Postoperative recreational sports and subjective shoulder function: a comprehensive analysis following intramedullary stabilization of displaced midshaft clavicular fractures.

Introduction Sports-related outcomes and the role of recreational sports activities for shoulder function after intramedullary stabilization (IMS) of displaced midshaft clavicular fractures (DMCFs) in the general population are not well known. In this study, we aimed to determine the sport-related outcomes (return-to-sports [RTS] rate, type of sports, time until RTS, and intensity) and to explore the role of sports after IMS of DMCFs. Materials and Methods This single-center, retrospective, cohort study included patients who underwent IMS of DMCFs between 2009 and 2022 at a Level II trauma center in Germany, experienced no major complications, and had completed at least 1 year of follow-up. Propensity score matching was conducted to obtain a balanced sample of patients who did not engage (cases) and engaged (controls) in postoperative sports activities by adjusting for age and fracture complexity. Groups were compared to assess the impact of regular sports activities on subjective shoulder functioning at follow-up, as evaluated using the Disabilities of the Arm, Shoulder, and Hand and Oxford Shoulder Score (OSS) questionnaires, after controlling for the patient- (i.e., sex and smoking) and treatment- (i.e., surgery duration and physical therapy) factors. Results Among the 199 patients included, the RTS rate was 97.5%, and 160 patients practiced regular postoperative activity, mostly in the same sport and intensity. In the matched cohort (39 cases and 39 controls), practicing regular sports activities postoperatively was the only independent factor associated with a higher OSS in the multiple regression analysis (unstandardized regression coefficient = 2.40; Bias-corrected and accelerated 95% confidence interval [0.28, 4.69]). Conclusions The sport-related outcomes after IMS of DMCFs in our cohort were comparable to those achieved after plate osteosynthesis, and IMS reported in the literature. Recreational sports activities benefitted subjective shoulder function, thereby encouraging further research and potentially influencing management policies. Level of evidence Grade IV - a retrospective observational cohort study.

Factors affecting duration of inability to work after intramedullary stabilization of displaced midshaft clavicular fractures.

BACKGROUND: Duration of inability to work (DIW) after displaced midshaft clavicular fractures (DMCF) is an important clinical and socioeconomic treatment outcome. However, evidence on DIW after DMCF intramedullary stabilization (IMS) is still limited. We aimed to examine DIW and identify medical and socioeconomic predictors with direct or indirect impact on DIW after IMS of DMCF. HYPOTHESIS: Socioeconomic predictors can explain the unique proportion of the DIW variance after IMS of DMCF above the variance explained by medical predictors. PATIENTS AND METHODS: Using a retrospective cohort unicentric design, we included patients surgically treated with IMS after DMCF from 2009-2022 with employment status subject to compulsory social security contributions, and without major postoperative complications, in one level II trauma center in Germany. In total, we tested the impact of 17 different medical (i.e., smoking, body mass index [BMI], operative duration, etc.) and socioeconomic predictors (i.e., health insurance type, physical workload, etc.) on DIW. Statistics included multiple regression and path analyses. RESULTS: A total of 166 patients met the eligibility criteria, with DIW 35.1±31.1days. Operative duration, physical workload, and physical therapy prolonged the DIW (p<0.001). In contrast, enrollment in private health insurance reduced the DIW (p<0.05). Furthermore, the effect of BMI and fracture complexity on DIW was fully mediated by operative duration. The model explained 43% of the DIW variance. DISCUSSION: Socioeconomic factors were found to directly predict the DIW, even after controlling for medical predictors, which confirmed our research question. This is in line with previous findings and highlights the relevance of socioeconomic predictors in this context. We believe that the proposed model can serve surgeons and patients as an orientation guide to estimate the DIW after IMS of DMCF. LEVEL OF EVIDENCE: IV - retrospective observational cohort study with no control group.

[The KomMent study: a pilot project on structured interprofessional communication in uro-oncology]. / Die KomMent-Studie: ein Pilotprojekt zur strukturierten interprofessionellen Kommunikation in der Uroonkologie.

BACKGROUND: Communication and interprofessional collaboration with patients diagnosed with cancer is challenging. Structured communication training has not yet been integrated into postgraduate medical education. The aim of this study was to evaluate the feasibility of an 80-teaching unit interprofessional communication training (ICT), as recommended in the National Cancer Plan, at a clinic with a uro-oncological focus. METHODS: A needs assessment was conducted using focus groups and individual interviews. Learning objectives were aligned with (inter)national learning objective catalogs. The ICT was developed using the six-step approach according to Kern and design-based research. Utilization and acceptance were evaluated. The ICT comprised six face-to-face workshops (50 teaching units) and team supervision sessions (10 teaching units). Six defined settings were identified for the individual workplace-based training (20 teaching units): Ward rounds, handover, reporting of medical findings, admission and discharge interviews, and a freely choosable setting. RESULTS: Physician participation rates in the workshops were 83.0% and nursing participation rates were 58.3%. Utilization of the workplace-based training was 97%. The physicians evaluated the ICT very positively. All participants felt better prepared for discussions with patients and relatives. For continuity, physicians were trained as mentors. CONCLUSION: The implementation of an ICT with 80 teaching units is successfully feasible in a urological clinic and leads to a sustainable improvement of the communication culture, among other things through mentor training.

[Remifentanil up2date - Part 2]. / Remifentanil up2date ­ Teil 2.

Remifentanil is a short-acting opioid of high analgetic potency and superior controllability. It is widely used in day-case surgery, procedural sedation, for reduction of recovery-times and obstetrics and whenever excellent controllability of opioid effects is needed. Especially in combination with propofol it is used for target controlled infusion (TCI). The second part of the article shows the differences between groups of patients regarding the use of remifentanil.

[Remifentanil Up2date - Part 1]. / Remifentanil up2date ­ Teil 1.

Remifentanil is a short-acting opioid of high analgetic potency and superior controllability. It is widely used in day-case surgery, procedural sedation, for reduction of recovery-times and obstetrics and whenever excellent controllability of opioid effects is needed. Especially in combination with Propofol it is used for target-controlled infusion (TCI). The first part of the article provides readers with information about historical aspects, pharmacological characteristics, effects and side effects of remifentanil.

Atypical cardioversion in unstable arrhythmia caused by clavicle surgery.

We report on a 54-year old male with traumatic brain injury, flail chest and floating shoulder undergoing intramedullary stabilization of a midshaft clavicle fracture in beach chair position. Intraoperatively the patient developed instable atrial fibrillation triggered by implantation of intramedullary nail. Secondary this case shows feasibility of cardioversion in latero-lateral electrode-position due to inaccessible standard positions and patient fixation between the operation table and the X-ray apparatus.

[Propofol up2date]. / Propofol up2date - Teil 2: Patientengruppen, unerwünschte Wirkungen und die Nachfolgesubstanz Fospropofol.

Propofol is a common hypnotic agent in anaesthesiology and intensive care medicine and for procedural sedation as well. Despite the intensive usage the full potential, pharmacokinetic and -dynamic abilities, interactions and side effects of the substance may not be realized by all providers. Additionally there is dispute and unwarranted myth about the substance. Propofol is a highly potent hypnotic with a wide range of (un)desired effects. This article is reviewing the diversity of the substance in clinical practice.