Predictive factors for docking site procedure in bone transport for large lower extremity segmental defects.

BACKGROUND: Segmental bone transport is a common technique for treating large segmental bone defects. However, a docking site procedure is often necessary in segmental bone transport. To date, no prognostic factors for the need of docking site procedure have been reported. Thus, the decision is often made at random, based on the surgeon's subjective judgment and experience. The aim of this study was to identify prognostic factors for the need of docking site operation. METHODS: Patients with segmental bone transport in lower extremity bone defects were included regardless of age, aetiology, and defect size. We excluded patients undergoing treatments that were not yet completed, and those who discontinued therapy by any reason. The need for docking site operation was modelled with logistical and linear regression as well as univariate analysis of variances (ANOVA). Receiver operating characteristics (ROC) curve analysis was also performed. RESULTS: Twenty-seven patients from age 12 to 74 years (mean age: 39.07 ± 18.20 years) were included. The mean defect size was 76.39 ± 41.10 mm. The duration of transport (days) showed a significant influence (p = 0.049, 95%CI: 1.00-1.02) on the need for docking site operation. No other significant influences were detected. CONCLUSION: A link between the duration of transport and the need for docking site operation was detected. Our data showed that if a threshold of about 188 days is exceeded, docking surgery should be considered.

Limited influence of blunt aortic injuries on the outcome of polytraumatized patients: a matched pair analysis.

INTRODUCTION: Traumatic lesions of great vessels such as the aorta are life-threatening injuries. There is limited evidence about the influence of traumatic aortic injuries in multiple trauma patients in particular with regard to posttraumatic complications. The aim of this study was to evaluate the influence of blunt thoracic aortic injuries in multiple trauma patients compared to a multiple trauma cohort without this specific injury. In addition, the safety of Thoracic Endovascular Aortic Repair (TEVAR) in multiple trauma patients was analyzed. MATERIALS AND METHODS: A retrospective study was performed. We included all multiple trauma patients (ISS ≥ 16, age > 14 years) between 2005 and 2014 with (group BTAI) and without (group nBTAI) blunt traumatic aortic injuries who were treated at our level-1 trauma center. Demographic as well as clinical parameters were analyzed including injury pattern, mechanism of injury, posttraumatic complications such as ARDS, multiple organ dysfunction syndrome (MODS) and others. A matched pair analysis was performed by propensity score matching. RESULTS: In total, 721 patients were enrolled (group BTAI: n = 45; nBTAI: n = 676). In the initial study population, surgical intervention was done in n = 32 (71.1%) patients (TEVAR: n = 25; 78.1%), there was an increased AISChest and overall injury severity in group BTAI with associated significantly more posttraumatic complications in group BTAI. The matched pair analysis consisted of 42 patients per group. Beside an increased ventilation time, no significant differences were evident after the matching process. There was a trend to increased risk for SIRS using binary logistic regression analysis. CONCLUSIONS: Multiple trauma patients with blunt thoracic aortic injuries who are treated at a level-1 trauma center show a comparable outcome matched to their counterparts without aortic injuries. Our study confirms that using TEVAR in polytraumatized patients is a safe procedure. In all patients treated with TEVAR, there were no procedure-related complications, especially no neurological deficit.

[Injury to the upper limbs and prevention in equestrian sports]. / Verletzungen der oberen Extremität und Prävention im Reitsport.

The upper limb is one of the most frequently injured body regions in equestrian sports, but it is unclear which injuries are involved, and there are no data on the associated accident mechanism. The present study is aimed at evaluating the accident mechanisms, injuries of the upper limbs, and the circumstances of the accident in equestrian sports. We included 218 patients who were all treated between 2006 and 2014 at the level I trauma center at the Medical University in Hannover because of equestrian-related accidents. The most frequent injuries were fractures and bruising in the shoulder area, fingers and hands, and the distal area of the lower arm, which were mostly caused by the horse kicking. To prevent hand injuries it is recommended that gloves are worn; the potential introduction of strengthened materials could protect the bones from severe bumping. Training in falling techniques to prevent serious injury to the upper limb would be useful. In general, primary prevention in equestrian sports should be extended to counteract the increasing neglect of protective equipment.

[Injury prevention in amateur football with FIFA 11+ : What is implemented on the football pitch?] / Verletzungsprävention im Amateurfußball mit FIFA 11+ : Was kommt auf dem Sportplatz an?

BACKGROUND: The warm-up and injury prevention program FIFA 11+ was developed to reduce injuries in recreational and amateur level football. Despite systematic education it is uncertain what amount of knowledge is passed down to the lower recreational level football players and what exercises are implemented in the daily routine. This study presents the summarized experiences of German coaches about the implementation of exercises on the football pitch. MATERIAL AND METHODS: In this study 142 coaches who participated in 1 (of 5) of the 2­day courses between 2013 and 2017 were sent a questionnaire. The questionnaire consisted of 24 questions, which were developed by the football union of Lower Saxony. Incomplete questionnaires were excluded from the study. RESULTS: A total of 121 questionnaires could be analyzed, which is a response rate of 85.2%. The mean time period between the 2­day training and answering the questionnaire was 29 months. Of the participating coaches 82.6% indicated that they use the program regularly (22% of the coaches use it twice a week or more frequently, 34% use it only once a week) and 6% of the coaches use additional programs to prevent injuries. A total of 86% of the participants believed in a reduction in the incidence of injuries induced by the FIFA 11+ concept, 89% of the participants rated the FIFA 11+ program as good ors very good, 91% rated the teaching concept as good or very good and 94% of the participants would recommend the 2­day advanced course to others. DISCUSSION: The prevention program as well as the advanced training concept were evaluated very positively. Most coaches use the program regularly. Nevertheless, many coaches use the FIFA 11+ exercises less than the recommended twice a week. Most coaches praised the good structure of the program, but also wished for the possibility of variations. CONCLUSION: The prevention program FIFA 11+ is seen by coaches in recreational and amateur football as an effective tool to prevent injury. Implementation on the football pitch is regular but not as frequent as the evidence-based recommendations in the training concept.

[Accidents in equestrian sports : Analysis of injury mechanisms and patterns]. / Unfälle im Reitsport : Analyse von Verletzungsmechanismen und -mustern.

BACKGROUND: Equestrian sports are one of the most popular forms of sport in Germany, while also being one of the most accident-prone sports. Furthermore, riding accidents are frequently associated with a high degree of severity of injuries and mortality. Nevertheless, there are insufficient data regarding incidences, demographics, mechanisms of accidents, injury severity and patterns and outcome of injured persons in amateur equestrian sports. Accordingly, it was the aim of the present study to retrospectively analyze these aspects. METHODS: A total of 503 patients were treated in the emergency room of the Hannover Medical School because of an accident during recreational horse riding between 2006 and 2011. The female gender was predominantly affected with 89.5 %. The mean age of the patients was 26.2 ± 14.9 years and women (24.5 ± 12.5 years) were on average younger than men (40.2 ± 23.9 years). A special risk group was girls and young women aged between 10 and 39 years. The overall injury severity was measured using the injury severity score (ISS). RESULTS: Based on the total population, head injuries were the most common location of injuries with 17.3 % followed by injuries to the upper extremities with 15.2 % and the thoracic and lumbar spine with 10.9 %. The three most common injury locations after falling from a horse were the head (17.5 %), the upper extremities (17.4 %), the thoracic and lumbar spine (12.9 %). The most frequent injuries while handling horses were foot injuries (17.2 %), followed by head (16.6 %) and mid-facial injuries (15.0 %). With respect to the mechanism of injury accidents while riding were predominant (74 %), while accidents when handling horses accounted for only 26 %. The median ISS was 9.8 points. The proportion of multiple trauma patients (ISS > 16) was 18.1 %. Based on the total sample, the average in-hospital patient stay was 5.3 ± 5.4 days with a significantly higher proportion of hospitalized patients in the group of riding accidents. Fatal cases were not found in this study but the danger of riding is not to be underestimated. The large number of sometimes severe injuries with ISS values up to 62 points can be interpreted as an indication that recreational riding can easily result in life-threatening situations. CONCLUSION: Girls and young women could be identified as a group at particular risk. It has been demonstrated in this study that the three most common injury locations after falling from a horse were the head, the upper extremities, the thoracic and lumbar spine. The most frequent injury locations while handling horses were foot injuries, followed by head and mid-facial injuries.

[Cervical spine injury in equestrian sports]. / Halswirbelsäulenverletzungen im Breitenreitsport.

The cervical spine is considered fragile and vulnerable to injuries in equestrian sport. This retrospective study investigates the injury pattern and severity. Patients of the medical university in Hannover from the years 2006-2011, who had an equestrian accident, were identified. Patients who had been injured in the course of their work were excluded. Results counted with a p-value < 0.05 were considered significant. In 13.1% of patients, there were 71 cervical spine injuries (92.4% female; 7.6% male). The mean age was 27.1 ± 13.2 years. Of these, 86.4% associated the injury to the riding accident. In 56 cases, it concerned falls from the horse. In 13.6% of the cases, the injury was caused while handling the horse. Sprains were most common (70.4%). Fractures of the neck vertebrae were found in 22.5% of the cases. The mean ISS was 7.0 ± 5.8 pts. Polytrauma was identified in 6.1% of patients (ISS ≥ 16 Pkt). The most common accompanying injury presented was an injury to the head (29.2%; p = 0.003). Of the 30 hospitalized patients, 13.3% were admitted to intensive medical care for 2.3 ± 15.4 d. The mortality was 0%. Injuries of the cervical spine are not to be underestimated in their frequency and severity. It is shown that, especially with injuries of the head and thoracic and lumbar spine area, patients are at increased risk of concurrent cervical lesions. The prevention of neck injuries is currently done in the form of riding helmets, airbag jackets, riding behavior and education. Further study of the prevention of neck injuries is required.

[Biopsy and approach routes for bone tumors. Where and how much is sufficient?]. / Biopsie und Zugangswege bei Knochentumoren. Wo und wie viel ist genug?

Although biopsies are a key step in the diagnosis of bone tumors, they are often still referred to as a minor intervention which can be carried out by any surgeon as an outpatient procedure or quickly carried out between other more important tasks. A biopsy should, however, be regarded as the final part of the diagnostic procedure preceded by careful evaluation of the clinical course and analysis of the required imaging studies. Although the biopsy procedure seems technically simple to perform, an incorrectly performed biopsy can become an obstacle to correct tissue analysis (sampling error) and adequate tumor resection and may reduce the patient's chances of survival. The principles by which an adequate and safe biopsy of bone tumors should be planned and executed are reviewed and the surgical approaches to different anatomical locations are presented.

[Challenges in the context of medical care during a naval research expedition. A case report]. / Herausforderungen im Rahmen der ärztlichen Begleitung einer Forschungsseereise. Ein Erfahrungsbericht.

Exploration for natural resources in the seabed of the Indian Ocean was undertaken by the German government institution of earth sciences and resources ("Bundesanstalt für Geowissenschaften und Rohstoffe", BGR) in November 2012. To provide for the medical safety of crew and scientists, a cooperation between the BGR and the trauma department of the Hannover Medical School was established. Research by physicians accompanying the naval expedition revealed that medical consultations mainly occur because of respiratory infections, abdominal discomfort, genitourinary discomfort and seasickness, with the rate of traumas being between 31% and 41%. Di Giovanna et al. stated that 97% of all emergencies on cruise ships are not critical and only 3% need an immediate emergency medical intervention. Consultations were already performed on the mainland prior to departure and included minor traumas due to non-appropriate footwear, otitis and respiratory infections. Seasickness was the main reason for consultation during the first days at sea. Strong seas resulted in some bruises. Minor injuries and foreign body injuries to the hands and feet also required consultation. First-degree sunburns resulted from exposure to the sun, while air-conditioning caused rhinosinusitis and conjunctivitis. A special consultation was a buccal splitting of tooth 36. An immediate emergency medical intervention was not necessary due to the relative low level of pain for the patient; however, due to the risk of further damage caused by nocturnal bruxism, a protective splint was formed using a small syringe. Other reasons for consultation were similar to those reported in the general literature. Medical activities at exotic locations may create the vision of a holiday character at first; however, intensive planning and preparation are needed. We recommend contacting police, customs, the federal institute for drugs and medical devices as well as the labour inspectorate, preferably in both the originating country and the destination, to prepare custom formalities and to obtain formal documents and approvals beforehand. It is advisable to be prepared not only for emergency situations, but also for general medical and dental problems. Improvisation in the treatment of special health problems is an unavoidable requisite.

[Abdominal wall injury - risk of seat belt use]. / Bauchwandzerreißung - Risiko Sicherheitsgurt?

Abdominal seat belt marks can be an indication of abdominal wall rupture. The focused assessment with sonography for trauma (FAST) and computed tomography (CT) scanning are the diagnostic tools of choice in hemodynamically stable patients. The typical mechanism of trauma frequently leads to additional intra-abdominal injuries, spinal injuries and in some cases aortic rupture. Abdominal wall injuries of grade IV according to Dennis should be surgically treated. The increasing numbers of obese vehicle occupants and the resulting special risk of injury warrant optimization of technical restraint systems.

[Interdisciplinary extremity board in the treatment of complex injuries]. / Interdisziplinäres Extremitäten-Board in der Behandlung von Komplexverletzungen.

BACKGROUND: Interdisciplinary case conferences are well-established in the field of oncology in order to provide the best possible treatment for patients with complex disease patterns which overlap several disciplines. METHODS: After studying the available literature the aims, indications, frequency, patient enrolment and documentation modalities, disciplines necessary to create the reconstruction plan and evaluation parameters of the board, were agreed in an interdisciplinary discussion among colleagues. The utilization of the extremity board and demographic features of the cases presented in the extremity board within the first 6 months were subsequently descriptively analyzed. RESULTS: The agreed primary aim of an extremity board is the timely and transparent preparation of a high-quality holistic reconstruction plan for optimized treatment of a challenging patient collective with complex injuries of the extremities. Decisive interfaces of an extremity board are the participation of interdisciplinary disciplines, established enrolment and documentation modalities and a longitudinal analysis of parameters of the acute medical treatment, the long-term function and quality of life of those affected. The patient collective so far mostly includes men under 40 years old with traumatic soft tissue defects and combined injuries. On average, reconstruction plans for 1-2 patients were approved in an interdisciplinary team per session. CONCLUSION: The extremity board serves as a platform for coordinated planning of treatment for patients with complex injuries. The limited personnel and time resources represent the greatest challenge for the successful implementation. The extremity board enables a high degree of interdisciplinary networking. The digital registration and documentation modality within the internal hospital documentation system is of utmost relevance. The preparation of the reconstruction plan is of decisive importance for the qualitative success of treatment and the restoration of function. The longitudinal analysis of appropriate parameters is imperative to measure the quality of treatment.

Effects of trauma-hemorrhage and IL-6 deficiency on splenic immune function in a murine trauma model.

Splenic immune function is known to be depressed following hemorrhage. The present study investigates the effects of femoral shaft fracture, isolated or in combination with hemorrhage, on early stage cytokine production capacity of splenocytes and observes the role of IL-6 under these conditions. Male IL-6 knockout (IL-6(-/-)) and wild-type mice (WT) were randomly divided into three groups: sham (S), isolated femoral fracture (Fx), and femoral fracture + volume controlled hemorrhage (TH-Fx) (n = 6 per group). Animals were sacrificed four hours after induction of hemorrhage and fracture. Cytokine release (TNF-α, IL-6, and IL-10) of isolated and LPS-stimulated splenocytes was determined by cytometric bead array. Femoral fracture with or without hemorrhage caused a suppression of in vitro cytokine production capacity of splenocytes at an early posttraumatic stage in WT and IL-6(-/-). In the absence of IL-6, the profile of splenic cytokine secretion is significantly altered, identifying this cytokine as a potential therapeutic target to modulate the posttraumatic immune response.

Systemic inflammatory effects of traumatic brain injury, femur fracture, and shock: an experimental murine polytrauma model.

OBJECTIVE: Despite broad research in neurotrauma and shock, little is known on systemic inflammatory effects of the clinically most relevant combined polytrauma. Experimental investigation in an animal model may provide relevant insight for therapeutic strategies. We describe the effects of a combined injury with respect to lymphocyte population and cytokine activation. METHODS: 45 male C57BL/6J mice (mean weight 27 g) were anesthetized with ketamine/xylazine. Animals were subjected to a weight drop closed traumatic brain injury (WD-TBI), a femoral fracture and hemorrhagic shock (FX-SH). Animals were subdivided into WD-TBI, FX-SH and combined trauma (CO-TX) groups. Subjects were sacrificed at 96 h. Blood was analysed for cytokines and by flow cytometry for lymphocyte populations. RESULTS: Mortality was 8%, 13% and 47% for FX-SH, WD-TBI and CO-TX groups (P < 0.05). TNFα (11/13/139 for FX-SH/WD-TBI/CO-TX; P < 0.05), CCL2 (78/96/227; P < 0.05) and IL-6 (16/48/281; P = 0.05) showed significant increases in the CO-TX group. Lymphocyte populations results for FX-SH, WD-TBI and CO-TX were: CD-4 (31/21/22; P = n.s.), CD-8 (7/28/34, P < 0.05), CD-4-CD-8 (11/12/18; P = n.s.), CD-56 (36/7/8; P < 0.05). CONCLUSION: This study shows that a combination of closed TBI and femur-fracture/ shock results in an increase of the humoral inflammation. More attention to combined injury models in inflammation research is indicated.

[Implant removal after intramedullary osteosyntheses. Literature review, technical details, and tips and tricks]. / Implantatentfernung nach intramedullären Osteosynthesen. Literaturreview, technische Hinweise und Tipps und Tricks.

We present a literature review about implant removal after intramedullary stabilization of femoral or tibial shaft fractures, upper extremity fractures, and pediatric fractures. A special focus is the difficult implant removal. Implant removal of nails gets difficult when implants are bent or broken. Other difficulties include broken interfaces between nail and removal instrument or when bone ingrowth hinders extraction. A special difficulty is posed by broken solid nails. Implant failure shows typical failure patterns regarding the location of the fatigue fracture. Based on well-documented clinical cases, we describe in detail surgical techniques as well as tips and tricks which help in the difficult circumstances of bent or broken implants in proximal, midshaft, or distal nail segments for a large variety of implants (solid, cannulated, slotted). We also describe an elegant technique for the safe removal of an infected cemented arthrodesis nail. The time required to perform a nail removal can easily exceed the planned amount. Nail removal can result in significant complications like soft tissue damage, fractures, infections, and other problems. Not only because of these problems, the decision on whether or not to remove the nail should be made with great care. Therefore, good communication with the patient and thorough information about risks and benefits are essential.

[Accidental hypothermia in multiple trauma patients]. / Akzidentelle Hypothermie beim Polytrauma.

BACKGROUND: Hypothermia, defined as a body core temperature below 35 °C, could be divided into an endogeneous, therapeutic and accidental hypothermia. At admission in the emergency room multiple trauma patients show a hypothermic core temperature in up to 66 %. A core temperature below 34 °C seems to be critical in these patients as this temperature limit has been demonstrated to be associated with an increased risk for post-traumatic complications and a decreased survival. In polytraumatised patients with a core temperature below 32 °C a mortality rate of 100 % has been described. MATERIAL AND METHODS: The main pathophysiological effects of hypothermia concern the haemo-dynamic, coagulatory and immune systems. Mild hypothermia (35-32 °C) leads to a vasoconstriction, tachycardia and increased cardiac output. After an increasing arrhythmia and bradycardia severe hypothermia (< 32 °C) finally results in a cardiac arrest. Hypothermia-induced coagulopathy comprises a dysfunction of the cellular and plasmatic coagulation with an increased blood loss. Due to the attenuation of the post-traumatic, pro-inflammatory immune response and enhancement of anti-inflammatory reactions, hypothermia counteracts an overwhelming systemic inflammation, concomitantly resulting in an increased susceptibility for infectious complications. RESULTS: Because of the negative effects of the -accidental hypothermia, effective rewarming is essential for adequate bleeding control and successful resuscitation. As aggressive rewarming (> 0.5 °C / h) has been reported to be associated with an increased mortality during the further course, this procedure should only be applied in hypothermic multiple trauma patients with haemorrhagic shock. CONCLUSION: Accidental hypothermia represents a serious problem in multiple trauma patients due to its frequency and negative pathophysiological effects. Therefore, early and effective re-warm-ing is essential in the treatment of hypothermic trauma patients. Possible protective effects of a therapeutic hypothermia in the treatment of trauma patients after initial resuscitation and operative bleeding control have to be clarified in further experimental and clinical studies.

Productive capacity of alveolar macrophages and pulmonary organ damage after femoral fracture and hemorrhage in IL-6 knockout mice.

Alveolar macrophages (AM) play an important role in the pathogenesis of posttraumatic pulmonary failure, and have been identified as major source of pulmonary cytokines. The effects of locally generated IL-6 as well as femoral fracture on the pulmonary inflammatory response and organ damage have not been fully elucidated. In the present study we evaluated the influence of femoral fracture, isolated or in combination with hemorrhage, on the immune function of AM and remote lung injury, and investigated the role of pulmonary IL-6 within this setting. 18 wild type (WT) and 18 IL-6 knockout mice (IL-6(-/-)) underwent standardized femoral fracture, isolated or in combination with volume-controlled hemorrhage, followed by fluid resuscitation and splint fixation of the fracture. Animals were sacrificed 4h after induction of fracture and hemorrhage. Animals were randomly assigned to three study groups (each consisting of six animals). Besides sham groups, experimental groups included animals with isolated femoral fracture or in combination with hemorrhagic shock. Cytokine release of AM was determined by flow cytometry. Pulmonary damage in terms of interstitial thickening and lung neutrophil infiltration was assessed by histology and immunohistology. The productive capacity of AM for pro-inflammatory cytokines was increased after isolated femoral fracture in WT and IL-6(-/-) mice. An additional hemorrhagic insult resulted in a further enhancement of pro-inflammatory cytokine release and an increased MCP-1 secretion in WT and IL-6(-/-) animals. MCP-1 and pro-inflammatory cytokine production of AM was attenuated in IL-6(-/-) mice compared to the respective WT groups. Interstitial thickening and lung neutrophil infiltration was only observed after femoral fracture combined with hemorrhagic shock with an attenuation of the pulmonary organ damage in IL-6(-/-) compared to WT animals. These results support the role of IL-6 as a therapeutic target for posttraumatic immune modulation. With an increased pro-inflammatory mediator release, already an isolated femoral fracture seems to influence the immune response of AM.

Accuracy of high tibial osteotomy: comparison between open- and closed-wedge technique.

High tibial osteotomy is an established technique for the treatment of varus malaligned knees. This study analyses the difference between the amount of correction in the preoperative planning and the postoperative result. Furthermore, it compares the difference of the accuracy between open-wedge osteotomy and closed-wedge osteotomy. About 61 patients were either treated with open-wedge or closed-wedge high tibial osteotomy. Preoperative planning and postoperative analysis were performed with a special planning software. The influence of operative technique, aetiology, age, number of previous surgeries, amount of correction and accuracy of the correction compared to the preoperative planning were analysed. The overall postoperative mechanical axis differed form preoperative planning by 2.1° ± 1.7°. The accuracy in the open-wedge group (1.7° ± 1.6°) was significantly higher than in the closed-wedge group (2.6° ± 1.8°; P = 0.038). In patients with congenital varus deformity, the accuracy of the correction was significantly higher than in patients with post-traumatic deformity. The authors recommend open-wedge technique in combination with fixed-angle plates for high tibial osteotomy.

[Comparison of early total care (ETC) and damage control orthopedics (DCO) in the treatment of multiple trauma with femoral shaft fractures: benefit and costs]. / Early Total Care (ETC) im Vergleich zu Damage Control Orthopedics (DCO) bei der Behandlung polytraumatisierter Patienten mit Femurschaftfrakturen: Nutzen und Kosten.

INTRODUCTION: Femoral fractures are common injuries in multiple trauma patients. The treatment concept of damage control orthopedics (DCO) is in competition with the concept of early total care (ETC). PATIENTS AND METHODS: In a retrospective study (2003-2007) 73 multiple trauma patients with femoral shaft fractures were included. The cohort was subdivided according to the Injury Severity Score (ISS) (16-24, 25-39 and more than 40) and treatment strategy (ETC versus DCO). Patients were analyzed for outcome and cost aspects. RESULTS: In the patient group with an ISS 16-24 ventilation time and intensive care treatment were longer after DCO treatment, overall costs and deficient cost cover were higher in the DCO group. In the patient group with an ISS 25-39 cost aspects showed a higher cover deficient in the DCO group. CONCLUSION: From an economic point of view the cost deficits for the ETC group were lower than in the DCO group. The treatment strategy should be selected by the pattern of injuries. The costs should be addressed by the Institute for the Hospital Remuneration System (INEK).

[Injury to the subclavian and vertebral arteries in childhood following blunt force trauma]. / Verletzung der Aa. subclavia und vertebralis im Kindesalter nach stumpfem Trauma.

Injuries of great vessels, such as the subclavian or vertebral arteries in childhood are rare. More frequent and therefore better described are dissections of the vertebral artery, which frequently occur following low energy trauma. The combination of dissection of the vertebral and subclavian arteries described in this case study led to sensory affections of the left arm. Therapeutic anticoagulation is the therapy of choice to avoid possible ischemic insults. The therapeutic approach of injuries to the subclavian artery remains unclear and is in the focus of discussions.

[Requirements of trauma networks in Lower Saxony]. / Anforderungen an Traumanetzwerke in Niedersachsen.

BACKGROUND: The German Association of Trauma Surgery has developed a concept for the quality-assured care of severely injured patients; this concept includes the establishment of trauma networks. In this study, hospitals and emergency services in Lower Saxony were asked about their demands on the Hannover regional trauma network. MATERIALS AND METHODS: Trauma departments in Lower Saxony and adjoining federal states were asked to self-assess their level of trauma care. The demands of emergency services and trauma departments on the trauma network were also ascertained. RESULTS: Responses to the questionnaire were received from 70.2% of trauma departments and 11.5% of emergency services organizations. Of these, 46.9% of the trauma departments classified themselves as a "center of basic care", 50.0% as a "regional trauma center", and 3.1% as a "national trauma center". Compared with the regional trauma centers, centers of basic care requested fast transfers of patients to a trauma center significantly more often, whereas trauma centers desired more educational activities. CONCLUSION: The demands of trauma centers on a trauma network correspond with the aims formulated by the German Association of Trauma Surgery. These demands depend on the level of trauma care provided. Close cooperation with emergency services is essential to strengthen collaboration within the trauma network.

Injury severity in polytrauma patients is underestimated using the injury severity score: a single-center correlation study in air rescue.

PURPOSE: Prehospital estimation of injury severity is essential for prehospital therapy, deciding on the destination hospital and the associated emergency room care. The aim of this study was to compare prehospital estimates of the abbreviated injury scale (AIS) and the Injury Severity Score (ISS) by emergency physicians with the values of AIS and ISS of injury severity determined at the conclusion of diagnostics. METHODS: In this prospective study, the ISS was determined prehospital by emergency physicians. The validated AIS and ISS were analyzed based on final diagnoses. A Bland-Altman plot was used in analyzing the agreement between two different assays as well as sensitivity and specificity were determined. Confidence intervals were calculated for a Wilson score. Significance level was set at p ≤ 0.05. RESULTS: The prehospital ISS was estimated at 26.0 ± 13.0 and was 34.7 ± 16.3 (p < 0.001) after in-hospital validation. In addition, most of the AIS subgroups were significantly higher in the final calculation than preclinically estimated (p < 0.05). When analyzing subgroups of trauma patients (ISS < 16 vs. ISS ≥ 16), we were able to demonstrate a sensitivity of > 90% to identify a multiple-trauma patient. Diagnosing a higher injury severity group (ISS ≥ 25), sensitivity dropped to 61.1%. The Bland-Altman plot demonstrates that injury severity is underestimated in higher injury levels. CONCLUSION: Multiple-trauma patients can be identified using the ISS. Anatomic scores might be used for transport decisions; however, an accurate estimation of the injury severity should also be based on other criteria such as patient status, mechanism of injury, and other triage criteria.