Objective: This study aimed to describe the type and number of traumatic injuries seen after devastating earthquakes and to evaluate the difficulties experienced in the treatment process in a primary affected center. Methods: Out of the 2176 patients who were treated in the emergency department, 372 (199 male and 173 female) patients with complete data were included in this single-center retrospective study. In addition to the demographic characteristics of the patients, orthopedic injuries, other organ system injuries, type of injury, treatments, mechanisms of injury, and time of presentation to the emergency department were recorded. Results: The most common age group for injury was 20-30 years old, consisting of 73 patients (19.62%), and the second most common age group was between 40 and 50, with 72 patients (19.35%). Injury after being trapped under rubble was seen in 152 (40.86%) patients, while non-debris causes were more common in 220 patients (59.14%). The most common site of injury was in the lower extremities, with 111 patients (29.84%), while multiple injuries were seen in 109 patients (29.3%). Lower extremity fractures were mostly seen in long bones such as the femur (12.28%) and tibia (11.4%). Upper extremity fractures, especially those due to falls, were most frequently in the distal radius (8.77%). After triage, 117 patients (31.45%) were hospitalized, whereas the majority of patients (58.33%) were discharged from the emergency department. Conclusion: This study has shown us that injuries following major earthquakes are of a wide spectrum and occur in large numbers and in a very short time. Even in a well-equipped hospital that is not affected by an earthquake, there are many barriers to appropriate management. The first 24 hours after an earthquake are critical. This period should be kept in mind while organizing and taking necessary precautions, and early responses to earthquakes should be meticulously planned. Cite this article as: Köroğlu M, Karakaplan M, Ergen E, et al. The initial response of a local hospital in the earthquake zone during the February 6, 2023 Kahramanmaraş earthquakes: Injuries and challenges. Acta Orthop Traumatol Turc., 2023;57(6):315-321.

Key Clinical Message: Femoral nerve palsy is rare and may progress insidiously, leading to late clinical presentation. Identifying the underlying cause is very important for treatment. An iliacus hematoma causing nerve palsy is perhaps the most innocent etiology. However, this hematoma sometimes causes only abdominal pain and may even be misdiagnosed as a late intra‐abdominal pathology.

Isolated distal radioulnar joint (DRUJ) dislocations are referred to as dorsal or volar of neglected isolated volar DRUJ dislocation which was detected at the second dislocations concerning the position of the ulnar head in relationship to the radius. In contrast to large joint dislocations such as a shoulder dislocation, the clinical picture may mimic a simple soft tissue injury and the dislocation may be missed. In this article, we aimed to present a case presentation to the emergency department. Our patient who had no complaint other than wrist pain was diagnosed with volar dislocation on lateral radiography and closed reduction was performed in the emergency department with sedation. There was no recurrence in the follow-up and we achieved a satisfactory result with a painless and unrestricted wrist joint at six months. DRUJ and the ligaments stabilize the joint work in anatomical coordination and play an important role in forearm rotation movement. Traumatic injuries to these structures range from isolated tears to severe fractured dislocations. Isolated DRUJ dislocations are rare. Initial treatment of this injury is closed reduction, post-reduction stability is important and fixation is required in case of instability. Although surgical treatment is performed in cases that cannot be closed reduced and in the presence of instability after reduction, it is possible to obtain successful results in acute cases with closed reduction performed with sedation in emergency departments. For this reason, a conservative approach should be tried before making a surgical decision in these injuries that require special attention in diagnosis.

Background: Chainsaw-related injuries vary from skin lacerations to amputation and may cause serious loss of work time in addition to temporary or permanent disability. Most studies in the literature have reported injuries to the lower or upper extremities separately. The aim of our study is to compare the loss of work time between upper- and lower-extremity chainsaw-related non-occupational injuries in rural areas. Methods: Chainsaw-related injuries that occurred in rural areas and were treated in our center between 2012 and 2022 were retrospectively reviewed. The patients’ demographics, the injured side and structures, the hand dominance of operators, lengths of hospital stays, the numbers of operations, complications, and loss of work time were recorded. Results: In total, 185 patients (181 males and four females) were enrolled in this study. The mean age was 45.5 years (range: 17–81). The mean follow-up time was 9.3 months (range: 6–24). The lower extremities were affected in 109 patients, while the upper extremities were affected in 76. The loss of work time was 60 and 75 days for lower- and upper-extremity injuries, respectively, and was statistically significantly higher for upper-extremity injuries (p < 0.001). The fracture rate was higher in the upper than the lower extremities, at 50% and 26.6%, respectively. Conclusions: Chainsaws may cause severe injuries in both the upper and lower extremities, and while the lower extremities were affected more frequently, upper-extremity injuries caused a greater loss of work time. Through the use of protective gear and simple precautions, chainsaw-related injuries and the associated loss of work time can be prevented.

Background: Pelvic injuries of the sacroiliac joint are unstable and require surgical intervention following high-energy trauma. In this study, we aimed to present the long-term clinical outcomes of patients with sacroiliac joint separation and sacroiliac fracture dislocation (crescent) injury. We compared the surgical interventions performed on the sacroiliac joint based on patient clinical data. Methods: By reviewing the records of 850 pelvic fractures treated in our clinic between 2000 and 2020, we identified 110 patients with sacroiliac joint injuries who were included in the study. The fractures were classified based on patient files and radiographs. The patients were categorized according to the surgical interventions performed on the sacroiliac joint into two groups: closed reduction with percutaneous iliosacral screws and open reduction with plates and screws. We further divided the patients who underwent open reduction and plate–screw fixation into anterior and posterior surgical approaches. Clinical outcomes were obtained by evaluating patients using a subjective pelvic scoring system. Additionally, complications observed after surgeries were investigated. Results: A total of 121 fractures from 110 patients were included in the study. Eleven of the patients had bilateral sacroiliac joint injuries, for which bilateral surgery was performed. The mean age of the patients at the time of injury was 35.15 years (range from 6 to 80 years). The mean follow-up period was 103.45 months (range from 16 to 253 months). According to the scoring system, the highest success rate was observed in plate–screw operations performed through the anterior approach to the sacroiliac joint, with excellent to good results in approximately 92% of patients. Both open reduction and internal fixation through the posterior approach and closed reduction and percutaneous iliosacral screw surgery yielded successful functional results, with no statistically significant difference between the methods (p = 0.880). Regarding complications, the most important problems were infections associated with plate–screw procedures using the posterior approach and neurologic injuries resulting from closed reduction screw surgery. Conclusions: Effective management of sacroiliac joint injuries requires surgical expertise and individualized treatment strategies. With appropriate technique and fixation, both open and closed surgical methods can achieve satisfactory anatomical reduction and functional outcomes. Although standardized treatment protocols may be developed, tailoring the approach to each patient is more important for optimal clinical success.

Different treatment options exist for the late-stage Kienböck disease (KD). The functional outcomes of patients undergoing scaphocapitate fusion (SCF), tendon ball arthroplasty (TBA), and radius metaphyseal core decompression in stages 3 to 4 KD were investigated. This is a retrospective study spanning ∼11 years, conducted at our clinic, involving the operated patient KD. The study included 51 patients with an average follow-up duration of 68 months (range: 16–130 months). Patients who underwent SCF, TBA, and radius metaphyseal core decompression were divided into three groups based on the surgical approach. The range of motion of the wrist joint and grip strength of the operated wrists were assessed alongside the unaffected wrist during follow-up evaluations. Satisfaction levels among patients were measured by comparing groups internally and based on disease stages. Functional outcomes were evaluated using quick disabilities of the arm, shoulder, and hand (Q-DASH) and Mayo wrist scoring scales. Of the patients, 28 were female (54.9%) and 23 were male (45.1%). The mean age was 34 years (range: 19–62 years). There were 12 patients (23.53%) in the radial decompression group, 10 patients (19.61%) in the SCF group, and 29 patients (56.86%) in the TBA group. When the wrist joint Range of motion (ROM)s are analyzed, the losses in both stages 3A and 3B disease are significant compared with the intact wrist in all three surgical methods. When the groups were compared, a higher loss of wrist joint ROM was observed in the TBA group, especially in Kienböck stage 3B patients (p < 0.001). Furthermore, there were no differences between patient scores in stage 3A when assessments were made using Q-DASH and Mayo scores (p = 0.156 for Q-DASH and p = 0.060 for Mayo). In stage 3B, Mayo's results were similar, while the radial decompression group was reported to be more favorable in terms of Q-DASH scores (p = 0.035). KD is surgically treated with various operations identified. In terms of functional outcomes, all three surgeries are considered satisfactory. However, in young and active patients, even in advanced stages of the disease, metaphyseal core decompression should be attempted as an initial treatment due to its easier approach and the avoidance of direct manipulation of the carpus.