[TraumaNetwork, Trauma Registry of the DGU®, Whitebook, S3 Guideline on Treatment of Polytrauma/Severe Injuries - An Approach for Validation by a Retrospective Analysis of 2304 Patients (2002-2011) of a Level 1 Trauma Centre]. / Traumanetzwerk, TraumaRegister der DGU®, Weißbuch, S3-Leitlinie Polytrauma ­ ein Versuch der Validierung durch eine retrospektive Analyse von 2304 Patienten (2002­2011) an einem überregionalen (Level 1) Traumazentrum.

Background: In the last decades, a reduction in mortality in severely injured patients with an ISS ≥ 16 could be observed. Some authors report a death rate of about 22 %. Moreover, there were some new insights in the last years such as the reduction in mortality by use of whole-body CT and the introduction of the S3 guideline of the German Society of Trauma Surgery "Treatment of Patients with Severe and Multiple Injuries" have supported the evidence-based treatment of severely injured patients. Methods: A retrospective analysis of 2304 patients was performed between 2002 and 2011. The data of the authors' clinic for the trauma registry of the DGU® were used. After applying the inclusion criteria, ISS ≥ 16 and primary transfer from the accident site, 968 patients remained. Results: In the study population, a mean ISS of 29.81 and a mean GCS of 9.42 were found. The average age was 46.04 years. The mortality rate was 28.7 %. A significant difference between decedents and survivors was found at the ISS, GCS, RTS, new ISS, TRISS, RISC, AIS head, AIS skin, RR pre-clinical, pre-clinical heart rate and age. To test whether the lethality was reduced by the increased use of whole-body CT, a division into a group prior to and from 2009 was performed. Results revealed a significant increase in the whole-body CT rate from 56.96 to 71.7 %. The mortality rate declined from 32.3 to 24.5 %. In the same way it was verified whether the S3 guideline had an impact on mortality. Therefore, a division into groups before and from 2011 was conducted. Here, the mortality rate decreased from 30.4 to 18.4 %. In addition, a comparison between 2010 and 2011 was performed. Overall, there were statistically significant differences in the trauma room time, the surgical time, the volume infused, the rate of multiple organ failure and the rate of whole-body CTs performed. Conclusion: In the period from 2002 to 2011 a mortality rate of 28.7 % was found. The higher rate in comparison to published data is most likely explained by the high rate of serious and severe head injuries. The increased use of whole-body CT and the introduction of the S3 guideline led to a significant decrease in mortality in the authors' patient population. This is due particularly to the accelerating of the treatment of severely injured patients, the reduction of the infused volume, shortened surgical phase within the first 24 hours and the increased use of whole-body CT.

A Single Dose of the Anti-Resorptive Peptide Human Calcitonin Paradoxically Augments Particle- and Endotoxin-Mediated Pro-Inflammatory Cytokine Production In Vitro.

The peptide hormone calcitonin (CT) is known to inhibit bone resorption and has previously been shown also to prevent particle-induced osteolysis, the leading cause of revision arthroplasty. In the present study, the influence of human CT on the initial inflammatory response to particulate wear debris or bacterial endotoxins, ultimately leading to osteoclast-mediated bone resorption, was analysed in human THP-1 macrophage-like cells. The cells were activated with either ultra-high molecular weight polyethylene (UHMWPE) particles or bacterial lipopolysaccharides (LPS) in order to simulate an osteolysis-associated inflammatory response. The cells were simultaneously treated with human CT (10(-9) M). Cytokine production of tumour necrosis factor (TNF)-α was quantified on both RNA and protein levels while interleukins (IL)-1ß and IL-6 were measured as secreted protein only. Stimulation of the cells with either particles or LPS led to a dose- and time-dependent increase of TNF-α mRNA production and protein secretion of TNF-α, IL-1ß, and IL-6. Application of CT mostly enhanced cytokine production as elicited by UHMWPE particles while a pronounced transient inhibitory effect on LPS-induced inflammation became evident at 24 h of incubation. Human CT displayed ambivalent effects on the wear- and LPS-induced production of pro-inflammatory cytokines. Thereby, the peptide primarily upregulated particle-induced inflammation while LPS-induced cytokine secretion was temporarily attenuated in a distinct manner. It needs to be evaluated whether the pro- or anti-inflammatory action of CT contributes to its known anti-resorptive effects. Thus, the therapeutic potential of the peptide in the treatment of either particle- or endotoxin-mediated bone resorption could be determined.

[No improved survival rate in severely injured patients by prehospital intubation : A retrospective data analysis and matched-pair analysis]. / Kein verbessertes Überleben bei schwerstverletzten Patienten durch die präklinische Intubation : Eine retrospektive Datenanalyse mit Matched-pair-Analyse.

BACKGROUND: Training programs for the treatment of trauma patients generally recommend establishing a secure airway if the patient presents with a Glasgow coma scale (GCS) score of less than 9; however, the evidence for its effectiveness is rather sparse. This study analyzed the effect of preclinical intubation on mortality of patients with a GCS <9 in an emergency medical situation. METHODS: This retrospective analysis included patients who were primarily admitted to a German level 1 trauma center between 2002 and 2012 with an injury severity score (ISS) ≥ 16, a GCS < 9 and primary transport from the site of the accident. Data were collected from the trauma registry of the German Society for Trauma Surgery and from hospital records. A total of 455 patients were included and a matched-pair analysis of 62 patients was conducted. RESULTS: Both analytical methods showed no significant reduction in mortality rate after prehospital intubation. In the retrospective analysis intubated patients presented with a significantly lower systolic blood pressure on admission, received a higher amount of fluid volume at all phases of treatment and arrived at the hospital after a prolonged rescue time. In the matched-pair analysis, intubated patients also received a higher amount of fluid volume and showed better peripheral oxygen saturation on admission. No further differences between the groups could be found. CONCLUSION: It appears that preclinical intubation in trauma patients with a GCS < 9 does not result in a better outcome. The preclinical intubation resulted in a reduced systolic blood pressure on arrival at hospital, a prolonged preclinical rescue time and a greater amount of infused fluid volume.

Cervical biomechanics and neck pain of "head-spinning" breakdancers.

The cervical spine of breakdancers is at great risk due to reversed body loading during headspin manoeuvers. This study focused on the cervical biomechanics of breakdancers and a correlation with neck pain. A standardized interview and biomechanical testing of the cervical spine of 25 participants with "headspin" ability ages 16-34 years and an age-matched cohort of 25 participants without any cervical spine problems was conducted. Neck pain history, Neck Disability Index (NDI), cervical range of motion (CROM) and cervical torque were recorded. The "headspin" group reported significantly better subjective fitness, more cervical complaints, higher pain intensity, a longer history of neck pain and a worse NDI compared to the "normal" collective. The "headspin" group showed a 2-2.5 times higher rate of neck pain than the normal population, with increased cervical flexion (p<0.05) and increased cervical torque in all planes (p<0.001). The CROM showed a negative moderate to strong correlation with NDI, pain intensity and history of neck pain. Sports medicine practitioners should be aware of headspin maneuver accidents that pose the risk of fractures, dislocations and spinal cord injuries of breakdancers.

Measurement of the silver ion concentration in wound fluids after implantation of silver-coated megaprostheses: correlation with the clinical outcome.

BACKGROUND: Tumor patients and patients after traumas are endangered by a reduced immune defense, and a silver coating on their megaprostheses may reduce their risks of infection. The aim of this study was to determine the silver ion concentration directly measured from the periprosthetic tissue and the influence on the clinical outcome. MATERIAL AND METHODS: Silver ions were evaluated in 5 mL wound fluids two days postoperatively and in blood patients 7 and 14 days after surgery using inductively coupled plasma emission spectrometry in 18 patients who underwent total joint replacement with a silver-coated megaendoprosthesis. RESULTS: The concentration of silver ions averaged 0.08 parts per million. Patients who showed an increased silver concentration in the blood postoperatively presented a lower silver concentration in the wound fluids and a delayed decrease in C-reactive protein levels. There were significantly fewer reinfections and shorter hospitalization in comparison with a group that did not receive a silver-coated megaprosthesis. CONCLUSION: An increased concentration of silver in the immediate surroundings of silver-coated prostheses was demonstrated for the first time in cohorts of patients with trauma or tumors. An elevated concentration of silver ions in the direct periprosthetic tissue may have reduced the infection rate.

[Stingray injury--a harmless injury for surfers?]. / Der Stachelrochenstich--eine harmlose Wellenreitverletzung?

BACKGROUND: Stingray injuries with potentially lethal outcomes have been described in the medical literature, but a stingray injury to a surfer does not belong to the injuries treated daily in Germany. PATIENTS: We report on a stingray injury to a 31-year-old female with an uncommon course. RESULTS: Diagnostics of and therapy for stingray injuries are described. CONCLUSION: Stingray stings are painful injuries. In addition to the pain-relieving heat deactivation of the stingray toxin, the wound has to be cleaned to avoid secondary infection. Non-radiopaque foreign bodies should be ruled out by MRI. Stingray bites can cause severe injuries to water sportsmen and women with the need for surgical intervention.

Diagnosis of cervical spine injuries in children: a systematic review.

OBJECTIVE: The objective of this systematic review was to discuss current knowledge of the diagnostic management of cervical spine (c-spine) injuries in children. METHODS: Studies dealing with this topic were collected from the following sources: MEDLINE via PubMed, Embase, and Cochrane. Where possible, a meta-analysis was performed. Furthermore, the level of evidence for all the included publications was assigned. RESULTS: The incidence of cervical spine injury (CSI) in children is rare (1.39 %). It seems that the upper c-spine is more often injured in children younger than 8 years of age. When a CSI is expected, immobilization should be performed. The best immobilization is achieved with a combination of a half-spine board, rigid collar, and tape. The literature for thoracic elevation or an occipital recess in children younger than 8 years of age is inhomogeneous. The c-spine in children can be cleared by a combination of the National Emergency X-Radiography Utilization Study (NEXUS) low-risk criteria and the Canadian C-Spine Rule. Caution is advised for nonverbal and/or unconscious children. In these children, plain radiographs should be performed. If these images are inadequate or show hints for bony injuries, a computed tomography (CT) of the c-spine should be considered. Additional views of the c-spine offer only little information for clearing the c-spine.

[Fracture of the diaphyseal radius during Cyr wheel practice - an uncommon injury of wheel gymnastics]. / Distale Radiusschaftfraktur beim Cyr Wheel-Turnen - eine ungewöhnliche Rhönradverletzung.

The cyr wheel is a modified gymnastic wheel with only one ring that can lead to extreme forces on the gymnast. We report on a distal radius shaft fracture (AO 22 A 2.1) and a fracture of the styloid process of the ulna that occurred after holding on to a slipping Cyr wheel and exposition to high pressure on the lower arm. The fracture was fixed by screws and a plate.

[The "wheel gymnast's elbow" - first description of a common overuse syndrome]. / "Der Rhönradellenbogen" - Erstbeschreibung eines häufigen Überlastungssyndroms.

BACKGROUND: Overuse syndromes of the elbow due to wheel gymnastics are unknown in medical literature. This study describes a common overuse syndrome of the elbow in wheel gymnastics. METHODS: We conducted internet research and interviewed 260 wheel gymnasts, who trained the "hip roll" element. RESULTS: 60.4 % of the gymnasts reported changes of the elbow region. The intensity of pain during training was 1.51 out of 10 points. Lacerations were reported in 33.1 %, hematomas were reported in 68.7 %, and a loss of hair at the elbow region was reported in 11.7 %. 11.5 % of the gymnasts described a bump and 5.8 % described a depression of the proximal ulnar region that was not found before wheel gymnastics. Gymnasts using protective gear reported significantly higher levels of pain compared to gymnasts without protective gear. DISCUSSION: The "wheel gymnast's elbow" is a common overuse syndrome of the proximal ulnar due to direct contact and friction of the proximal ulnar to the giant wheel bars. The "wheel gymnast's elbow" describes a combination of lacerations, hematoma, hair loss, bumps, and depression of the proximal ulnar region with only slight pain. CONCLUSION: An early preventive use of protective gear during "hip roll" training can possibly reduce the "wheel gymnast's elbow" syndrome.

[Minimally invasive dorsal stabilization of the thoracolumbar spine]. / Minimal-invasive dorsale Stabilisierung der thorakolumbalen Wirbelsäule.

Thoracolumbar spine injuries represent the vast majority of unstable spine fractures. In common, patients are instrumented from a dorsal position while primary stabilization of those fractures using a ventral approach remains exceptional. Fracture morphology and concomitant injuries of the discoligamentous complex help to determine whether combined positions or second staged ventral positioned stabilization is indicated. While segmental stabilization and proper fracture reduction are the primary goals, the latter is of specific importance due to the angular point of the vertebral column in fractures of the thoracolumbar spine. The invasive surgical approach in open reduction and stabilization from a dorsal position seems to be replaced increasingly by less invasive angular stable internal spine fixator systems. This article describes the principle, suited indications and the limitations of one of the internal spine fixators available to achieve angular stable percutaneous dorsal stabilization.

BCL2-938C>A and CALCA-1786T>C polymorphisms in aseptic loosened total hip arthroplasty.

The search for influencing factors and new pathways in aseptic loosening of arthroplasties is a major focus of recent studies. Analyses of polymorphisms of genes revealed a correlation between a specific allele variant and aseptic loosening. The BCL2 gene encoding Bcl-2 with its BCL2 -938C>A polymorphism is a crucial factor of cell cycle control and cell survival. The CALCA -1786T>C polymorphism belongs to the CALCA gene encoding alpha-Calcitonin Gene Related Peptide (CGRP) and Calcitonin. Both proteins are important in bone metabolism and capable to influence the process of aseptic loosening. To date, no studies are reported for aseptic loosening with these two single nucleotide polymorphisms (SNPs). In a retrospective study we determined the distribution of the BCL2-938C>A and the CALCA-1786T>C polymorphisms in 87 subjects with aseptic loosened hip arthroplasties using RFLP and pyrosequencing analysis. Genotype distribution with prognosis of the hip arthroplasty showed neither an association with clinical characteristics of the patients nor the implantation technique. We were unable to detect any influence of these polymorphisms on time to aseptic loosening. motion.

[Breakdancer's "Headspin Hole" - first description of a common overuse syndrome]. / Das "Headspin Hole" bei Breakdancern - medizinische Erstbeschreibung eines häufigen Uberlastungsschadens.

INTRODUCTION: Several typical injuries due to breakdancing have been described in medical literature, but until now the "headspin hole" has not been mentioned. METHODS: We conducted internet research and interviewed 106 breakdancers. RESULTS: 60.4 % of the breakdancers suffered from overuse of the scalp due to the headspin. Loss of hair was found in 31.1 % and painless lumps on the head in 23.6 %. Inflammation of the scalp was reported in 36.8 %. DISCUSSION: The "Headspin Hole" is a common overuse syndrome of the scalp specific to headspins causing hair loss, inflammation and lumps on the skull.