European Journal of Trauma and Emergency Surgery最新文献

Purpose: Traumatic anterior hip dislocation is a severe but poorly studied injury. This study aimed to analyze characteristics, risk factors and prognostic factors regarding long-term morbidity and outcomes in patients who had sustained traumatic anterior hip dislocation.

Methods: Demographics, injury mechanism, and treatment-related characteristics of patients with anterior hip dislocations at three level-one trauma centers from 2009-2023 were analyzed. Acetabular and femoral morphology were assessed using CT scans to identify anatomical risk factors. Incidence of avascular necrosis (AVN), post-traumatic osteoarthritis (PTOA), further complications, return to work and sports, and patient-reported outcomes (PROMs), including Tegner Activity Scale (TAS) and modified Harris Hip Score (mHHS) were recorded at the follow-up.

Results: Out of 196 patients with traumatic hip dislocations, 19 anterior dislocations (12 iliac anterosuperior and 7 obturator) were identified. Ipsilateral knee injuries occurred in 36.8%, and 73.7% had concomitant femoral head or acetabular rim fractures. Obturator dislocations were commonly simple dislocations, while iliac dislocations involved more complex associated fractures often requiring surgery. Acetabular anteversion and cam-type femoroacetabular impingement (FAI) were identified as risk factors. Twelve patients (63%) were available for follow-up (mean 8.33 ± 5.05 years). The majority demonstrated good to excellent mHHS (mean 86.9), and minimal TAS decrease (5.33 to 4.67). AVN was not observed, and only one patient required hip arthroplasty following PTOA.

Conclusion: Anterior hip dislocations commonly result from high-energy "dashboard" injuries, with acetabular anteversion and cam-type FAI morphology being contributing risk factors. Long-term functional outcomes were favorable, with low rates of avascular necrosis or osteoarthritis, independent of type and complexity of the dislocation.

Background: Increased efforts to understand the reasons for the rise in pedestrian related traffic fatalities have demonstrated that these injuries occur in minority and lower income neighborhoods. The purpose of our study was to characterize the patient population suffering from pedestrian injuries in suburban setting, to determine whether the incidence of pedestrian injuries is associated with the social deprivation index (SDI) and to identify zip codes with a higher incidence of pedestrian injuries.

Methods: Single center, descriptive, retrospective cohort study of all patients suffering from pedestrian injuries admitted to our Level I Trauma Center (01/2014-10/2022). Demographic characteristics were summarized by groups and presented using the median (IQR) or frequency (%). Spearman's rank correlation was computed to assess the relationship between incidence of pedestrian injuries and SDI. ArcGIS was utilized to map the number of pedestrians injured, SDI, and percentage of households without a vehicle by zip code.

Results: 719 patients identified had suffered pedestrian injuries. Median age of injury was 49(IQR 29-64), and median ISS was 8(IQR 4-14). There was a weak, but significant positive correlation between incidence of pedestrian injuries and SDI [r = .16; p-value = 0.02]. The zip code with the most injuries was Hempstead.

Conclusions: Hempstead has the highest number of pedestrian injuries, highest SDI and highest percentage of households without a vehicle. However, overall correlation between incidence of pedestrian injuries and SDI was weak, suggesting that SDI may not be the only factor. Future research should focus on investigating other factors such as the presence of multilane arterial roads in these areas.

Purpose: Current guidelines recommend noninvasive ventilation (NIV) for chest trauma patients with acute respiratory failure. This study aimed to identify factors predictive of NIV failure and assess the risk of pneumothorax during NIV.

Methods: This retrospective study was conducted in four adult ICUs from January 2010 to January 2021. Patients were included if they were admitted with chest trauma and treated with NIV for acute respiratory failure.

Results: A total of 134 patients were included in the study. At NIV initiation the mean PaO2/FiO2 ratio was 251 mm Hg and 30% of patients were hypercapnic. NIV failure occurred in 33 patients (24.6%). In multivariate analysis, no independent factors were significantly associated with failure. Among the 79 patients without a pneumothorax before NIV, 1 patient (1.3%) developed a pneumothorax under NIV. 55 patients had a pneumothorax before NIV, 33 were treated with a chest tube, and 2 (6%) experienced recurrence of pneumothorax during NIV. For the remaining 22 patients with minimal pneumothorax monitored without chest tube, 3 (13.6%) had worsening of the pneumothorax under NIV.

Conclusions: In this multicenter study on chest trauma patients, NIV success was observed in approximately 75% of cases. No independent predictive factors for NIV failure were identified. While the risk of pneumothorax worsening under NIV was low, careful monitoring is essential, particularly when managing pneumothorax conservatively without chest tube placement.

The Section for Skeletal Trauma and Sports Injuries of the European Society for Trauma and Emergency Surgery (ESTES) has reached a consensus among European countries in the treatment of proximal humerus fractures in a working group. As a result the ESTES recommendations on proximal humerus fractures in the elderly were published in 2021. The various treatment options and algorithms for this are now described in more detail and the procedures were explained in several related specialist articles. The recommendations include conservative and four possible surgical treatment options (ORIF, nailing, hemi- and total inverse arthroplasty). This article deals with hemi- and total inverse arthroplasty. Reverse total shoulder arthroplasty (RTSA) has emerged as a key treatment for complex proximal humerus fractures in elderly patients. It offers significant advantages in restoring function, alleviating pain, and providing durable outcomes compared to alternative approaches. Despite challenges related to implant complications and surgical expertise, ongoing advancements in technology and techniques continue to improve its effectiveness. With the rising incidence of complex fractures, RTSA is expected to play an increasingly vital role in maintaining the quality of life in aging populations.

Introduction: After structured (S3 guideline, ATLS^®) acute care of multiple trauma patients in trauma centers, post-acute missed injuries continue to occur with incidence rates ranging from 1.3 to 39% as described in literature. The aim of the tertiary survey was the reduction of these rates. However, high numbers of missed injuries continue to be reported. The aim of this prospective, single-center, blinded clinical diagnostic study was to determine whether the standardised use of 3-phase whole-body skeletal scintigraphy in severely injured patients can reduce the number of missed injuries compared with the established standard procedure for polytrauma diagnosis.

Methods: 26 patients aged 18 years or older (median 53.5 years, 4 female, 22 male) with an ISS ≥ 9 were evaluated by an orthopaedic and trauma surgeon using skeletal scintigraphy after completion of standardised trauma room diagnostics and tertiary survey, a median of 7 days after trauma. All clinical and diagnostic examinations were then analysed and a final consensus was reached on the bony injuries. An evaluation of each procedure against the consensus was performed for the whole body and five body regions.

Results: Skeletal scintigraphy was clearly superior to the established method (sensitivity 98.8% vs. 75.4%). Of the 60 additional bony injuries identified, 25 were treated without therapeutic consequences. Twenty-nine were treated conservatively without additional immobilisation and five with additional immobilisation. One unnecessary immobilisation was ended and no surgical treatment was required.

Conclusion: Three-phase whole-body skeletal scintigraphy is a low-risk, highly sensitive tool for reducing the incidence of missed injuries. A more liberal indication for skeletal scintigraphy should be given for injuries of increasing severity and in persons with impaired consciousness or paralysis, to avoid sequelae of missed injuries.

Clinical trial registration: The study was registered at the German Clinical Trails Register (DRKS) with the identifier DRKS00029402.

Purpose: This narrative review systematically compiles and analyzes existing literature on the use of helical plates in orthopaedic trauma surgery. By synthesizing data across various study types, it provides a comprehensive overview of the biomechanical characteristics, clinical outcomes, and anatomical advantages of helical plating.

Methods: A systematic search was performed using PubMed and Web of Science databases, employing defined search terms to identify relevant studies. Single case reports were excluded, while structured case series were included. Retrieved studies were categorized into five groups: simulation studies, biomechanical studies, case series, clinical comparative studies, and anatomical studies.

Results: The review identified studies from 1992 to 2023, with most of the research focusing on the femur (7 studies) and humerus (6 studies). Biomechanical studies (7) were the most common, followed by clinical case series (7), comparative studies (4), and finite element analyses (3). European institutions contributed to the majority of research, with additional studies from Asia and South America. No randomized controlled trials were found. Helical plates demonstrated comparable stability to straight plates, with distinct biomechanical advantages: superior torsional resistance in femoral fractures and improved neurovascular safety in humeral fractures.

Conclusion: Helical plates offer a viable alternative to straight plates in long bone fractures, particularly for protecting neurovascular structures. Optimal designs vary by location, with 45° helical plates recommended for humeral minimally invasive plate osteosynthesis, 180° helical plates for young patients with femoral fractures, and 90° helical plates in geriatric double plating constructs. Further high-quality research is needed to establish definitive clinical guidelines.

Purpose: Chest wall trauma involving rib fractures represents an anaesthetic challenge, often resulting in high opioid requirements, hypoventilation, hypostatic pneumonia and respiratory failure. Regional anaesthesia (RA) techniques have the potential to reduce opioid consumption and maintain oxygenation. In this study we characterise a cohort of trauma patients who have received RA blocks and assess the impact of such techniques on respiratory support requirements, opioid consumption and outcomes.

Methods: We retrospectively collected data from all patients with chest wall trauma who received RA techniques with catheter placement from October 2018 to August 2022.

Results: Data from 187 patients was reviewed. Mean age was 64.25 years, median injury burden was 7 rib fractures and mean STUMBL score was 33.4. Erector Spinae Plane block (n = 131, 70.1%) and Serratus Anterior Plane block (n = 43, 23%) were the most used techniques. Thirty patients (16%) underwent rib fixation. RA significantly reduced the highest respiratory support requirements 24 h post-RA compared to 24 h pre-RA (p = 0.001) and lowest recorded peripheral oxygen saturations also significantly improved (91.5% pre-RA vs. 92.9% post-RA, p < 0.001). Opioid consumption significantly reduced 24 h post-RA compared to 24 h pre-RA (20.5 mg vs. 14 mg of intravenous morphine equivalents, p < 0.001). One hundred and forty-nine (79.7%) patients required ICU admission and 168 (89.8%) survived to hospital discharge.

Conclusion: Our analysis demonstrated improvement in respiratory support and reduction in opioid consumption following RA techniques in a high injury burden patient cohort. These results support RA utilisation in patients with significant chest wall trauma, especially if rib fixation is not immediately available.

Background: Traumatic hip dislocations in children and adolescents are rare but can lead to severe outcomes like avascular necrosis. Delayed reductions, often due to overlooked dislocations in initial imaging, pose a major risk. The variability in symptoms and emergency care challenges early diagnosis. This multi-center study evaluates diagnostic approaches to enhance protocols for identifying traumatic hip dislocations in childhood.

Methods: This retrospective multi-center study included 76 patients (aged ≤ 17 years) with acute traumatic hip dislocations and open growth plates from 16 German hospitals. Patient data and imaging from 1979 to 2022 were analyzed, with statistical evaluation performed using SPSS under ethical guidelines.

Results: X-rays (single and biplanar views) were the primary diagnostic method, utilized in 85% of cases. Dislocations were missed in 12% (9 cases), primarily among children under eight years, with half of those under four. Delayed reductions (15.8%, n = 12) were linked to undetected dislocations in imaging in 9 cases. Conventional X-rays frequently missed dislocations, whereas MRI successfully identified all cases. Among the 76 patients, 54 (71%) had associated injuries, with 57.9% (n = 44) diagnosed exclusively via MRI.

Conclusion: Timely diagnosis of traumatic hip dislocations is crucial, as delays increase the risk of femoral head necrosis. An algorithmic approach is essential for young children, where dislocations may not be readily suspected. MRI is vital in the secondary diagnostic phase, providing superior visualization of associated injuries, including acetabular avulsions and soft tissue interpositions highlighting the need for integration of MRI into a unified diagnostic algorithm for children suspected of such injuries.

Level of evidence: IV.

This chapter outlines the essential requirements for emergency responses to severe injuries. It emphasises the critical steps healthcare professionals must take in urgent situations, including: Rapid assessment and triage to prioritise treatment; Techniques for controlling massive external haemorrhages to prevent life-threatening blood loss; Maintaining a clear airway, ventilation, and neck stabilisation to support breathing and minimise spinal injury risks; Intravenous fluid replacement and medication administration to stabilise patients' conditions; Proper immobilisation of injuries to prevent further harm during transportation; Facilitating rapid and effective transfers to specialised medical centres, with clear communication ensuring seamless continuity of care. By adhering to these protocols, healthcare providers can efficiently navigate emergency situations, saving lives and minimising the long-term impact of critical injuries and illnesses.