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.

Acute kidney injury (AKI) significantly contributes to the mortality and morbidity rates among pediatric liver transplant (LT) recipients. Our study aimed to assess the potential factors contributing to AKI in pediatric LT patients and to analyze the impact of AKI on postoperative mortality and hospitalization duration. About 235 pediatric LT patients under the age of 18 between the years 2015 and 2021 were evaluated retrospectively. The relationship between preoperative and intraoperative variables of the patients and AKI developed when the early postoperatıve period was assessed. A correlation was found between the patients’ preoperative age, albumin levels, and AKI. AKI was found to be associated with the duration of surgery and intraoperative blood transfusion. Our findings revealed that the severity of AKI in pediatric LT patients is linked to extended surgical durations and increased blood transfusions resulting from hemodynamically compromised blood loss. Furthermore, independent risk factors for AKI were identified as prolonged warm ischemia and the overall duration of the operation. Demiroz D, Colak YZ, Ozdes OO, Ucar M, Ali Erdogan M, Toprak HI, et al. Incidence and Risk Factors of Acute Kidney İnjury in Pediatric Liver Transplant Patients: A Retrospective Study. Indian J Crit Care Med 2024;28(1):75–79.

Background and Objectives: This retrospective cohort study aimed to evaluate the predictive validity of four frailty indices—Modified Frailty Index-5 (mFI-5), Edmonton Frail Scale (EFS), Clinical Frailty Scale (CFS), and Trauma-Specific Frailty Index (TSFI)—in forecasting postoperative complications and functional outcomes in elderly patients with proximal humerus fractures (PHFs) treated either surgically or conservatively. Materials and Methods: A total of 244 patients aged ≥60 years with PHFs treated at Erzurum Hospital between January 2018 and January 2023 were included. Patients were categorized into surgical (n = 110) and conservative (n = 134) groups. Surgical procedures included open reduction and internal fixation (n = 88), hemiarthroplasty (n = 10), and reverse shoulder arthroplasty (n = 12). Frailty was retrospectively assessed using mFI-5, EFS, CFS, and TSFI based on 24-month follow-up data. Outcomes included complications, reoperations, rehospitalizations, and functional results measured by the American Shoulder and Elbow Surgeons (ASES) score. Results: The overall complication rate was 13.1%, with nonunion being the most common. Reoperation and rehospitalization rates were 10.6% and 20%, respectively. The mean ASES score was 71.3 ± 15.2, with 60% of patients achieving good or excellent outcomes. Frailty scores, particularly mFI-5 and EFS, were significantly higher in the conservatively treated group compared to the surgical group (p < 0.01). Across both treatment modalities, patients with higher frailty scores had significantly increased complication rates; however, this effect was more pronounced in the surgical group. Multivariate logistic regression revealed that mFI-5 significantly predicted complications, reoperations, and rehospitalizations (p < 0.001). EFS was associated with reoperation risk (p = 0.018), while CFS and TSFI were not significantly correlated with any of the outcomes. Conclusions: Among the evaluated indices, mFI-5 showed the strongest predictive accuracy for adverse outcomes in elderly PHF patients. Notably, the negative impact of frailty was more evident among surgically treated patients. Routine frailty assessment may facilitate better risk stratification and individualized treatment planning in this population.

Background: The most important concern regarding living donor liver transplantation is the safety of living liver donors, of which anesthesia management is an important part. Sugammadex, which has recently been used frequently for the reversal of neuromuscular blockade, is known to cause adverse effects on the coagulation profile. This study seeks to assess the impact of neostigmine and sugammadex on coagulation parameters in living liver donors following hepatectomy. Methods: We compared the demographic, clinical, and coagulation parameters of 209 living liver donors who received sugammadex (2 mg/kg) for neuromuscular blockade reversal during donor hepatectomy procedures from January 2018 to July 2022, with 209 patients who received neostigmine (50 g/kg) for the same purpose during the same timeframe. We compared the following parameters: age, gender, prothrombin time (PT), partial thromboplastin time (PTT), international normalized ratio (INR), hemoglobin (Hb), platelet count, ICU stay, hospital stay, and relaparotomy for bleeding and other causes. Results: Demographic data and preoperative biochemical values were similar in both groups. PT (p = 0.004) and aPTT (p < 0.001) values were significantly longer in the postoperative period in both groups; the difference between preoperative and postoperative PT (p = 0.009) and aPTT (p < 0.001) was significantly higher in the sugammadex group. However, neither group showed any elongation beyond the reference range. The sugammadex group had an elevated postoperative platelet count (p = 0.040). The duration of patients’ stay in the ICU was significantly shorter in the sugammadex group (p < 0.001). Conclusion: The prolonged aPTT and PT associated with sugammadex did not lead to any postoperative bleeding complications. The sugammadex group significantly reduced the duration of ICU stays, while the hospital stays remained comparable. Further multicentric prospective randomized studies should support our study’s findings, which demonstrate the safe use of low-dose sugammadex.

Can Preoperative Parameters of Inflammation be Used to Predict Acute Kidney Injury in Pediatric Liver Transplant Recipients? A Single-Center Retrospective Study - Istanbul Medical Journal

The Effect of Rocuronium Dosage on Intubation Conditions in Liver Transplant Recipients - Istanbul Medical Journal