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During the COVID-19 pandemic, a 13.6 per cent reduction in the number of surgical procedures performed was observed in 2020. Despite great pressure on healthcare, the COVID-19 pandemic did not cause an increase in adverse surgical outcomes, and oncological surgery-related duration of hospital and ICU stay were significantly shorter.Background The COVID-19 pandemic caused disruption of regular healthcare leading to reduced hospital attendances, repurposing of surgical facilities, and cancellation of cancer screening programmes. This study aimed to determine the impact of COVID-19 on surgical care in the Netherlands. Methods A nationwide study was conducted in collaboration with the Dutch Institute for Clinical Auditing. Eight surgical audits were expanded with items regarding alterations in scheduling and treatment plans. Data on procedures performed in 2020 were compared with those from a historical cohort (2018-2019). Endpoints included total numbers of procedures performed and altered treatment plans. Secondary endpoints included complication, readmission, and mortality rates. Results Some 12 154 procedures were performed in participating hospitals in 2020, representing a decrease of 13.6 per cent compared with 2018-2019. The largest reduction (29.2 per cent) was for non-cancer procedures during the first COVID-19 wave. Surgical treatment was postponed for 9.6 per cent of patients. Alterations in surgical treatment plans were observed in 1.7 per cent. Time from diagnosis to surgery decreased (to 28 days in 2020, from 34 days in 2019 and 36 days in 2018; P < 0.001). For cancer-related procedures, duration of hospital stay decreased (5 versus 6 days; P < 0.001). Audit-specific complications, readmission, and mortality rates were unchanged, but ICU admissions decreased (16.5 versus 16.8 per cent; P < 0.001). Conclusion The reduction in the number of surgical operations was greatest for those without cancer. Where surgery was undertaken, it appeared to be delivered safely, with similar complication and mortality rates, fewer admissions to ICU, and a shorter hospital stay.Lay Summary COVID-19 has had a significant impact on healthcare worldwide. Hospital visits were reduced, operating facilities were used for COVID-19 care, and cancer screening programmes were cancelled. This study describes the impact of the COVID-19 pandemic on Dutch surgical healthcare in 2020. Patterns of care in terms of changed or delayed treatment are described for patients who had surgery in 2020, compared with those who had surgery in 2018-2019. The study found that mainly non-cancer surgical treatments were cancelled during months with high COVID-19 rates. Outcomes for patients undergoing surgery were similar but with fewer ICU admissions and shorter hospital stay. These data provide no insight into the burden endured by patients who had postponed or cancelled operations.

Purpose The importance of treating severely injured patients in higher-level trauma centers is undisputable. However, it is uncertain whether severely injured patients that were initially transported to a lower-level trauma center (i.e., undertriage) benefit from being transferred to a higher-level trauma center. Methods This observational study included all severely injured patients (i.e., Injury Severity Score ≥ 16) that were initially transported to a lower-level trauma center within eight ambulance regions. The exposure of interest was whether a patient was transferred to a higher-level trauma center. Primary outcomes were 24-h and 30-day mortality. Generalized linear models including inverse probability weights for several potential confounders were constructed to evaluate the association between transfer status and mortality. Results We included 165,404 trauma patients that were transported with high priority to a trauma center, of which 3932 patients were severely injured. 1065 (27.1%) patients were transported to a lower-level trauma center of which 322 (30.2%) were transferred to a higher-level trauma center. Transferring undertriaged patients to a higher-level trauma center was significantly associated with reduced 24-h (relative risk [RR] 0.26, 95%-CI 0.10–0.68) and 30-day mortality (RR 0.65, 0.46–0.92). Similar results were observed in patients with critical injuries (24-h: RR 0.35, 0.16–0.77; 30-day: RR 0.55, 0.37–0.80) and patients with traumatic brain injury (24-h: RR 0.31, 0.11–0.83; 30-day: RR 0.66, 0.46–0.96). Conclusions A minority of the undertriaged patients are transferred to a higher-level trauma center. An inter-hospital transfer appears to be safe and may improve the survival of severely injured patients initially transported to a lower-level trauma center.

Additional file 1. Methods of identifying patients with necrotizing soft tissue infections.

Supplemental material, sj-pdf-1-han-10.1177_15589447211040879 for Effect of Tendon Strip (FCR vs APL) on Outcome of CMC Thumb Joint Arthroplasty With Pyrocarbon Disk Interposition by Cecile Maria Cornelia Agnes van Laarhoven, Marcus Chen Yee Tong, Mark van Heijl, Arnold Herman Schuurman and Brigitte Egeberta Petronella Adriana van der Heijden in HAND

Additional file 1. .

This meta-analysis compares functional, clinical, and radiologic outcomes after operative vs nonoperative treatment of distal radial fractures in adults., Key Points Question What outcomes are associated with operative vs nonoperative treatment of distal radius fractures in adults? Findings This meta-analysis of 2254 unique participants in 23 unique studies showed that operative treatment of distal radius fractures improved the medium-term Disabilities of the Arm, Shoulder and Hand questionnaire score and grip strength compared with nonoperative treatment in adults, with no difference in overall complication rate. Meaning These findings suggest that operative treatment might be preferred for distal radius fractures., Importance No consensus has been reached to date regarding the optimal treatment for distal radius fractures. The international rate of operative treatment has been increasing, despite higher costs and limited functional outcome evidence to support this shift. Objectives To compare functional, clinical, and radiologic outcomes after operative vs nonoperative treatment of distal radius fractures in adults. Data Sources The PubMed/MEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases were searched from inception to June 15, 2019, for studies comparing operative vs nonoperative treatment of distal radius fractures. Study Selection Randomized clinical trials (RCTs) and observational studies reporting on the following: acute distal radius fracture with operative treatment (internal or external fixation) vs nonoperative treatment (cast immobilization, splinting, or bracing); patients 18 years or older; and functional outcome. Studies in a language other than English or reporting treatment for refracture were excluded. Data Extraction and Synthesis Data extraction was performed independently by 2 reviewers. Effect estimates were pooled using random-effects models and presented as risk ratios (RRs) or mean differences (MDs) with 95% CIs. Data were analyzed in September 2019. Main Outcomes and Measures The primary outcome measures included medium-term functional outcome measured with the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) and the overall complication rate after operative and nonoperative treatment. Results A total of 23 unique studies were included, consisting of 8 RCTs and 15 observational studies, that described 2254 unique patients. Among the studies that presented sex data, 1769 patients were women [80.6%]. Overall weighted mean age was 67 [range, 22-90] years). The RCTs included 656 patients (29.1%); observational studies, 1598 patients (70.9%). The overall pooled effect estimates the showed a significant improvement in medium-term (≤1 year) DASH score after operative treatment compared with nonoperative treatment (MD, −5.22 [95% CI, −8.87 to −1.57]; P = .005; I2 = 84%). No difference in complication rate was observed (RR, 1.03 [95% CI, 0.69-1.55]; P = .87; I2 = 62%). A significant improvement in grip strength was noted after operative treatment, measured in kilograms (MD, 2.73 [95% CI, 0.15-5.32]; P = .04; I2 = 79%) and as a percentage of the unaffected side (MD, 8.21 [95% CI, 2.26-14.15]; P = .007; I2 = 76%). No improvement in medium-term DASH score was found in the subgroup of studies that only included patients 60 years or older (MD, −0.98 [95% CI, −3.52 to 1.57]; P = .45; I2 = 34%]), compared with a larger improvement in medium-term DASH score after operative treatment in the other studies that included patients 18 years or older (MD, −7.50 [95% CI, −12.40 to −2.60]; P = .003; I2 = 77%); the difference between these subgroups was statically significant (test for subgroup differences, P = .02). Conclusions and Relevance This meta-analysis suggests that operative treatment of distal radius fractures improves the medium-term DASH score and grip strength compared with nonoperative treatment in adults, with no difference in overall complication rate. The findings suggest that operative treatment might be more effective and have a greater effect on the health and well-being of younger, nonelderly patients.

Objectives/Interrogation: For treatment of CMC thumb joint osteoarthritis, a pyrocarbondisc can be used after distal hemitrapeziectomy as interposition arthroplasty. This disc can be secured with either a strip of the Flexor Carpi Radialis (FCR) or Abductor Pollicis Longus (APL) tendon. We analyzed[for full text, please go to the a.m. URL], 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

The prehospital trauma triage system consisting of regional ambulance services and overarching availability of mobile medical teams, the level criteria for trauma centres and inhospital care for trauma patients are wellorganised in the Netherlands. However, the quality of prehospital triage in the Netherlands is inadequate at the moment, with an average undertriage rate of more than 30%. There is, thus, much room for improvement in the quality of prehospital triage. Research in this area is now taking off, partly because of the arrival of a new quality indicator from the Netherlands National Health Care Institute, which states that at least 90% of multipletrauma patients should be primarily taken to a level 1 trauma centre.

This thesis is about the treatment of clavicle and proximal humeral fractures and is the result of a Swiss-Dutch collaboration. Clavicle and proximal humeral fractures are very common and used to be treated non-operatively. The last two decades we have seen a shift however towards more operative treatment. Despite many trials and other studies, until now there is still an ongoing debate about what the best treatment modality is for these fractures. ‘Patient selection’ together with ‘shared decision making’ are hot topics and are probably the key to future indications for operative or non-operative treatment of these fractures. This thesis presents several studies that aim to provide further evidence that can aid in making a decision for the best treatment for every single patient. The first part is about medial, shaft and lateral clavicle fractures. Medial clavicle fractures are rare injuries and generally treated non-operatively. We present an operative technique for displaced medial clavicle fractures. In this retrospective study we found excellent functional results. Furthermore, two studies about the intramedullary treatment of clavicle fractures were performed. One about the application of an end cap and one about the suitability of displaced clavicle shaft fractures. We concluded that the application of an end cap did not result in less implant related irritation and that fractures more lateral from the middle were less suitable for this technique from medial. Another study compared two implants for the treatment of instable lateral clavicle fracture. We concluded that whenever possible the superior plate with lateral extension should be used but that the Hook plate was a good alternative for very lateral fractures. And lastly, the current concepts for the treatment of collar bone fractures are discussed and treatment algorithms proposed. The second part covers the treatment of proximal humeral fractures. A systematic review and meta-analysis on displaced proximal humeral fractures (DPHF) was performed comparing the operative and non-operative treatment. As we found no difference in functional outcome, we concluded that for the typical patient presenting with a DPHF we recommend the non-operative treatment. In addition, a study on the long-term functional outcome and implant-related irritation after minimally invasive plate osteosynthesis (MIPO) of DPHF was performed. Satisfying functional outcomes after a mean of 8 years follow-up were found. However, about one third of the patients had a second operation for implant removal due to implant-related irritation. We also present a minimally invasive technique for proximal humeral fracture-dislocations. Functional results were promising and in 86% the humeral head was preserved. However, there is a high rate of re-operations either because of complications or for implant removal. In a last study we present the current concepts of proximal humeral fracture treatment. In general, non- or slightly-displaced proximal humeral fractures are treated non-operatively. Also, DPHF with elderly, osteoporotic and polymorbid patients can be treated conservatively. Older patients with a proximal humeral fracture-dislocation should be treated with a prosthesis, young and active patients with an osteosynthesis. For active and fit patients with a DPHF there is no consensus.

Worldwide, every five seconds a life is cut short as a result of an injury. Additionally, many more lives are affected by injury-related disabilities. In first world countries, systems of trauma care have been shown to substantially reduce the mortality associated with injury. In these trauma systems, different levels of trauma centers exist. In general, two levels of trauma centers can be distinguished; higher-level and lower-level trauma centers. Ensuring transport of severely injured patients to higher-level trauma center has a profound impact on these patients’ survival. At the same time, transport of patients without severe injuries to lower-level trauma centers should be warranted, in order to lower the preventable burden on higher-level trauma centers and unnecessary high costs. Every single day, emergency medical services (EMS) providers assess and make decisions for each individual patient: they have to start initial care, decide whether treatment at a trauma center is necessary, and if so, transport that patient to the most appropriate trauma center. This process of prehospital trauma triage plays a central role in every trauma system. The goal is to identify the at-risk patients and to timely transport them to the most appropriate trauma center. However, identification of severely injured patients is a challenging task. Prehospital trauma triage protocols have been developed to aid EMS providers in identifying severely injured patients. This thesis showed that currently used prehospital trauma triage protocols and triage quality are falling short and desperately need improvement. Evaluation of the prehospital trauma triage in different regions of the Netherlands showed that the triage protocol in use functioned so poorly; even flipping a coin had a higher chance of correctly identifying a severely injured patient. Fortunately, the EMS providers also rely on their clinical judgment and experience to assess the patient. Consequently, a large proportion of the severely injured patients are transported to higher-level trauma centers. Yet, work remains to be done, since 22%-27% of the severely injured patients were not transported to a higher-level trauma center. The newly developed and validated prediction model, as described in this thesis, could identify about 90% of the severely injured patients. This triage prediction model could aid EMS providers in their transport decisions. Furthermore, addition of EMS provider judgment could enhance the accuracy even more. The current trauma system is well designed; however, it can be improved substantially by accurate prehospital trauma triage. Inadequate prehospital trauma triage has a negative impact on the whole trauma system chain, such as a decreased functional outcome for the patient and relatively higher trauma care costs. Innovation, education, and regional collaboration are the three pillars on which this improvement is based. A newly developed triage tool serves as an important first step on the road ahead to optimize prehospital trauma triage. This road will lead to an improvement of the entire trauma care chain and provide future patients with the care they deserve.

With an overall incidence of 29 to 64 per 100.000 people a year, clavicle fractures are one of the most common fractures around the shoulder girdle. They account for 2.6% to 4% of all fractures in adults. About 80% of all clavicle fractures are located in the middle third of the clavicle. Although it is an ongoing topic of debate whether a displaced midshaft clavicle fracture (DMCF) should be treated conservatively or operatively, over the last decade, surgical fixation of DMCF’s has been increasing. Open reduction and plate fixation (PF) or intramedullary pin fixation (IMF) are two the most commonly used operative techniques. In this thesis, clinical and biomechanical properties of both operative techniques are reported. The main focus is on the optimal surgical approach for treating DMCF’s and minimizing implant-related irritation.