Onur Tezel

A comparison of suprascapular nerve block and procedural sedation analgesia in shoulder dislocation reduction

OBJECTIVES Dislocation of the shoulder joint is one of the most common dislocations. The reduction procedure is a painful procedure. In this study, 2 different treatment groups were compared for pain control during shoulder dislocation reduction. It was aimed to evaluate the differences between the groups in reduction, success, length of hospital stay, complications, side effects, patient-physician satisfaction, and ease of application. METHODS The study was planned to be prospective and randomized. As procedural sedation analgesia (SA), titration of ketamine 1 to 2 mg/kg was administered intravenously to group 1. Suprascapular nerve block (SNB) was applied under ultrasound guidance (USG) to group 2. Conformity to normal distribution of variables was examined with the Kolmogorov-Smirnov test. The χ2 test and Fisher test were used to evaluate differences between the groups in categorical variables and the Mann-Whitney U test, and a value of P<.05 was accepted as statistically significant. RESULTS The study comprised a total of 41 patients; 20 in the group 1 and 21 in the group 2. No statistically significant difference was determined between the groups in terms of age (P=.916), sex (P=.972), reduction success (P=.540), and patient-physician satisfaction (P=.198). The time spent in the emergency department (ED) by patients in the SA group was signficantly longer compared with the SNB group. No side effects were observed in the SNB group. CONCLUSIONS Suprascapular nerve block, which can be easily applied under USG in the ED, can be evaluated as a good alternative to SA in the reduction of shoulder dislocations.

The relationship between Injury Severity Scores and transfusion requirements of 108 consecutive cases injured with high kinetic energy weapons: a tertiary center end-mode mortality analysis

BACKGROUND We aimed in this study to investigate the relationship between Injury Severity Score (ISS) and transfusion strategies required during medical intervention in patients wounded by high kinetic energy (HKE) gunshot, and to analyze end-mode mortality. METHODS The medical data of patients were included in the study. We evaluated whether there was any significant correlation in terms of demographic characteristics, HKE weapon type, ISSs, and transfusion strategy options and transfusion requirements. RESULTS Causes of mortality in cases resulting in mortality during hospitalization were evaluated. One hundred and eight consecutive patients were included in the study. All patients except one were male, with an average age of 25 years. 64.8% of them were injured by long-barreled firearms, whereas 35.2% were injured by explosives. Average ISS was 13.9. ISS values for the patients with and without transfusion were 16 (5-48) and 9 (3-36), respectively. Causes of mortality were evaluated in terms of systemic inflammatory response syndrome (SIRS), sepsis, and multiorgan dysfunction syndrome (MODS). DISCUSSION It was determined that there was a significant correlation between increase in ISS values in cases with HKE weapon wounds and their transfusion requirements, whereas this requirement was independent of the ISS value in cases with explosive wounds.

Open Defective Trapezium Fracture Treated with Local Bone Graft: A Case Report

DOI: 10.4328/JCAM.1406 Received: 16.11.2012 Accepted: 04.12.2012 Publihed Online: 04.12.2012 Corresponding Author: Omer Ersen, Maresal Cakmak Military Hospital Palandoken, Erzurum, Turkey. T.: +905335275181 E-Mail: merschenn@yahoo.com Ozet Trapezium kiriklari nadir kiriklardir ve tum karpal kemik kiriklarinin %3-5’ini olustururlar. Bunlarin yaklasik %20’si vertikal sagittal split kiriklardir ve izole olarak cok nadir gorulurler. Literaturde bildirilen trapezium kiriklari cok azdir. Normal basparmak fonksiyonunun kazanilabilmesi icin acik trapezium kiriklarinda yaralanmis yapilarin tam restorasyonu saglanmalidir. Aksi takdirde hareket kisitliligi, agri ve kuvvetsizlige bagli fonksiyon kayiplari gorulebilir. Bu vaka takdiminde distal radiustan elde edilen lokal kemik grefti ile defektif trapezium kiriginin tedavisi sonucu normal basparmak fonksiyonu elde edilmesi sunulmustur.