Epidemiology of complete knee dislocations: an updated classification system.

INTRODUCTION: Current classifications of complete knee dislocations do not capture the extent of the complex concomitant ligamentous and bony injuries, which may have an impact on future outcomes. The purpose of this retrospective study was to evaluate the epidemiology of complete knee dislocations as well as to present an updated classification system based on the author's experience at a Level-I trauma center. MATERIALS AND METHODS: Only patients with complete loss of contact of the articulating bones and ≥ 18 years of age who admitted in our level-I trauma center between 2002 and 2019 were included. Patients were identified using a retrospective systematical query in the Hospital Information System (HIS) using the International Statistical Classification of Diseases and Related Health Problems Version10 (ICD-10) codes of the German Diagnosis Related Groups (G-DRG). RESULTS: Final data included 80 patients, with the majority of patients being male (n = 64; 80.0%). Mean age was 34.9 years (range: 18-70 years). External protective fixation was applied in 32 patients (40.0%). Reconstruction of the posterior cruciate ligament and the anterior cruciate ligament were performed in 56.3% (n = 45) and 55.0% (n = 44) of cases, respectively. The lateral collateral ligament complex was surgically addressed in 47.5% (n = 38), while the medial collateral ligament complex was reconstructed in 40% (n = 32). Surgery of the lateral meniscus and the medial meniscus was needed in 31.1% (n = 25) and 30.0% (n = 24). Neurovascular surgery occurred in 13.8% (n = 11). From the characteristic injury-patterns the authors of this study present a new classification system that ranks the injuries from Grade-A to Grade-D according to their severity. CONCLUSION: This retrospective study demonstrates that the historically used classification systems for dislocations of the knee are insufficient for these severe injuries. Concomitant ligamentous, neurovascular, bony, and meniscal injuries were frequent, and required several staged procedures. Consequently, an updated classification system is proposed.

Characteristics and Injury Patterns in Electric-Scooter Related Accidents-A Prospective Two-Center Report from Germany.

Since the introduction of rental E-scooters in Germany in mid-June 2019, the safety of this new means of transport has been the subject of extensive public debate. However, valid data on injuries and usage habits are not yet available. This retrospective two-center study included a total of 76 patients who presented to the emergency department following E-scooter-related accidents. The mean age was 34.3 ± 12.4 years and 69.7% of the patients were male. About half of the patients were admitted by ambulance (42.1%). Fractures were found in 48.6% of patients, and 27.6% required surgical treatment due to a fracture. The upper extremities were the most commonly affected body region, followed by injuries to the lower extremity and to the head and face. Only one patient had worn a helmet. In-hospital treatment was necessary for 26.3% of the cases. Patients presented to the emergency department mainly during the weekend and on-call times. This is the first report on E-scooter-related injuries in Germany. Accidents with E-scooters can cause serious injuries and, therefore, represent a further burden to emergency departments. The use of E-scooters appears to be mostly recreational, and the rate of use of protective gear is low.

The influence of alcohol on the outcome of trauma patients: a matched-pair analysis of the TraumaRegister DGU®.

BACKGROUND AND PURPOSE: In the diagnosis and treatment of trauma patients, numerous individual and trauma-related factors must be considered, all of which may influence the outcome. Although alcohol exposure is a major risk factor for an accident, its influence on the outcome is unclear. This matched-pair analysis investigates the hypothesis that alcohol has no negative impact on the outcome of trauma patients. MATERIALS AND METHODS: In a retrospective matched-pair analysis of the multi-centre database of the TraumaRegister DGU® patients with a maximum Abbreviated Injury Scale (MAIS) of 3 or greater from the years 2015 and 2016 with an alcohol level ≥ 0.5‰ were compared to patients with a measured alcohol level of 0.0‰. The patients were matched according to age, gender, AIS body regions (head, thorax, abdomen, pelvis/extremities) and survival presumption (Revised Injury Severity Classification Score (RISC) II the TraumaRegister ervals). RESULTS: After matching, a total of 834 patients were enrolled, with 417 patients in group with positive blood alcohol levels (BAL +) with a median alcohol level of 1.82‰ and 417 patients in the negative-alcohol group (BAL -). As a mechanism of injury, the BAL + group showed more often penetrating injuries, pedestrian accidents and low energy falls compared to car and motorcycle accidents in the BAL - group. BAL + patients were significantly less sedated (BAL -: 66.7% vs. BAL + : 56.2%, p = 0.002), less frequently transported by rescue helicopter, were more frequently hypotensive (BAL -: 42 patients (10.3%) vs. BAL + : 61 patients (15.2%), p = 0.045, Table 2) and exhibited lower base excess levels associated with an acidotic metabolic status compared to sober patients (acidosis: BAL -: 24 patients (6.1%) vs. BAL + : 61 patients (17.2%), p < 0.001). There was no difference regarding in-hospital complications, length of stay or mortality rate. CONCLUSIONS AND IMPLICATIONS: Our data demonstrate that alcohol exposure in trauma patients has no impact on complication or mortality rates. On the other hand, there are initially clear differences in the mechanism of injury, sedation, mode of transport and the acid-base balance.