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5. Deep Surgical Site Infection after Fracture Has a Profound Effect on Functional Outcomes

Author

Gitajn, Ida Leah, Werth, Paul M., Carlini, Anthony R., Bosse, Michael J., Gary, Joshua L., Firoozabadi, Reza, Obremskey, William, McKinley, Todd O., Castillo, Renan C., O’Toole, Robert V., Westrick, Edward R., Carroll, Eben A., Goodman, James Brett, Holden, Martha B., Miller, Anna N., Spraggs-Hughes, Amanda, Brennan, Michael L., Tornetta, Paul, III, Weaver, Michael J., Heng, Marilyn, Osborn, Patrick M., Rivera, Jessica C., Murray, Clinton K., Kimmel, Joseph E., Moon, Charles, Hsu, Joseph R., Karunakar, Madhav A., Kempton, Laurence B., Seymour, Rachel B., Sims, Stephen H., Churchill, Christine, Reilly, Rachel M., Zura, Robert D., Howes, Cameron, Mir, Hassan, Wagstrom, Emily A., Mullis, Brian, Anglen, Jeffrey O., Mullis, Leilani S., Shively, Karl D., Gaski, Greg E., Natoli, Roman M., Sorkin, Anthony, Virkus, Walter, Hymes, Robert A., Holzman, Michael A., Malekzadeh, A. Stephen, Schulman, Jeff E., Schwartzbach, Cary C., Lee, Olivia C., Krause, Peter C., Morandi, Massimo 'Max', Choo, Andrew, Munz, John W., Boutte, Sterling, Galpin, Matthew C., Frisch, H. Michael, Kaufman, Adam M., LeCroy, C. Michael, Smith, Christopher S., Stall, Alec C., Horne, Andrea, Nascone, Jason W., OʼHara, Nathan N., Paryavi, Ebrahim, Sciadini, Marcus F., Degani, Yasmin, Howe, Andrea L., Hayda, Roman, Evans, Andrew R., Sietsema, Debra L., Stawicki, Stanislaw P., Wojda, Thomas, Gardner, Michael J., Bishop, Julius A., Rehman, Saqib, Caroom, Cyrus, Sheridan, Elizabeth, Miclau, Theodore, Morshed, Saam, Higgins, Thomas F., Haller, Justin M., Matuszewski, Paul E., Aneja, Arun, Wright, Raymond D., Jr., Bergin, Patrick F., Bhanat, Eldrin, Graves, Matt L., Morellato, John, Spitler, Clay A., Teague, David, Ertl, William, Ahn, Jaimo, Hesketh, Patrick, Moloney, Gele B., Weinlein, John C., Zelle, Boris A., Agarwal, Animesh, Karia, Ravi A., Sathy, Ashoke, Sanders, Drew T., Weiss, David B., Yarboro, Seth R., Lester-Ballard, Veronica, McVey, Eric D., Dagal, Arman, Githens, Michael, Kleweno, Conor, Agel, Julie, Whiting, Paul S., Simske, Natasha M., Siy, Alexander B., Attum, Basem, Burgos, Eduardo, Gajari, Vamshi, Rodriguez-Buitrago, Andres, Sethi, Manish, Tummuru, Rajesh R., DʼAlleyrand, Jean-Claude G., Allen, Lauren E., Collins, Susan C., Huang, Yanjie, and Taylor, Tara J.

Published
2024
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9. Early major fracture care in polytrauma--priorities in the context of concomitant injuries: A Delphi consensus process and systematic review.

Author

Pfeifer, Roman, Klingebiel, Felix Karl-Ludwig, Balogh, Zsolt J., Beeres, Frank J. P., Coimbra, Raul, Fang, Christian, Giannoudis, Peter V., Hietbrink, Falco, Hildebrand, Frank, Kurihara, Hayato, Lustenberger, Thomas, Marzi, Ingo, Oertel, Markus F., Peralta, Ruben, Rajasekaran, Shanmuganathan, Schemitsch, Emil H., Vallier, Heather A., Zelle, Boris A., Kalbas, Yannik, and Pape, Hans-Christoph

Published
2024
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22. Does Topical Vancomycin Powder Use in Fracture Surgery Change Bacteriology and Antibiotic Susceptibilities? An Analysis of the VANCO Trial

Author

Joshi, Manjari, O'Toole, Robert V., Carlini, Anthony R., Gary, Joshua L., Obremskey, William T., Murray, Clinton K., Gaski, Greg, Reid, J. Spence, Degani, Yasmin, Taylor, Tara J., Collins, Susan C., Huang, Yanjie, Whiting, Paul S., Patterson, Joseph T., Lee, Olivia C., Castillo, Renan C., Bosse, Michael J., Hsu, Joseph R., Karunakar, Madhav A., Kempton, Laurence B., Seymour, Rachel B., Sims, Stephen H., Churchill, Christine, Carroll, Eben, Goodman, James Brett, Holden, Martha B., Gardner, Michael J., Miller, Anna N., Spraggs-Hughes, Amanda, Brennan, Michael L., Weaver, Michael J., Rivera, Jessica C., Kimmel, Joseph E., Reilly, Rachel M., Zura, Robert D., Howes, Cameron, Mir, Hassan, Schmidt, Andrew H., Wagstrom, Emily A., Westberg, Jerald R., McKinley, Todd O., Natoli, Roman M., Sorkin, Anthony, Virkus, Walter, Hill, Lauren C., Hymes, Robert A., Holzman, Michael, Malekzadeh, A. Stephen, Schulman, Jeff E., Schwartzbach, Cary C., Krause, Peter C., Choo, Andrew, Boutte, Sterling, Frisch, H. Michael, Kaufman, Adam M., Large, Thomas M., LeCroy, C. Michael, Smith, Christopher S., Horne, Andrea, LeBrun, Christopher T., Nascone, Jason W., O'Hara, Nathan N., Sciadini, Marcus F., Slobogean, Gerard P., Howe, Andrea L., Rudnicki, Joshua S., Evans, Andrew R., Sietsema, Debra L., Stawicki, Stanislaw P., Wojda, Thomas R., Bishop, Julius A., Rehman, Saqib, Caroom, Cyrus, Ly, Thuan V., Sheridan, Elizabeth, Haller, Justin M., Bergin, Patrick F., Bhanat, Eldrin, Graves, Matt L., Jones, LaRita C., Morellato, John, Spitler, Clay A., Teague, David, Ertl, William, Moloney, Gele B., Weinlein, John C., Zelle, Boris A., Agarwal, Animesh, Karia, Ravi A., Sathy, Ashoke, Sanders, Drew, Weiss, David B., Yarboro, Seth R., Lester-Ballard, Veronica, McVey, Eric D., Firoozabadi, Reza, Simske, Natasha M., Siy, Alexander B., Attum, Basem, Burgos, Eduardo J., Gajari, Vamshi, Rodriguez-Buitrago, Andres, Sethi, Manish K., Trochez, Karen M., and Allen, Lauren E.

Published
2024
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26. Post-traumatic growth in polytraumatized patients after 20+ years: a long-term follow-up study of 337 patients treated at a level 1 trauma center

Author

Kalbas, Yannik, Halvachizadeh, Sascha, Kumabe, Yohei, Luidl, Anna Theresa, Steel, Jennifer Lynne, Zelle, Boris A, Cinelli, Paolo, Pape, Hans-Christoph, Pfeifer, Roman, and University of Zurich

Subjects
10021 Department of Trauma Surgery, Emergency Medicine, Orthopedics and Sports Medicine, Surgery, 610 Medicine & health, Critical Care and Intensive Care Medicine
Abstract

Purpose There is limited research on the long-term psychiatric outcomes of polytraumatized patients. Existing studies focus mainly on the negative sequelae. Post-traumatic growth (PTG) describes positive personal development after severe physical or mental distress. In this study, we investigated post-traumatic growth in polytraumatized patients at least 20 years after trauma. Methods Patients treated for polytrauma at a German level 1 trauma center between 1971 and 1990, were contacted 20+ years later. A questionnaire with 37 questions from the stress-related growth scale (SRGS) and the post-traumatic growth inventory (PGI) was administered. PTG was quantified in five specific areas. PTG and patient demographics were then analyzed using logistic regression. Results Eligible questionnaires were returned by 337 patients. 96.5% of patients reported improvements regarding at least one of the 37 questions. Approximately, a third of patients noticed distinct improvements regarding their relationship to others (29.2%), appreciation of life (36.2%) and attitudes towards new possibilities (32.5%). Patient demographics were significant predictors for the development of PTG: Older (p p = 0.042) and married patients (p = 0.047) showed a greater expression of PTG. We also saw significantly more PTG in patients with higher injury severity (p = 0.033). Conclusion 20 years after polytrauma, patients report improvements in their relationship with others, appreciation of life and attitude towards new possibilities. Women and married patients show higher expression of PTG. Furthermore, there is higher expression of PTG with higher age and injury severity. Post-traumatic growth should be identified and fostered in clinical practice. Level of evidence III—prospective long-term follow-up study.

Published
2023

28. Post-traumatic growth in polytraumatized patients after 20+ years: a long-term follow-up study of 337 patients treated at a level 1 trauma center

Author

Kalbas, Yannik; https://orcid.org/0000-0002-1550-328X, Halvachizadeh, Sascha; https://orcid.org/0000-0003-1393-3232, Kumabe, Yohei; https://orcid.org/0000-0003-2356-2930, Luidl, Anna Theresa, Steel, Jennifer Lynne, Zelle, Boris A, Cinelli, Paolo; https://orcid.org/0000-0002-0163-9055, Pape, Hans-Christoph; https://orcid.org/0000-0002-2059-4980, Pfeifer, Roman; https://orcid.org/0000-0003-1543-3995, Kalbas, Yannik; https://orcid.org/0000-0002-1550-328X, Halvachizadeh, Sascha; https://orcid.org/0000-0003-1393-3232, Kumabe, Yohei; https://orcid.org/0000-0003-2356-2930, Luidl, Anna Theresa, Steel, Jennifer Lynne, Zelle, Boris A, Cinelli, Paolo; https://orcid.org/0000-0002-0163-9055, Pape, Hans-Christoph; https://orcid.org/0000-0002-2059-4980, and Pfeifer, Roman; https://orcid.org/0000-0003-1543-3995

Abstract

PURPOSE: There is limited research on the long-term psychiatric outcomes of polytraumatized patients. Existing studies focus mainly on the negative sequelae. Post-traumatic growth (PTG) describes positive personal development after severe physical or mental distress. In this study, we investigated post-traumatic growth in polytraumatized patients at least 20 years after trauma. METHODS: Patients treated for polytrauma at a German level 1 trauma center between 1971 and 1990, were contacted 20+ years later. A questionnaire with 37 questions from the stress-related growth scale (SRGS) and the post-traumatic growth inventory (PGI) was administered. PTG was quantified in five specific areas. PTG and patient demographics were then analyzed using logistic regression. RESULTS: Eligible questionnaires were returned by 337 patients. 96.5% of patients reported improvements regarding at least one of the 37 questions. Approximately, a third of patients noticed distinct improvements regarding their relationship to others (29.2%), appreciation of life (36.2%) and attitudes towards new possibilities (32.5%). Patient demographics were significant predictors for the development of PTG: Older (p < 0.001), female (p = 0.042) and married patients (p = 0.047) showed a greater expression of PTG. We also saw significantly more PTG in patients with higher injury severity (p = 0.033). CONCLUSION: 20 years after polytrauma, patients report improvements in their relationship with others, appreciation of life and attitude towards new possibilities. Women and married patients show higher expression of PTG. Furthermore, there is higher expression of PTG with higher age and injury severity. Post-traumatic growth should be identified and fostered in clinical practice. LEVEL OF EVIDENCE: III-prospective long-term follow-up study.

Published
2023

44. The local soft tissue status and the prediction of local complications following fractures of the ankle region

Author

Halvachizadeh, Sascha, Klingebiel, Felix Karl Ludwig, Pfeifer, Roman, Gosteli, Martina, Schuerle, Simone, Cinelli, Paolo, Zelle, Boris A, Pape, Hans-Christoph, University of Zurich, and Halvachizadeh, Sascha

Subjects
Anklefracture, 610 Medicine & health, Review, Ankle Fractures, Soft tissue injury, Soft tissue status, Closed fracture, Swelling, Prediction, Tibial Fractures, Fracture Fixation, Internal, Fractures, Open, 10021 Department of Trauma Surgery, Treatment Outcome, 2732 Orthopedics and Sports Medicine, Humans, General Earth and Planetary Sciences, Ankle, 2711 Emergency Medicine, Retrospective Studies, General Environmental Science
Abstract

Introduction: Well-known risk factors (RF) for soft tissue complications following surgical treatment of fracture of the ankle region include diabetes, smoking, and the local soft tissue status. A weighted analysis might provide a risk profile that guides the surgical treatment strategy. The aim of this meta-analysis was to provide a risk profile for soft tissue complications following closed fractures of the ankle region. Methods: This review provides a meta-analysis of studies that investigate potential risk factors for complications in fractures of the ankle region. Inclusion criteria: Original articles that were published between 2000 and 2020 in English or German language that calculated odds ratios (OR) of RF for soft tissue complications. Further, this study only includes articles that investigated fractures of the ankle region including pilon fracture, calcaneal fractures, and fractures of the malleoli. This study excluded articles that provide exploratory analyses, narrative reviews, and case reports. RF were stratified as patient specific systemic RF (PSS), patient specific local RF (PSL), and non-patient specific RF (NPS). PSS RF includes comorbidities, American society of anaesthesiology (ASA), requirement of medication, additional injuries, and smoking or substance abuse. PSL RF includes soft tissue status, wounds, and associated complications. NPS RF includes duration of surgery, staged procedure, or time to definitive surgery. Random effect (RE) models were utilized to summarize the effect measure (OR) for each group or specific RF. Results: Out of 1352 unique articles, 34 were included for quantitative analyses. Out of 370 complications, the most commonly assessed RF were comorbidities (34.6%). Local soft tissue status accounted for 7.5% of all complications. The overall rate for complication was 10.9% (standard deviation, SD 8.7%). PSS RF had an OR of 1.04 (95%CI 1.01 to 1.06, p = 0.006), PSL an OR of 1.79 (95% 1.28 to 2.49, p = 0.0006), and NPS RF an OR of 1.01 (95%CI 0.97 to 1.05, p = 0.595). Additional injuries did not predict complications (OR 1.23, 95%CI 0.44 to 3.45, p = 0.516). The most predictive RF were open fracture (OR 3.47, 95%CI 1.64 to 7.34, p < 0.001), followed by local tissue damage (OR 3.05, 95%CI 1.23 to 40.92, p = 0.04), and diabetes (OR 2.3, 95%CI 1.1 to 4.79, p = 0.26). Conclusion: Among all RFs for regional soft tissue complications, the most predictive is the local soft tissue status, while additional injuries or NPS RF were less predictive. The soft tissue damage can be quantified and outweighs the cofactors described in previous publications. The soft tissue status appears to have a more important role in the decision making of the treatment strategy when compared with comorbidities such as diabetes., Injury, 53 (6)

Published
2022

46. Long-term analysis of chronic pain associated with lower extremity injuries

Author

Rauer, Thomas; https://orcid.org/0000-0003-4775-1103, Friedl, Eva, Gamble, Jamison G, Zelle, Boris A, Pape, Hans-Christoph; https://orcid.org/0000-0002-2059-4980, Pfeifer, Roman; https://orcid.org/0000-0003-1543-3995, Rauer, Thomas; https://orcid.org/0000-0003-4775-1103, Friedl, Eva, Gamble, Jamison G, Zelle, Boris A, Pape, Hans-Christoph; https://orcid.org/0000-0002-2059-4980, and Pfeifer, Roman; https://orcid.org/0000-0003-1543-3995

Abstract

INTRODUCTION The main objective of this study is to examine chronic pain and limping in relation to lower extremity and pelvic fracture location in addition to fracture combinations if multiple fractures are present on the same leg that have not been previously reported. We hypothesize that fracture pattern and location of lower extremity and pelvis fractures of multiple injured patients influence their long-term pain outcome. MATERIALS AND METHODS Retrospective cohort study. Patients with treated multiple lower limb and pelvic fractures at a level 1 trauma center and followed up for at least 10 years postinjury were assessed. Lower leg pain subdivided into persistent, load-dependent and intermittent pain, as well as limping were recorded by using self-administered patient questionnaires and standardized physical examinations performed by a trauma surgeon. Descriptive statistics were used to present comparative measurements between groups. RESULTS Fifty-seven percent of patients (n = 301) showed chronic lower limb pain 10 years postinjury. Ten percent of all patients with chronic pain displayed persistent pain, and here the most common fracture combination was tibial shaft fractures in combination with femoral shaft or proximal tibial fractures (13%). One hundred fifty-one patients reported load-dependent pain, with the most common fracture combinations being fractures of the foot in combination with femoral shaft fractures or distal tibial fractures (11%). One hundred twenty patients reported intermittent pain, with the most common fracture combinations involving the shaft of the tibia with either the femoral shaft or distal tibia (9%). Two hundred fifteen patients showed a persistent limp, and here the most common fractures were fractures of the femoral shaft (19%), tibial shaft (17%), and pelvis (15%). CONCLUSIONS In multiple injured patients with lower extremity injuries, the combination of fractures and their location are critical factors in long-term outcome.

Published
2022

47. The local soft tissue status and the prediction of local complications following fractures of the ankle region

Author

Halvachizadeh, Sascha; https://orcid.org/0000-0003-1393-3232, Klingebiel, Felix Karl Ludwig, Pfeifer, Roman; https://orcid.org/0000-0003-1543-3995, Gosteli, Martina; https://orcid.org/0000-0002-6519-7620, Schuerle, Simone, Cinelli, Paolo; https://orcid.org/0000-0002-0163-9055, Zelle, Boris A, Pape, Hans-Christoph; https://orcid.org/0000-0002-2059-4980, Halvachizadeh, Sascha; https://orcid.org/0000-0003-1393-3232, Klingebiel, Felix Karl Ludwig, Pfeifer, Roman; https://orcid.org/0000-0003-1543-3995, Gosteli, Martina; https://orcid.org/0000-0002-6519-7620, Schuerle, Simone, Cinelli, Paolo; https://orcid.org/0000-0002-0163-9055, Zelle, Boris A, and Pape, Hans-Christoph; https://orcid.org/0000-0002-2059-4980

Abstract

INTRODUCTION Well-known risk factors (RF) for soft tissue complications following surgical treatment of fracture of the ankle region include diabetes, smoking, and the local soft tissue status. A weighted analysis might provide a risk profile that guides the surgical treatment strategy. The aim of this meta-analysis was to provide a risk profile for soft tissue complications following closed fractures of the ankle region. METHODS This review provides a meta-analysis of studies that investigate potential risk factors for complications in fractures of the ankle region. INCLUSION CRITERIA Original articles that were published between 2000 and 2020 in English or German language that calculated odds ratios (OR) of RF for soft tissue complications. Further, this study only includes articles that investigated fractures of the ankle region including pilon fracture, calcaneal fractures, and fractures of the malleoli. This study excluded articles that provide exploratory analyses, narrative reviews, and case reports. RF were stratified as patient specific systemic RF (PSS), patient specific local RF (PSL), and non-patient specific RF (NPS). PSS RF includes comorbidities, American society of anaesthesiology (ASA), requirement of medication, additional injuries, and smoking or substance abuse. PSL RF includes soft tissue status, wounds, and associated complications. NPS RF includes duration of surgery, staged procedure, or time to definitive surgery. Random effect (RE) models were utilized to summarize the effect measure (OR) for each group or specific RF. RESULTS Out of 1352 unique articles, 34 were included for quantitative analyses. Out of 370 complications, the most commonly assessed RF were comorbidities (34.6%). Local soft tissue status accounted for 7.5% of all complications. The overall rate for complication was 10.9% (standard deviation, SD 8.7%). PSS RF had an OR of 1.04 (95%CI 1.01 to 1.06, p = 0.006), PSL an OR of 1.79 (95% 1.28 to 2.49, p = 0.0006), and NPS RF an O

Published
2022

50. Bewältigungsmechanismen schwerverletzter Patienten über 20 Jahre nach Trauma. Eine retrospektive Langzeitstudie

Author

Kalbas, Yannik, Halvachizadeh, Sascha, Luidl, Anna-Theresa, Zelle, Boris, Pfeifer, Roman, and Pape, Hans-Christoph

Subjects
ddc: 610, Langzeitstudie, Medicine and health, Bewältigungsmechanismen, Polytrauma
Abstract

Fragestellung: Es existieren wenige Studien zu der psychiatrischen Langzeitergebnissen schwerverletzter Patienten und diese fokussieren sich zudem meist nur auf negative Effekte wie posttraumatische Belastungsstörung und Depression. In dieser Retrospektiven Kohortenstudie untersuchen wir Bewältigungsmechanismen [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Published
2021
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