To investigate the influence of various factors on the two outcome parameters "procedure - specific complication" (femoral head necrosis, infection, nonunion, femoral neck shortening, screw ...loosening, implant penetration) and "functional outcome" in patients with displaced and undisplaced femoral neck fracture treated by cannulated screw fixation. All cases of a femoral neck fracture, operated by cannulated screw fixation, in the period from December 2014 to December 2017 were included. The observation period of the included patients was 12 months. Information on their outcome was collected after evaluation of current x-ray images and on request from the responsible further treatment physician. Continuous data were presented as mean value ± standard deviation, categorical data as absolute and relative frequency. The effect of potential factors on endpoints was estimated with a multivariable logistic regression analysis and 95% confidence intervals calculated. The null hypothesis Odds Ratio = 1 was checked by the Wald test. The likelihood ratio test was used to test for deviation from linearity. The mean age of the 56 included patients was 72 years (36 min, 96 max), 44.5% (n = 25) were male and 55.5% (n = 25) female. The femoral neck fractures were classified as follows: Garden I: 73%, Garden II: 16%, Garden III: 11%, Pauwels I: 73%, Pauwels II: 21%, Pauwels III: 5%, 31-B1: 73%, 31-B2: 27%, 31-B3: 0%. The factor patient age showed a statistically significant influence on the outcome parameter procedure-specific complication. None of the remaining factors examined showed a statistically significant influence on both outcome parameters procedure-specific complication and functional outcome. 69% of the patients from age 80 onwards suffered a procedure-specific complication. A rate of 41% procedure-specific complications as an outcome parameter in trauma surgery shows a necessity for improvement. The increasing risk of procedure-specific complications for patients with a femoral neck fracture treated by cannulated screw fixation is associated with rising patient age. A more stable head-perserving operative method or an endoprosthetic procedure should be considered in high-risk patients (≥80 y.o.).
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
ZusammenfassungHintergrundDer Krieg in der Ukraine und die medizinische Versorgung der Verletzten in den Krankenhäusern in Deutschland stellen nun schon für mehr als 15 Monate eine Herausforderung ...dar. Ein Großteil der traumatologischen Patienten wurde über das GMLZ am BBK über die Kleeblätter und die Traumanetzwerke verteilt. Initial wurden zahlreiche Hilfsangebote mit großer Solidarität vorangetrieben. Zur Dokumentation der aktuellen Motivationslage, aber auch zur Identifikation von Verbesserungspotenzial wurde eine zweizeitige Befragung der leitenden Ärzte der in den Traumanetzwerken organisierten und zertifizierten Krankenhäuser durchgeführt.Material und MethodenOnline Befragung der leitenden Ärzte der Traumanetzwerkkliniken mit einem halbstrukturierten schriftlichen Fragebogen im Dezember 2022 und Verlaufsbefragung im Rahmen des TNT-Kongresses im September 2023 in Frankfurt.ErgebnisseZur Auswertung kamen 113 Fragebögen im Dezember 2022 und 70 Fragebögen im September 2023. Jeweils zu etwa je einem Drittel kamen die Antworten aus ÜTZ, RTZ, LTZ. Im Mittel wurden bis Dezember in allen teilnehmenden Kliniken 2,7 Patienten behandelt und bis September insgesamt in mehr als der Hälfte der Kliniken nicht mehr als 5. An führenden Herausforderungen wurden zu beiden Zeitpunkten von allen Teilnehmern die lange Liegedauer, der anspruchsvolle Keimstatus und teils ungeklärte bzw. nicht vollumfängliche Kostenerstattung, genannt. Trotzdem besitzen mehr als 80 % der Fachabteilungen den Rückhalt ihres Klinikträgers als auch ihrer Mitarbeiter für die weitere Behandlung von Verletzten aus der Ukraine.SchlussfolgerungenDie medizinischen und fachlichen Herausforderungen der Behandlung der Verletzten aus der Ukraine sind, wie erwartet, gekennzeichnet durch die anspruchsvollen Verletzungsmuster des Bewegungsapparates und die Besiedelung mit multiresistenten Keimen. Daraus resultiert ein langer Behandlungsverlauf, der nicht immer kostendeckend vergütet wird. Trotz dieser Herausforderungen ist die Solidarität in den Krankenhäusern der TNW ungebrochen. Gleichzeitig gibt es aber zahlreiche Verbesserungsmöglichkeiten, um gemeinsam mit der Politik die Voraussetzungen für zukünftige vergleichbare humanitäre Hilfeleistung zu verbessern.
ZusammenfassungDie Ruhigstellung von Frakturen und Luxationen gehört zur Basistechnik der unfallchirurgischen Versorgung. Das Wissen über die verschiedenen Materialien, Techniken und möglichen ...Komplikationen sollte in der Unfallchirurgie bekannt sein. Der klassische Weißgips ist trotz anderer Techniken weiterhin fester Bestandteil in der unfallchirurgischen Versorgung. Die Anlage eines solchen Gipses muss erlernt werden, da bei Nichtbeachtung der Grundlagen Schäden für den Patienten drohen. In vielen Kliniken wird die Anlage eines Gipses nach ärztlicher Indikationsstellung an die Pflege delegiert, hierdurch fehlt jungen ärztlichen Kollegen das Wissen über die Durchführung. Neben der Versorgung von Frakturen gehört die Ruhigstellung nach Luxationen, Entzündungen und ligamentären Verletzungen zu den Einsatzgebieten. Im Folgenden wird die Anlage eines Gipses anhand eines Fallbeispiels von der Indikation über die Durchführung bis hin zu den möglichen Komplikationen detailliert behandelt.
Aim of the study
Emergency department thoracotomy (EDT) may be the last chance for survival in some severe thoracic trauma. This study investigates a representative collective with the aim to compare ...the findings in Europe to the international experience. Moreover, the influence of different levels of trauma care is investigated.
Methods
All emergency thoracotomies in patients with an ISS ≥ 9 from TR-DGU (2009–2014) within the first 60 min after arrival were identified. EDTs were identified separately, and mini thoracotomies and drainage systems were excluded.
Results
99,013 patients with sufficient data were observed. 1736 (1.8%) received thoracotomy during their hospital stay. 887 patients had a thoracotomy within the first hour in the emergency department (ED). 52.5% were treated in supraregional trauma centers (STC), 36.4% in regional (RTC) and 11.0% in local trauma centers (LTC). The mortality rates were 39.4% (STC), 20.9% (RTC) and 20.8% (LTC). The overall mortality rate showed no significant differences for blunt (28.2%) and penetrating trauma (31.3%). In case of cardiac arrest in the ED, a survival rate of 4.8% for blunt trauma and 20.7% for penetrating trauma was determined if EDT was carried out. Those patients showed a higher rate in severe thoracic organ injuries due to penetrating trauma but less extrathoracic injuries.
Conclusion
Just over half of EDTs were performed in STC. Emergency room resuscitation followed by EDT had survival rates of 4.8% and 20.7% for blunt and penetrating trauma patients, respectively.
Trauma registries are a crucial component of trauma systems, as they could be utilized to perform a benchmarking of quality of care and enable research in a critical but important area of health ...care. The aim of this study is to compare the performance of two national trauma systems: Germany (TraumaRegister DGU®, TR-DGU) and Israel (Israeli National Trauma Registry, INTR).
The present study was a retrospective analysis of data from the described above trauma registries in Israel and Germany. Adult patients from both registries treated during 2015-2019 with an Injury Severity Score (ISS) ≥ 16 points were included. Patient demographics, type, distribution, mechanism, and severity of injury, treatment delivered and length of stay (LOS) in the ICU and in the hospital were included in the analysis.
Data were available from 12,585 Israeli patients and 55,660 German patients. Age and sex distribution were comparable, and road traffic collisions were the most prevalent cause of injuries. The ISS of German patients was higher (ISS 24 vs. 20), more patients were treated on an intensive care unit (92 vs. 32%), and mortality was higher (19.4 vs. 9.5%) as well.
Despite similar inclusion criteria (ISS ≥ 16), remarkable differences between the two national datasets were observed. Most probably, this was caused by different recruitment strategies of both registries, like trauma team activation and need for intensive care in TR-DGU. More detailed analyses are needed to uncover similarities and differences of both trauma systems.
This prospective, multicenter observational cohort study was carried out in 12 trauma centers in Germany and Switzerland. Its purpose was to evaluate the rate of undertriage, as well as potential ...consequences, and relate these with different Trauma Team Activation Protocols (TTA-Protocols), as this has not been done before in Germany.
: Each trauma center collected the data during a three-month period between December 2019 and February 2021. All 12 participating hospitals are certified as supra-regional trauma centers. Here, we report a subgroup analysis of undertriaged patients. Those included in the study were all consecutive adult patients (age ≥ 18 years) with acute trauma admitted to the emergency department of one of the participating hospitals by the prehospital emergency medical service (EMS) within 6 h after trauma. The data contained information on age, sex, trauma mechanism, pre- and in-hospital physiology, emergency interventions, emergency surgical interventions, intensive care unit (ICU) stay, and death within 48 h. Trauma team activation (TTA) was initiated by the emergency medical services. This should follow the national guidelines for severe trauma using established field triage criteria. We used various denominators, such as ISS, and criteria for the appropriateness of TTA to evaluate the undertriage in four groups.
: This study included a total of 3754 patients. The average injury severity score was 5.1 points, and 7.0% of cases (
= 261) presented with an injury severity score (ISS) of 16+. TTA was initiated for a total of 974 (26%) patients. In group 1, we evaluated how successful the actual practice in the EMS was in identifying patients with ISS 16+. The undertriage rate was 15.3%, but mortality was lower in the undertriage cohort compared to those with a TTA (5% vs. 10%). In group 2, we evaluated the actual practice of EMS in terms of identifying patients meeting the appropriateness of TTA criteria; this showed a higher undertriage rate of 35.9%, but as seen in group 1, the mortality was lower (5.9% vs. 3.3%). In group 3, we showed that, if the EMS were to strictly follow guideline criteria, the rate of undertriage would be even higher (26.2%) regarding ISS 16+. Using the appropriateness of TTA criteria to define the gold standard for TTA (group 4), 764 cases (20.4%) fulfilled at least one condition for retrospective definition of TTA requirement.
: Regarding ISS 16+, the rate of undertriage in actual practice was 15.3%, but those patients did not have a higher mortality.
Navigated Total Knee Replacement: A Meta-Analysis Bauwens, Kai; Matthes, Gerrit; Wich, Michael ...
Journal of bone and joint surgery. American volume,
2007-February, Volume:
89, Issue:
2
Journal Article
Peer reviewed
BackgroundProponents of navigated knee arthroplasty stress its potential to increase the precision of component placement. We conducted a systematic review and meta-analysis to substantiate the ...validity and relevance of this contention.MethodsWe searched major medical and publishersʼ databases for randomized trials and any other studies comparing navigated with conventional knee arthroplasty. Major periodicals were searched manually. We made no restrictions for types of studies or language. Methodological features were rated independently by two reviewers. After testing for publication bias and heterogeneity was done, the data were aggregated by random-effects modeling. We estimated the weighted mean differences of mechanical limb axes and functional scales and the risk ratios of deviations from the straight axis with 95% confidence intervals.ResultsWe included thirty-three studies (eleven randomized trials) of varying methodological quality involving 3423 patients with a mean age (and standard deviation) of 67.3 ± 4.1 years (62.6% were women, and 83.7% had primary osteoarthritis). The mean preoperative deviation from the mechanical axis was 2.3° ± 5.1°. There was no evidence of publication bias, but there was strong statistical heterogeneity. The alignment of the mechanical axes did not differ between the navigated and conventional surgery group (weighted mean difference, 0.2°; 95% confidence interval, -0.2° to 0.5°). Patients managed with navigated surgery had a lower risk of malalignment at critical thresholds of >3° (risk ratio, 0.79; 95% confidence interval, 0.71 to 0.87) and >2° (risk ratio, 0.76; 95% confidence interval, 0.71 to 0.82). No conclusive inferences could be drawn on functional outcomes or complication rates. Navigation lengthened the mean duration of surgery by 23%.ConclusionsNavigated knee replacement provides few advantages over conventional surgery on the basis of radiographic end points. Its clinical benefits are unclear and remain to be defined on a larger scale.Level of EvidenceTherapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.
Abstract Purpose Delayed diagnosed injuries (DDI) in severely injured patients are an essential problem faced by emergency staff. Aim of the current study was to analyse incidence and type of DDI in ...a large trauma cohort. Furthermore, factors predicting DDI were investigated to create a score to identify patients at risk for DDI. Methods Multiply injured patients admitted between 2011 and 2020 and documented in the TraumaRegister DGU® were analysed. Primary admitted patients with severe injuries and/or intensive care who survived at least 24 h were included. The prevalence, type and severity of DDI were described. Through multivariate logistic regression analysis, risk factors for DDI were identified. Results were used to create a ‘Risk for Delayed Diagnoses’ (RIDD) score. Results Of 99,754 multiply injured patients, 9,175 (9.2%) had 13,226 injuries first diagnosed on ICU. Most common DDI were head injuries (35.8%), extremity injuries (33.3%) and thoracic injuries (19.7%). Patients with DDI had a higher ISS, were more frequently unconscious, in shock, required more blood transfusions, and stayed longer on ICU and in hospital. Multivariate analysis identified seven factors indicating a higher risk for DDI (OR from 1.2 to 1.9). The sum of these factors gives the RIDD score, which expresses the individual risk for a DDI ranging from 3.6% (0 points) to 24.8% (6 + points). Conclusion DDI are present in a sounding number of trauma patients. The reported results highlight the importance of a highly suspicious and thorough physical examination in the trauma room. The introduced RIDD score might help to identify patients at high risk for DDI. A tertiary survey should be implemented to minimise delayed diagnosed or even missed injuries.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Zusammenfassung
Die Ruhigstellung von Frakturen und Luxationen gehört zur Basistechnik der unfallchirurgischen Versorgung. Das Wissen über die verschiedenen Materialien, Techniken und möglichen ...Komplikationen sollte in der Unfallchirurgie bekannt sein. Der klassische Weißgips ist trotz anderer Techniken weiterhin fester Bestandteil in der unfallchirurgischen Versorgung. Die Anlage eines solchen Gipses muss erlernt werden, da bei Nichtbeachtung der Grundlagen Schäden für den Patienten drohen. In vielen Kliniken wird die Anlage eines Gipses nach ärztlicher Indikationsstellung an die Pflege delegiert, hierdurch fehlt jungen ärztlichen Kollegen das Wissen über die Durchführung. Neben der Versorgung von Frakturen gehört die Ruhigstellung nach Luxationen, Entzündungen und ligamentären Verletzungen zu den Einsatzgebieten. Im Folgenden wird die Anlage eines Gipses anhand eines Fallbeispiels von der Indikation über die Durchführung bis hin zu den möglichen Komplikationen detailliert behandelt.
Full text
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
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