Search

Study Design: Retrospective database analysis. Objective: Polytraumatized patients with spinal injuries require tailor-made treatment plans. Severity of both spinal and concomitant injuries determine timing of spinal surgery. Aim of this study was to evaluate the role of spinal injury localization, severity and concurrent injury patterns on timing of surgery and subsequent outcome. Methods: The TraumaRegister DGU® was utilized and patients, aged ≥16 years, with an Injury Severity Score (ISS) ≥16 and diagnosed with relevant spinal injuries (abbreviated injury scale, AIS ≥ 3) were selected. Concurrent spinal and non-spinal injuries were analysed and the relation between injury severity, concurrent injury patterns and timing of spinal surgery was determined. Results: 12.596 patients with a mean age of 50.8 years were included. 7.2% of patients had relevant multisegmental spinal injuries. Furthermore, 50% of patients with spine injuries AIS ≥3 had a more severe non-spinal injury to another body part. ICU and hospital stay were superior in patients treated within 48 hrs for lumbar and thoracic spinal injuries. In cervical injuries early intervention (<48 hrs) was associated with increased mortality rates (9.7 vs 6.3%). Conclusions: The current multicentre study demonstrates that polytrauma patients frequently sustain multiple spinal injuries, and those with an index spine injury may therefore benefit from standardized whole-spine imaging. Moreover, timing of surgical spinal surgery and outcome appear to depend on the severity of concomitant injuries and spinal injury localization. Future prospective studies are needed to identify trauma characteristics that are associated with improved outcome upon early or late spinal surgery. [ABSTRACT FROM AUTHOR] more...

Purpose: Removal of symptomatic hardware after fracture fixation is common, especially in patients with clavicle fracture. Yet, refracture after hardware removal is a relatively common complication in those patients. The aim of this study was to identify risk factors for clavicle refractures that could be influenced by the surgical treatment provided. Methods: All patients from a level one trauma center from 2017 to 2022 were screened for eligibility. Inclusion criteria included hardware removal after plate osteosynthesis of the clavicle, age ≥ 18 years, and signed informed consent. Groups were stratified according to occurrence of refracture: no-refracture (NR) vs. refracture (R). Nearest-neighbor matching in a ratio of 5:1 was performed. Parameter investigated included baseline demographics, fracture characteristics and surgical treatment details. A subgroup analysis of only clavicle shaft fractures was performed. Results: Sixty patients were included with 50 patients in Group NR and 10 in Group R. Baseline characteristics were comparable between the groups. A subgroup analysis on shaft fractures revealed that a significantly larger working length (number of empty screw holes adjacent to the fracture site) in Group NR (1.94 ± 0.85) compared to the refracture group (1.20 ± 0.92) (p = 0.042). Logistic regression yielded an inverse correlation with the number of empty screw holes to the fracture site and the occurrence of refractures (OR 0.369, 95% CI 0.132–0.873; p = 0.035). Time in situ, lag screw application, plate positioning and the total amount of screws did not affect either of the groups. Conclusion: An increased working length in patients with clavicle shaft fractures might be a protective measure for occurrence of refractures after hardware removal. [ABSTRACT FROM AUTHOR] more...

Background and Objectives: In the triaging of polytrauma, patients with less severe injuries and lower somatic stress often undergo isolated definitive orthopedic surgery without damage-control procedures. Adverse events, particularly sepsis, should be minimized. We aimed to identify sex-specific predictors for sepsis in polytrauma patients undergoing stand-alone definitive surgery. Materials and Methods: Our institutional trauma database, containing data from 3653 patients between 1996 and 2022, was filtered for polytrauma patients who underwent definitive surgery, were aged ≥16 years, and had an Injury Severity Score (ISS) ≥16. Injury and physiological parameters were documented upon admission, as well as on the first and second days thereafter. Surgical data were also recorded. All factors were evaluated for their association with sepsis development. Results: Among the 276 patients (71.1% male; mean age 45.0 years, 95% confidence interval 42.7–47.2 years; median ISS of 27, interquartile range, 20–34), the rate of sepsis was 13.8% (n = 38), with a higher incidence in males (16.7%; n = 33) than in females (6.8%; n = 5) (p = 0.026). Head and thorax injuries were more common and severe in septic males, with thorax injuries being predictive. Male patients who developed sepsis also had a higher ISS, an increased heart rate (HR), and lower pH at admission, with ISS and HR being predictive of sepsis. On the first day post-admission, septic males showed higher Base Excess and lower Prothrombin Time. Lactate levels were elevated on both the first and second days post-admission. Surgical predictors for males included less primary extremity surgeries and later secondary spine surgeries. Conclusions: Sepsis is more common in males undergoing stand-alone definitive surgery. Several factors, particularly acidosis and coagulopathy, are associated with this phenomenon. Fewer primary extremity surgeries and delayed secondary spine surgeries were also linked to a higher sepsis risk in males. These findings may help identify patients eligible for stand-alone definitive surgery and underscore the need for more data on female polytrauma patients. [ABSTRACT FROM AUTHOR] more...

Introduction: Pelvic ring fractures are known to be associated with complications associated with adjacent organ injuries, such as the urogenital tract (e.g. erectile dysfunction (ED), which are sometimes diagnosed in a delayed fashion. Therefore, we assessed the quality of life (QoL) and the rate of erectile dysfunction (ED) following pelvic ring fractures at a minimum of 3 years after pelvic ring injury. Methods: Between January 1, 2016, and December 31, 2020, adult male patients (≥ 18 years) with pelvic ring injuries were included in the study. Fractures were classified according to the Young & Burgess (Y&B) classification system, while pelvic contusions were categorized as the control group. Data were collected using a written questionnaire that assessed Quality of Life (QoL) by Short Form 12 (SF-12) and erectile dysfunction (ED) with the International Index of Erectile Function 5 (IIEF-5). ED was stratified as follows: no ED (21–25 points), mild ED (16–21 points), moderate ED (9–15 points), and severe ED (5–7 points). Comorbidities and risk factors for ED were also assessed, including vasculopathy, peripheral artery disease, hypercholesterolemia, coronary artery disease, diabetes, and smoking. Results: A total of 182 patients were included, with a mean age at injury of 53.5 years (SD 17.1) and a mean age at the time of the questionnaire of 57.8 years (SD 17.4). The distribution of patients was as follows: APC Group (n = 20, 11.1%), LC Group (n = 94, 52.2%), CMVS Group (n = 6, 3.3%), and Control Group (n = 60, 33.3%). The mean Injury Severity Score (ISS) was 24.6 points (SD 16.4). Regarding erectile dysfunction, 8 patients (17.4%) had no ED, 10 (21.7%) had mild ED, 6 (13.0%) had moderate ED, and 22 (47.8%) had severe ED. Quality of Life (QoL) was significantly reduced in patients with CMVS pelvic fractures, particularly in physical role function, which scored 62.5 points (SD 29.6, p < 0.001). All patients in the APC Group reported at least a mild form of ED. APC injuries were identified as an independent risk factor for lower IIEF-5 scores (OR -4.5, 95% CI -8.3 to -0.7, p = 0.02), comparable to other risk factors such as hypertension (OR -9.2, 95% CI -12.8 to -5.6, p < 0.001), diabetes (OR -5.3, 95% CI -9.4 to -1.2, p = 0.012), and smoking (OR -2.6, 95% CI -5.2 to -0.04, p = 0.05). Conclusion: Vertical shear fractures are associated with significantly lower quality of life compared to APC or LC fractures three years post-injury. The APC type of pelvic ring injury was identified as an independent risk factor for the development of erectile dysfunction (ED). Early screening and appropriate management should be initiated for patients with APC injuries to address and mitigate the risk of ED. [ABSTRACT FROM AUTHOR] more...

Introduction: Regional anesthesia increases in popularity in orthopaedic surgery. It is usually applied in elective surgeries of the extremities. The aim of this study was to assess indication of the use of general anesthesia in the surgical treatment of distal radius fractures. Methods: Patients undergoing surgical fixation for distal radius fractures between January 1st, 2020, and December 31st, 2021, were included. Exclusion criteria encompassed incomplete 12-month follow-up, transferred or multiply injured patients, those with prior upper limb fractures, or admission for revision surgeries. Patients were categorized by anesthesia type: GA or plexus block anesthesia (PA). Primary outcomes comprised tourniquet utilization and duration of surgery, while secondary outcomes encompassed complications (e.g., complex regional pain syndrome [CRPS], local wound infection, implant removal necessity) and range of motion at three, six, and twelve months post-surgery. Fractures were classified using the AO/OTA system. Results: The study enrolled 127 patients, with 90 (70.9%) in Group GA and 37 (29.1%) in Group PA. Mean patient age was 56.95 (± 18.59) years, with comparable demographics and fracture distribution between groups. Group GA exhibited higher tourniquet usage (96.7% vs. 83.8%, p = 0.029) and longer surgery durations (85.17 ± 37.8 min vs. 65.0 ± 23.0 min, p = 0.013). Complication rates were comparable, Group GA 12.2% versus Group PA 5.4% p = 0.407, OR 2.44; 95%CI 0.51 to 11.58, p = 0.343). Short-term functional outcomes favored Group PA at three months (e.g., Pronation: 81.1° ± 13.6 vs. 74.3° ± 17.5, p = 0.046). Conclusion: Solely classifying distal radius fractures does not dictate anesthesia choice. Complexity of injury, anticipated surgery duration, less use of tourniquet, and rehabilitation duration may guide regional anesthesia utilization over GA in distal radius fracture fixation. [ABSTRACT FROM AUTHOR] more...