Early Outcomes of Pelvic Trauma Patients - Complications, ICU Stay and Treatment Concepts in Two ATLS Compliant Trauma Centers: Germany and Qatar.

PURPOSE OF THE STUDY Pelvic trauma causes severe threats especially to polytraumatized patients. Not only it is in itself a possible cause for significant bleeding, but it also indicates a high risk for intra-abdominal injuries. The initial treatment of patients with pelvic trauma follows the ATLS principles of priority-oriented treatment. To examine the value of this highly standardized concept and to evaluate the effect of different patient collectives on early outcome parameters, two large collectives from Germany and Qatar were analyzed regarding injury parameters and early outcomes. MATERIAL AND METHODS Patients were recruited in Hamad General Hospital, Doha, Qatar (HGH) and BG Trauma Center Ludwigshafen, Germany (BG). All patients that were treated with a pelvic fracture between 2013 and 2016 were included in this retrospective analysis. Demographic parameters were collected as well as type of injury and the frequency of complication parameters as pneumonia, acute kidney failure, ARDS, sepsis and amount of blood transfusion. 1436 patients with pelvic fracture (645 from BG and 791 from HGH) were recruited. The mean age was 57.4 years in the BG and 33.6 years in the HGH group (p<0.000). The mean ISS was 17.81 in the BG and 15.88 in the HGH group (p=0.009). The mean pelvic AIS was 2.65 in the BG and 2.25 in the HGH group (p<0.000). RESULTS The mean frequency of complications was 9.3% in the BG and 9.9% in the HGH group (p=0.128). The mean frequency of ARDS was significantly higher in the BG group than in the HGH group (5.6% vs. 1.8%, p<0.000). The mean frequency of blood transfusion was significantly lower in the BG group than in the HGH group (28.8% vs. 39.2%, p<0.000). CONCLUSIONS Despite significant differences in the two collectives, this analysis shows comparable results regarding early outcome parameters in patients with pelvic injuries. In total, pelvic injuries are accompanied by a relatively high complication risk and need to be evaluated and treated according to priority-based algorithms. Key words: ATLS®, pelvic injury, complications, polytrauma.

[PHTLS team course: a pilot project. Structured student education in prehospital care of severely injured patients]. / Der PHTLS-TEAM-Kurs ­ ein Pilotprojekt. Strukturierte studentische Ausbildung in der präklinischen Versorgung schwerverletzter Patienten.

BACKGROUND: The training of medical school students at the University of Heidelberg seems to be improvable regarding prehospital trauma treatment compared to an established anaesthesiology-based training for medical emergencies. This study addresses the current situation and possibilities for advancing this training. MATERIAL AND METHODS: A baseline was set by interviews of the medical school students. Based on this the hypothesis was postulated that there is a deficit in the education of the medical school students concerning the training in prehospital trauma treatment. This was proved by questionnaires given to the students in the 7th and 8th semesters at the University of Heidelberg Medical School. The results were evaluated and a possible approach for improvement was developed. RESULTS: A total of 111 questionnaires could be evaluated. It could be shown that the existing education was not effectual and that there is a need for a praxis-orientated 1-day course in prehospital trauma treatment. CONCLUSION: Especially the treatment of multiply injured patients is a challenge for young medical professionals. However, there is a high motivation to learn and train in emergency medicine. The students long for a practical trauma course compared to the advanced medical CPR course provided by the Department of Anaesthesiology of the University of Heidelberg. Those algorithm-based trauma courses do exist with PHTLS® and ATLS®. Based on these courses we developed the PHTLS® TEAM course.

Reality-augmented virtual fluoroscopy for computer-assisted diaphyseal long bone fracture osteosynthesis: a novel technique and feasibility study results.

In this paper, a novel technique to create a reality-augmented virtual fluoroscopy for computer-assisted diaphyseal long bone fracture osteosynthesis and feasibility study results are presented. With this novel technique, repositioning of bone fragments during closed fracture reduction and osteosynthesis can lead to image updates in the virtual imaging planes of all acquired images without any radiation. The technique is achieved with a two-stage method. After acquiring a few (normally two) calibrated fluoroscopic images and before fracture reduction, the first stage, data preparation, interactively identifies and segments the bone fragments from the background in each image. After that, the second stage, image updates, repositions the fragment projection on to each virtual imaging plane in real time during fracture reduction and osteosynthesis using an OpenGL-based texture warping. Combined with a photorealistic virtual implant model rendering technique, the present technique allows the control of a closed indirect fracture osteosynthesis in the real world through direct insight into the virtual world. The first clinical study results show the reduction in the X-ray radiation to the patient as well as to the surgical team, and the improved operative precision, guaranteeing more safety for the patient. Furthermore, based on the experiences gained from this clinical study, two technical enhancements are proposed. One focuses on eliminating the user interactions with automated identifications and segmentations of bone fragments. The other focuses on providing non-photorealistic implant visualization. Further experiments are performed to validate the effectiveness of the proposed enhancements.