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Background Management of pelvic fracture associated haemorrhage is often complex with high morbidity and mortality rates. Different treatment options are used to control bleeding with an on-going discussion in the trauma community regarding the best management algorithm. Main body Recent studies have shown trans-arterial embolisation (TAE) to be a safe and effective technique to control pelvic fracture associated haemorrhage. Computed tomography (CT) evidence of active bleeding, haemodynamic instability, and pelvic fracture patterns are amongst important indicators for TAE. Conclusion Herein, we aim to provide a comprehensive literature review of the effectiveness of TAE in controlling haemorrhage secondary to pelvic fracture according to the indications, technique and embolic agents, and outcomes, whilst incorporating our Level 1 major trauma centre’s (MTC) results between 2014-2017. Electronic supplementary material The online version of this article (10.1186/s42155-018-0031-3) contains supplementary material, which is available to authorized users.

To review the management of patients >16 years with blunt splenic injury in a single, UK, major trauma centre and identify whether the following are associated with success or failure of non-operative management with selective use of arterial embolization (NOM ± AE): age, Injury Severity Score (ISS), head injury, haemodynamic instability, massive transfusion, radiological hard signs [contrast extravasation or pseudoaneurysm on the initial computed tomography (CT) scan], grade, and presence of intraparenchymal haematoma or splenic laceration. Retrospective, cross-sectional study undertaken between April 2012 and October 2015. Paediatric patients, penetrating splenic trauma, and iatrogenic injuries were excluded. Follow-up was for at least 30 days. 154 patients were included. Median age was 38 years, 77.3% were male, and median ISS was 22. 14/87 (16.1%) patients re-bled following NOM in a median of 2.3 days (IQR 0.8–3.6 days). 8/28 (28.6%) patients re-bled following AE in a median of 2.0 days (IQR 1.3–3.7 days). Grade III–V injuries are a significant predictor of the failure of NOM ± AE (OR 15.6, 95% CI 3.1–78.9, p = 0.001). No grade I injuries and only 3.3% grade II injuries re-bled following NOM ± AE. Age ≥55 years, ISS, radiological hard signs, and haemodynamic instability are not significant predictors of the failure of NOM ± AE, but an intraparenchymal or subcapsular haematoma increases the likelihood of failure 11-fold (OR 10.9, 95% CI 2.2–55.1, p = 0.004). Higher grade injuries (III–V) and intraparenchymal or subcapsular haematomas are associated with a higher failure rate of NOM ± AE and should be managed more aggressively. Grade I and II injuries can be discharged after 24 h with appropriate advice.

Articles describe a retrospective cohort study to assess the feasibility of reducing neointimal hyperplasia following interventions in chronic total occlusive peripheral vascular disease. The “sandwich” technique implemented is a novel modified angioplasty technique that combines heparin-bonded (Viabahn) stents with drug-eluting stents (Zilver PTX) deployed during arterial recanalisation. A review of 46 cases underwent this procedure at our institution as a limb saving procedure is conducted to determine mid-long-term patency outcomes and identify any subsequent interventions. Followup demonstrates favourable mid-long-term patency in 50% of TASC-C cases. No documented postprocedural complications were noted with unrelated observed mortality rates in either TASC-C or TASC-D subgroups. An observed advantage could be gained by using this new stenting technique via the subintimal recanalisation route. Albeit not statistically significant, type II diabetics and patients on aspiring had better sustained patency angioplasties. The sandwich technique has been shown to effectively offer symptoms relief and reduce total duration of hospital stay. Study findings support the need to evaluate the long-term efficacy through a larger longitudinal prospective study. However, to overcome the encountered study limitations, a well-structured methodology for comparison with conventional angioplasty techniques is essential to assess the synergetic potential of the sandwich technique.

Purpose. To determine whether a change in prophylactic antibiotic protocol for orthopaedic surgeries may reduce the frequency of Clostridium difficile–associated diarrhoeal infections. Methods. Records of 1331 patients who underwent trauma or elective surgeries involving implantation of metalwork were reviewed. 231 trauma and 394 elective patients who received intravenous cefuroxime–based antibiotic prophylaxis between August 2006 and January 2007 were compared with 216 trauma and 490 elective patients who received a single dose of gentamicin and flucloxacillin or teicoplanin for antibiotic prophylaxis between August 2007 and January 2008. Diarrhoeal faecal specimens of 148 (33%) trauma patients and 106 (12%) elective patients were examined. The outcome variables were the rates of C difficile infection and early deep wound infection. Results. There were 32 cases of C difficile–associated diarrhoeal infection and 28 cases of early deep wound infection. The frequency of C difficile–associated diarrhoeal infection decreased after use of the new antibiotic protocol (from 4 to 1%, p=0.004), particularly in the trauma patients (from 8 to 3%, p=0.02); in the elective patients the difference was not significant (from 1 to 0.5%, p=0.27). The change of antibiotic protocol did not significantly affect the incidence of deep wound infections in the trauma (p=0.46) or elective (p=0.90) patients. The rate of C difficile infection was 8-fold higher in the trauma than elective patients, both before and after the change of protocol. Conclusion. Changing antibiotic protocol is one way of reducing the incidence of C difficile–associated diarrhoeal infections in orthopaedic patients, without increasing the rate of deep wound infections.