Analysis of The Orthopedic Forensic Cases Admitted to The Emergency Department in A Tertiary Care Setting

INTRODUCTION: This study aims to evaluate the orthopedic forensic cases admitted to the emergency department (ED). METHODS: Forensic cases admitted to the ED were analyzed retrospectively between June 01st, 2018 and June 30th, 2018 in a tertiary care setting. Patients who were not consulted to the Orthopedics clinic and with insufficient data were excluded. Age groups (0-18 years, 19-64 years, >64 years), gender (male, female), trauma etiology (traffic accidents, physical assault, penetrating injuries, falls, gunshot injuries, electrical injuries, dent injuries), surgical intervention requirement, presence of fracture, affected body part, hospitalization and mortality status were recorded from hospital information system, forensic reports, and patient charts. RESULTS: A total of 3732 forensic cases were analyzed and 500 orthopedic cases were included in the study. Admission causes were as follows: traffic accidents (n=301, 60.2%), physical assault (n=136, 27.2%), penetrating injuries (n=15, 3.0%), falls (n=25, 5.0%), gunshot injuries (n=21, 4.2%), electrical injuries (n=1, 0.2%), dent injury (n=1, 0.2%). Reported injury sites were as follows: upper extremity (n=195, 39.0%), lower extremity (n=174, 34.8%), spinal colon (n=1, 0.2%), pelvis (n=21, 4.2%), multipletrauma (n=109, 21.8%). A total of 41 (8.2%) patients required hospitalization mortality was positive in 4 (0.8%) patients. Surgical intervention and fracture rates were statistically significant between patients over and under 65 years old (p=0.015 and 0.005, respectively; Chi-square test). DISCUSSION AND CONCLUSION: The current study showed that the only factor related to fracture and surgical intervention was the age among forensic cases with a complaint of orthopedic injury.

Üçüncü Basamak Bir Hastanenin Acil Servisine Başvuran Ortopedik Adli Olguların İncelenmesİ

GİRİŞ ve AMAÇ: Bu çalışmanın amacı acil servise (AS) başvuran ortopedik adli olguların değerlendirilmesidir. YÖNTEM ve GEREÇLER: Üçüncü basamak bir sağlık kuruluşunun acil servisine 1 Haziran 2018 ve 30 Haziran 2018 tarihleri arasında başvuran adli olgular geriye dönük olarak incelendi. Ortopedi kliniğine konsulte edilmeyen ve yetersiz verisi olan olgular dışlandı. Yaş grupları (0-18 yaş, 19-64 yaş, 64 yaş üzeri), cinsiyet (kadın, erkek) travma etyolojisi (trafik kazaları, darp, kesici-delici alet yaralanmaları, ateşli silah yaralanmaları, elektrik yaralanmaları, göçük altında kalma yaralanmaları), cerrahi gereksinim, kırık varlığı, etkilenen vücut kısmı, hastaneye yatış durumu ve mortalite durumları, adli raporlar, hastane bilgi sistemi ve hasta dosyalarından kaydedildi. BULGULAR: Toplamda 3732 adli olgu incelendi ve 500 tane ortopedik olgu çalışmaya dahil edildi. Başvuru nedenleri şu şekilde bulundu; trafik kazaları (n=301, % 60.2), darp (n=136, % 27.2), kesici delici alet yaralanmaları (n=15, % 3.0), düşmeler (n=25, % 5.0), ateşli silah yaralanmaları (n=21, % 4.2), elektrik yaralanmaları (n=1, % 0.2), göçük altında kalma (n=1, % 0.2). Yaralanan bölgelerde şu şekilde bulundu; üst ekstremite (n=195, % 39.0), alt ekstremite (n=174, % 34.8), spinal kolon (n=1, % 0.2), pelvis (n=21, % 4.2), çoklu travma (n=109, 21.8). Toplamda 41 (% 8.2) hastanın hastaneye yatırıldığı ve mortalitenin 4 (% 0.8) olguda görüldüğü bulundu. Cerrahi girişim gereksinimi ve kırık oranları 65 yaş üstü ve altı hastalarda istatistiksel olarak anlamlı şekilde farklıydı (sırasıyla p=0.015 ve p=0.005; Ki-Kare testi). TARTIŞMA ve SONUÇ: Bu çalışma ortopedik yaralanmaların eşlik ettiği adli olgularda cerrahi girişim gereksinimi ve kırık ile ilişkili tek faktörün yaş olduğunu göstermiştir.

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1. Pribitkin EA, Ezzat WH. Classification and treatment of the saddle nose deformity. Otolaryngol Clin North Am. 2009; 42(3): 437-461.

2. Daniel RK, Brenner KA. Saddle nose deformity: A new classification and treatment. Facial Plast Surg Clin North Am. 2006; 14(4): 301-312.

3. Bilen BT, Kilinc H. Reconstruction of saddle nose deformity with three-dimensional costal cartilage graft. J Craniofac Surg. 2007; 18(3): 511-515.

4. Yabe T, Muraoka M. Treatment of saddle type nasal fracture using Kirschner wirw fixation of nasal septum. Ann Plast Surg. 2004; 53(1): 89-92.

5. Beekhuis GJ. Saddle nose deformity: etiology, prevention, and treatment; augmentation rhinoplasty with polyamide. Laryngoscope. 1974; 84(1): 2-42.

6. Smith JC, Kacker A, Anand VK. Midline nasal and hard palate destruction in cocain abusers and cocain’s role in rhinologic practice. Ear Nose Throat J. 2002; 81(3): 172-177.

7. Merkonidis C, Verma S, Salam MA. Saddle nose deformity in a patint with crohn disease. J Laryngol Otol. 2005; 119(7): 573-576.

8. Schreiber BE, Twigg S, Marais J, Keat AC. Saddle-nose deformities in the rheumataology clinic. Ear Nose Throat J. 2014; 93(4-5):45-47.

9. Gürkov R, Berghaus A. Nasal reconstruction in advanced sinunasal sarcoidosis. Rhinology. 2009; 47(3): 327-329.

10. Wu F, Hao SP: Rosai-Dorfman disease as saddle nose. 2008; 138(1): 124-125.

11. Shine NP, Hamilton S, McShane DP. Takayasu’s arteritis and saddle nose deformity: a new association. J Laryngol Otol. 2006; 120(1): 59-62.

12. Frederich JM. Nasal reconstruction art and practice. Mosby. 2009.

13. Graham HE, Connolly C, Pahal GS, Stafford FW. ‘Saddle nose’ deformity caused by advanced squamous cell carcinoma of the nasal septum. BMJ Case Rep. 2014

14. Tardy ME Jr, Schwartz M, Parras G. Saddle nose deformity: autogenous graft repair. Facial Plast Surg. 1989; 6(2): 121-134.

15. Durbec M, Disant F. Saddle nose: classification and therapeutic management. Eur Ann Otorhinolaryngol Head Neck Dis. 2014; 131(2): 99-106.

16. Hyun SM, Jang YJ. Treatment outcomes of saddle nose correction. JAMA Facial Plastic Surg. 2013; 15(4): 280-286.

17. Godin MS, Waldman SR, Johnson CM Jr. The use of expanded polytetrafluoroethylene (Gore-Tex) in rhinoplasty. A 6-year experience. Arch Otolaryngol Head Neck Surg. 1995; 121(10): 1131-1136.

18. Blais P. Industrial Polymers as implants: their value and their limitations. In: Rubin LR, editor. Biomaterials in reconstructive surgery. St Louis: Mosby; 1983. Pp. 112-144.

19. Vuyk HD, Adamson PA. Biomaterials in rhinoplasty. Clin Otolaryngol Allied Sci. 1998; 23(3):209-217.

20. Adams JS. Grafts and implants in nasal and chin augmentation. Otolaryngol Clin North Am. 1987; 20: 913-920.

21. Stuscker FJ, Gage-White L. Survey of surgical implants. Facial Plast Surg. 1986; 3: 141-144

22. Lohuis PJ, Watts SJ, Vuyk HD. Augmentation of the nasal dorsum using Gore-Tex: intermediate results of a retrospective analysis of experience in 66 patients. Clin Otolaryngol Allied Sci. 2001; 26(3): 214-217.

23. Romo T 3rd, Sclafani AP, Jacono AA. Nasal reconstruction using porous polyethylene implants.

24. Tham C, Lai YL, Weng CJ, Chen YR. Silicone augmentation rhinoplasty in an Oriental population. Ann Plast Surg. 2005; 54(1): 6-7.

25. Berghaus A. Porous polyethylene in reconstruction head and neck surgery. Arch Otolaryngol. 1985; 111(3): 154-160.

26. Turegun M, Sengezer M, Guler M. Reconstruction of saddle nose deformities using porous polyethylene implant. Aesthetic Plast Surg. 1998; 22(1): 38-41.

27. Turegun M, Acarturk TO, Ozturk S, Sengezer M. Aesthetic and functional restoration using dorsal saddle shaped Medpor implant in secondary rhinoplasty. Ann Plast Surg. 2008; 60(6): 600-603.

28. Mendelsohn M, Dunlop G. Gore-tex augmentation grafting in rhinoplasty—is it safe? J otolaryngol. 1998; 27(6): 337-341.

29. Queen TA, Palmer FR 3rd. Gore-Tex for nasal augmentation: a recent series and a review of the literature. Ann Otol Rhinol Laryngol. 1995; 104(11): 850-852.

30. Berman M, Pearce WJ, Tinnin M. The use of Gore-Tex-PTFE bonded to silikone rubber as an alloplastic implant material. Laryngoscope. 1986; 96(5): 480-483.

31. Kim JG, Rhee SC, Cho PD, Lee SH. Absorbable plate as a perpendicular strut for acute saddle nose deformities. Arch Plast Surg. 2012; 39(2): 113-117.

32. Gunter JP, Rohrich RJ. Augmentation rhinoplasty: dorsal onlay grafting shaped autogenous septal cartilage. Plast Reconstr Surg. 1990; 86(1): 39-45.

33. Raffi Der Sarkissian. Cartilage grafting in rhinoplasty and nasal reconstruction. In: Azizzadeh B, Murphy MR, Johnson CM, Numa W, eds. Master techniques in rhinoplasty. Philadelphia, Saunders. 2011. p. 143-157.

34. Sherris DA, Kern EB. The versatile autogenous rib graft in septorhinoplasty. Am J Rhinol. 1998; 12(3): 221-227.

35. Gibson T, Davis WB. The distortion of autogenous cartilage grafts: Its cause and prevention. Br J Plast Surg. 1958; 10: 257-273.

36. Gunter JP, Clark CP, Friedman RM. Internal stabilization of autogenous rib cartilage grafts in rhinoplasty: a barrier to cartilage warping. Plat Reconstr Surg. 1997; 100(1): 161-169.

37. Tastan E, Yucel OT, Aydin E, Aydogan F, Beriat K, Ulusoy MG. The oblique split method: a novel technique for carving costal cartilage grafts. JAMA Facial Plastic Surg. 2013; 15(3): 198-203.

38. Ozturan O, Aksoy F, Veyseller B, Apuhan T, Yıldırım YS. Severe saddle nose: choices for augmentation and application of accordion technique against warping. Aesthetic Plast Surg. 2013; 37(1): 106-116.

39. Esen F, Oksuz S, Melikoglu C, Karagöz H, Ülkür E. Saddle-nose deformity repair with microplate-adapted costal cartilage. Aesthetic Plast Surg. 2014; 38(4): 733-741.

40. Ahmed A, Imani P, Vuyk HD. Reconstruction of significant saddle nose deformity using autogenous costal cartilage graft with incorporated mirror image spreader grafts. Laryngoscope. 2010; 120(3): 491-494.

41. Cheney ML. Reconstructive grafting by the open nasal approach. Facial Plast Surg Clin North Am. 1993; 1: 99-109.

42. Romo T 3rd, Jablonski RD. Nasal reconstruction using split calvarial grafts. Otolaryngol Head Neck Surg. 1992; 107(5): 622-630.

43. Young VL, Schuster RH, Harris LW. Intracerebral hematoma complicating split calvarial bone-graft harvesting. Plast Reconstr Surg. 1990; 86(4): 763-765.

44. Shipchandler TZ, Chung BJ, Alam DS. Saddle nose deformity reconstruction with a split calvarial bone L-shaped strut. Arch Facial Plast Surg. 2008; 10(5): 305-311

45. Baser B, Shahani R, Khanna S, Grewal DS. Calvarial bone grafts for augmentation rhinoplasty. J Laryngol Otol. 1991; 105(12): 1018-1020.

46. Mutaf M. The anatomik replication technique (ART): a new approach in saddle nose correction. Ann Plast Surg. 2008; 61(2): 169-177.

47. Kridel RW, Konior RJ. Irradiated cartilage grafts in the nose: a preliminary report. Arch Otolaryngol Head Neck Surg. 1993; 119(1): 24-31.

48. Murakami CS, Cook TA, Guida RA. Nasal reconstruction with articulated irradiated rib cartilage. Arch Otolaryngol Head Neck Surg. 1991; 117: 327-330.

49. Gunter JP, Clark CP, Robinson JB. The rate of warping in irradiated and nonirradiated homograft rib cartilage: a controlled comparison and clinical implications. Plast Reconstr Surg. 1999; 103(1): 265-270

50. Thomassin JM, Paris J, Richard-Vitton T. Management and asthetic results of support grafts in saddle nose surgery. Aesthetic Plast Surg. 2001; 25(5): 332-337.

51. Ambro BT, Zimmerman J, Rosenthal M. Nasal septal perforation repair with porcine small intestinal submucosa. Arch Facial Plast Surg. 2003; 5(6): 528-529.

52. Erdem T, Ozturan O. Graft materials used in the reconstruction of saddle nose. Kulak Burun Bogaz Ihtis Derg. 2002; 9(6): 435-440.

53. Dagli AS, Akalin Y, Bilgili H, Seckin S, Ensari S. Correction of saddle nose deformities by coral implantation. Eur Arch Otorhinolaryngol. 1997; 254(6): 274-276.

54. Lo S, Kenway B, Hosni A. Acellular porcine dermal collagen implant in saddle nose deformity. Plast Reconstr Surg. 2011; 128(2): 82-84.

55. Humphrey CD, Arkins JP, Dayan SH. Soft tissue fillers in the nose. Aesthet Surg. 2009; 29(6): 477-484.

56. Daniel RK, Calvert JW. Diced cartilage grafts in rhinoplasty surgery. Plast Reconstr Surg. 2004; 113(7): 2156-2171.

57. Daniel RK. Aesthetic Plastic Surgery: Rhinoplasty. Boston; Little, brown. 1993.

58. Erol OO. The Turkish delight: a pliable graft for rhinoplasty. Plast Reconstr Surg. 2000; 105(6): 2229-2241.

59. Kalogjera L, Bedekovic V, Baudoin T, Ivkic M. Modified alar swing procedure in saddle nose correction. Aesthetic Plast Surg. 2003; 27(3): 209-212.

60. Gunter JP, Rohrich RJ, Adams WP. Dallas rhinoplasty. St. Louis, Quality Medical Publishing: 2002.