TITLE:
Audit Report: Emergency Orthopedic Cases at Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey—Emergency Orthopedics
AUTHORS:
Ahmed Dervis
KEYWORDS:
Orthopedic Emergencies, Audit, Open Fractures, Compartment Syndrome, Polytrauma, Istanbul
JOURNAL NAME:
Open Journal of Orthopedics,
Vol.15 No.9,
September
28,
2025
ABSTRACT: Background: Orthopedic emergencies constitute a major workload in tertiary trauma centers, often requiring rapid intervention to prevent disability or mortality. This audit was conducted to evaluate patterns, timeliness, and outcomes of emergency orthopedic cases at Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, with the aim of identifying strengths and areas for improvement in acute care delivery. Methods: A mixed prospective and retrospective audit was performed over 20 months (September 2023 - May 2025). Prospective data included emergency consultations, time-to-intervention records, and resident neurovascular documentation. Retrospective data were obtained from surgical logs, trauma call sheets, and complication registries. All patients presenting with orthopedic emergencies—including open fractures, neurovascular injuries, compartment syndrome, septic arthritis/osteomyelitis, pediatric fractures, and polytrauma—were included. Key performance indicators assessed were time to intervention, appropriateness of prophylactic antibiotics, complication rates, imaging delays, and quality of resident documentation. Results: A total of 361 emergency orthopedic cases were analyzed. Open fractures (n = 108) had an average intervention time of 6.5 hours with a 12% complication rate, while fracture-dislocations with neurovascular compromise (n = 47) were managed within 2.8 hours and showed a 6% complication rate. Compartment syndrome (n = 19) was treated with fasciotomy within 4 hours in 74% of cases, though late diagnosis led to a 21% complication rate. Pediatric emergencies (n = 100) had a low complication rate (2%), largely due to strong interdisciplinary coordination. Polytrauma patients (n = 55) received operative care within 3 hours but demonstrated a 15% complication or mortality rate. Positive trends included early consultant involvement and efficient pediatric trauma handling, while key challenges involved delayed referrals, limited access to urgent MRI/CT, and incomplete neurovascular documentation in 32% of cases. Conclusion: Emergency orthopedic care at this tertiary trauma center is generally timely and well-coordinated, particularly in polytrauma and pediatric cases. However, delayed transfers, infection management, and variable recognition of compartment and vascular syndromes remain areas of concern. Targeted simulation training, improved imaging access, standardized documentation, and enhanced regional coordination are recommended to further optimize outcomes in high-stakes orthopedic emergencies.