Kahramanmaraş Deprem Sonrası Crush Sendromlu Çocukların Klinik Özellikleri Ve Erken Tedavi Sonuçları: Araştırma Makalesi

Objective: Extensive muscle crush injury that results in crush syndrome is often fatal if not treated promptly and vigorously. Although cases of Crush syndrome experienced by adults were frequently published in the previous literature, data on Crush syndrome in children are limited. In this study, we aimed to elucidate the clinical and laboratory findings of children with Crush syndromewho applied to our institution after the earthquake. Methods:Thirty-eight children with crush syndrome who applied to our institution after the earthquake disaster have been enrolled in this retrospective analysis. Demographic, clinical, and laboratory characteristics and early outcomes of children with crush wounds have been evaluated retrospectively. All children with crush wounds have been included in the analysis. Age, sex, height, and weight of the patient, admission and follow-up laboratory parameters, presence of comorbid diseases, and transcutaneous oximetry measurement results have been obtained from the hospital’s electronic database. Results: The stay under wreckage ranged from 4 to 160 hours, averaging 30 hours. The mean length of hospital stay was 13days, and the length of intensive care unit stay was seven days. There was a statistically significant difference between the initial and final measurements of WBC, PLT, CRP, glucose, BUN, creatinine, AST, ALT, LDH, uric acid, CK, and albumin values (p<0.05). Children with multiple extremity involvementhad significantly elevated initiallaboratory measurements, while those with single extremity involvement presented higher values in the final measurements (p<0.05). Conclusion: The high creatine kinase levelsmight indicate the severity of muscle damage in Crush syndrome. Elevated creatine kinase could be used to indicatemortality in these patients. Early assessment of compartment pressure can eliminate the risk of amputation. Rapid diagnosis and aggressive fluid resuscitation in the emergency department can prevent acute kidney injury or failure.Amaç: Crush sendromuyla sonuçlanan yaygın kas ezilme yaralanması, hızlı ve kuvvetli bir şekilde tedavi edilmezse genellikle ölümcüldür. Önceki literatürde yetişkinlerin yaşadığı Crush sendromu vakaları sıklıkla yayınlanmış olsa da, çocuklarda Crush sendromuna ilişkin veriler sınırlıdır. Bu çalışmada deprem sonrası kurumumuza başvuran Crush sendromlu çocukların klinik ve laboratuvar bulgularının aydınlatılmasını amaçladık. Yöntem: Bu retrospektif çalışmaya deprem felaketi sonrası kurumumuza başvuran ezilme sendromlu 38 çocuk dahil edildi. Ezilme yarası olan çocukların demografik, klinik ve laboratuvar özellikleri ile erken dönem sonuçları retrospektif olarak değerlendirildi. Ezilme yarası olan tüm çocuklar analize dahil edilmiştir. Hastanın yaşı, cinsiyeti, boyu, kilosu, başvuru ve takip laboratuvar parametreleri, eşlik eden hastalık varlığı ve transkutan oksimetre ölçüm sonuçları hastanenin elektronik veri tabanından elde edildi. Bulgular: Enkaz altında kalma süresi 4 ile 160 saat arasında değişerek ortalama 30 saat olmuştur. Ortalama hastanede kalış süresi 13 gün, yoğun bakımda kalış süresi ise yedi gündü. WBC, PLT, CRP, glukoz, BUN, kreatinin, AST, ALT, LDH, ürik asit, CK ve albümin değerlerinin başlangıç ve son ölçümleri arasında istatistiksel olarak anlamlı fark vardı (p<0,05). Birden fazla ekstremite tutulumu olan çocuklarda ilk laboratuvar ölçümlerinde anlamlı olarak yüksek bulunurken, tek ekstremite tutulumu olanlarda son ölçümlerde daha yüksek değerler saptandı (p<0.05). Sonuç: Yüksek kreatin kinaz seviyeleri, Crush sendromunda kas hasarının şiddetini gösterebilir. Yüksek kreatin kinaz bu hastalarda mortaliteyi belirtmek için kullanılabilir. Bölme basıncının erken değerlendirilmesi amputasyon riskini ortadan kaldırabilir. Acil serviste hızlı tanı ve agresif sıvı resüsitasyonu, akut böbrek hasarını veya yetmezliğini önleyebilir

Eklem Tutulumu Olan İnstabil Distal Radius Kırıklarının Cerrahi Tedavisi: Araştırma Makalesi

Objective: Radius distal end fractures are the most common type among whole-body bone fractures, constituting 8 – 15% of all fractures. Within the scope of this study, it was aimed to evaluate the results of anatomical plate fixation methods applied by volar intervention in the surgical treatment of distal radius fractures. Method: In our study, 41 adult patients with distal radius fractures treated with open reduction and fixation of alternate volar plates with a mean follow-up of 20 months were evaluated retrospectively. Frykman and AO classification systems were used in the evaluation of fractures. Gartland – Werley clinical scoring method, DASH, and Stewart radiological evaluation scale were utilized by measuring the patients with a dynamometer and goniometer. Results: According to the Gartland and Werley clinical evaluation criteria, 25 (61%) of 41 fractures had excellent, 9 (22%) good, 6 (14.6%) moderate, and 1 (2.4%) poor results. There was no statistical difference between the joint motion angles, grip strengths, and clinical evaluation results in the comparison of the operated patients with the unaffected hand. According to the results of the Stewart Radiological evaluation, 11 (26.8%) of the patients had excellent, 28 (68.3%) good, 1 (2.4%) moderate, and 1 (2.4%) poor results. There was no statistical difference compared to the healthy wrist. Conclusion: Radius volar plates have provided successful results as they are an effective method in providing anatomical complete reduction and alignment in intra-articular and extra-articular unstable fractures, which are especially problematic in the lower end of the radius, and allow joint movements in the early period thanks to its high fixation strength. Volar intervention, on the other hand, allows reaching the lower end of the radius with minimal surgical trauma and allows a fixation more compatible with the surrounding tissues with low complication rates.Amaç: Radius distal uç kırıkları, tüm vücut kemik kırıkları arasında en sık görülen tiptir ve tüm kırıkların %8 – 15'ini oluşturur. Bu çalışma kapsamında radius distal uç kırıklarının cerrahi tedavisinde volar girişim ile uygulanan anatomik plak tespit yöntemlerinin sonuçlarının değerlendirmesi amaçlanmıştır. Yöntem: Çalışmamıza radius distal uç kırığı nedeniyle açık redüksiyon ve değişik volar plak tespitiyle tedavi edilen ortalama takip süresi 20 ay olan erişkin 41 distal radius kırıklı hasta retrospektif olarak değerlendirildi. Çalışmaya dahil 41 hastanın kırıkların değerlendirmesinde Frykman ve AO sınıflandırma sistemleri kullanıldı. Hastalara dinamometre ve goniyometre ile ölçümler yapılarak, Gartland – Werley klinik skorlama yöntemi, DASH ve Stewart radyolojik değerlendirme skalası kullanıldı. Bulgular: Gartland ve Werley klinik değerlendirme kriterlerine göre 41 kırığın 25 (%61)’inde mükemmel, 9 (%22)’nda iyi, 6 (%14.6)’sında orta ve 1 (%2.4)’inde kötü sonuç elde edildi. Opere edilen hastaların sağlam taraf el ile karşılaştırılmasında eklem hareket açıları kavrama güçleri ve klinik değerlendirme sonuçları arasın da istatistik olarak fark yoktu. Stewart Radyolojik değerlendirmesi sonucuna göre hastaların 11 (%26.8)’inde mükemmel, 28 (%68.3)’inde iyi, 1 (%2.4)’inde orta, 1 (%2.4)’inde kötü sonuç elde edildi. Sağlam taraf el bileğine göre istatistiki olarak fark yoktu. Sonuç: Radius volar plaklar, radius alt uç bölgesinde özellikle tedavisi sorunlu olan eklem içi ve dışı instabil kırıklarda anatomik tam redüksiyonun ve dizilimin sağlanmasında etkin olan yöntem olması ve yüksek tespit dayanıklılığı sayesinde eklem hareketlerine erken dönemde izin vermesi ile başarılı sonuçlar sağlamıştır. Volar girişim ise, radius alt ucuna minimal cerrahi travma ile ulaşmayı sağladığı gibi çevresel dokular ile daha uyumlu bir tespite izin verir. Yaşanan komplikasyon oranları düşüktür ve dikkat ve öğrenme eğrisi ile ilgilidir

Is it difficult to dominate the coronal and sagittal planes in convex rod rotation technique? The effect of the ucar convex rod rotation technique

WOS: 000433244300009PubMed ID: 29899772Study Design: Prospective multicenter study. Objective: To analyze the effect of the Ucar convex rod rotation technique on coronal and sagittal correction in the treatment of Lenke type I adolescent idiopathic scoliosis. Summary of Background Data: Various common curve correction techniques were used in scoliosis. This report describes the efficacy of the global vertebral correction technique with convex rod rotation. Materials and Methods: A total of 28 consecutive patients with Lenke type I adolescent idiopathic scoliosis managed with Ucar convex rod rotation technique between October 2012 and September 2015 were included. The average patient age was 14.8 years at the time of surgery. Measurements of curve magnitude and balance were made on standing anteroposterior, and lateral radiographs were taken before surgery, postoperatively, and at the last follow-up to assess deformity correction, spinal balance, and complications related to instrumentation. Results: The average preoperative main thoracic angle was 64.8 degrees and was decreased to 15.5 degrees postoperatively. The average preoperative T4-T12 thoracic kyphosis was 19.6 degrees and was improved to 24.8 degrees. All patients had mildly imbalanced or balanced shoulders at the final follow-up. Conclusion: Correction rates in the coronal and sagittal planes were as acceptable as those achieved with conventional methods

Our results of mini open approach in patients with carpal tunnel syndrome

Objective: In this study, we aimed to evaluate the results of patients underwent surgical release with mini open surgical method due to Carpal tunnel syndrome (CTS) and the surgical technique. Methods: 50 wrists of the 42 patients that we could reach after they were applied mini open surgical method between 2009- 2013 were analyzed retrospectively. After surgery, patients were followed for an average 47.4 months. CTS was detected in 26 of the patients in right hand, in 10 of the patients in left hand and in seven of them bilaterally. In 27 Preoperative patients advanced in 21 intermediate and in 2 mild Electromyography (EMG) findings compliant with CTS were found. Results: We did not apply a second operation to any of our patients. None of the patients showed any post operative sensitivity on scar tissue and there was no neurovascular damage in any patients during the surgery. The patients returned to their daily activities average on the 10th day after the surgery [range 7-15 days]. In their follow up EMG was not done on a routine basis to the patients. Patients were followed clinically. Conclusion: The advantages of the surgery process we conducted with over pillar mini incision compared to other techniques that there is less pillar region pain and less scar tenderness, shorter return to work and the technique is efficient, cheap and easy to apply