Assoc

Prof

Mehmet Sabri

Balık

Orthopedics Recep Tayyip Erdoğan University

I C O T R A U M A 2 0 2 1


Assist

Prof

Metin

Yadigaroğlu

Emergency

Medicine

University of Samsun, Medical Faculty

Specialist

Doctor

Ahmet Akbaş Surgical Oncology Health Sciences University, Samsun


Specialist

Doctor

Kenan Demir Histology and

Embryology



Specialist

Doctor

Mehmet Cenk

Turgut

Orthopedics Erzurum Training and Research Hospital

Specialist

Doctor

Murat Güzel Emergency

Medicine



Dr Bengü Tosun EMA LTD

Abstract Review Panel

Each abstract was scored double blind review.

Professor Fatih Özkan Assoc. Prof. Ahmet Beşir Specialist Doctor Ahmet

Akbaş

Professor Ferda Kahveci Assoc. Prof. Başar Erdivanlı Specialist Doctor Kenan

Demir

Professor Fevzi Toraman Assoc. Prof. Doğukan

Özdemir

Specialist Doctor Mehmet

Cenk Turgut

Professor Mehmet Derya

Demirağ

Assoc. Prof. Ersin Köksal Specialist Doctor Murat

Güzel

Professor Mustafa Kemal

Atilla

Assoc. Prof. Kemalettin

Koltka

Specialist Doctor Mustafa

Usanmaz

Professor Mustafa Süren Assoc. Prof. Mehmet Sabri

Balık

Specialist Doctor Rumeysa

Göç

Professor Remzi İşçimen Assoc. Prof. Murat Yücel Specialist Doctor Selim

Görgün

Professor Soner Şahin Assoc. Prof. Vaner Köksal Specialist Doctor Tümer

Çalışkan

Professor Uğur Arslan Assist. Prof. Abdulkerim

Olgun

Büşra Akpınar, MD

Professor Zekeriya

Alanoğlu

Assist. Prof. Metin

Yadigaroğlu

I C O T R A U M A 2 0 2 1


Table of Contents

Mid-Term Surgical Treatment Results in Patients with Trimalleolar Fractures

Bünyamin Arı ............................................................................................................................. 1

Demographic and Clinical Characteristics of Patients with Traumatic Tendon Injuries of the

Hand and the Physical Therapy Prescription

Gonca Sağlam and Hilal Telli .................................................................................................... 2

Successful Surgical Intervention in Traumatic Carotid Artery Thrombosis After a Motor

Vehicle Accident

Görkem Yiğit .............................................................................................................................. 4

Antimicrobial Resistance in Clinical Strains of Stenotrophomonas Maltophilia; 10 Years

Surveillance

Melek Bilgin, Hacer İşler and Eşe Başbulut .............................................................................. 6

Evaluation of Osteoporosis in Patients Over 45 Years Old with Distal Radius Fracture,

Association with Fracture History and Body Mass Index

Emine Esra Ergül ....................................................................................................................... 7

Epidemiological Evaluation of Eye Traumas in Erzincan Region

Mehmet Tahir Eski ..................................................................................................................... 9

Evaluation of Pediatric Pelvic Fractures: A 10-Year Experience of a Level-3 Trauma Centre

Samet Erinç and Mustafa Hacı Özdemir .................................................................................. 10

Our Experience on Emergency Damage Control Surgery in Fatal Extremity Traumas

Bülent Kılıç .............................................................................................................................. 11

A New and Safe Method for Intravitreal Injections: Intravitreal Injection Cabin

Gökhan Özgür and Mehmet Gökhan Aslan ............................................................................. 13

Examination of Demographic and Clinical Data of Pediatric Trauma Patients

Sinan Yavuz ............................................................................................................................. 15

Knowledge Levels of Healthcare Employees About Glass Particle Contamination in Drug

Ampoules and Using Filter Needles

Nida Nur Söğüt and Arzu Erkoç .............................................................................................. 16

Recovery Results of Patients with Brain Herniation Prevented by Decompresive Craniectomy

Cem Demirel and Vaner Köksal .............................................................................................. 17

Early Results of Surgical Treatment of Elbow Terrible Triad Trauma;Could Early Accelerated

Physiotherapy and Indomethacin Reduce the Complications?

İhsan Özdamar .......................................................................................................................... 18

Trauma Associated with Firegun Injury: A Case Report

Çiğdem Şimşek, Mehtap Balci, Fatih Balci and Selman Çavuşoğlu ....................................... 20

Forearm Fractures and the Covid-19 Pandemic

Serdar Toy ................................................................................................................................ 22

Evaluating the Provision of Medical Imaging in Severely Injured Patients in Emergency

Departments: A Turkish Survey Based on Royal College of Radiologists Standards

Fatih Karagüzel and Kaan Alişar ............................................................................................. 23

I C O T R A U M A 2 0 2 1


Depression and COVID-19 Fear Levels in Hemodialysis Patients

Demet Yavuz and Ayşe Pınar Doğru Balakbabalar ................................................................. 24

Our Results of Percutaneous Screw Fixation for Unstable Scaphoid Fractures

Mehmet Cenk Turgut ............................................................................................................... 25

Treatment and Outcomes of Supracondylar Humerus Fracture in Covid-19 Pandemic

Oktay Polat ............................................................................................................................... 26

Retrospective Analysis of Our Temporal Bone Fracture Case

Ayşe Çeçen and Asude Ünal .................................................................................................... 27

Retrospective Analysis of Trauma Patients in the Intensive Care Unit

Sevda Akdeniz .......................................................................................................................... 28

Evaluation of Factors Affecting the Prolongation of Preoperative Preparations in Geriatric Hip

Fractures .......................................................................................................................................

Abbas Tokyay .......................................................................................................................... 29

Quality of Life After Trochanteric Fractures in Elderly

Mustafa Caner Okkaoğlu ......................................................................................................... 30

Approach to Isolated Nasal Fracture in the Emergency Department Patients with Face Trauma

Süheyla Kandemir .................................................................................................................... 31

Multi-Disciplinary Management of Penetrating Thoracic Trauma

Abdullah Özdemir .................................................................................................................... 32

Two Case Reports on Diagnosis and Treatment of Aneurysmal Bone Cyst with Metacarp and

Phalanx Insocation

Murat Taşçı .............................................................................................................................. 34

Factors Affecting Quality of Working Conditions of Operating Room Staffs

Nevin Esra Gümüş ................................................................................................................... 35

Individualized Pain Management for Rib Fractures

Ayşe Hızal and Başar Erdivanlı ............................................................................................... 36

Multitrauma due to Tractor Accident: Case Report

Mehtap Balcı, Fatih Balcı and Çiğdem Şimşek ....................................................................... 38

A Retrospective Analysis of 484 Cases with Motorcycle-Related Thoracic Injuries

Nilay Çavuşoğlu Yalçın, Erhan Özyurt and Muharrem Özkaya .............................................. 39

Inpatient Admission Times of Trauma Patients Requiring Orthopedic Surgery at an

Emergency Department

Ortaç Güran .............................................................................................................................. 40

Does the Diameter of the Appendix Have a Role in the Preferred Stump Closure Method in

Laparoscopic Appendectomy?

Hüseyin Bayhan and Semra Demirli Atıcı ............................................................................... 41

Early Shoulder Surgery Facilitated Discontinuation of Deep Sedoanalgesia in a Patient with

Thoracic Cavity Instability

Emre Karagöz and Hızır Kazdal .............................................................................................. 42

I C O T R A U M A 2 0 2 1


Amniotic Fluid Embolism with Sudden Cardiac Arrest During Cesarean Section

Kamuran Uluç .......................................................................................................................... 44

Clinical Efficacy of Closed Reduction and Percutaneous Transverse K-Wire For Length-

Saving Fixation in Fifth Metacarpal Base Fracture

Mert Karaduman ...................................................................................................................... 46

The Intensive Care Unit During the Covid-19 Pandemic Period Trauma Patients and

Outcomes

Yavuz Çeçen and Özgür Kömürcü ........................................................................................... 47

Does Two Stage Surgery for Ankle Fractures with Dislocation Affects Functional Results?

Özay Subaşı and Pınar Kaya Subaşı ........................................................................................ 49

Management of Traumatic Pneumothorax: Evaluation of 83 Cases

İlteriş Türk ................................................................................................................................ 50

Respiratory Infections Among Patients with Trauma in Intensive Care Units

Özlem Koyuncu Özyurt and Ülkü Arslan ................................................................................ 51

Investigation of Pediatric Cases Brought to the Emergency Department due to Electric Shock

Melih Çamcı ............................................................................................................................. 52

Treatment Management of Patients Diagnosed with Bladder Injury Secondary to Pelvic

Fractures

Ahmet Emre Cinislioğlu ........................................................................................................... 53

Awake Fiberoptic Nasal Intubation in Cervical Spine Injury: A Case Report

Pınar Küçükdemirci Kaya ........................................................................................................ 54

Health Problems and Health System Management of Syrian Refugees in Turkey, a

Comprehensive Review

Esra Ersöz Genç, Sinan Paslı and İdris Genç ........................................................................... 55

St Eleve Myocardial Infarction Admitted to the Emergency Department with Atypical

Symptoms After Fire Response

Esra Ersöz Genç, Sinan Paslı and İdris Genç ........................................................................... 56

I C O T R A U M A 2 0 2 1

1


Mid-Term Surgical Treatment Results in Patients with Trimalleolar

Fractures

Dr. Bünyamin Arı

Turgut Özal University, Department of Orthopedics and Traumatology Faculty of Medicine, Malatya, Turkey

Email: [email protected] ORCID: 0000-0001-9720-1869

Abstract

Aim: This study aimed to present mid-term surgical results of trimalleolar ankle fracture, which is a rare

injury of lateral, medial and posterior malleolus.

Method: Patients presenting with trimalleolar fracture were reviewed for outcomes. Range of motion

and American College of Foot and Ankle Surgeons scores at 6th postoperative month were presented and

discussed.

Results: Eight adult patients who presented with traumatic trimalleolar fracture were reviewed.

Preoperative planning included two-plane x-ray imaging and computerized tomography. All patients

underwent open reduction and internal fixation under spinal anesthesia, followed by early ankle exercises

and regular follow-up at 15th day, 1st month, 3rd month and 6th month postoperatively. The mean age

was 60.2 years. Initial injuries were ankle sprainand closed fractures (6 patients), fractures due to fall

from height (2 patients, type 1 and type 2A fracture) and ankle dislocation requiring closed reduction (2

patients). Surgery was postponed due to fracture blisters in 3 patients to the 10th day on average. Mean

time to surgery was 3 days in the rest. All patients returned to their normal routines. At 6th month, mean

ankle rnage of motions were 10⁰ dorsiflexion, 25⁰ plantar flexion, 4⁰ inversion, 3⁰ eversion. Mean

American College Foot and Ankle Surgeons score was 78.4. One patient had delayed union.

Conclusion: Trimalleolus fractures are rare but unstable fractures. Rigid fixation provides return to

routine preoperative activity and range of motion and is a safe method."

Keywords: Trimalleolus fractures,Rigid fixation

mailto:[email protected]

I C O T R A U M A 2 0 2 1

2


Demographic and Clinical Characteristics of Patients with Traumatic

Tendon Injuries of the Hand and the Physical Therapy Prescription

*Gonca Sağlam1, M.D. and Hilal Telli2, M.D.

Karadeniz Technical University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Trabzon,

Turkey1

Kütahya Health Science University Evliya Çelebi Research and Training Hospital, Department of Physical Medicine and

Rehabilitation, Kütahya, Turkey2

E-mail1: [email protected], E-mail2: [email protected]

Abstract

Objective: Tendon and ligament injuries account for a substantial part of musculoskeletal injuries, and

can contribute to reductions in quality of life, significant disability, and considerable costs for the

healthcare system. Traumatic tendon injuries are the second most frequent type of hand injury, and the

majority of them are open flexor or extensor tendon injuries. This study aimed to assess the demographic,

etiologic, and clinical characteristics of patients with traumatic hand tendon injuries, and to demonstrate

the physical therapy prescriptions.

Materials and Methods: The clinical data of 108 patients admitted to Physical Medicine and

Rehabilitation Outpatient Clinic after hand tendon repair were analyzed retrospectively in this study.

Demographic and clinical features of the patients including age, gender, presence of occupational trauma,

injury profile, accompanying injuries, etiology of the injury, presence of complex regional pain

syndrome, affected zones, and prescribed conservative treatments were recorded.

Results: Eighty-five patients (78.7%) were male and 23 (21.3%) were female in the study population.

The average age of the patients was 37,15±14,29. Tendon injuries occurred most frequently in the third

decade. 51 cases (47.2%) were injured due to occupational accidents. Of all patients, 62 of them (57.40%)

had flexor tendon injuries and 46 of them (42.59%) had extensor tendon injuries. 41 patients (37.9%) had

accompanying additional injuries and most of them included metacarpal or phalangeal fracture. The most

common etiology of the injury was direct laceration with a sharp object. 18 patients (16.66%) were

diagnosed with complex regional pain syndrome (table 1). Zone 2 was determined as the most affected

site among the flexor tendon injuries while zone 5 was the most affected in the extensor tendon injuries

(table 2). 62 patients (57.4%) were given a home-based exercise program and 46 patients (42.5%) were

prescribed a physical therapy program including an exercise program. The physical therapy program

consisted of superficial and deep heat therapy, electrotherapy, whirlpool, and cold therapy in rare cases.

Retrograde massage and contrast bath were included in 93 patients (86.11%) presenting with edema.

Conclusion: Traumatic tendon injuries commonly occur due to occupational injuries and result in loss

of productivity and reduced work capacity. Therefore, it is essential to prevent occupational injuries and

to educate the employees. Epidemiological studies on hand tendon injuries are important for evaluating

the patient profile, revealing the mechanisms and etiologies of injury. A multidimensional approach

should be considered to reduce the incidence and improve clinical outcomes of traumatic hand tendon

injuries.

Keywords: Hand trauma, tendon injury, physical therapy



I C O T R A U M A 2 0 2 1

3


Table 1. Demographic and Clinical Features of the Patients

Patients with Tendon Injury (n:108)

Age (mean±SD) 37.15±14.29

M/F 85/23

Occupational trauma n (%) 51 (47.22)

Flexor Tendon Injury n (%) 62 (57.40)

Extensor Tendon Injury n (%) 46 (42.59)

*Accompanying

Injuries n (%)

Metacarpal/phalangeal

fracture

21 (19.44)

Digital nerve injury 19 (17.59)

Other nerve injury 9 (8.33)

Vessel injury

7 (6.48)

Total 41 (37.9)

Etiology

Sharp object direct laceration

(broken glass, knives, table

saw etc.)

91 (84.25)

Crush injury 8 (7.40)

Avulsions 5 (4.62)

Motor vehicle accidents 3 (2.77)

Animal bite 1 (0.92)

Presence of Complex Regional

Pain Syndrome

n (%)

18 (16.66)

*More than one option may apply.

Table 2. Distribution of Injuries According to the Injured Zones

Flexor Tendon Injury

n (%)

Zone 1 3 (4.83)

Zone 2 29 (46.77)

Zone 3 9 (14.51)

Zone 4 6 (5.55)

Zone 5 15 (24.19)

Extensor Tendon Injury

n (%)

Zone 1 3 (6.52)

Zone 2 2 (4.34)

Zone 3 3 (6.52)

Zone 4 8 (17.39)

Zone 5 16 (37.78)

Zone 6 4 (8.69)

Zone 7 10 (21.73)

I C O T R A U M A 2 0 2 1

4


Successful Surgical Intervention in Traumatic Carotid Artery

Thrombosis After a Motor Vehicle Accident

Görkem Yiğit, M.D.

Yozgat City Hospital, Department of Cardiovascular Surgery, Yozgat, Turkey

E-mail: [email protected]

Abstract

Objective: Blunt carotid artery injury (BCAI) can lead to impaired brain perfusion due to ischemic stroke

and thromboembolic events. Early diagnosis and prompt management of BCAI could dramatically reduce

thromboembolic events.

Case Presentation: Following a motor vehicle accident, a previously healthy 19-year-old male patient

was admitted to the emergency department. He had paresthesia in his right-hand fingertips with no motor

dysfunction, and normal sensory and motor examination of other extremities. The result of servical CTA,

left common carotid artery (CCA) after first 6 cm segment was totally occluded due to thrombosis (Figure

1A-D). Longitudinal arteriotomy was performed after clamping of the CCA, ICA, and ECA. At the level

of the left CCA, there was clearly a 1x0.5 cm in size thrombus material without dissection flap. Organized

thrombus material was removed and simple laceration in the intima was repaired primarily. No other

pathology was observed within the lumen of the artery. By removing the clamps, good retrograde and

antegrade flows were observed. The arteriotomy was primarily closed with polypropylene 7/0 afterwards.

Neurological examination after one month revealed completely normal motor function and sensations in

the extremities, without any other surgical complications. Neither residual stenosis of the left CCA, nor

progression of the stenosis of the CCA were documented with carotid CTA (Figure 2A-E).

Conclusions: BCAIs are uncommon but potentially lethal conditions that require immediate diagnosis

and treatment. To reduce the risk of a potential neurological complication, it is critical to determine the

diagnosis and management protocol as quickly as possible after a detailed clinical examination.


I C O T R A U M A 2 0 2 1

5


Figure. 1. (A) The axial section CTA of the neck

demonstrating thrombosis and occlusion in the

left CCA. (B) Non-opacification was seen in left

ICA-ECA bifurcation level. (C) Left (ICA) and

(ECA) showed patent at the level of C2 vertebra

(D) 3D-CTA examination of the carotid artery

revealing total occlusion before the bifurcation

level.

Figure 2. (A) The axial section CTA of the neck

demonstrating normally contrasted left ICA and

ECA. (B)(C) Normally contrasted left CCA. (D)

The sagittal section CTA of the neck demonstrating

normally contrasted left CCA. (E) 3D-CTA

examination of the carotid artery revealing no-

occlusion and completely normal blood flow.

Keywords: Carotid artery thrombosis; Blunt carotid artery injury; Trauma; Carotid artery; Open repair.

I C O T R A U M A 2 0 2 1

6


Antimicrobial Resistance in Clinical Strains of Stenotrophomonas

maltophilia; 10 Years Surveillance

* Melek Bilgin1, M.D., Hacer İşler2, M.D. and Eşe Başbulut3, M.D.

Health Sciences University, Medical Microbiology Department, Samsun Training and Research Hospital, Samsun,

Turkey1,2,3

E-mail1:[email protected] , E-mail2: [email protected], E-mail3:[email protected]

Abstract

Objective Stenotrophomonas maltophilia is an opportunistic pathogen of increasing importance

particularly in the immunocompromised patient population, and cases of community-acquired. It’s

known that S. maltophilia can cause several different infections and it is mostly isolated from respiratory

tract, bloodstream, wound and urinary tract specimens. Infections caused by S. maltophilia are difficult

to manage because of its intrinsic resistance to a range of different antibiotics. The aim of this study was

to investigate the distribution and antimicrobial susceptibility patterns of S. maltophilia strains isolated

during a ten-year period.

Materials and Methods: The present study was conducted in the Microbiology Laboratory at Samsun

Education and Research Hospital. A retrospective analysis was carried out for susceptibility patterns of

clinical isolates of S. maltophilia that were isolated during a period of ten years (January 2010–December

2019). Identification and antimicrobial susceptibilities of the isolates were determined by Vitek2

Compact (Biomeriux, France).

Results: A total of 276 clinical isolates of S. maltophilia were included and only one specimen per site

per patient was considered in this study. Male patients accounted for a larger proportion (178 pts, 64.5%)

than female patients (98 pts, 35.5%). The median age of patients was 60 years (range 0-93 ys) for men

and 66 years (range 8-102ys) for women. Also 153 patients (55.4%) were over 65 years old. Out of 276

S.maltophilia strains, 20.7 % were isolated from outpatient clinics and 79.3 % from hospitalized patients

and 38.8 % of hospitalized patients were admitted to the Intensive Care Unit. Lower respiratory tract

specimens (n=104) were the most common specimens that S. maltophilia strains were isolated. Antibiotic

susceptibilities to trimetoprim-sulfametoksazol (TMP-SXT), levofloxacin and ceftazidim were; 92.8%,

93.1% and 60.1%, respectively. In our study, the average hospitalization period of the patients between

the years 2014-2019 was 19.47 (1-115) days; mortality rate was found to be 21.05%.

Conclusion: Stenotrophomonas maltophilia bacteremia is a critical situation for patients with high

attributable mortality. Although TMP-SXT resistance is not yet to be feared, increased resistance rates

should be taken into consideration. Antimicrobial resistance rates of S. maltophilia strains vary among

healthcare centers. In view of the varying resistance rates, requirement for active and comprehensive

antimicrobial surveillance systems might be suggested.

Keywords: Stenotrophomonas maltophilia, antimicrobial susceptibility, trimethoprim-sulfamethoxazole,

levofloxacin.




I C O T R A U M A 2 0 2 1

7


Evaluation of Osteoporosis in Patients over 45 Years Old with Distal

Radius Fracture, Association with Fracture History and Body Mass

Index

Emine Esra Ergül, M.D.

Erzincan Binali Yıldırım University Mengücek Gazi Training and Research Hospital, Department of Physical Medicine and

Rehabilitation, Erzincan, Turkey.


Abstract

Objective: Distal radius fractures constitute one-sixth of fractures admitted to the emergency department.

It often occurs in the elderly and children after a fall. Especially women over 45 years old,

postmenopausal and osteoporotic are in the high-risk group. It is considered to be the precursors of other

fractures, especially vertebral and hip fractures. Osteoporosis and osteoporotic fractures have become

important health problems in terms of morbidity, mortality, and cost with the prolongation of life

expectancy. This study aims to investigate osteoporosis and fracture history in patients over 45 years of

age with distal radius fracture, and to evaluate its association with demographic data and body mass index

(BMI).

Materials and Methods: The clinical data of 100 patients with distal radius fracture admitted to The

Physical Medicine and Rehabilitation Outpatient Clinic were analyzed retrospectively in this study.

Demographic and clinical features of the patients including age, gender, fracture history, BMI, bone

densitometry results were recorded.

Results: Seventy-two patients (72%) were female and twenty-eight (28%) were male in the study

population. The average age of the patients was 63,71±9,530. 11 cases (11%) had a history of fracture

and 89 cases (89%) had no known fracture history. Osteoporosis in 55 cases (55%), osteopenia in 34

cases (34%), and normal bone densitometry values in 11 cases (11%) were determined. Age, BMI, L1-

L4 T scores, L2-L4 T scores, femoral neck, and total femur T scores of cases with and without a history

of fracture were examined and a significant difference was found between the two groups (p<0,001).

Whereas cases with a history of fracture had lower T-scores and BMI values, the mean age was found to

be higher. The correlations between the T scores of the cases and the BMI values were found to be

significant (p<0.001 and r=0,682 for L1-L4 T score, p<0.001 and r=0,690 for L2-L4 T score, p<0.001

and r=0,728 for femoral neck T score, p<0.001 and r=0,737 for total femur T score).

Conclusion: Distal radius fractures are common fractures and are mostly associated with osteoporosis in

patients over 45 years old. It is also accepted as a predictor of hip and vertebral fractures associated with

a higher level of morbidity and mortality. Bone mineral densitometry values were evaluated as lower in

cases with a history of fracture. The presence of osteoporosis should be investigated in patients presenting

with distal radius fracture and necessary treatments should be started in the early period.

Keywords: Distal radius fracture, osteoporosis, body mass index


I C O T R A U M A 2 0 2 1

8


Table 1. Demographic and Clinical Features of the Patients

Patients with Distal Radius Fracture (n:100)

Age (mean±SD) 63,71±9,530

M/F 28/72

Osteoporosis n (%) 55 (55)

Osteopenia n (%) 34 (34)

Normal bone densitometry n (%) 11 (11)

History of fracture n (%) 11 (11)

Table 2. The History of Fracture History and Other Variables

Report

History of fracture Age L1-L4 L2_L4 Femoral Neck Femur Total

Yes

(n=11)

Mean 77,09 -4,091 -4,100 -3,791 -3,818

Std. Deviation 6,964 ,3590 ,2793 ,4826 ,4557

Median 76,00 -4,000 -4,100 -3,900 -4,000

Minimum 68 -4,7 -4,6 -4,2 -4,3

Maximum 87 -3,6 -3,6 -2,5 -2,7

No

(n=89)

Mean 62,06 -2,209 -2,193 -2,012 -2,007

Std. Deviation 8,456 1,2078 1,1972 1,1112 1,1061

Median 61,00 -2,400 -2,300 -2,300 -2,200

Minimum 46 -4,6 -4,5 -4,0 -4,0

Maximum 85 1,2 1,3 ,9 ,8

I C O T R A U M A 2 0 2 1

9


Epidemiological Evaluation of Eye Traumas in Erzincan Region

Dr. Mehmet Tahir Eski

Private Neon Hospital, Department of Ophthalmology, Erzincan, Turkey


Abstract

Aim: We would like to evaluate the risk factors, etiological and clinical features of eye trauma cases who

applied to the ophthalmalogy department of our hospital. Since there are not enough epidemiological

studies in Turkey, we aimed to contribute to epidemiological studies by examining them.

Method: Trauma patients who applied to the ophthalmalogy clinic of our hospital between 2018 and

2021 were reviewed retrospectively. 651 eyes of 603 patients were evaluated. Patients who applied to our

hospital's eye clinic due to trauma were evaluated in terms of gender, age, occupation, rural/urban

location, which eye was affected, diagnosis, cause of trauma, educational status, and need for additional

intervention for treatment.

Results: When the cases were examined in terms of gender, it was seen that there were 513 (78.8%)

males and 138 (21.2%) females. The mean age was 21.4 (0-74) years. 49(7.5%) of the cases were 16

years or younger. There were 61 (9.3%) patients over the age of 65. The occupations most affected by

trauma, excluding children, were workers 161 (24.7%) and farmers 78 (11.9%). It was seen that patients,

514 (78.6%) lived in the urban area and 137 (21.4%) lived in the rural area who applied to the eye clinic.

Trauma affected 43% left, 50% right and 7% right and left eyes. Among the diagnoses,

corneal/conjunctival abrasion/foreign body 471 (72.3%) ranked first. Among all cases, the most common

cause of trauma was corneal foreign body 351 (53.9%) and tree branch strike 157 (24.1%). When the

educational status of the patients was evaluated, it was seen that 443 (68%) patients were in high school

or higher education level. In the treatment plan, 504 (77.4%) patients improved without the need for

additional intervention/surgery.

Conclusion: We found that eye traumas are more common in men than women in our region. In addition,

we have determined that the rate of childhood traumas is too high. In addition, we concluded that those

working in industry and agriculture in the Erzincan region have a higher risk of eye trauma compared to

other occupational groups. We attributed the fact that our hospital was in the city center, despite the high

education level of the patients and the fact that there was a lot of traumas in the urban area. We realized

that necessary precautions should be taken and more awareness should be raised since eye traumas can

cause serious visual loss that can cause problems.

Keywords: Eye travma, eye epidomiology, Cornell foreign body


I C O T R A U M A 2 0 2 1

10


Evaluation of Pediatric Pelvic Fractures: A 10-Year Experience of a

Level-3 Trauma Centre

Dr. Samet Erinç1 and Prof. Dr. Mustafa Hacı Özdemir2

Health Sciences University, Şişli Hamidiye Etfal Training and Research Hospital,Department of Orthopedics and

Traumatology Service, Istanbul, Turkey1,2


Abstract

Background: Pediatric pelvic fractures are very rare injuries with an incidence to be reported between

0.5% and 7.5%. Therefore, there is no established treatment algorithm in the literature. The aim of the

presented study was to analyze the pediatric patients with pelvic injuries and to evaluate the fracture

patterns, concomitant injuries, and initial treatments of the patients.

Methods: A retrospective analysis was made of thirty - eight pediatric patients under aged 18 years

admitted to our clinic after a pelvic injury between 2011 – 2020. The following data were collected;

demographics of the patients, injury mechanism, treatment management, hospital and intensive care unit

(ICU) stay. The pelvic fractures were classified according to Torode/Zieg (TZ)(16) and AO/Tile/OTA

classification systems.

Results: Evaluation was made of 38 patients, comprising 18 (47%) females and 20 (53%) males. The

mechanism of injury was fall from >2mt in 21 (55.2%) patients, pedestrian struck by a motor vehicle in

10 (26%) patients, motor vehicle accident in 6 (15.7%) patients and sport injury in 1 (2.1%) patient. The

mean Injury Severity Score was 18.2± 13.3 (4 – 64). Sacroiliac joint disruption was seen 6 (15.7%)

patients and symphysis pubis diastasis in 4 (10.5%) patients. The most affected part of the pelvic ring

was pubic ramus in 28 (73.6%) patients of which 7 patients (18.4%) had also acetabular fracture,

following by sacrum fracture in 18 (47.3%) patients and iliac wing fracture in 9 (23.6%) patients. Extra-

pelvic fractures were seen in 28 (65.8%) patients. The most common extra pelvic fracture was lower

extremity fracture observed in the 18(47.3%) patients. The most common extra-skeletal injury was solid

organ injury (26.3%, n = 10), followed by chest injury (21%, n = 8) and cranial injury (5.3%, n=2). Pelvic

fractures treated conservatively in 28 (73.7%) patients. Symphysis pubis plating was applied to 2 (5.2%)

patients with symphysis pubis diastases without posterior pelvic arc injury. 2 (5.2%) patients treated with

external fixation. Open reduction and internally fixation was performed in 6 (15.7%) patients for an

acetabular fracture.

Conclusion: The severity of the pelvic fracture increases the risk of concomitant injury, therefore, risk

of mortality and morbidity. Multidisciplinary intervention is critical in the management of the pediatric

pelvic fractures and collaboration is needed to avoid from serious complications of this type of high

energy injuries.

Keywords: Pediatric fracture; Pelvic ring; Pediatric pelvis; Pediatric pelvic fracture; Pediatric emergency



I C O T R A U M A 2 0 2 1

11


Our Experience on Emergency Damage Control Surgery in Fatal

Extremity Traumas

Dr. Bulent Kilic

Health Science University, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Orthopedics and

Traumatology Clinic, Istanbul, Turkey.


Abstract

Objective: Damage control surgery (DCS) is an accepted method of minimal surgical management of

unstable trauma patients with severe disorders in the last 20 years. In 1983 Stone was first describe the

bailout approach of staged surgical procedures for severely injured patients. Politrauma is a disaster for

emergency department of the hospitals. The cases are challenging and need multiple-disciplinary

approach including general surgeon, neurosurgeons, orthopaedic trauma surgeons, emergency medicine

specialists and anesthrsiologist. All these specialists should work like an orchestra. Lack of multiple-

disciplanary could result in the death, so that damage control surgery is proposed to overcome this

problem. The goal of DCS is a short operating time, followed by transport to an intensive care.The basic

principle of damage control surgery is to keep the patient alive, reduce disability and functional losses

with acceptable degrees. Various complications can develop after surgical procedures. Many patients

have multiple organ injuries and have a 50% risk of death after surgery. In patients whose bleeding can

not be stopped, hypovolemia and metabolic problems will occur (hypothermia, coagulation problems,

acidosis). The risk of death in patients with large vessel injuries is very high. The first purpose of surgery

is to control bleeding. In our study; We aimed to share the successful experiences of our emergency

damage control surgeries in patients with isolated bone trauma with life-threatening risks.

Method: Between 2020-2021, 3 patients that were operated for damage control surgery due to the life-

threatinig traumas were included in this study. 3 patients with hypovolemia which developed rapidly due

to fractures developed after high energy traumas and were life-threatening. All cases developed in the

emergency department of our hospital. Despite all the interventions and treatments in the emergency

room, all of our patients developed hypovolemia, which did not respond to medical treatments. The

progressive hypovolemias of all our patients were attributed to active bleeding at the fracture sites after

evaluations. All patients were taken to the operating room under emergency conditions. In 1 patient, open

reduction, internal fixation and grefonaj were performed due to fracture in which the comminuted

acetabulum and femoral head protruded into the pelvis (Figure 1A). In 1 patient open reduction and

internal fixation were performed due to a fracture in which the comminuted acetabulum and femoral head

dislocated (Figure 1B). 1 patient had femoral fragmented, bilateral tibia fragmented and elbow

fragmented fractures. In this patient, 1 femur and bilateral tibia were fixed with external fixators. The

patient's elbow fracture was not intervened because it did not cause bleeding (Figure 1C).

Results: The mean age of our patients was 27.6 (22-36) and they were male patients. 1 patient had fallen

from a height, 2 patients applied due to in-vehicle traffic accident. Patient with isolated acetebulum

fracture had liver injury that were treated with medical treatment and no need for surgery. Hypovelaemia,

which developed due to trauma-related bleeding on fractures' area and did not respond to medical

treatment, in all 3 of our patients improved after damage-controlled surgeries performed under emergency

conditions. No major vessel injury was detected in our patients. For vessel injuries CT-anjiogram was

applied to all patients and no majör vessel injuries were detected and it was concluded that all of our


I C O T R A U M A 2 0 2 1

12


patients had massive bleeding in the surgically applied fracture sites and continued leakage from the

fracture sites. All patients were moved to intensive care units after DCS for close follow-up. Their

hypovolemias recovered quickly. There was no patient loss. There were functional losses in the surgical

areas. Wound infection and embolism did not develop in our patients. In 2 of our patients, pressure ulcers

developed due to prolonged lying down.Pressure ulcers were recovered with dressing and mobilisation

of the patients. One of our patients developed a psychological disorder treated undervision of a specialist

psychiatrist.

1A 1B

1C

Figure 1: Preoperative and postoperative radiographs of patients who underwent surgical

intervention.

Conclusion: Damage control surgery performed under emergency conditions is a life-saving surgery, it

should one of the common choices for patients with politraumas. Each patient with polytraumas must be

evaluated on a case-by-case basis, as no single approach is proper to manage and overcome this condition.

Keywords: Fracture, Bleeding, Damage Control.

I C O T R A U M A 2 0 2 1

13


A New and Safe Method for Intravitreal Injections: Intravitreal

Injection Cabin

*Assist. Prof. Gökhan Özgür1 and Assist. Prof. Mehmet Gökhan Aslan2

Health Sciences University, Samsun Training and Research Hospital, Samsun, Turkey 1

Recep Tayyip Erdoğan University, Medical Faculty, Rize, Turkey 2


Abstract

Introduction and Purpose: Intravitreal injections (IVE) have become the most commonly performed

intraocular treatments worldwide. There is no international standard regarding the environment and

conditions in which IVE should be performed. This study aims to demonstrate the safety and efficacy of

a new IVE cabin and report the results after 1 year of experience.

Method: This study was performed in Samsun Education & Training Hospital Ophthalmology

department between September 2020-May 2021. All injections were performed by the same surgeon. The

demographic data and medical history of the patients were recorded. The patients were followed for at

least 1 month for any late complication. The IVE cabin is a newly registered concept in a modular

structure designed with dimensions of 3m x 2m x 2.5m. (Figure 1). Its mainframe consists of stainless

steel and laminated glass. A laminar flow filtration unit with HEPA 14 filter was used to ensure the

positive pressure air quality inside the cabin. Hence, ISO Class 5 level air quality was obtained inside the

cabin. The positive laminar flow provided a clean surgical environment by sweeping out the particles and

microorganisms. The maximum air purity is achieved both in the surgical operation area and in the cabin.

The suspended uncontrolled particle level in the air is kept under predetermined safe limits via high air-

cycle numbers and dynamic overpressure. Moreover, the cabin can be installed in any desired

environment with customized dimension solutions.

Results: A total of 163 eyes of 121 patients were included in this study. The mean injection number was

2.86±0.63 (n=467) per eye. There were 80 female and 41 male patients and the mean age of the

participants was 65.4 ±12.3. The majority of the patients had diabetic macular edema (n=72) and followed

by age-related macular degeneration (n=31), retinal vein occlusion (n=18). All four currently available

intravitreal treatment medications were applied (bevacizumab, aflibercept, ranibizumab, and

dexamethasone). The endophthalmitis rate was 0% in the new IVE cabin after 1 year of on-duty follow-

up.

Discussion and Conclusion: There is only the Arcsterile module so far to replace operation theatres in

the literature. However, its design is mostly focused on performing surgeries which increased the

complexity compared to the new IVE cabin. The IVE Cabin provides a cost-effective and adjustable

environment for IVE in operating room standards. It is a safe and practical application to improve the

management of the patients considering the exponentially increasing numbers of intravitreal treatments.

Keywords: Intravitreal Injection; Endophthalmitis; Intravitreal Injection Cabin



I C O T R A U M A 2 0 2 1

14


Figure 1: The IVE cabin

I C O T R A U M A 2 0 2 1

15


Examination of Demographic and Clinical Data of Pediatric Trauma

Patients

Dr. Sinan Yavuz

Batman Training and Research Hospital, Department of Pediatric Intensive Care, Batman, Turkey.


Abstract

Objective: The aim of this study is to examine the demographic and clinical data of pediatric patients

hospitalized in our pediatric intensive care unit due to trauma.

Materials and Methods: Thirty pediatric patients admitted to the pediatric intensive care unit with the

diagnosis of trauma between March 2021 and September 2021 were evaluated within the scope of the

study. Demographic and clinical data of the patients were analyzed retrospectively. Trauma type, need

for operation, increased intracranial pressure (ICP) status, mortality, Glasgow score, and inotropic needs

were evaluated retrospectively.

Results: Twenty-two patients (66.6%) were male and 8 (33.3%) were female. The mean age of the

patients was 53.6 months. The mean length of stay was 11 days (3-36 days). No mortality was observed

in any of the patients. Twenty (66.6%) of the patients were falling from a height, 8 (26%) were non-

vehicle traffic accidents, 4 (13%) were stabbing. Intracranial lesion was detected in 14 (46%) of the

patients. A total of 6 (20%) patients underwent surgical operation. Twelve (40%) patients needed

mechanical ventilator. The mean number of mechanical ventilator days was 6.5 days. The mean PRISM

score of the patients was 4.8. Seven patients with a glaskow score ≤8 were connected to mechanical

ventilator directly at presentation. In the follow-up of 5 patients, a mechanical ventilator was needed. A

total of 6 (20%) patients needed inotropes due to low mean arterial pressure (MAP) for age. All patients

were transferred to the surgical services in good health. 3 (10%) patients were included in the long-term

physical therapy rehabilitation program.

Discussion: Trauma is one of the common causes of death in the pediatric patient group. Regional

characteristics clearly affect the type of trauma. Cases of falling from a height are common in the region

where our hospital serves, due to the hot weather and high rates of sleeping on high places. Early initiation

of head-sparing treatments has been effective in preventing raising ICP and reducing mortality. It is

possible to obtain satisfactory results with effective and preventive treatments with multidisciplinary

management in pediatric trauma patients.

Keywords: Trauma, Pediatrics, Intensive care, Critical


I C O T R A U M A 2 0 2 1

16


Knowledge Levels of Healthcare Employees About Glass Particle

Contamination in Drug Ampoules and Using Filter Needles

MSN. Nida Nur Söğüt1 and PhD. BSN. Assist. Prof. Arzu Erkoç2

Başakşehir Çam and Sakura City Hospital, Istanbul,Turkey 1

Istanbul University-Cerrahpaşa, Florence Nightingale Faculty of Nursing, Istanbul, Turkey2

E-mail 1: [email protected], E-mail 2: [email protected]

Abstract

While the glass ampoule form of drugs is being prepared for treatment, a large number of micro and

macro sized glass particles are formed during the breakage of the neck part and spilled into the ampoule

and contaminates the drug. Medicines in glass ampoule form are injected into patients by parenteral routes

and cause various health problems. This descriptive and cross-sectional study was planned to determine

knowledge levels of nurses and physicians about micro-size glass particle contamination to drug content

during opening of parenteral drugs in glass ampoule form and used of filtered needles to reduce

contamination. The research was conducted with a total of 600 healthcare employees, 300 physicians and

300 nurses, working in the Surgery and Internal Medicine Departments of Istanbul University-

Cerrahpaşa Medical Faculty Hospital between October 2020-November 2020. "Personal Information

Form" and "Information form on glass particle contamination and filter needle use" prepared by the

researcher by face-to-face interview method were used. The Kuder-Richardson 20 test, which was used

to test the internal consistency of the "Information form on glass particle contamination and filter needle

use" was performed and the internal consistency coefficient was calculated as ɑ=0.620. Descriptive tests

and CI-Square test were used in the analysis of the data. The data were analyzed at the %95 confidence

interval, p<0.05 significance level. The age of the health workers was 32.08±6.66 years and the majority

(76.8%) were in the 35 and over age group. The majority of them were women (64.5%), and healthcare

professionals with 6 years or less of professional experience (59.6%). 48.3% (n=290) of the healthcare

professionals were working in the internal medicine departments of the hospital and 51.7% (n=310) of

them were working in the units affiliated to the surgical medicine sciences. Each of the questions asked

to healthcare professionals regarding glass particle contamination and use of filter needles was answered

correctly at different rates (28-76%). In the study, a significant difference was found between occupation,

professional experience, number of ampoules used in clinic, getting an training and correct answers to

some of the questions asked on the level of knowledge about glass particulate contamination and using

filter needles (p≤0.05). Healthcare professionals knowledge of glass particle contamination and using

filter needles is moderate. A significant difference between the variables such as profession, professional

experience, the number of ampoules used in the clinic and the level of education with the level of

knowledge. It is recommended to plan training for healthcare professionals on glass particle

contamination and using filter needles.

Keywords: Ampoules, Contamination, Glass particle, Healthcare employee, Needle filter.



I C O T R A U M A 2 0 2 1

17


Recovery Results of Patients with Brain Herniation Prevented by

Decompresive Craniectomy

Dr. Cem Demirel1 and Dr. Vaner Köksal2

Samsun University, Medical School, Department of Neurosurgery, Samsun, Turkey1,2


Abstract

Introduction: Cerebral herniation is a can cause cerebral death threatening human life and a condition

that requires emergency surgical treatment of neurosurgery. Therefore, it is the most important urgent

problem of neurosurgery practice. In this study, the improvement, and differences in clinical conditions

after decompressive craniectomy surgical treatment performed on patients with acute cerebral herniation

syndrome in the emergency department (ED) and neurology clinics were investigated.

Material & Methods: Patients who were admitted to the ED and intensive care unit of neurology due to

sudden loss of consciousness and going to deep coma in Samsun Training and Research Hospital between

June 2015-2021, whose clinical picture of acute cerebral herniation was detected by radiological imaging

and who underwent decompressive craniectomy surgery were included in this retrospective study. The

patients were divided into 2 groups as group A, a traumatic brain injury and group B, those who had

ischemic brain injury (stroke).

Results: There were 38 patients in total in group A. Of the patients, 27 (71%) were male and 11 (29%)

were female. The age ranged between 9-72 (43). Patients were divided into two groups according to

Glasgow Coma Scale (GCS) at admission to the ED. Those with GCS 6-8 were called coma (group A1)

and those with GCS 3-5 were called deep coma (group A2). There were 21 patients in group A1 and 17

patients in group A2. Twenty-five (65%) of the patients were admitted after a trauma, and 13 (35%) with

a spontaneous clinical picture. Since anisocoria was detected in the ED in 23 patients, it was considered

as an uncal herniation. Fourteen of 23 patients admitted with uncal herniation were evaluated in group A,

and 9 patients were evaluated in group B according to their state of consciousness. In group B, 19 of 32

(59%) patients who were operated for ischemic brain injury were male and 13 (41%) were female.

Decompressive surgery was performed in eight patients due to the diagnosis of ischemic cerebrovascular

disease, while they were under medical treatment due to rapid neurological regression. According to GCS,

the prognosis of group 1 patients after surgical intervention was better than group 2 patients. Permanent

neurological sequelae were more observed in group 2 patients (p<0.05).

Conclusion: The time between the loss of consciousness after the trauma and the patients’ admission to

the ED and then to the surgery is very important. Prolongation of this process may cause permanent

irreversible disruption of the normal physiology of the brain. In addition, it has been observed that the

prognoses of those with dominant hemisphere damage in patients with ischemic cerebral damage, and

generally those with left hemisphere damage, have a worse prognosis than those with right hemisphere

damage.

Keywords: Decompression, craniectomy, brain herniation, cerebral edema



I C O T R A U M A 2 0 2 1

18


Early Results of Surgical Treatment of Elbow Terrible Triad Trauma;

Could Early Accelerated Physiotherapy and Indomethacin Reduce The

Complications?

Dr. İhsan Özdamar

Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, Istanbul, Turkey


Abstract

Objective: The treatment of the terrible triad injury of the elbow is challenging for orthopaedic surgeons.

This injury, which is generally seen in the young patient group, causes serious pathologies including the

bone structure and also the ligaments and capsule of the elbow joint. Severe joint stiffness, heterotopic

ossification, limitation of elbow range of motion and pain are the most reported complications after

surgery. Our hypothesis was that accelerated physiotherapy and indomethacin could reduce these

complications?

Methods: The present study was conducted to analysis the retrospective datas of prospectively designed

study including 6 patients with elbow terrible triad who were treated in our hospital between January

2020 and April 2020. Inclusion criterias were patients older than 18 years old, isolated elbow terrible

triad injury, and gave permission to include the study. Exclusion criterias were as follows: 1: Patients

with open or pathological fracture, previous elbow surgeries, lack of follow-ups.

Treatment protocol; The elbow was reduced under sedation and long arm cast splint was applied. patients

with x-ray images, computed tomography images were operated as soon as possible. The average time

from injury to operation was 2 (1-5) days. Firstly, the radius was fixed with a headless screw using a

lateral incision and the lateral collateral ligament was repaired with an anchor. The ulnar coronoid process

and medial collateral ligament were repaired in 4 patients with a medial incision. 1 patient with ulna

diaphysis and coronoid process fracture was repaired with posterior incision. Immediately after the

operation at post op day 1, all patients were given 3x25 mg of indomethacin daily for 3 weeks. Angle-

adjustable elbow brace was used to all patients 1 day after the operation, and controlled elbow movement

was started under supervision of a physiotherapist who had a ten years experience in upper extremity

physiotherapy. By increasing the range of motion of the joint with weekly controls, elbow brace was used

for 8 weeks.

Figure 1A: Preop X-Ray View Figure 1B: Postop Anterior-

Posterior X-Ray View

Figure 1C: Postop Lateral X-Ray

View


I C O T R A U M A 2 0 2 1

19


Results: Elbow joint range of motion was limited to 10° in 1 patient. All patients had more than 120° of

flexion (mean 125) (range 120-130). The supination-pronation gap was above mean 100°. The mean

MAYO elbow score average was found to be 80(range 75-85). Heterotopic ossification and elbow

stiffness were not observed in any of our patients. The mean Post Op VAS scores was 1,3. (range 1-2).

There was no infection or implant failure or union problem in any patients.

Conclusion: Serious complications such as elbow stiffness and heterotopic ossification are seen after

terrible triple trauma to the elbow. Anatomical reduction in the early period after such injuries,

administration of indomethacin for postoperative anti-heterotopic ossification prophylaxis, and early

mobilization with an open-adjusted elbow brace will prevent the development of these complications.

Keywords: Terrible triad, physiotherapy, indomethacin, Elbow stiffness.

I C O T R A U M A 2 0 2 1

20


Trauma Associated with Firegun Injury: A Case Report

Dr. Çiğdem Şimşek1, Dr. Mehtap Balci2,

Dr. Fatih Balci3 and Dr. Selman Çavuşoğlu4

Adana Yüreğir State Hospital, Anesthesiology and Reanimation, Adana, Turkey1

Nuh Naci Yazgan University, Anesthesiology and Reanimation, Kayseri, Turkey2

Kayseri City Hospital, Anesthesiology and Reanimation, Kayseri, Turkey3

Adana Yüreğir State Hospital, General Surgery, Adana, Turkey4

E-mail 1: [email protected], E-mail2: [email protected], E-mail3: [email protected],

E-mail4: [email protected]

Abstract

Introduction: Trauma is the first cause of death in children and youth, and the third leading cause of

death in all age groups after cancer and cardiovascular diseases. In this case, we presented our anesthesia

experience in a trauma patient due to gunshot injury.

Case: In the physical examination of a 20-year-old male patient who applied to the emergency department

with a gunshot injury; BP: 100/85 mmHg, HR: 98 bpm, conscious, agitated, alcohol intake is present, a

bullet hole in the abdomen and widespread pain, defense, rebound findings, and hematuria was observed

in the urinary catheter inserted in the patient. No pathology was detected in other system examinations.

The patient was monitored and two 20-gauge vascular access was opened and fluid therapy was started.

Since the hemodynamics was stable, imaging methods were performed for diagnosis. In the non-contrast

abdominal tomography; hyperdense appearance of foreign body at the level of the superior pubic ramus

on the left in the pelvis, and an increase in soft tissue (hematoma) in which air densities are observed in

the pelvis at the level of the left, adjacent to the bladder. No pathology was detected in the cranial and

thorax tomography. Due to the patient's current injuries, general surgery and urology consultations were

requested and it was decided to undergo an emergency operation. In the preoperative laboratory

examination, it was observed that hemoglobin was 11.9 g/dl, hematocrit was 33.7%, leukocytes 20.77

K/mm3, C-reactive protein: 190 mg/L. Invasive monitoring was performed in the operating room for the

patient who was taken to emergency operation. In his anamnesis, the patient who had taken alcohol and

solid food 4 hours before the operation was intubated by medical aspiration prophylaxis before general

anesthesia with 5 mg/kg pentothal, 1 mg/kg rocuronium bromide, 1 mg/kg lidocaine, rapid serial

induction and tracheal compression. In the maintenance of anesthesia, 50/50% oxygen/air mixture, 1

MAC sevoflurane and after intubation, 1 microgram/kg fentanyl was applied and the abdomen was

entered with a superior medial incision by general surgery. It was observed that there were also 2

perforations in the colon, and the perforated areas were sutured in a double layer, and an ileostomy was

opened in the protective right lower quadrant. The bladder was opened under double suspension sutures

by the urology, and the perforation at the base of the bladder was sutured. For postoperative analgesia,

tramadol 100 mg IV, paracetamol vial 1 g IV infusion and dexketoprofen trometamol 50 mg IV were

administered. The bullet core in the patient's body could not be removed because it was stuck in the base

of the ramus pubis (Picture 1). The operation was completed without any problems and the patient was

extubated and sent to the 3rd step intensive care unit.

Discussion: All trauma patients are difficult cases for both the anesthetist and the surgical team. Mortality

and morbidity of these patients can be reduced by making early diagnosis, making appropriate





I C O T R A U M A 2 0 2 1

21


preparations in the peroperative period, providing invasive monitoring, appropriate fluid therapy and

postoperative analgesia in the operation.

Keywords: Gunshot wound, General anesthesia, Rapid serial induction, Balance anesthesia

I C O T R A U M A 2 0 2 1

22


Forearm Fractures and the Covid-19 Pandemic

Dr. Serdar Toy

Ağrı Training and Research Hospital,

Department of Orthopedics and Traumatology,

Ağrı, Turkey


Abstract

Aim: Fractures of both the radius and the ulna that co-occur are called both-bone forearm fractures. The

treatment of both-bone forearm fractures is open reduction and internal fixation in adults, during closed

reduction and circular casting or elastic intramedullary nailing in children. This study aimed to analyze

whether there was any change in patients' demographics and terms of clinical approach in the first and

second years of the Covid-19 pandemic.

Materials and Methods: Patients who applied to the orthopedics and traumatology clinic between March

3 and August 10 in 2020 and 2021 were evaluated retrospectively. We noted the dates of admission, age,

gender, and treatment of the patients.

Results: Seventy-seven patients applied to our clinic for both-bone forearm fractures in 2020, while 117

patients were admitted for the same reasons in 2021. There was no statistically significant difference

between the months and years of admission (p=0.474). The mean age of the patients was 13.4 (SD: 14.5).

We divided the ages of the patients into three groups. There were 108 patients aged 1 to 10 years, 47

patients aged 11 to 15 years, and 39 patients aged 16 and over. There was no statistically significant

difference between the age groups of the patients and the years they applied (p=0.123). We applied closed

reduction and casting to127 patients, elastic intramedullary nailing to 28 patients, and open reduction and

internal fixation to 39 patients. There was no statistically significant difference between the treatment

methods and the years in which the patients were admitted (p=0.372).

Conclusion: Despite some restrictions because of the Covid-19 pandemic, there has been no change in

the number of both-bone forearm fractures, one of the orthopedic emergencies, and the treatment options

for these fractures.

Keywords: Bone fractures; Coronavirus; Fracture; Forearm; Orthopedics


I C O T R A U M A 2 0 2 1

23


Evaluating the Provision of Medical Imaging in Severely Injured

Patients in Emergency Departments: A Turkish Survey based on Royal

College of Radiologists Standards

*Dr. Fatih Karagüzel1 and Dr. Kaan Alişar2

Okan University, Medical Faculty, Radiology Department Istanbul, Turkey1,2


Abstract

Aim: To evaluate the provision of medical imaging in severely injured patients (SIP) in emergency

departments and compliance with other national guidelines

Materials and Methods: A 21-question survey was developed in Surveymonkey™ with attention to

content and response process validity. The standards of the questionnaire were derived from the Royal

College of Radiologists publication, “Standards of practice and guidance for trauma radiology in severely

injured patients”. A convenience sample of respondents was enrolled between June and October 2021,

consisting of emergency physicians (EP). The descriptive data were reported and a multinomial logistic

regression model was estimated.

Results: A total of 132 surveys were initiated and 118 surveys had complete or near-complete responses.

According to the participants; radiologists in the emergency department participate in trauma

management at a rate of 87.29%. 67.96% of EP can reach the radiologist within 30 minutes for the

evaluation of the images of SIP. Only 10.87% of emergency department’s on-call consultant radiologists

can provide the final report on the SIP within one hour of multidetector computed tomography (MDCT)

image acquisition. Life support facilities are considered adequate in emergency imaging environments at

a rate of 64.4%. 11% of EP can not transfer SIP to the CT unit within 30 minutes. Whole-body contrast-

enhanced MDCT was preferred by 66.1%. 50.8% of the participants cannot transfer SIP to reach the MR

unit within 24 hours. Only 7.6% of emergency departments are co-located to interventional radiology

facilities (IRF) and only 22.2% of these IRF have a trauma team. When severely injured patients need to

be transferred from one unit to another, 58.47% of EP can transfer SIP locally acquired images to the

receiving hospital within two hours.

Conclusion: This study highlights significant deficiencies in the care and imaging of severely injured

patients within hospitals in Turkey. Developing national guidelines in accordance with western examples

will lead to the development of Turkish medical standards.

Keywords: Trauma, severely injured, medical imaging, emergency, guideline



I C O T R A U M A 2 0 2 1

24


Depression and COVID-19 Fear Levels in Hemodialysis Patients

Dr. Demet Yavuz1 and Dr. Ayşe Pınar Doğru Balakbabalar2

Department of Internal Medicine, Division of Nephrology1, Depertment of Psychiatry, 2 Samsun Training and Research

Hospital, Samsun, Turkey


Abstract

Introduction. Covid-19 is a serious infectious disease for which a specific treatment could not be found

yet. Covid-19 affects physical health as well as psychological health. Depression is still the most common

health problem in hemodialysis (HD) patients. The aim of the study was to investigate the link between

depression, and fear of covid-19 in hemodialysis patients.

Material and methods. A total of 130 patients were included in study (66 woman; median age 53 (min

19, max 76) years; hemodialysis duration 46±29.9 months). Demographic data and laboratory values

were evaluated. We used ‘’Beck Depression Inventory’’ (BDI) and "Fear of COVID-19 Scale" in all

patients.

Result: The mean BDI score of all patients was 16.17 (min 3, max 54). The BDI score was higher in

women (18.8±9.79) compared to men (15±9.98) (p<0.05). Being female increased the depression score.

According to the BDI scores, 56 (43.1%) patients with depressive mood (BDI score ≥ 17) and 74 (56.9%)

patients without depressive mood (BDI score < 17) were determined. 98 (75.4%) patients expressed that

they had not been infected with covid-19 before, whereas 32 (24.6%) patients declared that they had been

infected with covid-19 before. Considering all patients, the mean fear of Covid-19 scale score was 16.17

(min 5, max 35). The fear of Covid-19 scale score was higher in women (17.12±5.36) compared to men

(15.18±5.4) (p<0.05). Fourteen (10.8%) patients were smokers, and 68 (52.3%) patients had three and

more chronic diseases.

BDI score was positively correlated with the fear of Covid-19 scale score (r=0.552 p<0.001),

hemodialysis duration (r=0.725 p<0.001) and age (r=0.402 p<0.001), and negatively correlated with

creatinine (r=-0.267 p< 0.001) and albumin (r=-0.249 p<0.001) levels. The fear of Covid-19 scale score

was positively correlated hemodialysis duration (r=0.288 p<0.001), age (r=0.428 p<0.001), number of

cigarettes (r=0.178 p<0.05), and number of chronic diseases (r=0.399 p<0.001).

In multivariate linear regression analysis, BDI was independently associated with the fear of Covid-19

scale (β= 0.46; 95% confidence interval, 0.375 to 0.546, p<0.001) and age (β= 0.85; 95% confidence

interval, 0.039 to 0.132, p<0.001).

Conclusion. The result of this study indicate that BDI score is positively correlated with the fear of Covid-

19. The higher fear of Covid-19 scale associated with the presence of depression. It should be considered

that hemodialysis patients need support in terms of depression during the Covid-19 pandemic.

Keywords: Depression, Fear of COVID-19 Scale and Hemodialysis.



I C O T R A U M A 2 0 2 1

25


Our Results of Percutaneous Screw Fixation for Unstable Scaphoid

Fractures

Dr. Mehmet Cenk Turgut

Erzurum Regional Training and Research Hospital, Department of Orthopedics and Traumatology,

Erzurum, Turkey


Abstract

Aim: Ongoing with implant and technical developments, fixation of the unstable scaphoid fracture with

percutaneous screws has become popular day by day. The advantages of this method are short

immobilization time, early motion, and being a closed surgical method. Uncertainty remains about the

treatment of unstable scaphoid fractures. The rates of nonunion are very high in these fractures, which

are traditionally treated with casting. Percutaneous screw fixation, which also allows fracture

compression under fluoroscopy control, has been used more and more day by day. This study aimed to

evaluate the surgical technique and explore the potential benefits of percutaneous screw fixation for

unstable scaphoid fractures.

Materials and Methods: We retrospectively investigated the cases who applied to our clinic with

scaphoid fracture between January 2020 and March 2021 and were operated on with percutaneous screw

fixation. Patients' ages, genders, Quick-DASH Scores, patient follow-up times, time from trauma to

operation, and patient satisfaction were evaluated and documented. Patients who applied to our clinic 48

hours after trauma were not included in the study.

Results: Seven patients were included in the study. There were five male patients and two female patients

in the study. The mean age of the patients was 29.14 years. All patients were operated on within the first

24 hours after trauma. The mean follow-up time was 7.7 (range: 6-10) months. Analyzing all the results,

the Quick-DASH gave a mean score of 0,65 (range: 0–2,3) points. The results were statistically

significant. Nonunion was not observed in any of the patients, and all patients were satisfied. No

complication was observed in any of the patients.

Conclusion: The technique of percutaneous screw fixation was successfully used to treat seven unstable

scaphoid fractures. The favorable outcome of this treatment option and the prompt functional recovery

deserve further investigation. Longer-term studies and more numbers of patients are needed to observe

the complications and deficiencies of the technique.

Keywords: Scaphoid fractures; Percutaneous screw fixation


I C O T R A U M A 2 0 2 1

26


Treatment and Outcomes of Supracondylar Humerus Fracture in Covid-

19 Pandemic

Oktay Polat, M.D.

Department of Orthopedic and Traumatology, Ağrı Training and Research Hospital, Ağrı, Turkey.


Abstract

Purpose: Supracondylar humerus fractures are one of the most common fractures in childhood and can

be considered as the most serious fracture in this period. Problems related to diagnosis and treatment,

complications, and sequelae have not been fully resolved yet. The purpose of our own clinical experience

was to diagnose Covid-19 pandemic periods in a region and evaluate our success.

Material and methods: The patients who applied to our clinic with a supracondylar fracture between

March 2020 and March 2021 were evaluated retrospectively. Children younger than 14 years of age were

included in the study. Age, gender, fracture type, treatment method, complications, length of hospital

stay, and follow-up period of the patients were evaluated.

Results: A total of 109 patients were included in the study. The mean age of the patients included in the

study was 7 (range: 3-13) years. While 41 (37.6%) of the patients were female, 68 (62.4%) were male.

While 6 of the patients (5.5%) had flexion fractures, 103 (94.5%) patients had extension type fractures.

Extension type 1 fractures in 35 (32.1%) patients, extension type 2 fractures in 25 (22.9%) patients,

extension type 3 fractures in 37 (33.9) patients, and extension type 4 fractures in 6 (5.5%) patients. was

available. Hastaların 35'i (%32,1) alçı ile tedavi edilirken, 74'ü (%67,9) cerrahi olarak tedavi edildi. The

number of patients with double k-wire fixation was 38 (34.9%). The number of patients who were

operated on with three k-wires was 36 (33.0%). Closed reduction and percutaneous pinning were

performed in 50 (45.9%) patients, and open reduction and internal fixation were performed in 21 (19.3%)

patients. The patients were followed up for a mean of 5 (range: 3-7) months. No iatrogenic vessel or nerve

injury was observed. Traumatic ulnar nerve injury in one patient and traumatic radial nerve injury in 3

patients were reported. In 3 of these patients, neurological nerve damage healed in an average of 2.6

months. However, there was no improvement in traumatic radial nerve injury in 1 patient. According to

Flynn criteria, functional results were excellent in 88 (80.7%), good in 17 (15.6%), moderate in 3 (2.7%),

and poor in 1 (0.9%) patient; cosmetic results were excellent in 84 (77.1%) patients, good in 18 (16.5%)

and fair in 7 (6.4%) patients.

Conclusion: While the supracondylar humerus can be followed with a cast in nondisplaced fractures, the

most preferred treatment for displaced supracondylar humeral fractures is a closed reduction with two or

three lateral k-wires and percutaneous fixation. In case of instability of the medial colon, an extra medial

pin can be added. Open reduction internal fixation can be applied in extension type 4 fractures and flexion

type unstable fractures due to the reduction difficulty and the possibility of iatrogenic nerve injury.

Keywords: Child, Elbow, Humerus, Fracture fixation


I C O T R A U M A 2 0 2 1

27


Retrospective Analysis of Our Temporal Bone Fracture Case

Assist. Prof. Ayşe Çeçen1, M.D. and Assist. Prof. Asude Ünal2, M.D.

Samsun University School of Medicine, Department of Otorhinolaryngology, Samsun, Turkey1

University of Health Sciences, Samsun Health Practices and Research Center, Department of Otorhinolaryngology,

Samsun, Turkey2

E-mail 1: [email protected] E-mail 2: [email protected]

Abstract

Background: Accidents and injuries likely to result in death have increased substantially due to high

speed and active lifestyle, which have been the products of advanced technology in the last century. Road

accidents are the leading cause of this type of trauma. In parallel, the incidence of temporal bone fractures

has also increased. In this study, the patients with temporal bone fractures who were followed up in our

hospital between 2018-2020 were examined in terms of age, gender, type of trauma, examination

findings, imaging method and treatment methods.

Methods: The information of 30 patients who were admitted to Samsun Training and Research Hospital,

Department of Otorhinolaryngology, Neurosurgery, and Neurology between 2018 and 2020 and were

treated with temporal bone fractures were retrospectively analyzed. In all patients, the diagnosis was

made by anamnesis, physical examination and computed tomography (BT).

Results: Thirty patients, 10 female and 20 male, were included in the study. The mean age of the patients

was 35.6 (min: 7, max: 76). The mean age of women was 33.2, and the mean age of men was 30.5. The

fracture was in the right ear in 22 patients and in the left ear in 8 patients. In the etiology, the most

common causes were domestic accidents and assault in women, and traffic accidents and assault in men.

On physical examination, facial asymmetry, edema, ecchymosis, soft tissue loss and abrasion, clear or

bloody ear discharge, perforated tympanic membrane, hemotympanium, ecchymosis on the mastoid bone

were observed. As the imaging method, temporal CT and brain CT were found in 10 patients, and only

brain CT in 20 patients. 19 patients included in the study had longitudinal fractures, 7 patients had

transverse fractures, and 4 patients had mixed type fractures. There were facial paralysis due to temporal

bone fracture in 9 patients, conductive or sensorineural hearing loss in 19 patients, and hemotympanium

in 5 patients.

Conclusion: Since temporal bone fractures are usually seen together with head trauma, our priority in

treatment should be the diagnosis and treatment of life-threatening intracranial pathologies. After the

patient is stabilized, high-resolution temporal CT should be performed for the management of

autoneurological complications and patients should be carefully evaluated for early and late

complications.

Keywords: Temporal Bone Fracture, Complication, Temporal CT



I C O T R A U M A 2 0 2 1

28


Retrospective Analysis of Trauma Patients in the Intensive Care Unit

Dr. Sevda Akdeniz

University of Health Sciences, Samsun Training and Research Hospital, Department of Anesthesiology and Reanimation,

Samsun, Turkey


Abstract

Objective: In this study, we aimed to investigate the characteristics of trauma patients hospitalized in

intensive care unit of a hospital.

Materials and Methods: The data of 98 trauma patients were evaluated retrospectively in the surgical

intensive care unit between November 2020 and September 2021. Patients were rated in terms of age,

gender, etiology of trauma, clinic diagnoses, requirement for mechanic ventilation, intensive care unit

stay, and mortality rates. Ethics committee was not recruited for study and it was conducted in accordance

with the Helsinki principles.

Results: A total of 1043 patients were treated in the intensive care units and 98 (9.39%) patients were

followed up for trauma. Male to female ratio was 2.06 with the mean age of 55.71±25.56 years. The

causes of trauma were fall (n = 38, 38.8%), fall from height (n = 26, 26.5%), violence (n = 26, 26.5%),

traffic accidents (n = 7, 7.2%), and crush (n = 1, 1%) (Figure 1). The anatomic sites of trauma were:

multiple site 24.5%, head 21.4%, limbs 19.4%, thorax 15.3%, abdomen 10.2%, spine 8.2% and isolated

pelvis 1% (Figure 2). The mean Glasgow coma score was 12.05±4.1. The rate of erythrocyte suspension,

fresh frozen plasma, thrombocyte suspension and albumin were 40.8%, 29.5%, 3.1%, and 9.2%

respectively. The number of patients invasive mechanically ventilated was 33.7%, the rate of operated

patients was 69.4%, and the mortality rate was 16.3%. The mean intensive care unit stay was 6.7±9.87

days.

Conclusion: In our study, it was seen that most of the patients hospitalized in the ICU due to trauma were

male patients, and the most common cause was a fall.

Figure 1. Causes of trauma Figure 2. Anatomic sites of trauma

Keywords: Trauma, intensive care unit, analysis

38.8%

26.5%26.5%

7.2%

11%Multiple

Head

Limbs

Thorax

Abdomen

24.5%

21.4%

19.4%

15.3%

10.2%

8.2% 1%Multiple

Head

Limbs

Thorax

Abdomen

Spine


I C O T R A U M A 2 0 2 1

29


Evaluation of Factors Affecting the Prolongation of Preoperative

Preparations in Geriatric Hip Fractures

Assist. Prof. Abbas Tokyay

Van Yüzüncü Yıl University, Faculty of Medicine, Department of Orthopedics and Traumatology, Van, Turkey.


Abstract

Introduction: Hip fractures are one of the most common reasons in geriatric patients for presentation to

the emergency department which needs urgent surgery. Preoperative preparations usually take a long time

because the patients are elderly and have systemic chronic diseases.

This prolonged process results from the reorganization of addressing chronic diseases, providing normal

blood values suitable for the surgery, ensuring the fluid balance, arranging the place in the intensive care

unit according to the postoperative intensive care needs, and waiting for the operating room. This

prolongs the hospital stay, which increases the risk of complications, and creates a higher cost and

workload in terms of health.

Our aim is to determine the factors that cause the prolongation of the preoperative preparations for

geriatric hip fractures and identify possible solutions.

Materials and Methods: Patients who underwent surgery in our center for hip fractures between January

2017 and July 2020 were evaluated. The data of the patients were obtained retrospectively from the file

archives of our hospital. Demographic structures of the patients, comorbid diseases, consultations

requested from related branches, whether they needed intensive care, waiting times for intensive care,

completion of radiological and laboratory tests, waiting times for surgery, time to hospital admission, and

time to surgery were determined. Those who underwent surgery after the first two days were considered

to have a prolonged waiting period for surgery.

Results: The mean age of 92 patients (49 females, 43 males) was 74.6±6.24 (61-93). A total of 178

consultations from related branches were requested from 83 (90.2%) patients and. Evaluation of the

consultations was completed in 2,4(1-7) days on average. For 42 (45.6%) patients, a place was prepared

for intensive care before surgery. Twenty-eight (30.4%) of the patients were admitted to the intensive

care unit after surgery. Intensive care waiting times lasted an average of 3.2(1-8) days. Radiological

examinations were completed on the first day of hospitalization. Laboratory results were obtained in two

days on average, while routine tests (thyroid functions and some hormonal tests) were completed in one

day. The operating room's waiting time was considered as the expected time for the surgery after all

preparations were made, and this time was determined as 2.1(1-5) days on average.

Conclusion: The long preoperative preparations for hip fractures in the geriatric age group delay the

treatment. This increases the complication rate and health cost, and burden. In order to reduce this time,

the patient's examinations should be done immediately as soon as the patient comes to the emergency

room, and time loss should be prevented by performing multiple disciplinary studies.

Keywords: Preoperative waiting time, Hip fracture, Complication


I C O T R A U M A 2 0 2 1

30


Quality of Life After Trochanteric Fractures in Elderly

Mustafa Caner Okkaoglu, M.D.

Health Sciences University Kecioren Training and Research Hospital, Orthopaedics and Traumatology Department,

Ankara, Turkey


Abstract

Objectives: To assess the elderly patients’ with trochanteric fractures , quality of life using Short Form

36 (SF-36) and describe factors affecting SF-36 scores after treatment the fracture.

Methods: The patient with trochanteric fractures who were operated in our clinic between April 2017

and September 2019 were included in our study. SF 36 questionnaire were administrated to the patients

post-operatively after 1 year. We retrospectively evaluated and compared the scores according to age,

gender, fracture type, ASA Type of the patients.

Results: All patients’ mean mental component summary was 42.88(24-59.8), physical component

summary was 33.81 (17.7-56,2). The mean physical role as a SF 36 component in women was

significantly lower than men. (21.36 & 32.57, p=0.003). The mean emotional role and social function

were significantly lower in above 80 years old group (p=0.002, p= 0.003). Fracture type was not found

as an indicative factor for SF 36 scores. ASA 2 group patients had significantly higher physical

functioning, physical role, general health, vitality, social functioning and role emotional scores (p= 0.042,

p= 0, 045, p= 0, 045, p= 0,032, p=0,042, p=0,044 respectively).

Conclusion: Patients with trochanteric hip fractures still had lower quality of life scores compared to the

normal population, even 1 year after fracture treatment. In addition, it was found that age, ASA score,

and gender may also be effective in these low quality of life scores.

Keywords: Quality of life, hip fractures, elderly


I C O T R A U M A 2 0 2 1

31


Approach to Isolated Nasal Fracture in The Emergency Department

Patients with Face Trauma

Dr. Süheyla Kandemir

Kırıkkale Yüksek İhtisas Hospital, Department of Otorhinolaryngology, Kırıkkale, Turkey


Abstract

Objective: Nasal fractures are the most common type of facial bone fracture. The aim of this study is to

describe the frequency, etiology and demographic characteristics of isolated nasal fractures in patients

admitted to the emergency department with facial trauma.

Materials And Methods: 108 people who applied to Kırıkkale Yüksek İhtisas Hospital emergency

department due to facial trauma in a 1-year period between 2020-2021 were included in the study. The

demographic and etiological characteristics of patients with facial trauma were analyzed retrospectively,

whether they had nasal fractures and if there was any, how much was intervened. Obtained data were

analyzed statistically.

Results: The median (range) ages of patients was 27 (3-84). The study included 108 patients—48 female

and 60 male patients. While 69 (63.8%) of the patients presenting with facial trauma had nasal fracture,

39 (36.2%) did not. Closed reduction was performed in 51 (73.9%) of 69 patients with nasal fractures.

Reduction was not performed in the remaining 18 patients due to non-displaced fractures. Nose bleeding

was present in 78% of all patients when they presented to the emergency department. The most common

cause of trauma was falling (48.1%), followed by beating (21.2%), traffic accident (16.6%) and school

trauma (13.8%).

Conclusion: Isolated nasal fractures are common in patients with facial trauma. When the recent

etiological causes of nasal fractures are examined, we see that school traumas are also included. Education

should be given more place in schools. The adoption of personal and public strategies and measures may

prevent facial fractures.

Keywords: Facial trauma, nasal fracture, closed reduction, etiology, school trauma


I C O T R A U M A 2 0 2 1

32


Multi-disciplinary Management of Penetrating Thoracic Trauma

Asst. Prof. Abdullah Özdemir

Recep Tayyip Erdogan University, Department of Anesthesiology and Reanimation, Rize,Turkey


Abstract

Introduction: Penetrating traumas may cause high mortality even in young patients (1, 2). Prompt

diagnosis and treatment are essential to prevent mortality. We discussed the management of a case of

penetrating trauma involving both abdominal and thoracic cavities.

Case:29-year-old male patient who was brought to the emergency room after stabbing. Radiologic

imaging revealed hemopneumothorax and diaphragmatic rupture on the left side (Figure 1). He also had

arterial and nevre injury on the left side. Physical findings and laboratory values are given in Table 1. He

received 3 units of erythrocyte suspension and 1 unit of fresh frozen plasma due to shock and was taken

into emergency operation. Rapid serial intubation was performed.

Laparoscopy revealed stomach contents, perforation in the stomach corpus, and rupture of the left

diaphragm. Both injuries were repaired and thoracic surgeon placed a chest tube. Simultaneously,

orthopedic surgeons repaired left unlar nevre and with the help of cardiovascular surgeons, anastomosed

the full-thickness cut in the ulnar artery. The patient received 1500 ml of crystalloids, one unit of

erythrocytes and fresh frozen plasma, had 1700 ml of bleeding and 300 ml of urine output and was

transferred to intensive care unit to receive sedoanalgesia and antibiotherapy. He was extubated the next

day, and was transferred to the surgical ward two days later.

Discussion:Penetrating traumas account for 20% of all major traumas in the United States (3).

Diaphragmatic injuries are often accompanied by hollow organ injuries. After blunt and penetrating

injuries, the left side of the diaphragm is most commonly affected. (4). In our case, there was gastric

perforation with left diaphragmatic injury after trauma, which is consistent with the literature.

Arterial injuries need urgent surgical intervention, otherwise limb loss may ensue. Upper extremity

injuries account for approximately 30% of vascular traumas. While subclavian and axillary artery injuries

are less common due to anatomical reasons, injuries of the brachial, radial and ulnar arteries are more

common. Depending on the severity of the trauma, nerve and tendon injuries can also be seen in addition

to vascular injuries.

The important thing in all trauma cases is to identify all injuries at once and initiate the necessary

treatments in the correct order, beginning with the life-threatening injuries. In our case, the shock state

was addressed first. The preference of blood products in place of meticulous fluid therapy was to prevent

edema, promote tissue perfusion, and limit the inflammation. Although the ulnar artery was cut, the

preference was given to abdominal trauma in order to limit abdominal sepsis and prevent further shock.

A multi-disciplinary perspective in the approach to trauma patients is important to improve outcomes.

Keywords: Thoracic Injuries; Wounds, Stab; Laparoscopy; Diaphragmatic injury; Multi-disciplinary

teams.


I C O T R A U M A 2 0 2 1

33


Figure 1. Figure shows computerized tomography image in the axial plane at the level of T9. Gastric

contents are visible inside the left diaphragm (white arrows).

Table 1. Physical examination findings and laboratory values

Admission After

surgery

Postoperative

day 1

Revized Trauma Score 6 11 12

Arterial blood pressure, mmHg

(systolic/diastolic)

70/40 98/67 110/72

Heart rate, /minute 120 94 82

Hemoglobin, g/dL 9.2 11.1 11.4

Arterial blood gas

pH 7.21 7,27 7,36

FiO2, % 45 40 30

PaO2, mmHg 98 119 98

PaCO2, mmHg 46 43 44

Lactate, mmol/L 2.9 2.4 1,6

I C O T R A U M A 2 0 2 1

34


Two Case Reports on Diagnosis and Treatment of Aneurysmal Bone

Cyst with Metacarp and Phalanx Insocation

Murat Taşçı, M.D.

Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, Istanbul, Turkey.


Abstract

Aim: The localization of aneurysmal bone cyst (ABC) in the hand is rarer than in other localities. When

we look at the literature, there are mostly case-level reports. Aneurysmal bone cyst is a bone tumor with

an aggressive course with a locus. Recurrence rates are high. We think that we will contribute to the

literature by presenting 2 cases located in the proximal phalanx and metacarpal, which we have surgically

treated and followed.

Methods and Findings: Our first case was a 10-year-old female patient who applied with the complaint

of swelling in the finger. After the X-ray and MRI findings, surgery was planned with the preliminary

diagnosis of ABC. The bone was reached with the dorsal approach. The window was opened with the

help of a scalpel from the bony cortex. Allograft was placed after cautery curettage. The pathology of the

patient was compatible with ABC. In the 3-year follow-up of the patient, no recurrence was observed and

functional limitation did not develop.Our other patient, a 24-year-old male patient, presented with the

complaint of increasing swelling at the level of the third metacarp of the right hand. The operation was

planned with the pre-diagnosis of ABC in the X-ray, CT and MRI examinations. The bone was reached

with the dorsal approach. The window opened to the bone. After curettage with cautery, the medulla was

filled with bone grafts taken from the iliac crest. His pathology was compatible with ABC. There was no

recurrence and no functional limitation in the one-year follow-up of the patient.

Impacts: ABC is a benign tumor and it is one of the tumors with a locally aggressive course. Their

localization is more often the pelvis and spine. However, it can also be detected in different regions such

as the hand. The most common complaints of the patients are swelling and pain (1). The patients are

mostly at the age of children and young adults (2-3-4). One of our patients was a child and the other was

a young adult, and their complaints were swelling in their hands.Curettage and grafting are the most

commonly preferred surgical treatment methods in the treatment of ABC. However, recurrences have

been reported with this treatment method (5-6). En bloc resection treatment is another treatment option.

No recurrence has been reported in patients treated with this method (7-8). However, the patient has

disadvantages such as limitation of joint movement and donor site problems.There are some adjuvant

treatment methods applied to reduce recurrences. Some of these are cryosurgery, electrical cauterization

and phenol application. Studies showing that recurrences decrease with cauterization are available in the

literature (9-10). We also preferred cauterization after curettage in the treatment of our two patients with

ABC in the hand region. No functional limitation developed in our patients. However, our case series is

insufficient in terms of the number of cases and follow-up period.

Keywords: Aneurysmal Bone Cyst, Metacarp, Phalanks


I C O T R A U M A 2 0 2 1

35


Factors Affecting Quality of Working Conditions of Operating Room

Staffs

Dr. Nevin Esra Gümüş

Gazi State Hospital, Samsun, Turkey

[email protected]

Abstract

There is a strong relationship between working conditions and quality of life. An adequate working

environment provided by institutions for their staff to achieve the desired performance ensures

employees’ performance and job satisfaction. Quality of working conditions in health services is of

particular importance because healthcare professionals work in the highly sensitive area of human life, in

which there is no room for error. The purpose of this study was to evaluate the quality of life perceptions,

their sub-dimensions, and the variables affecting these among healthcare professionals in a public hospital

operating room. A socio-demographic characteristics questionnaire consisting of 21 questions and the

"Healthcare Professionals’ Quality of Work Life Scale" developed by Aydin et al. (2011) and consisting

of 27 questions in six dimensions were applied to 43 specialist physicians, 38 anesthesia technicians, and

21 nurses. The factors of focus were work accident–occupational illness risk and physical working

conditions at work, discrimination at work, opportunities for continuous progress and improvement,

social integration into the organization, work stress and time pressure, and organizational laws.

Descriptive statistical methods, One-Way ANOVA, the Kruskal Wallis test, and Spearman Rho

correlation analysis were used in the data analysis. According to the study findings, work stress and time

pressure were negatively correlated with the age of the healthcare professionals (Spearman r(100) = -

.265, p = .007). Working time in the unit was negatively correlated with discrimination at work (Spearman

r(100) = -.322, p = .001) and social integration into the organization (Spearman r(100) = -.292, p = .003

). Work accident-occupational disease risk and physical conditions at work were positively correlated

with work stress and time pressure (Spearman r(100) = -.354, p < .001). Discrimination at work and social

integration into the organization (Spearman r(100) = .495) were positively correlated with work stress

and time pressure (Spearman r(100) =.258, p < .001). Opportunities for continuous progress and

improvement exhibited positive correlation with social integration into the organization (Spearman r(100)

=.372, p < .001) and organizational laws (Spearman r(100) =.372, p = .002). It is thought that the

experience they have developed in their jobs with increase in the age of the employees may have reduced

the work stress and time pressure. It has been found that the time spent in the unit reduces discrimination

at work and increases social integration into the organization. The risk of work accident-occupational

diseases and adverse physical conditions, discrimination and social integration problems with the

organization increases work stress and time pressure. In conclusion, the factors used to evaluate quality

of work life are inter-related in a multidimensional manner, while situations that make working conditions

physically and psychologically difficult increase work stress and adversely affect the quality of work life.

Keywords: Quality of Work Life, Quality of Life, Operating Room Staff

I C O T R A U M A 2 0 2 1

36


Individualized Pain Management for Rib Fractures

*Dr. Ayse Hizal1 and Assoc. Prof. Basar Erdivanli2

Recep Tayyip Erdogan University, Department of Anesthesiology and Reanimation, Rize, Turkey 1,2


Abstract

Introduction: The degree of pulmonary contusion and pain are the decisive factors for respiratory

functions after thoracic injury. Hypoventilation, impaired gas exchange at the area under the rib fractures

and altered respiratory mechanics are the main causes of morbidity and mortality. The degree of contusion

is not modifiable, whereas the pain due to rib fractures is. Effective analgesia may prevent

hypoventilation, improve physiotherapy, and thereby promote clearance of the secretions and prevent

secondary complications like pneumonia, respiratory failure, and need for mechanical ventilation. We

aimed to present the benefits of an individualized analgesic approach.

Cases: All cases were managed according to an algorithm based on pain, numerical cough scoring

system, and inspiratory capacity score (PICS). The initial medical therapy is supplemented with neuraxial

and/or peripheral plane blocks, if necessary (Figure 1). Patient characteristics are given in Table 1.

Case 1 was unable to cough due to 7 rib fractures on the left side. He required two sequential serratus

anterior plane blocks and recovered well. The use of dual anticoagulants ruled out epidural

catheterization, there’s no need for serratus catheter placement since systemic analgesics provided

adequate analgesia.

Case 2 had multiple fractures around the thoracic cage. He required invasive mechanical ventilation due

to flail chest, and sedoanalgesia due to pain, both of which prevented neurological monitoring.

Continuous bilateral serratus anterior plane block via catheterization allowed us to stop the sedoanalgesia

and extubate the patient on the 10th day. Case 3 had contusion and several rib fractures on the left side.

After catheterization of the serratus anterior plane, he was able to adhere to physiotherapy. Case 4 had

bilateral posterior rib fractures. Due to emphysema, ultrasonographic visualization was poor and he

received an epidural catheter, instead.

Discussion: Management of rib fractures complicated with concomitant injuries requires an

individualized approach. Need for regional blocks should be evaluated according to anticoagulant

therapy, rib fracture score, number and location of fractures, the position required for the block and

possible harms due to contributing injuries, ultrasonographic visibility of the structures and the potential

benefit for the patient. The concentration and volume of epidural and peripheral infusions and the site of

catheterization should be planned according to the location and quantity of fractures, and patient

complaints, as well. Close monitoring of hemodynamic changes and drug side effects during the first

hour of the block is required. Daily assessments for viability of the catheter, PICS, and revision of the

local anesthetic doses are essential.

Conclusion: Pain management of rib fractures is notoriously difficult. Decisions on choosing the

appropriate analgesics and techniques may be complicated by comorbidities, anticoagulant therapy,

number and location of fractures and concomitant injuries. Although a protocolized approach is crucial,

pain management should be individualized to improve outcomes.

Keywords: Thoracic Injuries; Rib Fractures; Pain Management; Nerve Block*, Analgesia, Epidural.



I C O T R A U M A 2 0 2 1

37


Figure 1: Institutional pain management algorithm

Table 1. Patient characteristics.

Case Age Cause

of

trauma

Comorbidities Medications Other injuries Rib fractures Rib

fracture

score

Pain management

1 74y Fall

from

height

Type II DM,

hypertension,

recent

percutaneous

coronary

intervention

Clopidogrel,

acetylsalicylic

acid

Radius fracture left

posterolateral

ribs (3-9)

10 Single SAP block

(twice, daily)

Paracetamol

IV tramadol PCA

2 32y Traffic

accident

Smoking - T6 to T7 vertebral

fracture, sternal

fracture, right

pneumothorax,

flail chest

Right anterior

ribs (1-4)

Left lateral ribs

(5-10)

14 Initial sedoanalgesia

with fentanyl and

midazolam

4 days later, bilateral

SAP catheter was

added.

PAtient extubated on

10th day, catheter

removed.

2 day course of

tramadol,

paracetamol and

duloxetine

3 55y Traffic

accident

- - Pelvic fracture,

tibia fracture,

contusion,

hemothorax and

pneumothorax on

the left side

Left

posterolateral

ribs (3-12)

Ribs 3-5 had

multiple

fractures

14 SAP catheter

Paracetamol

NSAIDs

4 36y Fall

from

height

- - Laceration of the

liver and spleen,

contusion on the

left lung, right

hemothorax

Right posterior

ribs (7-10)

Left posterior

ribs (9-11)

Subcutaneous

emphysema,

poor USG

visibility

14 T7-T8 epidural

catheter

I C O T R A U M A 2 0 2 1

38


Multitrauma due to Tractor Accident: Case Report

Dr. Mehtap Balcı1, Dr. Fatih Balcı2 and Dr. Çiğdem Şimşek3

Nuh Naci Yazgan University Anesthesiology and Reanimation, Kayseri, Turkey1

Kayseri City Hospital, Anesthesiology and Reanimation, Kayseri, Türkiye2

Adana Yüreğir State Hospital, Anesthesiology and Reanimation, Adana, Türkiye

E-mail1: [email protected], E-mail2: [email protected], E-mail3: [email protected]

Abstract

Trauma is the leading cause of death in children and young people. Successful results are closely related

to the treatment in the first hours. Survival rate increases with rapid intervention and comprehensive

intensive care follow-up .We presented our intensive care experience in a patient with multitrauma due

to a tractor accident.

A 19-years-old male patient was brought to emergency department due to tractor overturning. On

admission, he was conscious, cooperative, but tachypneic. On physical examination 5 cm incision on the

scalp, ecchymosis on the right scapula, tenderness on the right upper quadrant of the abdomen were

detected. Radiologic imaging showed lung contusion, fracture on the right scapula, liver laceration. The

patient was admitted into anesthesia intensive care unit.

He was monitored with arterial, nasogastric and urinary catheters. In the first 15 minutes, 2 liters of

ringer's lactate were given, maintenance was achieved with 200 cc/h and tramadol 3x100mg was started.

Glyceryl trinitrate infusion was started to limit systolic blood pressure to 110mmHg. Neurological,

hemodynamic, and hemoglobin were monitored. Blood and urine cultures were taken. Laboratory exams

showed AST 479 U/L, ALT 576 U/L, CKMB 126 U/L, CK 1385 U/L, LDH 830 U/L, WBC 17.9,

Hb14.4g/dl, CRP 16 mg/L. The patient was consulted to general surgery, neurosurgery, thoracic surgery

and infectious diseases departments; emergency surgery was ruled out. On the second day, ceftriaxone

1gr 3x1 was started due to gram (-) bacillus in blood cultures and a rising CRP (62 mg/L). Velpau bandage

was applied. Enteral nutrition was started targeting 25 kcal/kg/day. Daily chest radiograms and abdominal

ultrasound at three-day intervals were requested by the thoracic surgery and general surgery departments,

respectively. The size of the hematoma in the 4-5-8 th segments of liver decreased from 9x6 cm to 6x5

cm on the third examination.

The patient was followed up for 10 days. Liver function tests improved and there was no bleeding. After

ten days the patient was discharged to general surgery ward with stable hemodynamics. As a result, not

every trauma patient has to go to surgery. With proper follow-up, they can recover without surgery.

The trauma patients are difficult cases for anesthesia and surgery departments. These patients should not

be evaluated only from an orthopedic point of view. It should also be considered in terms of possible

organ injuries, acute kidney failure, infection, pain, nutrition and blood pressure regulation for bleeding.

With appropriate and rapid treatment, many patients can recover without needing for surgical

intervention.Reduction in mortality and morbidity depends on rapid and appropriate treatment. Fluid

replacement, pain control and nutrition should not be ignored.

Keywords: Multitrauma, intensive care, hemodynamic




I C O T R A U M A 2 0 2 1

39


A Retrospective Analysis of 484 Cases with Motorcycle-Related Thoracic

Injuries

Nilay Çavuşoğlu Yalçın1, M.D., Erhan Özyurt2, M.D.

and Assoc. Prof. Muharrem Özkaya3, M.D.

Antalya Training and Research Hospital, Thoracic Surgery, Antalya, Turkey.1

Antalya Training and Research Hospital, Anesthesiology and Reanimation, Antalya, Turkey.2

Antalya Training and Research Hospital, Thoracic Surgery, Antalya, Turkey.3

E-mail1: [email protected], E-mail2: [email protected], E-mail3: [email protected]

Abstract

Background: The aim of this study was to determine patterns of thoracic injury and clinical outcomes

resulting from motorcycle crashes. To our knowledge, this is the first study specifically investigating the

motorcycle-related thoracic injuries.

Methods: Data of all motorcycle crashes presenting to University of Health Sciences, Antalya Training

And Research Hospital between 2015 and 2018 were retrospectively collected and analyzed.

Demography of patients, type of thoracic injury, associated injuries, treatment in the operating room,

hospital and intensive care unit stay and mortality were recorded.

Results: Among 484 admissions due to motorcycle crashes, there were 93patients (19.21%) aged 18

years or younger, 364 patients (75.2%) aged 19 years to 55 years, and 27 patients (5.5%) older than 55

years. A total of 84 (17.35%) patients sustained thoracic injuries. Approximately 46% of patients

sustained associated injuries, with orthopedic injuries being the most prevalent (32%). followed by

head/neck/face injuries (20%) and abdominal injury (15%). The duration of hospital stay was 4.57 days,

21 patients (4.3%) required a stay in the intensive care unit, and 20 patients (4.1%) required thoracic

surgery in the operating room.

Conclusion: This study provides unique information on epidemiological characteristics of thoracic

injuries caused by motorcycle crashes.

Keywords: Motorcycle crashes, thoracic trauma, out of vehicle




I C O T R A U M A 2 0 2 1

40


Inpatient Admission Times of Trauma Patients Requiring Orthopedic

Surgery at an Emergency Department

Dr. Ortac Guran

Sancaktepe Şehit Prof.Dr. İlhan Varank Training and Research Hospital, İstanbul, Turkey

E-mail:[email protected]

Abstract

Initial management of trauma cases in an emergency department should be completed quickly by

interdisciplinary teams and inpatient admission should not be delayed. In this study, we examined

inpatient admission times of 118 trauma patients with orthopedic surgery indications taken to an

emergency department of a tertiary referral hospital between January 2021 and April 2021. Inpatient

admission times were compared across trauma types (pediatric lower extremity, pediatric upper

extremity, adult lower extremity, adult upper extremity, geriatric hip fractures, and multiple trauma

cases). Multiple trauma cases had the longest inpatient admission time (n=11, 109 minutes), followed by

geriatric hip fractures (n=26, 64 minutes), adult lower extremity traumas (n=35, 54 minutes), adult upper

extremity traumas (n=23, 44 minutes) and pediatric upper extremity traumas (n=13, 44 minutes), and

pediatric lower extremity traumas (n=10, 40 minutes; p<0.01). Geriatric hip fractures had significantly

longer admission times when compared to adult upper extremity traumas (p=0.018). In conclusion,

multiple trauma patients had the longest inpatient admission period among trauma cases which could be

due to the requirement of multiple consultations across departments. Geriatric hip fractures could be

complicated by significant comorbidities and consent process of legal patient guardians. Residents should

consider expected delays in different types of trauma patients requiring orthopedic surgery to optimize

emergency department management and patient turnover.

Keywords: Wounds and injuries; Inpatients.


I C O T R A U M A 2 0 2 1

41


Does the Diameter of the Appendix Have a Role in the Preferred Stump

Closure Method in Laparoscopic Appendectomy?

* Hüseyin Bayhan1, M.D. and Semra Demirli Atıcı2, M.D.

Mardin Training and Research Hospital, General Surgery, Mardin, Turkey.1

Derik State Hospital, General Surgery, Mardin, Turkey.2


Abstract

Objective: There are many different stump closure methods in laparoscopic appendectomy, which is the

gold standard treatment for acute appendicitis (AA). Our study planned to compare the retrospective

demographic characteristics of patients who used hem-o-lok clip and endoscopic stapler, which are two

different stump closure methods, in laparoscopic appendectomy due to AA, and the impacts of

demographic characteristics and appendiceal stump diameters on method selection.

Methods and Materials: 78 patients were included in the study, who underwent laparoscopic

appendectomy due to AA in the General Surgery Clinic of Mardin Training and Research Hospital

between June-October 2021, and all patients aged >18 years, non-pregnant, appendix histopathology not

compatible with malignancy, and completed laparoscopically. Patients who met the inclusion criteria

were divided into two groups according to appendiceal stump closure techniques: Group 1 (n=20) using

endoscopic staplers and Group 2 (n=58) using hem-o-lok clips. Demographic characteristics of the

patients, duration of operation, macroscopic complication of the appendix, postoperative hospital stay,

appendiceal stump diameter in postoperative histopathological examination, postoperative morbidity and

mortality were analyzed.

Results: Of the patients who met the inclusion criteria, 34 (43.6%) were female and 44 (56.4%) were

male. There was no significant difference in age and gender between Group 1 and Group 2 patients

(p>0.05). The median operation time was 40 minutes (35-85 minutes) in Group 1 and 25 minutes (20-45

minutes) in Group 2. The median operation time was longer in Group 1 than Group 2, which was

statistically significant (p<0.05). The median appendix stump diameter was 1.4 cm (1.1-1.8 cm) in Group

1 patients,while it was 0.9 (0.8-1.4 cm) in Group 2. It was observed that the width of the appendix stump

was wider in Group 1 patients than in Group 2 patients (p<0.05). In addition, when the operation notes

and histopathological data of Group 1 patients were evaluated, the incidence of complicated appendicitis

was statistically higher than Group 2 patients (p <0.05). Median hospital stay was 2.25 days (1-4 days)

in Group 1 and 1.08 days (1-2 days) in Group 2. It was observed that the hospital stay of Group 1 patients

was statistically longer than Group 2 patients (p <0.05). There was no morbidity or mortality observed

within postoperative 30-day follow up of Group 1 and Group 2 patients.

Discussion: In cases where laparoscopic appendectomy was performed with the diagnosis of acute

appendicitis, if the hemelog clip is thought to be insufficient for closure of the appendix stump, endo

stapler can be safely used in the presence of sufficient experience and equipment.



I C O T R A U M A 2 0 2 1

42


Keywords: Acute Appendicitis, Laparoscopic, Appendix Stump Diameter, Stapler

Early Shoulder Surgery Facilitated Discontinuation of Deep

Sedoanalgesia in a Patient with Thoracic Cavity Instability

*Dr. Emre Karagoz 1 and Asst. Prof. Hizir Kazdal 2

Recep Tayyip Erdogan University Training and Research Hospital, Department of Anesthesiology and Reanimation, Rize,

Turkey 1

Recep Tayyip Erdogan University, Medical Faculty, Department of Anesthesiology and Reanimation, Rize, Turkey 2


Abstract

Introduction: Thoracic traumas are life-threatening conditions requiring urgent diagnosis and treatment.

Fracture of each of the bony structures may injure arteries, nerves, or solid organs. Additionally, they are

frequently complicated with additional injuries. We present a case where an early repair of the shoulder

facilitated the weaning process.

Case presentation: Following fall from a 4-meters tall tree, 70-years-old male presented with Glasgow

coma score of 13, confusion, disorientation, multiple fractures on the temporal and mastoid and

zygomatic bones, left subdural hematoma and multiple subarachnoid bleeding foci on the right side, left

sided emphysema, pneumothorax, comminuted fracture of the scapula, and multiple (ribs 1 to 9)

consecutive, displaced rib fractures with posterior fractures on the left side (Figure 1). He was

hospitalized and received intravenous fluids, analgesics and antibiotherapy. The next day, Glasgow coma

score dropped to 11 and he was admitted to intensive care unit. Due to full expansion of the

hemopneumothorax a chest tube was placed, and due to increased cerebral edema he received

dexamethasone treatment. For the following 10 days, he received fentanyl sedoanalgesia (RAAS -4), had

Glasgow coma score of 6 and a velpeau bandage was used to stabilize the shoulder but was not successful

because the patient continuously moved his shoulder despite deep levels of sedoanalgesia (Figure 2A).

As the thoracic cage appeared more stable on the 13th day, he was extubated and started on bi-level

positive airway pressure support and intermittent oral feeding. But the left upper part of the thoracic cage

appeared unstable and the patient was intubated again. He was consulted to orthopedic clinic for shoulder

stabilization surgery. Due to concerns of aggravating the already present inflammation, the surgery was

postponed for two days, where the intravenous fluid therapy and nutritional therapy were optimized. After

the surgery, he was extubated and required no positive airway pressure (Figure 2B).

Discussion: This case shows a beneficial cooperation between the anesthesiology and orthopedics clinics.

The patient had multiple injuries on and inside the thoracic cavity, and additional injuries on the head and

brain. The massive hemothorax and subarachnoid hemorrhage foci delayed use of anticoagulants. The

need for deep sedation to stabilize the shoulder interfered with a proper neurological examination. Due

to these concerns, although the patient still had infiltrations in the basal region of the right lung, the patient

was admitted to shoulder stabilization surgery which involved stabilization of the clavicle and the

acromion of scapula for 220 minutes. We were aware that such an operation may aggravate the

inflammation.



I C O T R A U M A 2 0 2 1

43


This case shows that a timely decision of major surgery may improve the patient outcome. The

multidisciplinary evaluation and careful planning of the perioperative period was crucial in the success

of the intervention.

Keywords: Thoracic trauma; Flail Chest; Serial rib fracture; Clavicular fracture; Scapular fracture.

Figure 1. Computerized tomography images on the axial plane show left sided effusion and rib fractures

at the levels of T3, T6, and T8.

I C O T R A U M A 2 0 2 1

44


Figure 2. Posteroanterior chest radiograms showing the displaced clavicular and acromion fractures.

The picture on the left belongs to 2 days before the operation (A) and the picture on the right belongs to

the postoperative day 1 (B).

Amniotic Fluid Embolism with Sudden Cardiac Arrest During Cesarean

Section

Kamuran Uluç, M.D.

Intensive Care Clinic, University of Health Sciences Turkey, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul,

Turkey.


Abstract

Introduction-Purpose: Amniotic Fluid Embolism (AFE) in pregnant women 1,9-2,5/100000 it is an

obstetric fatal clinical picture that occurs decently and has a mortality rate of % 11-44 (1). Amniotic fluid

embolism occurs during pregnancy or soon after birth. AFE is an obstetric emergency that is accompanied

by sudden onset hypoxia, hypotension and severe coagulopathy. When amniotic fluid enters the maternal

circulation, it causes cardiogenic shock, respiratory failure, more often an inflammatory and anaphylactic

response (2). In our case, we aimed to present the diagnosis and treatment of a patient who developed

sudden cardiac arrest during delivery.

Case: At the age of 46, she was in her 6 th pregnancy at 39 weeks of gestation and had an emergency

cesarean section with the diagnosis of recurrent painful sectio without any known additional disease.

Sudden bradycardia, decrease in SpO2, and cardiac arrest after hypotension developed in the 13 th minute

of the operation in the patient who was operated under general anesthesia. CPR was started immediately.

The baby was delivered during CPR. As the mother became hypotensive, dopamine and norepinephrine

infusion was started. At the end of the operation, she was admitted to the intensive care unit as intubated.

The laboratory values at the entrance and exit of the intensive care unit are given in the table (Table- 1).

We excluded other outlier diagnoses such as Air embolism , Pulmonary embolism, Acute myocardial

infarction from the laboratory and the patient's clinic. PA lung X-ray and thorax CT also showed

infiltration areas in the upper and lower lobes of the right lung. After fiberoptic bronchoscopy with a

preliminary diagnosis of amniotic fluid embolism, broncho alveolar lavage (BAL) material showed signs

consistent with amniotic fluid (3,4). On the 3 rd postoperative day, the patient with stable vital signs was

extubated, and on the 4 th postoperative day, complete blood, biochemistry, and blood gas findings were

transferred from the intensive care unit to the obstetrics and gynecology department after physiological

values were found.

Discussion and Conclusion: We quickly ruled out other conditions that could cause cardiac arrest in our

patient. The general principles of the treatment of amnion fluid embolism are the provision of adequate

oxygenation, support of circulation and correction of coagulopathy (5). Immediate removal of the baby

is important to increase the chance of survival for mother and baby. Despite all the advances in treatment,

we still have a high mortality rate, which is a pathology. In these cases, considering AFE in the differential

diagnosis and following it under intensive care conditions may be life-saving.


I C O T R A U M A 2 0 2 1

45


Keywords: Amniotic fluid embolism (AFE) , Emergency, Cardiopulmonary arrest, Pregnancy, Cesarean

Table 1: Laboratory values at the entrance and exit to the intensive care unit

Laboratory values

(reference range)

Introductıon to ICU

(mechanical ventilation support)

4 th Day In ICU

(room air)

pH 7,03 7,43

PaO2 142 90 mmHg

PaCO2 38 mmHg 40 mmHg

HCO3 8 mEq/L 23 mEq/L

Base Deficit -4 mEq/L 2 mEq/L

Lactate 5 mmol/L 0,5 mmol/L

Hb 12 gr/dL 14 gr/dL

Htc % 35 % 41

Platelet count

(160-400 ), 109/L

290 340

Fibrinogen

(2- 4) g/L

2 g/L

2,1 g/L

INR (0.9-1.2) 1,15 1,14

D-dimer

(0- 500 ng/mL)

20 15

I C O T R A U M A 2 0 2 1

46


Clinical Efficacy of Closed Reduction and Percutaneous Transverse K-

Wire for Length-Saving Fixation in Fifth Metacarpal Base Fracture

Assist. Prof. Mert Karaduman, M.D.

Health Sciences University, Keçiören Training and Research Hospital, Department of Orthopaedics and Traumatology,

Division of Hand Surgery, Ankara, Turkey


Abstract

Background and Aim: Intra-articular fracture-dislocation at the base of the fifth metacarp is similar to

Bennetts thumb fracture and is called 'reverse Bennett'. This type of fracture tends to be unstable due to

the oblique fracture line and unopposed extensor carpi ulnaris pulling on the fracture fragment. Although

metacarp base fractures are generally approached conservatively, 'reverse Bennett fractures usually

require stabilization with K-wire for the abovementioned reasons. This study aimed to evaluate the

clinical efficacy of a modified internal fixation method for treating an intra-articular fifth metacarpal base

fracture.

Methods: From January 2019 to October 2021, 14 patients with the intra-articular fifth metacarpal base

fractures of the hands were treated with the percutaneous transverse K-wire for length-saving fixation

combined with the intra-articular fracture fixation method in our institution. Each patient's age, gender,

dominant hand, fracture side, trauma mechanism, K-wire removal days, the flexion-extension arc of the

metacarpophalangeal joint, postoperative visual analog pain score, the time of return to work and daily

activities, the time of starting a rehabilitation exercise program, and follow-up time were recorded and

calculated retrospectively.

Results: Out of 14 patients in total, two were female, and 12 were male; the mean age of the patients was

32,6±14.4 years. The fractured side was the right hand in 78.6% of the patients. Fractures were due to

falling in 2 patients and due to fighting in 12 patients. The mean operative time was 36.7 ± 17.2 minutes.

All patients recovered well, with no cases of nonunion besides these functional results, there were two

pin-side infections. Pin-side infections healed with local antibiotics without any effect on functional

results. K-wire was removed in an average of 42.7 ± 2.09 days. After the radiological bone union was

obtained as a result of the surgery, functional finger movements were achieved (flexion-extension arc of

the metacarpophalangeal joint 92.5 ± 6.8, visual analog pain score 1.5 ±0.65). Functional exercises were

performed immediately after surgery (3.2 ±1.1 days). The return time to work and daily activities after

surgery was short (43.7 ±2.8, 6.8 ±1.0; respectively). The mean follow-up time was 7.7 months (range,

1-18 months).

Conclusion: The length-saving fixation technique is simple, effective, and therapeutic for fifth

metacarpal intra-articular base fractures. This method also allows early and safe mobilization of the

metacarpophalangeal and finger joints.


I C O T R A U M A 2 0 2 1

47


Keywords: Reverse Bennett fracture; Closed reduction; Fifth metacarpal base fracture; K-wire fixation.

The Intensive Care Unit during the Covid-19 Pandemic Period Trauma

Patients and Outcomes

Yavuz Çeçen1, M.D. and Assist. Prof., Özgür Kömürcü2, M.D.

University of Health Sciences, Samsun Health Practices and Research Center, Department of Anesthesiology and

Reanimation, Samsun, Turkey.1

Ondokuz Mayıs University Faculty of Medicine, Department of Anesthesiology and Reanimation, Samsun, Turkey.2


Abstract

In the last two decades, the third and most severe coronavirus-related epidemics are being managed

worldwide despite great difficulties and disruptions in health systems (1). Most countries resorted to

quarantine measures throughout country to combat this epidemic (2). The effects of the worldwide

quarantine are not yet fully understood. However, studies show significant changes in the follow-up of

trauma patients due to changes in the etiology of trauma, quarantine measures, and increased need for

emergency and intensive care units during the comorbid COVID-19 pandemic period (3). Our study

aimed to evaluate trauma patients admitted to the intensive care unit during the Covid-19 pandemic and

their outcomes. Our study was conducted with patients with negative Covid-19 test results between

January 1, 2020, and May 1, 2020. Patients with suspected pulmonary tomography for Covid-19 or,

according to PCR results, were excluded from the study since Covid-19 (+) patients were followed in the

intensive care unit where Covid-19 (+) patients were observed in our center. Due to the Covid-19 cases

seen in our country since March 2020, demographic characteristics of trauma patients admitted to our

intensive care unit within three months before March 2020 (precovid period), and trauma patients

admitted to our intensive care unit within three months after March 2020 (postcovid period), trauma

etiologies, trauma scores, intensive care unit duration, mortality rates, and cognitive functions at

discharge from intensive care were compared. At the time of the study, 22 of 465 patients before the

Covid-19 pandemic and 22 of 401 patients after the Covid-19 pandemic were admitted to our level 3

intensive care unit due to trauma, and it was observed that the number of trauma patients during the

pandemic period was similar to the pre-pandemic period (p= 0.614). Demographic characteristics of

patients for both periods [(gender (p = 0.936), age (p = 0.718), additional systemic diseases (p = 0.346)]

were similar; however, trauma patients admitted during the Covid-19 pandemic period had lower Apache

II scores. [(mean ± SD) (22.6 ± 6 / 19 ± 5.3) (p = 0.017)]. Trauma scores in both groups were similar

according to the revised trauma score [(mean ± SD) (2.6 ± 1.2 / 2.6 ± 1.2) (p = 0.905)]. Mortality rate (p

= 0.389), duration of intensive care unit (p = 0.689), and Glasgow outcome scale (p = 0.693) were not

statistically different in both periods.

Table1: Demographic data and trauma scores

PreCovid-19 Trauma

Patient

n=22

PostCovid-19 Trauma

Patient

n=22

P value



I C O T R A U M A 2 0 2 1

48


Age, year mean ± SD 44.9 ± 25.1 46.4 ± 21.4 0.718

Gender (F) % 22.7 27.3 0.346

Systemic Disease 0.346

Diabetes Mellitus % 22.7 31.8

Hypertension % 31.8 40.9

CAD % 18.2 18.2

COPD % 22.7 18.2

APACHE II Score mean ± SD 22.6 ± 6 19 ± 5.3 0.017

≥ 30 % 18.2 -

20-29 % 45.5 50

< 20 % 36.4 50

RTS mean ± SD 2.6 ± 1.2 2.6 ± 1.2 0.905

APACHE: Acute Physiology and Chronic Health Evaluation; CAD: Coronary Artery Disease; COPD: Chronic

Obstructive Pulmonary Disease; RTS: Revised Trauma Score

Table2: Patient results

PreCovid-19 Trauma Patient

n=22

PostCovid-19 Trauma Patient

n=22 P value

Mortality % 72.7 81.8 0.389

APACHE II Score (mean) ≥ 30 % 18.2 - 0.758

APACHE II Score (mean) 20-29 % 45.5 50 0.999

APACHE II Score (mean) < 20 % 36.4 50 0.457

GOS mean ± SD 3.5 ± 1.5 3.4 ± 1.5 0.693

ICU time (day) mean ± SD 2.5 ± 3.4 3 ± 5.1 0.689

APACHE: Acute Physiology and Chronic Health Evaluation; GOS: Glasgow Outcome Scale; ICU: Intensive Care

Unit

Our study observed that the follow-up and treatment processes of trauma patients during the pandemic

period were similar to the pre-pandemic period, and the mortality and intensive care unit stay did not

change. However, since our study was retrospective, with a limited number of patients, we think it would

be appropriate to conduct prospective studies on the treatment processes of trauma patients during the the

pandemic period.

Keywords: Covid-19, Trauma, Intensive Care

I C O T R A U M A 2 0 2 1

49


Does Two Stage Surgery for Ankle Fractures with Dislocation Affects

Functional Results?

Dr. Özay Subaşı1 and Dr. Pınar Kaya Subaşı2

Erzincan University School of Medicine, Orthopedics and Traumatology1

Mengücek Gazi Training and Research Hospital, Physical Medicine and Rehabilitation, Erzincan2


Abstract

Fracture-dislocations of the ankle is a common orthopedic problem. Open reduction and internal fixation is viewed

as the gold standard treatment for fracture-dislocations of the ankle. Soft tissue injuries associated with ankle

fracture-dislocations may increase postoperative wound complication rates. Ankle-spanning frame plays a

fundamental role in the local damage control orthopedics while gaining time for definitive surgery. This situation,

which allows us to gain time against wound complications, may affect functional ankle scores in the postoperative

period.The objective of this study was to evaluate the effect of two-stage surgery for the unstable ankle fracture-

dislocation compared to one-stage surgery in terms of American Orthopedic Foot and Ankle Society hindfoot-

ankle and Olerud-Molander ankle scores. We analyzed 30 patients, who met our study criteria. Patients who have

incomplete medical records, lost to follow-up visits, polytraumatized patients and having neurological or locomotor

comorbid diseases that affecting the walking and motion of the lower extremities were excluded from study. The

patients were divided into two groups according to staged surgeries. American Orthopedic Foot and Ankle Society

hindfoot-ankle and Olerud-Molander ankle scores were investigated with a minimum of 6 months period (p= 0.094

and p= 0.126, respectively). Two-stage surgery can be performed safely in carefully-selected patients with the

unstable ankle fracture-dislocations with serious soft tissue injuries and two-stage surgery does not affect the

postoperative American Orthopedic Foot and Ankle Society hindfoot-ankle and Olerud-Molander ankle scores

statistically compared to one-stage surgery at a minimum of 6 months of follow-up period.

Keywords: Two- stage surgery, ankle fractures, fracture dislocation, functional results.



I C O T R A U M A 2 0 2 1

50


Management of Traumatic Pneumothorax: Evaluation of 83 Cases

Dr. İlteriş Türk

Health Sciences University, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey


Abstract

Background: Major thoracic traumas often result in pneumothorax. In the management of traumatic

pneumothorax, surgical intervention decision should be taken according to the concomitant pathologies.

Methods: 83 inpatients followed in our clinic with the diagnosis of pneumothorax due to isolated thoracic

trauma in the last one year were included in the study. The age, gender, type of trauma, pathologies

accompanying the pneumothorax, surgical treatment, follow up time with tube thoracostomy and

hospitalization time of the patients were retrospectively analyzed.

Results: 69 patients were male and 14 were female, with a mean age of 48.9 (min:19, max:83). In 61

patients, pneumothorax occurred due to blunt trauma such as traffic accident, falling, animal crash and

beatings, and also in 22 patients the etiology was owing to penetrating trauma from stab wound. The most

common pathologies accompanying pneumothorax were rib fracture in 31 patients (37.3%) and

hemothorax in 26 patients (31.3%). Also clavicle and scapula fractures, subcutaneous emphysema and

pneumomediastinum were also coexisting pathologies more rarely. Tube thoracostomy with 28 F chest

tube was applied to 54.2% of the patients (45 patients) (Figure 1,2). In 22 patients (26.5%) pneumothorax

resolved with nasal oxygen treatment without the need for surgical intervention. Video-assisted thoracic

surgery (VATS) was performed for bleeding control in 10 patients (12%). Also less often catheter

thoracostomy with 10F drainage catheter, exploration with thoracotomy and rib fixation were handled in

treatment. The mean tube thoracostomy stay was 3.7 days and the total hospital stay was 4.1 days in

patients followed up with drains. In patients followed by nasal oxygen with a conservative approach, the

mean hospital stay was calculated as 2.1 days. One patient died secondary to trauma despite thoracotomy.

Conclusion: We recommend following up with 28F tube thoracostomy in traumatic pneumothorax

patients with hemothorax which often accompanies it and also VATS in cases where the clinic

deteriorates, hematoma evacuation and bleeding control are required. In cases of rib, clavicle and scapula

fractures that develop without hemothorax due to isolated thoracic traumas, operation and stabilization

are not required as long as severe deformity and flail chest are not observed. Traumatic minimal

pneumothorax cases without hemothorax can be followed with a conservative approach or treated with

smaller diameter catheters (10F).

Keywords: Traumatic pneumothorax, tube thoracostomy, VATS.


I C O T R A U M A 2 0 2 1

51


Respiratory Infections Among Patients with Trauma in Intensive Care

Units

Dr. Özlem Koyuncu Özyurt¹, Dr. Ülkü Arslan²

Akdeniz University, Department of Medical Microbiology, Faculty of Medicine, Antalya, Turkey¹

Akdeniz University, Department of Anestesiology and Reanimation, Faculty of Medicine, Antalya, Turkey²


Abstract

Background and Purpose: Infection is among the complications frequently seen in patients followed in

the post-traumatic intensive care unit. Post-traumatic infections are most commonly encountered as

pneumonia. The most commonly isolated organisms are Acinetobacter baumanii, Klebsiella pneumoniae,

Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa. The aim of our study is to

investigate the prevalence of respiratory infections and the distribution of the causative pathogen in

trauma patients hospitalized in the intensive care unit of our hospital.

Methods: Our study included 121 trauma patients over the age of 18 who applied to our hospital between

November 2020 and November 2021 and were admitted to the intensive care unit. The data of the patients

were reviewed retrospectively.

Results: Bacterial growth was observed in tracheal sputum cultures of 39 (32.2%) patients. A total of 99

bacterial growths were detected from 39 patients. The predominant microorganisms associated with

respiratory infections were A.baumanii (32; 32.3%), Klebsiella spp (18; 18.1%), Pseudomonas

aeruginosa (14; 14.1%), S.aureus (14; 14.1%) Other Enterobacterales except Klebsiella spp. (11; 11.1%),

Enterococcus spp. (3; 3%), S.pneumoniae (3; 3%) others. (4; 4%). According to the injury mechanism,

respiratory infection rates are respectively assaults (66.6% ) , auto/pedestrian (65%), falls (61.9%), motor

vehicle collision/crash (61.5%) and others (50%). Infection rates by injury sites were 64.1 %for multiple

and 35.9% for isolated trauma. Of the trauma patients who developed infection, 30 (76.9%) had head,

22 (56.4%) had thorax, 20 (51.3%) had abdomen, 15 (38.5%) had extremity and 6 (15.4) had vertebral

trauma.

Conclusion: Injuries to the thorax, head, and abdomen are associated with a significantly increased risk

of pneumonia because of changes in respiratory mechanics. Respiratory infections occur frequently in

trauma patients. In this study, we detailed HAI frequencies, injury features, pathogens in trauma patient

population. Early and appropriate antimicrobial therapy is an essential determinant of clinical outcome.

Keywords: Trauma, respiratory infection, intensive care unit



I C O T R A U M A 2 0 2 1

52


Investigation of Pediatric Cases Brought to the Emergency Department

due to Electric Shock

Dr. Melih Çamcı

Ağrı Training and Research Hospital, Emergency Medicine Department, Ağrı, Turkey


Abstract

Background and Aim: Due to the widespread use of electricity in daily life, it has an important place in

injury rates. Infants and young children are exposed to low-voltage electrical current from the domestic

power line due to biting cables and inserting conductive objects into sockets, while older children and

adolescents are exposed to high-voltage electric current by climbing trees and electricity poles or in the

work environment. It causes a wide-spectrum clinical presentation that causes multiple system effects

and sequelae such as burns, cardiac, neurological and renal damage, other traumas, death. In this regard,

the approach, follow-up and treatment of exposure to low and high voltage electric current in the

emergency department differ. Our aim is to contribute to the trauma approach by evaluating pediatric

patients admitted to the emergency department with electric shock.

Methodology: In our study, 36 pediatric patients under the age of 18 who were brought to the emergency

department of Ağrı Training and Research Hospital due to electric shock between 01.11.2019 and

01.11.2021 were included. The cases were analyzed by retrospectively scanning the hospital information

management system and patient files. The demographic information of the patients, the types of exposure

to electric current, other accompanying traumas, whether system involvement developed in the

emergency department follow-up, and the prognosis and outcome of the patients were recorded.

Findings: In our findings, 28 (77.7%) boys and 8 (22.2%) girls were among 36 patients who applied to

the emergency department due to electric shock. The median age of the patients was 7.6 (8 months-17.3

years). When separated by age groups, 24 (66.6%) children were found to be over 5 years old and 12

(33.3%) children under 5 years old. It was determined that 18 (50%) of the patients were exposed indoors,

14 (38.8%) on the street, and 4 (11.1%) out-of-home exposures. 32 (88.8%) of the patients had contact

with low-voltage electric current and 4 (11.1%) of them had contact with high-voltage electric current.

Of the patients who were first evaluated and treated in the emergency department, 2 (5.5%) were

discharged from the outpatient clinic, 14 (38.8%) patients were observed in the emergency department,

18 (50%) patients were treated by inpatient hospitalization, 1 (2.7%) underwent surgery due to a

comminuted fracture of the forearm caused by throwing after electric shock, 1 (2.7%) patient was referred

to the burn center, no patient resulted in death. No cardiac, neurologic, renal or multi-organ damage was

observed in the follow-up of the patients.

Results: Patients who are exposed to low-voltage electric current, especially indoors, and if there is no

finding in the evaluation in the emergency room, can be followed up in the emergency room. However,

all patients with symptoms, especially those exposed to high voltage, should be hospitalized and

monitored for organ involvement and complications.

Keywords: Electrical injury, emergency department, trauma, pediatric emergency


I C O T R A U M A 2 0 2 1

53


Treatment Management of Patients Diagnosed with Bladder Injury

Secondary to Pelvic Fractures

Dr. Ahmet Emre Cinislioglu

University of Health Sciences Erzurum Regional Training and Research Hospital, Department of Urology, Erzurum, Turkey


Abstract

Background: Extraperitoneal bladder rupture is commonly associated with pelvic trauma. Usually,

distortion of the pelvic ring is caused by a cut of the anterolateral bladder wall near the bladder floor or

by trauma on the opposite side. While 83% of patients with bladder rupture have a pelvic fracture, less

than 10% of patients with a pelvic fracture have a ruptured bladder. While most intraperitoneal bladder

injuries are surgically repaired, extraperitoneal bladder injuries can be treated non-surgically in the

absence of complex injury patterns such as bladder neck injury or the presence of bone spicules in the

bladder.

Objective: In this study, we aimed to retrospectively evaluate the clinical features, follow-up and

treatment approaches of patients with bladder trauma due to pelvic fracture in our clinic.

Methodology: The study included 9 patients who had pelvic fracture and were diagnosed with

extraperitoneal bladder trauma as a result of the tests performed in Erzurum City Hospital Emergency

Service between January 2019 and August 2021. Demographic and clinical characteristics of the patients,

laboratory and radiological examinations, details of the treatments applied to the patients, treatment

procedures of the patients who underwent surgical treatment, patient files, visit and operation notes, and

patient discharge reports were reviewed and evaluated retrospectively.

Results: 13 patients were included in the study. The mean age of the patients was 45.7 (± 14.35) years.

Pelvic fracture was detected in 7 (77.7%) patients due to motor vehicle accident and 2 (22.2%) patients

due to falling. Macroscopic hematuria was observed in 6 (66.7%) patients, a palpable bladder in 2 (22.2%)

patients, and pelvic fluid collection on abdominal computed tomography in 1 (11.1%) patient. While

conservative treatment consisting of continuous bladder drainage and antibiotic prophylaxis was applied

in 8 (88.9%) patients, surgical intervention was performed in 1 patient (11.1%) when it was determined

that trauma caused pathology in the bladder neck.

Conclusion: Extraperitoneal bladder ruptures are almost exclusively associated with pelvic fracture.

Bladder injury should be suspected when trauma is followed by macroscopic hematuria, suprapubic or

abdominal pain, and difficulty or voiding. Bladder rupture caused by pelvic fractures is rare; however,

due to the high mortality rate, early recognition of signs and symptoms can be lifesaving.

Keywords: Trauma; Bladder, Hematuria.


I C O T R A U M A 2 0 2 1

54


Awake Fiberoptic Nasal Intubation in Cervical Spine Injury: A Case

Report

Dr. Pınar Küçükdemirci Kaya

University of Health Sciences-Bursa Faculty of Medicine City Hospital Bursa, Turkey


Abstract

Introduction: Fiberoptic intubation (FOI) with a flexible fiberoptic bronchoscope has become a mainstay

of difficult airway management in awake, sedated, and anesthetized patients. FOI is often performed in

patients with cervical spine injury or instability. Although there are no outcome data to support a

recommendation of FOI over other techniques in patients with cervical spine injury.

Case report: 70-year-old male patient with history of falling from high was brought by ambulance to

emergency department. He had a large left forehead hematoma, superficial laceration across the bridge

of nose and he could not move his extremities. GCS score was 15, blood pressure was 140/85 mmHg and

his heart rate was 75 bpm. No pathological findings were found in laboratory findings. Computed

tomography showed nondeplase fractures in C5-C6 level. Nerosurgeon was decided to continue

conservative management and he was admitted to the intensive-care-unit (ICU) with Philadelphia collar.

On 3rd day of ICU, the patient developed acute respiratory failure. Overall, due to the cervical deplase

fractures, patient was considered as a diffucult intubation. Intensivist decided to awake fiberoptic nasal

intubation. Local anesthesia was achieved with lidocaine %10 (0,2 mg/kg). Nasotracheal tube was

softened with warm normal saline and it lumbricated for prevention for mucosal laceration Fiberoptic

bronchoscope passed through nasal fossa into the trachea then fiberoptic nasotracheal intubation easily

was performed (Figure1). The article was prepared by obtaining the consent of patient’s daughter.

Discussion: FOI has not been proven superior to other intubation techniques and supraglottic airway

devices with regard to intubation success rates or clinical outcomes in patients with cervical spine injury.

Although all airway interventions, from mask ventilation to direct or indirect laryngoscopy, result in some

degree of neck movement. FOI maintains the head and neck in a neutral position during airway

management and awake FOI reducing the risk of aspiration. Consequently awake FOI technıques in

patients with injured cervical spines may have several benefits.

Keywords: Fiberoptic nasal intubation (FOI), cervical spine injury, difficult airway management.

Figure 1. Cervical trauma patient undergoing nasal fiberoptic intubation (FOI)


I C O T R A U M A 2 0 2 1

55


Health Problems and Health System Management of Syrian Refugees in

Turkey, a Comprehensive Review

*Dr. Esra Ersöz Genç1, Dr. Sinan Paslı2 and İdris Genç3

Karadeniz Technical University, Emergency Medicine Department (Faculty of Medicine), Trabzon, Turkey1,2

Ministry of Interıor Disaster and Emergency Management Presidency, Trabzon, Turkey3

E-mail 1: [email protected], E-mail 2: [email protected], E-mail 3: [email protected]

Abstract

December 17, 2010 in the Arab Spring, also known as riots and the subsequent civil war April 29th 2011

in Hatay Yayladağı large quantities by entering 252 people Syrian groups in wire mesh, surpassing in

Turkey has started influx of refugees. There is no precise information on the total number of Syrian

refugees living in Turkey. According to AFAD data, there are 255,686 Syrian refugees living in the camps

under AFAD's responsibility as of 07.10.2016.

Keywords: migration, health system, individuals with special needs




I C O T R A U M A 2 0 2 1

56


St Eleve Myocardial Infarction Admitted to the Emergency Department

with Atypical Symptoms After Fire Response

*Dr. Esra Ersöz Genç1, Dr. Sinan Paslı2 and İdris Genç3

Karadeniz Technical University, Emergency Medicine Department (Faculty of Medicine), Trabzon, Turkey1,2

Ministry of Interıor Disaster and Emergency Management Presidency, Trabzon, Turkey3

E-mail 1: [email protected], E-mail 2: [email protected], E-mail 3: [email protected]

Abstract

The term acute myocardial infarction (AMI); known as a heart attack, should be used when there is

evidence of myocardial damage with necrosis in a clinical setting consistent with myocardial ischemia.

Our patient, applied to the emergency department with the complaint of nausea and vomiting after

intervening in an open air fire.

Keywords: Fire, Heart Attack, STEMI, Firefighting




abstracts of the international congress of trauma 2021

Documents