Outcome after operative treatment of proximal humeral fractures in elderly patients.

BACKGROUND: The proximal humeral fracture (PHF) (5 %) of the elderly is the third most common fracture after proximal femoral and distal radius fractures. Proximal femoral fractures often lead to a loss of autonomy. OBJECTIVES: The aim of this study is to show how PHF changes the patient's autonomy and the coping with everyday life as well as which factors influence the outcome 1 year (y) after surgery. MATERIALS AND METHODS: Data of 62 patients with surgical treatment of a PHF ≥ 60 y was prospectively collected. With a telephone interview Short Form (SF) 12 (physical and mental health; PH, MH), Barthel Index (BI), range of motion, pain, and satisfaction was observed after 3 and 12 months. The dependence of outcome on different factors was investigated. RESULTS: The mean age was 73.3 y (median 73, 60-94). Mortality after 3 months was 3 % and after 1 y 11 %. The PH before the injury (47.9) was significantly better than after 3 months (37.1) and after 1 y (42.6). The MH showed no difference. The BI before the injury (92) was significantly better than after 3 months (86), but the same after 1 y (91). After 1 y > 50 % were able to abduct and flex the arm > 90°. More than two-thirds were able to perform everyday life activities for body care and nutrition after 1 y. Approximately, 73 % of the patients had little or no pain, and 84 % were satisfied with the result after 1 y. Good score values before the fracture resulted in better outcome. Higher severity in fracture led to a higher level of pain. DISCUSSION: A surgically treated PHF in the elderly does not lead to a relevant impairment in quality of life. Despite the lack of complete retrieval of range of motion patients achieve a good to very good result in coping with everyday life.

Pediatric trauma care with computed tomography--criteria for CT scanning.

Trauma centers, trauma management concepts, as well as integration of whole-body computed tomography (CT) reduced mortality significantly. The accuracy of a trauma care algorithm with emergency CT in children was evaluated. Data of 71 children with emergency CT were recorded retrospectively. In addition to epidemiological data admission date, kind of CT scan, mechanism of injury, missed diagnoses, injury severity score (ISS), admission to and time on intensive care unit (ICU), and time of hospitalization were observed. The algorithm for CT scanning was based on mechanism of injury, pattern of injury, and altered vital signs. Sixty-nine percent of the children reached the ER during on-call service hours. A percentage of 32.4 received a whole-body scan and 67.6 % a cranial scan. The mean ER ISS was 9.9 points (1-57). Children have different trauma mechanisms compared to adults. A percentage of 33.8 of the children had relevant trauma related findings in the CT scan. In 2 children, (2.8 %) 3 diagnoses (2.2 %) were initially missed. After reevaluation of the CT data, all diagnoses were identified. Thus, the accuracy of our algorithm in children was 100 %. In children, our algorithm detected all injuries, but only one third of the children had relevant trauma related findings in the CT scan. In order to reduce radiation exposure but preserve the advantages of CT, a new algorithm was developed with more flexibility taking the child's age and mental status more into account as well as clinical findings. The mechanism of injury itself is not anymore an indication for CT scanning.

Triplane Fracture of the Distal Fibula.

This is a case report of a 14-year-old girl with a triplane fracture of the distal fibula. The fracture showed displacement and was treated by open reduction, internal fixation, and 5 weeks of external immobilization. The follow-up 5 months after injury yielded an excellent clinical result. Triplane fractures are also seen in locations other than the growth plate of the distal tibia. Due to the occurrence close to the end of the growth period, the potential for growth deformity is negligible. There has been no previous report of a transitional fracture in this location.