Injury最新文献

This letter addresses the research conducted by Lin et al. regarding the shock index (SI) as an indicator of compensated shock in normotensive trauma cases. We acknowledge the authors' efforts while highlighting significant limitations: overlooked confounding due to cardioactive drugs, survival bias from omitting early fatalities, influences of prehospital fluid resuscitation, and insufficient age-specific SI thresholds. We additionally challenge transfusion as a surrogate for shock and emphasize the variation in injury mechanisms. Suggestions consist of modifications in pharmacovigilance, incorporation of early mortality statistics, and multi-center confirmations with microcirculatory outcomes.

Background: Chronic posttraumatic sequelae, such as chronic ankle joint infection with loss of the articular cartilage, significant ankle deformities with advanced osteoarthritis, or significant bone loss of the distal tibia or talus, cause chronic ankle pain and functional impairment. Arthrodesis is usually required to relieve pain and improve function. These disabling conditions cannot be treated with ordinary arthrodesis methods, particularly if they are associated with severe osteoporosis and/or poor soft-tissue coverage. The present study aimed to report the outcomes and complications of ankle arthrodesis with circular external fixators in patients with end-stage, posttraumatic ankle arthritis, infection, and/or bone loss.

Methods: Patients treated with tibiotalar and tibiocalcaneal fusion for posttraumatic sequelae using the circular external fixator between January 2001 and January 2022 were retrospectively reviewed. The outcomes were evaluated using the Catagni tibiotarsal fusion score, and the complications were recorded.

Results: The study included 81 consecutive patients; 58 were males, and 23 were females. The mean age of the patients was 41.52 years (range, 18-75). Successful arthrodesis was obtained in 73 patients (90.1 %). Twenty-four patients (29.6 %) developed complications. Most complications were minor except for unacceptable deformity in four patients, refracture of the arthrodesis site in one patient, and failure of arthrodesis in seven patients. At the final evaluation, the mean Catagni Score was 85.4 (range, 52-96). Fifty-eight patients achieved excellent results, 13 patients achieved good results, two patients achieved fair results, and eight patients achieved poor results. Higher Catagni scores were associated with patients without pre-operative infection, with union, without unplanned additional surgical procedures, without complications, and with better final results (all p < 0.001). In the multivariate regression analyses, we observed that the Catagni score tends to decrease as patient age increases (p = 0.010). Catagni scores of the anterior arthrodesis position were higher than the cases of the sinus tarsi position (p < 0.001).

Conclusion: Tibiotarsal arthrodesis with the circular external fixator can effectively treat complex ankle joint problems resulting from severe injuries. The Catagni score is a simple and reliable evaluation score after tibiotarsal arthrodesis surgeries.

Background: Acute extensor tendon injuries of the hand, commonly managed by plastic surgeons, require timely repair to optimize outcomes. This study evaluates the functional results, complications, and patient-reported outcomes of acute extensor tendon repairs performed in an outpatient setting using the Wide Awake Local Anaesthetic No Tourniquet (WALANT) technique in Northern Ireland.

Methods: A retrospective service evaluation analyzed 222 patients undergoing extensor tendon repair between 2018 and 2023. Inclusion criteria were adults (>18 years) with open injuries repaired via sutures. Exclusions included partial tears, fractures, and chronic injuries. Primary outcomes included Total Active Motion (TAM) and Patient-Rated Wrist/Hand Evaluation (PRWHE) scores. Secondary outcomes were infection, rupture rates, and grip strength.

Results: Mean age was 41 years, with 72.5 % males and 54.1 % non-dominant hand injuries. Mechanisms included lacerations (64 %), crush injuries (22 %), and avulsions (14 %). TAM was comparable across injury zones (Verdan classification), though distal zones (e.g., Zone 1) showed ∼30° lower TAM. PRWHE scores (mean: 8.2/50) indicated minimal pain/functional disability. Complications included two superficial infections (0.82 %) and one re-rupture (0.41 %). Grip strength matched normative values. Controlled Active Motion (CAM) rehabilitation yielded satisfactory outcomes, with proximal zones (Zones 7-8) associated with poorer PROMs.

Conclusion: Outpatient extensor tendon repair under WALANT is safe and effective, with low complication rates and favorable functional outcomes. Timely repair (<3 days), meticulous technique, and CAM rehabilitation contributed to success, supporting cost-effective management outside main operating theatres. Proximal injuries and rehabilitation protocols warrant further optimization. This study addresses a regional literature gap, advocating for prospective research to refine surgical and therapeutic strategies.

Therapeutic level: IV.

Background: Severe thoracic trauma is a leading contributor to mortality in critically injured patients, particularly when complicated by concomitant severe traumatic brain injury (TBI), which may independently impair neurological and respiratory function. Accurate assessment and timely intervention play a crucial role in these patients. However, risk factors for severe thoracic trauma remain unclear, and a prediction rule remains to be established. We developed and internally validated a nomogram that allows clinicians to quantify the risk of severe thoracic trauma.

Methods: Clinical data from the MIMIC-IV database were retrospectively searched to identify a study cohort comprising patients with severe thoracic trauma. Using LASSO regression analysis, We screened out independent risk factors associated with 28-day mortality and incorporated them into nomogram model. The performance of each model was assessed by calculating receiver operating characteristic (ROC) curves, calibration plots and decision curve analysis (DCA).

Results: The final analysis incorporated 2159 patients, with 192 deaths (8.9 %) occurring within 28-day of ICU admission. we constructed a nomogram that incorporates risk factors including heart rate (HR), traumatic brain injury (TBI), oxygen saturation (SpO2), systolic blood pressure (SBP), ventilation, and Sequential Organ Failure Assessment (SOFA) score on the first day of admission to ICU. The nomogram outperformed SOFA and Model 1 (risk factors including SBP, SpO2, TBI and ventilation) with an area under the receiver operating characteristic curve (ROC) of 0.854 (95 %CI 0.736-0.791, P < 0.001) in the training cohort and 0.859 (95 %CI 0.713-0.794, P < 0.001) in the validation cohort. The analysis of the calibration curve demonstrated that the nomogram exhibited a strong alignment with the observed 28-day mortality rates in severe thoracic trauma patients.

Conclusions: The study identified independent risk factors associated with the 28-day mortality risk and developed predictive nomogram models for ICU patients suffering from severe thoracic trauma. The nomogram shows promise in guiding strategies aimed at improving prognosis for patients with such injuries.

Not applicable.