Burak Yaşar

Objective: Idiopathic orbital inflammation (IOI) is a nonspecific inflammatory orbital disorder that may cause diplopia and extraocular motility restriction. Orbital trauma in patients with pre-existing IOI and diplopia may complicate the etiologic differentiation of post-traumatic ocular findings and the surgical decision-making process. To the best of our knowledge, no case describing the surgical management of a traumatic orbital floor blow-out fracture in a patient with pre-existing IOI has been reported in the literature. This case report aims to present the clinical approach to an orbital floor blow-out fracture in a patient with IOI, with particular emphasis on surgical timing and the selection of reconstructive material. Case: A 40-year-old woman presented ∼24 hours after blunt periorbital trauma. She had been receiving systemic corticosteroid and methotrexate therapy for IOI and had used prism glasses for diplopia before the trauma. On presentation, marked periorbital edema, ecchymosis, left enophthalmos, extraocular motility restriction in superior and lateral gaze, and diplopia were present. Computed tomography revealed an ∼2.8 cm² blow-out fracture of the left orbital floor. Because of the pre-existing diplopia, history of IOI, and marked post-traumatic inflammation, the contribution of mechanical restriction, post-traumatic edema, and the underlying inflammatory orbital disease to the early diplopia and motility restriction could not be clearly distinguished. After confirming that the IOI was inactive and that there was no ophthalmologic contraindication to surgery, and following resolution of the acute edema, the orbital floor was reconstructed with titanium mesh during the first week after trauma. Results: Postoperatively, the extraocular motility restriction resolved completely, with normal ocular movements in all directions of gaze. With prism glasses, diplopia markedly improved and was limited to extreme superolateral gaze. By the second postoperative day, this residual diplopia had also nearly completely resolved. No apparent inflammatory reactivation of IOI was observed postoperatively, and methotrexate therapy was resumed. Conclusion: The evaluation of orbital blow-out fractures in patients with pre-existing IOI and diplopia may be challenging because traumatic and inflammatory processes can produce overlapping clinical findings. Surgical decision-making should be based on the combined assessment of the pretraumatic ocular status, disease activity, serial ophthalmologic examinations, enophthalmos, defect size, and other radiologic features. Surgical timing should take into account IOI activity and post-traumatic inflammatory findings, whereas the selection of reconstructive material should consider the mechanical requirements of the defect, the underlying inflammatory disease, and material biocompatibility. In this case, following confirmation of inactive IOI and resolution of the acute edema, titanium mesh reconstruction performed during the first week after trauma was not associated with IOI reactivation or an apparent implant-related inflammatory complication in the early postoperative period. However, this observation from a single case should not be interpreted as a generalizable conclusion regarding the safety of titanium mesh in patients with IOI.

Background: Following the 6 February 2023 earthquake, a significant number of people living in various urban areas suffered crush injuries while trapped under the rubble of collapsed buildings. A significant number of people affected by the earthquake, who were hospitalized for long periods and underwent various surgical interventions for significant injuries, including limb loss, were treated in the plastic surgery department. This study aimed to assess the psychological well-being of patients under our care after the earthquake. Methods: A total of 33 patients (15 males, 18 females) with crush injuries who were referred to our clinic and agreed to undergo psychological examination were included in the study. Our team collaborated with plastic surgeons, psychologists, and allied physicians to carry out interventions, assessments, and interviews. Demographic, injury, psychological, and social support information was collected for evaluation after hospitalization. Results: The study found that, in terms of personal factors, aggression and depression levels were significantly higher in men than in women. As for age, verbal aggression level ( r = −0.405), depression level ( r = −0.369), and numerous psychotic symptoms ( r = −0.439) were inversely correlated with age. When social factors were investigated, verbal aggression ( r = 0.376) and self-confidence ( r = 0.432) were directly proportional to higher education levels. Depression and psychosis levels were found to be statistically significantly higher in patients with lower incomes ( P < 0.05). Patients who lost their next of kin were found to be statistically significantly affected by acute stress ( P = 0.003). As for medical factors, several psychotic symptoms were inversely correlated with larger areas of injury ( r = −0.385). Increasing numbers of debridement sessions were also found to be directly correlated with anxiety symptoms ( r = 0.345). Conclusions: The surgical team responsible for providing medical care to patients after an earthquake should be aware of the psychological state of the individuals they treat. Providing psychological and social support by the surgical team in the early stages after the earthquake, particularly for young patients, patients with low incomes, and those who have lost family members, may be considered a potentially beneficial component of multidisciplinary post-disaster care.

Introduction: Acute hand trauma is frequently accompanied by psychological distress; however, the demographic and injury-related factors associated with this response remain poorly understood. This study aimed to identify factors associated with early psychological distress in patients with acute hand trauma. Methods: We prospectively evaluated 134 adult patients presenting with acute hand trauma. Patients completed the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI), and psychiatric symptoms were additionally assessed by a psychiatrist using the Brief Psychiatric Rating Scale (BPRS). Demographic characteristics, psychiatric history, pain scores, injury characteristics, and structural injuries were recorded. Multivariable linear regression analysis was performed to identify independent factors associated with psychological distress. Results: Anxiety symptoms were the most common psychological manifestation, affecting 44% of patients. Previous psychiatric history, nerve injury, and work-related injury were independently associated with higher psychological distress scores. Younger age and female sex showed associations in univariable analyses but were not independent predictors after multivariable adjustment.Conclusion: Early psychological distress following acute hand trauma appears to be influenced primarily by patient-related factors and nerve injury rather than anatomical injury level alone. Early psychological screening should be considered, particularly for patients with a previous psychiatric history or concomitant nerve injury.

Objectives: This study looked at what factors lead to complications after extensor tendon repair, with a focus on how the location of the injury affects patient outcomes. Patients and methods: This retrospective cohort study looked at 206 patients with extensor tendon injuries. All patients were treated at one center using the same surgical and rehabilitation protocols. We collected data on patient demographics, details of the injuries, and any complications after surgery. Logistic regression was employed to identify predictors of complications. Results: The complication rate was 22.3%, with adhesions and extensor lag being the most common. Smoking (odds ratio = 0.161) and higher modified Hand Injury Severity Score values were identified as significant predictors of complications. Complication rates varied across injury zones, with zones 1 and 2 exhibiting the highest rates (26.1%), although the differences were not statistically significant. Conclusion: Smoking and injury severity emerged as key predictors of complications. This shows the need to address modifiable risk factors through targeted interventions such as smoking cessation programs and intensive follow-up for high-risk patients. The results show that no particular injury zone is always linked to poor outcomes. This highlights the need for more research on surgical and rehabilitation strategies for different zones.

(1) Background: The Festival of Sacrifice, commonly known as Eid al-Adha, has a profound religious and cultural impact on nations with a Muslim majority. This festival is celebrated every year in Muslim countries; however, it is a time in which patients present to the emergency department with serious injuries. In our study, we examined current injuries occurring during Eid al-Adha in one of the largest hospitals in Türkiye, providing the largest patient population to date. This included mapping tendon and maxillofacial injuries, a first in the literature. To the best of our knowledge, this is the largest case series of injuries sustained during Eid al-Adha. The significance of this study lies in its potential to significantly benefit patients and healthcare systems by providing reference data. (2) Methods: Patients admitted to Ankara City Hospital during Eid al-Adha between 2019 and 2023 were examined. The demographic characteristics, injury patterns, and injury sites of patients admitted on the four days of Eid al-Adha were collected and analyzed. Maxillofacial traumas during the festival were analyzed. Tendon injuries on the left hand, which is the most commonly injured body part in the literature, were mapped into a figure. To compare the change in the number of patients, a comparison was made with the number of patients in our hospital for four consecutive days 2 weeks before Eid. Statistical analysis was performed using IBM SPSS Statistics for Windows. (3) Results: A total of 610 patients, including 101 female and 509 male patients, were included in this study. A statistically significant increase (p < 0.001 for all years) in hospital admission due to injury was observed. Individuals between the ages of 30 and 40 years were the most frequently admitted patients (n = 182, 29.8%). Knife injuries were significantly more common in all patients (p < 0.001). When the total number of patients was evaluated in terms of injured areas where patients present to the emergency department, left-hand injuries were found to be significantly more common than injuries in other areas (p < 0.001 for all). The extensor pollicus longus tendon was the most commonly injured tendon among all extensor and flexor tendon injuries (n = 104). The most commonly injured tendon was the flexor tendon in zone 2 of the first finger (n = 45). This study showed that injuries to the extensor tendon in zone 1 of the fifth finger, the flexor tendon in zone 4 of the first finger, and the flexor tendon in zone 1 of the fifth finger were never seen. Twenty-five patients with maxillofacial injuries were admitted to the hospital. Orbital floor fractures were the most common type of maxillofacial injury. The anesthesia technique we preferred for all patients was local anesthesia (n = 267). Wide-awake local anesthesia no tourniquet (WALANT) was the second most preferred anesthetic technique. The number of patients who were selected in a random 4-day period for each year were compared with the number of patients who came during Eid al-Adha. The Mann–Whitney U tests revealed a significant increase in injuries on the first day of Eid al-Adha compared to non-festival days (p < 0.001). However, no significant differences were observed on the subsequent days or in the overall injury counts during the festival period (p = 0.841 for day 2, p = 0.151 for day 3, p = 0.310 for day 4). (4) Conclusions: According to this study, which is the largest known case series in the literature, the number of patients admitted to the hospital increased annually. In our study, we observed a significant increase in injuries only on the first day of Eid al-Adha compared to a randomly selected 4-day period of the same year. Left-hand extensor tendon injuries from a knife were the most common injuries in middle-aged men. The extensor pollicis longus tendon was the most commonly injured extensor tendon, with zones 3 and 4 being the most commonly affected. The flexor pollicis longus tendon was the most commonly injured flexor tendon in zone 2. During this period, patients may not only need hand surgery but also maxillofacial plastic surgery. We recommend, in addition to the indications I,n the literature that during Eid al-Adha, the WALANT technique should be widely adopted in patients where local anesthesia will be insufficient. We also recommend utilizing a diagram to manage the patient load during Eid al-Adha and prevent overburdening the healthcare system.

Background: Eid al-Adha is celebrated every year in Muslim countries; however, it is a time when patients present to the emergency department with serious injuries. In our study, we examined current injuries at the time of Eid al-Adha in the largest patient population in one of the largest hospitals in Turkiye, including tendon injury map and maxillofacial injuries for the first time in the literature. Methods: Between 2019 and 2023, patients admitted to Ankara City Hospital during Eid al-Adha were examined. The demographic characteristics, injury patterns, and injury sites of the patients were evaluated by analyzing the patients admitted on the four days of Eid al-Adha. Statistical analysis were performed using IBM SPSS Statistics for Windows. Results: Six hundred and ten patients, including 101 female and 509 male patients, were included in this study. There was a statistically significant increase (p