Background The decision of fasciotomy or amputation in crush syndrome is controversial and challenging for surgeons. We aimed to share our experiences after the Kahramanmaraş earthquake, to predict the severity of crush syndrome and mortality, and to guide the surgical decision. Methods The clinical data of patients during their first week of hospitalization were analyzed retrospectively. Totally, 233 crush syndrome patients were included. Demographic data, physical and laboratory findings, surgical treatments, and outcomes were recorded. Results The mean time under the rubble was 41.89 ± 29.75 h. Fasciotomy and amputation were performed in 41 (17.6%) and 72 (30.9%) patients. One hundred and two patients (56.7%) underwent hemodialysis. Fifteen patients (6.4%) died. Lower extremity injury, abdominal trauma, and thoracic trauma were associated with mortality. Mortality was significantly increased in patients with thigh injuries (p = 0.028). The mean peak CK concentration was 69.817.69 ± 134.812.04 U/L. Peak CK concentration increased substantially with amputation (p = 0.002), lower limb injury (p < 0.001), abdominal trauma (p = 0.011), and thoracic trauma (p = 0.048). Conclusions Thigh injury is associated with the severity of crush syndrome and mortality. Late fasciotomy should not be preferred in crush syndrome. Amputation is life-saving, especially in desperate lower extremity injuries.

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Level III.

We aimed to assess the longitudinal extensibility of the dorsal skin of the hand. Measurements were done in five hand positions on the dominant hands of 64 volunteers. The positions were full flexion of the wrist and fingers, drop hand, flat hand, hand with opposed thumb and full extension. Dorsal marks were made on the skin in full flexion. The marks were transferred to transparent parchment paper strips with the hand in the different positions. Skin extensibility was assessed by the change in the distance between two skin marks from the full extension position to the other positions. Opposition required the highest degree of skin extensibility in the dorsal radial region, followed orderly by ulnar and central regions. Generally, the extensibility increased from distal to proximal and from ulnar to radial. These findings may be useful in the management of dorsal hand soft tissue defects.

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The aim of this study was retrospective assessment of the reduction quality, hospitalization time, and relief of pain in hematoma block assisted closed reduction versus sedoanalgesia assisted closed reduction. Materials and Methods: There were 106 patients included who diagnosed as isolated displaced distal fracture of radius and treated with closed reduction. Hematoma block was used in 45 patients and sedoanalgesia was used in 61 patients. Midazolam (0,1 mg/kg) and fentanyl (1 mcg/kg) combination was administered as the sedoanalgesic agent, and lidocaine (10 ml, 1%) as the local anaestetic. Demographic data, fracture type according to Frykman classification, and mechanism of trauma were noted. Pain status of patients were recorded by using the Visual analog scale (VAS). Sarmiento criteria was used for the evaluation of the reduction quality. Cost of the analgesic procedure was assessed based on the prices of the analgesia procedures, used pharmaceuticals and medical consumables. Results: Both groups were similar in terms of gender, age, fracture type and affected side., Hospitalization time was shorter in hematoma block group, and VAS was significantly lower. Quality of reduction was similar in both groups. Cost per patient was four times higher in sedoanalgesia group compare to hematoma block group. Conclusion: Hematoma block is an effective, easily performed method that can be used prior to the closed reduction of the distal radius fractures to relieve the pain. Older patients can be susceptible to adverse effects of sedoanalgesia and hematoma block can be chosen as a more reliable method to provide the analgesia. Amaç: Bu çalışmanın amacı deplase distal radius kırıklarının redüksiyonu sırasında, analjezi amaçlı kullanılan hematom bloğu ve sedoanaljezi tekniklerinin redüksiyon kalitesi, hastanede kalış süresi ve ağrı kontrolü açısından retrospektif olarak karşılaştırılmasıdır. Gereç ve Yöntem: İzole deplase distal radius kırığı tanısı ile kapalı redüksiyon uygulanan 106 hasta değerlendirildi. Hastaların 45'ine hematom bloğu, 61'ine sedoanaljezi uygulandı. Sedoanaljezik olarak midazolam (0,1mg/kg) ve fentanyl (1 mcg/kg), lokal anestezik olarak da lidokain (10 ml %1) kullanıldı. Demografik veriler, Frykman sınıflamasına göre kırık tipleri ve travma mekanizmaları değerlendirildi. Hastaların ağrı değerlendirmesi Vizüel analog skala (VAS) ile yapıldı. Redüksiyon kalitesi Sarmiento kriterlerine göre değerlendirildi. Analjezi yöntemlerinin maliyet değerlendirilmesi prosedürlerin ücretleri, kullanılan ilaçlar ve medikal malzemeler üzerinden yapıldı. Bulgular: Her iki grup cinsiyet, yaş, kırık tipi ve etkilenen taraf açısından benzerdi. Hematom bloğu grubunda hastanede kalış süresi daha kısa idi ve VAS skoru belirgin olarak daha düşüktü. Redüksiyon kalitesi her iki grupta benzerdi. Hasta başı maliyet, sedoanaljezi grubunda hematom bloğu ile karşılaştırıldığında dört kat fazla idi. Sonuç: Hematom bloğu, distal radius kırıklarının redüksiyonu öncesi ağrıyı azaltmak için kullanılan kolay ve etkili bir yöntemdir. Özellikle...

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