Background The presence of in-house attending trauma surgeons has improved efficiency of processes in the treatment of polytrauma patients. However, literature remains equivocal regarding the ...influence of the presence of in-house attendings on mortality. In our hospital there is a double trauma surgeon on-call system. In this system an in-house trauma surgeon is 24/7 backed up by a second trauma surgeon to assist with urgent surgery or multiple casualties. The aim of this study was to evaluate outcome in severely injured patients in this unique trauma system. Methods From 2014 to 2021, a prospective population-based cohort consisting of consecutive polytrauma patients aged greater than or equal to 15 years requiring both urgent surgery (less than or equal to 24h) and admission to Intensive Care Unit (ICU) was investigated. Demographics, treatment, outcome parameters and pre- and in-hospital transfer times were analyzed. Results Three hundred thirteen patients with a median age of 44 years (71% male), and median Injury Severity Score (ISS) of 33 were included. Mortality rate was 19% (68% due to traumatic brain injury). All patients stayed less than or equal to 32 min in ED before transport to either CT or OR. Fifty-one percent of patients who needed damage control surgery (DCS) had a more deranged physiology, needed more blood products, were more quickly in OR with shorter time in OR, than patients with early definitive care (EDC). There was no difference in mortality rate between DCS and EDC patients. Fifty-six percent of patients had surgery during off-hours. There was no difference in outcome between patients who had surgery during daytime and during off-hours. Death could possibly have been prevented in 1 exsanguinating patient (1.7%). Conclusion In this cohort of severely injured patients in need of urgent surgery and ICU support it was demonstrated that surgical decision making was swift and accurate with low preventable death rates. 24/7 Physical presence of a dedicated trauma team has likely contributed to these good outcomes. Keywords: Polytrauma, Mortality, Double trauma surgeon on-call service
Bacteriophage therapy has recently attracted increased interest, particularly in difficult-to-treat infections. Although it is not a novel concept, standardized treatment guidelines are currently ...lacking. We present the first steps towards the establishment of a “multidisciplinary phage task force” (MPTF) and a standardized treatment pathway, based on our experience of four patients with severe musculoskeletal infections. After review of their medical history and current clinical status, a multidisciplinary team found four patients with musculoskeletal infections eligible for bacteriophage therapy within the scope of Article 37 of the Declaration of Helsinki. Treatment protocols were set up in collaboration with phage scientists and specialists. Based on the isolated pathogens, phage cocktails were selected and applied intraoperatively. A draining system allowed postoperative administration for a maximum of 10 days, 3 times per day. All patients received concomitant antibiotics and their clinical status was followed daily during phage therapy. No severe side-effects related to the phage application protocol were noted. After a single course of phage therapy with concomitant antibiotics, no recurrence of infection with the causative strains occurred, with follow-up periods ranging from 8 to 16 months. This study presents the successful outcome of bacteriophage therapy using a standardized treatment pathway for patients with severe musculoskeletal infection. A multidisciplinary team approach in the form of an MPTF is paramount in this process.
Conventional anatomically contoured plates do not adequately fit most tibiae. This emphasizes the need for a more thorough morphological study. Statistical shape models are promising tools to display ...anatomical variations within a population. Herein, we aim to provide a better insight into the anatomical variations of the tibia and tibia plateau. Seventy-nine CT scans of tibiae were segmented, and a principal component analysis was performed. Five morphologically important parameters were measured on the 3D models of the mean tibial shapes as well as the -3SD and +3 SD tibial shapes of the first five components. Longer, wider tibiae are related to a more rounded course of the posterior column, a less prominent tip of the medial malleolus, and a more posteriorly directed fibular notch. Varus/valgus deformations and the angulation of the posterior tibia plateau represent only a small percentage of the total variation. Right and left tibiae are not always perfectly symmetrical, especially not at the level of the tibia plateau. The largest degree of anatomical variation of the tibia is found in its length and around the tibia plateau. Because of the large variation in the anatomy, a more patient-specific approach could improve implant fit, anatomical reduction, biomechanical stability and hardware-related complications.
Abstract Background Previous studies showed that the amount of hip flexion and the combination of knee valgus and lateral trunk motion, measured with two-dimensional video analysis, were related to ...three-dimensional measured knee joint moments during single-leg drop vertical jumps, but it remains unclear whether these measurements can be used to identify non-contact knee injury risk. Methods Fifty injury-free female athletes participated in the study. Two-dimensional video analysis was used to measure hip flexion, knee valgus and lateral trunk motion angles during single-leg drop vertical jumps. Time loss non-contact knee injuries were registered during a one-year follow-up. Independent t-tests and receiver operating characteristic analysis were used to analyze the predictive ability of the two-dimensional angles. Findings Seven participants sustained a time loss non-contact knee injury. Hip flexion was not significantly different between groups ( P > .05). The combination of knee valgus and lateral trunk motion was significantly smaller in the injured ( P = .036) and non-injured legs ( P = .009) of the future injured group compared with the respective matched leg of the non-injured group. The receiver operating characteristic analysis showed a significant discriminative accuracy between groups for the combination of knee valgus and lateral trunk motion of the uninjured leg of the future injured group with the matched leg of the non-injured group (area under curve = 0.803; P = .012). Interpretation The measurement of a combination of increased knee valgus and ipsilateral trunk motion during the single-leg drop vertical jump with two-dimensional video analysis can be used to help identify female athletes with increased non-contact knee injury risk.
Cerebral palsy (CP) is a heterogeneous group of motor disorders attributed to a non-progressive lesion in the developing brain. Knowledge on skeletal muscle properties is important to understand the ...impact of CP and treatment but data at the microscopic levels are limited and inconsistent. Currently, muscle biopsies are collected during surgery and are restricted to CP eligible for such treatment or they may refer to another muscle or older children in typically developing (TD) biopsies. A minimally invasive technique to collect (repeated) muscle biopsies in young CP and TD children is needed to provide insights into the early muscle microscopic alterations and their evolution in CP. This paper describes the protocol used to 1) collect microbiopsies of the medial gastrocnemius (MG) and semitendinosus (ST) in CP children and age-matched TD children, 2) handle the biopsies for histology, 3) stain the biopsies to address muscle structure (Hematoxylin & Eosin), fiber size and proportion (myosin heavy chain), counting of the satellite cells (Pax7) and capillaries (CD31). Technique feasibility and safety as well as staining feasibility and measure accuracy were evaluated. Two microbiopsies per muscle were collected in 56 CP (5.8±1.1 yr) and 32 TD (6±1.1 yr) children using ultrasound-guided percutaneous microbiopsy technique. The biopsy procedure was safe (absence of complications) and well tolerated (Score pain using Wong-Baker faces). Cross-sectionally orientated fibers were found in 86% (CP) and 92% (TD) of the biopsies with 60% (CP) and 85% (TD) containing more than 150 fibers. Fiber staining was successful in all MG biopsies but failed in 30% (CP) and 16% (TD) of the ST biopsies. Satellite cell staining was successful in 89% (CP) and 85% (TD) for MG and in 70% (CP) and 90% (TD) for ST biopsies, while capillary staining was successful in 88% (CP) and 100% (TD) of the MG and in 86% (CP) and 90% (TD) for the ST biopsies. Intraclass coefficient correlation showed reliable and reproducible measures of all outcomes. This study shows that the percutaneous microbiopsy technique is a safe and feasible tool to collect (repeated) muscle biopsies in young CP and TD children for histological analysis and it provides sufficient muscle tissue of good quality for reliable quantification.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The implant-related failure risks of proximal humerus plates remain high, and therefore, improved solutions are needed. Systematic and efficient computational analyses can assist design optimisation ...of implant systems and may help reduce complication rates.
A previously developed validated computer simulation framework was used to optimise the screw orientations of a standard locking plate. Twenty low-density proximal humerus models with simulated unstable 3-part fractures were fixed using the Proximal Humeral Internal Locking System (PHILOS, DePuy Synthes) with six proximal screws. In a parametric analysis, the screw orientations were varied by relocating their tips within the humeral head and optimised based on two different metrics. In a first approach, average bone mineral density (BMD) around the screw tips was maximised. In a second approach, the average bone strain around the screw tips was evaluated using finite element (FE) analyses in three physiological loading situations and minimized to maximise the predicted fixation stability.
Optimisation based on BMD did not deliver any improvement. The final FE-based optimised configuration involved the adjustment of each screw and exhibited significantly smaller peri-implant bone strain (−18.49% ± 9.56%, p < 0.001) than the standard plate. Moreover, the optimised configuration provided a proportionally larger benefit for those digital subjects that had a higher predicted failure risk with the PHILOS plate.
Our findings suggest that the design of the investigated proximal humerus plate could be improved by changing the screw orientations. This study demonstrates the potential of FE analyses for implant optimisation. However, the results do not allow direct translation into a novel plate design, mainly owing to the use of a restricted set of bone samples, a single simplified fracture model, and lack of direct biomechanical confirmation of the computational findings.
A cohort-specific optimised proximal humerus locking plate design was evaluated using a previously validated computer simulation framework. This study showed that screw angle optimisation solely based on BMD is not sufficient and that incorporating the mechanical aspects is required. This approach could be used in the future to inform about the best screw trajectories for variable-angle locking plates or to develop novel implants for improved treatment of proximal humerus fractures. It is therefore expected to help reduce the complication rates of the implant-based treatment of these challenging injuries.
Histological data on muscle fiber size and proportion in (very) young typically developing (TD) children is not well documented and data on capillarization and satellite cell content are also ...lacking.
This study investigated the microscopic properties of the medial gastrocnemius muscle in growing TD children, grouped according to age and gender to provide normal reference values in healthy children.
Microbiopsies of the medial gastrocnemius (MG) muscle were collected in 46 TD boys and girls aged 2-10 years subdivided into 4 age groups (2-4, 4-6, 6-8 and 8-10 years). Sections were immunostained to assess fiber type cross-sectional area (fCSA) and proportion, the number of satellite cells (SC), capillary to fiber ratio (C/F), capillary density for type I and II fiber (CFD), capillary domain, capillary-to-fiber perimeter exchange index (CFPE) and heterogeneity index. fCSA was normalized to fibula length
and the coefficient of variation (CV) was calculated to reflect fCSA intrasubject variability.
Absolute fCSA of all fibers increased with age (r = 0.72,
< 0.001) but more in boys (+112%,
< 0.05) than in girls (+48%,
> 0.05) Normalized fCSA, CV and fiber proportion did not differ between age groups and gender. C/F was strongly correlated with age in boys (r = 0.83,
< 0.001), and to a lesser extent in girls (r = 0.37,
= 0.115), while other capillary parameters as well as the number of SC remained stable with increasing age in boys and girls.
This study provides reference values of histological measures in MG according to age in normally growing boys and girls. These data may be used as a reference to determine disease impact and efficacy of therapeutic approach on the muscle.
The optimal treatment and rehabilitation strategy for Achilles tendon ruptures is still under debate. There is a paradigm shift toward early mobilization and weightbearing. We examined the treatment ...effect of accelerated functional rehabilitation in nonoperative management of acute Achilles tendon ruptures. A systematic search of PubMed, EMBASE, and Web of Science databases for articles comparing accelerated versus delayed rehabilitation in the nonoperative management of acute Achilles tendon rupture was performed. Outcomes of interest were Achilles tendon rupture score (ATRS) (standardized patient-reported instrument related to symptoms and physical activity after treatment of an acute Achilles tendon rupture), rerupture rate, strength, range of motion, return to work, and sports. A total of 2001 articles were identified using our search strategy. We included 6 randomized controlled trials of interest. Although the concept of accelerated rehabilitation has gained popularity in recent years, no statistically significant differences could be revealed in any of the outcomes of interest. We performed a meta-analysis on the following outcomes: ATRS (mean difference -0.93 95% confidence interval CI -6.01 to 4.14), Rerupture rate (odds ratio OR 0.97, 95% CI: 0.46-2.03), Return to sports (OR 1.31, 95% CI 0.76-2.25), Return to work (mean difference 5.24, 95% CI to -12.04 to 22.51). The treatment effect of accelerated rehabilitation in nonoperatively treated patients seems to be small. However, we recommend accelerated rehabilitation for all conservatively treated patients, because it is a safe option and no detrimental effects have been described in the literature. Furthermore, many patients prefer this type of rehabilitation to avoid the practical disadvantages of prolonged immobilization.
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