Reconstruction surgery after the excision of musculoskeletal tumors has advanced greatly in the last few decades. After resection of a large piece of bone, limb reconstruction (when is necessary) can ...be easily achieved with mechanical reconstruction with metallic prosthesis, or biological reconstruction with bone. The use of bone in reconstructive orthopedic surgery is to repair skeletal defects and accelerate bone healing. Bone grafts can be used to achieve this. Those can be allografts and autografts.
The standard in bone grafting consists of tissue harvested from the patient, autograft, usually from the iliac crest or distal femur and tibia. Allografts are taken from donors or cadavers and they serve as alternatives to autograft in bone reconstruction. In our case, the patients were treated with wide resection of the bone segment. The defect was reconstructed with intercalary bone and osteosynthesis was made with locking plates. A cadaveric graft was used. Autogenous bone is generally used as an optimal graft because it integrates faster and with fewer complications. Allogenous bone can carry the risk of viral infection for the recipient. Anyhow, allografts can serve as the only therapeutic options, besides endoprosthesis devices for large size reconstruction.
Background. The prevalence of hip fractures is steadily increasing, as the population ages. These fractures are associated with significant morbidity and mortality. Most of these fractures are ...treated surgically. Factors related to surgical intervention can play a significant role in the outcome.
This study examines the association of in-hospital mortality with the timing of surgery, sex, and age of patients treated surgically due to a hip fracture at Clinical Hospital Shtip in a 2-year long period.
Material and Methods. A total of 348 patients admitted with a diagnosis of hip fracture who were treated surgically were identified. Data about sex and age were collected. The outcome was assessed for groups treated within 24, 48, 72, and more than 72 hours after admission. Descriptive statistical methods, chi-square test, t-test for independent samples, and odds - ratio with 95% confidence interval (CI) were used in statistical analysis.
Results. The delay of surgical treatment beyond 24 hours did not increase the risk of death (OR=0.65, 95%CI=0.23-1.73). Delays beyond 48h and 72h increased the risk of death progressively (OR=1.17, 95%CI=0.50-2.75, and OR=1.65, 95%CI=0.69-3.95 respectively). Mortality was significantly higher in the 76-85-years age group.
Conclusions. Association between surgical delay and in-hospital mortality in hip fracture patients is disputed. Confounding factors such as age, sex, comorbidities, and type of treatment determine the outcome. Patients with hip fractures, without any additional disease, should be operated on as soon as possible after admission to the hospital. Delay beyond 48 hours may increase the risk for in-hospital mortality.
BACKGROUND: Biphasic treatment of pilon fractures has been accepted as standard modality of care.
AIM: The aim of the present study was to evaluate the effect of timing of definitive surgery for ...closed pilon fractures on the short-term functional outcome.
MATERIALS AND METHODS: Prospective study focused the patients suffering pilon fracture that has undergone treatment in a biphasic manner. Initially, spanning external fixator was applied, while the definitive osteosynthesis was performed within the next several days, in accordance with surgeon’s knowledge. The final functional outcome was evaluated using the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score.
RESULTS: Forty-two patients were included in the study. Mean time passed from injury to definitive surgery was 11.0 ± 3.4 days. Mean value of the functional score was 86.54 ± 13.2 points, with no significant differences with regard to the demographics and injury features. Pearson correlation coefficient demonstrated negative significant correlation between timing of definitive surgery and functional outcome (r = −0.428, p = 0.033). Complications were noted in 16% of the patients.
CONCLUSION: Definitive surgery should be planned as soon as possible, once the surgeon considers the soft-tissue status acceptable for surgery. Injudicious postponing has a negative effect on the short-term functional outcome.
5th Albanian Congress of Trauma and Emergency Surgery Dogjani, Agron; Gjata, Arben; Dracini, Xheladin ...
Albanian journal of trauma and emergency surgery (Online),
12/2021, Letnik:
5, Številka:
2.5
Journal Article
Recenzirano
Odprti dostop
The 5th Albanian Congress of Trauma and Emergency Surgery - ACTES 2021, on November 12-13, 2021 - Hybrid Edition. The biggest event in region about Trauma & Emergency Surgery and not only,... ...organized by ASTES - Albanian Society for Trauma and Emergency Surgery with support of UMT (University of Medicine of Tirana). "With persistence and clear ideas, everything is possible" is our slogan. The main topic of this congress is trauma and emergency surgery and more ... The Local Scientific Committee, led by the Prof. Arben Gjata (Rector of University of Medicine of Tirana, but complemented by experts in the field from many other specialties and societies together with the ASTES Executive Board and Section Chairs. Colleagues from all Albanian areas and many European and non- European countries will be taking part in 21 sessions during 2 days: Thank you very much for your support and encouragement!
The principles of fracture management in patients with multiple injuries continue to be of crucial importance. Early treatment of unstable polytraumatized patients with head, chest, abdomen or pelvic ...injuries, with blood loss followed by immediate fracture fixation (Early Total Care -ETC) may be associated with secondary life threatening posttraumatic systemic inflammatory response syndrome (SIRS). Development of SIRS is typically a function of the type and severity of the initial injury (the “first hit”). Immediate Fracture fixation, using reamed nails or plates, in such unstable patients with multiple injuries is subsequently defined as the “second hit” and may be associated with development of acute respiratory distress syndrome (ARDS) and multiple organ failure (MOF), with relatively high morbidity and mortality.
The other alternative for long bone fracture fixation in unstable polytraumatized patients is based on immediate treatment of life threatening conditions related to the injuries, followed by the initial use of minimally invasive modular external frames for long bone fractures and is called Damage Control Orthopedics (DCO) and is widely accepted. In order to refine the DCO concept and to avoid an overuse of external fixation, the “Safe Definitive Surgery” (SDS) concept has been introduced, which is a dynamic synthesis of both strategies (ETC and DCO). The SDS strategy employs clinical parameters and includes repeated assessment of patients. The following paper is going to summarize historical backgrounds and recent concepts in treatment of polytraumatized patients.
Purpose
It is known that the magnitude of surgery and timing of surgical procedures represents a crucial step of care in polytraumatized patients. In contrast, it is not clear which specific factors ...are most critical when evaluating the surgical load (physiologic burden to the patient incurred by surgical procedures). Additionally, there is a dearth of evidence for which body region and surgical procedures are associated with high surgical burden. The aim of this study was to identify key factors and quantify the surgical load for different types of fracture fixation in multiple anatomic regions.
Methods
A standardized questionnaire was developed by experts from Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT)-Trauma committee. Questions included relevance and composition of the surgical load, operational staging criteria, and stratification of operation procedures in different anatomic regions. Quantitative values according to a five-point Likert scale were chosen by the correspondents to determine the surgical load value based on their expertise. The surgical load for different surgical procedures in different body regions could be chosen in a range between “1,” defined as the surgical load equivalent to external (monolateral) fixator application, and “5,” defined as the maximal surgical load possible in that specific anatomic region.
Results
This questionnaire was completed online by 196 trauma surgeons from 61 countries in between Jun 26, 2022, and July 16, 2022 that are members of SICOT. The surgical load (SL) overall was considered very important by 77.0% of correspondents and important by 20.9% correspondents. Intraoperative blood loss (43.2%) and soft tissue damage (29.6%) were chosen as the most significant factors by participating surgeons. The decision for staged procedures was dictated by involved body region (56.1%), followed by bleeding risk (18.9%) and fracture complexity (9.2%). Percutaneous or intramedullary procedures as well as fractures in distal anatomic regions, such as hands, ankles, and feet, were consistently ranked lower in their surgical load.
Conclusion
This study demonstrates a consensus in the trauma community about the crucial relevance of the surgical load in polytrauma care. The surgical load is ranked higher with increased intraoperative bleeding and greater soft tissue damage/extent of surgical approach and depends relevantly on the anatomic region and kind of operative procedure. The experts especially consider anatomic regions and the risk of intraoperative bleeding as well as fracture complexity to guide staging protocols. Specialized guidance and teaching is required to assess both the patient’s physiological status and the estimated surgical load reliably in the preoperative decision-making and operative staging.
Purpose
Unstable pelvic ring injury can result in a life-threatening situation and lead to long-term disability. Established classification systems, recently emerged resuscitative and treatment ...options as well as techniques, have facilitated expansion in how these injuries can be studied and managed. This study aims to access practice variation in the management of unstable pelvic injuries around the globe.
Methods
A standardized questionnaire including 15 questions was developed by experts from the SICOT trauma committee (Société Internationale de Chirurgie Orthopédique et de Traumatologie) and then distributed among members. The survey was conducted online for one month in 2022 with 358 trauma surgeons, encompassing responses from 80 countries (experience > 5 years = 79%). Topics in the questionnaire included surgical and interventional treatment strategies, classification, staging/reconstruction procedures, and preoperative imaging. Answer options for treatment strategies were ranked on a 4-point rating scale with following options: (1) always (A), (2) often (O), (3) seldom (S), and (4) never (N). Stratification was performed according to geographic regions (continents).
Results
The Young and Burgess (52%) and Tile/AO (47%) classification systems were commonly used. Preoperative three-dimensional (3D) computed tomography (CT) scans were utilized by 93% of respondents. Rescue screws (RS), C-clamps (CC), angioembolization (AE), and pelvic packing (PP) were observed to be rarely implemented in practice (A + O: RS = 24%, CC = 25%, AE = 21%, PP = 25%). External fixation was the most common method temporized fixation (A + O = 71%). Percutaneous screw fixation was the most common definitive fixation technique (A + O = 57%). In contrast, 3D navigation techniques were rarely utilized (A + O = 15%). Most standards in treatment of unstable pelvic ring injuries are implemented equally across the globe. The greatest differences were observed in augmented techniques to bleeding control, such as angioembolization and REBOA, more commonly used in Europe (both), North America (both), and Oceania (only angioembolization).
Conclusion
The Young-Burgess and Tile/AO classifications are used approximately equally across the world. Initial non-invasive stabilization with binders and temporary external fixation are commonly utilized, while specific haemorrhage control techniques such as pelvic packing and angioembolization are rarely and REBOA almost never considered. The substantial regional differences’ impact on outcomes needs to be further explored.
In the past distal tibia fractures, including intraarticular fractures, frequently led to poor functional outcomes. The Ruedi-Allgower four steps open method, and later the Patterson and Sirkin ...recommendations for delayed operative treatment has made a drastic advancement in the treatment of these fractures. The two-stage minimally-invasive protocol using locking plate fixation proved a historical turning point, improving functional results to the highest levels compared to all other methods.
To present the superior results of the two-stage minimally-invasive method using locking plate fixation, making this a historic step forward in treating distal tibia fractures.
A prospective longitudinal study, collecting data from Traumatology-Clinic in the 2014-2016 periods, available for nine-month follow-up. Twenty-three patients were finally included in the study.
In analysing the data collected, we focused our attention on the final functional outcomes as indicated by dorsiflexion nine months after injury and also according to the AOFAS Ankle-Hindfoot Scale. Results were excellent with no or minimal consequences. Where complications were present, these were benign and did not require further surgery.
We believe this modern method for the treatment of distal tibia fractures should be applied routinely and considered as the gold standard in this domain.
This event reflects the author's involvement in internationally recognized education and training models, as ATLS, ETC, and DSTC, and UEMS Boards of Emergency SurgeryDo different countries need very ...different things? I don’t think so, for the simple reason that in Europe and about the challenges we face, with regard to trauma and other medical and surgical emergencies, similarities are much greater than differences.• We all agree on the need for a trauma system “to assure that patients (…) seamlessly receive the proper care, in the proper locations, with proper interventions and, if necessary, transfer to a hospital able to provide the best and most appropriate care” (www.aast.org).• We all agree that teamwork is necessary for prehospital care, transportation, emergency room care, intensive care, surgery, and in/post-hospital rehabilitation.• We all agree on the need for trauma registries with, as much as possible, global follow-up of patient's course.• And finally, we all agree that it is necessary to educate, how to prevent and how to treat.This is also apparent from the recommendations of the European Trauma Course Organization (ETCO) about equipment and facilities: complete trauma team, trauma admission bay close to the ambulance entrance, enough space and adequate lighting, the adjacent operating room to allow emergency procedures, standardequipment for the initial management of major trauma, immediate availability of additional equipment as difficult airway equipment, X-ray, ultrasound machine, surgical instruments, readily available bloodproducts and massive transfusion equipment, co-located CT scanner to allow immediately imaging and access to angiography and interventional radiology, 24 hours a day within 30-60 minutes of request.
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