Impact of the earthquake during COVID-19 lockdown on fracture admission at a tertiary trauma centre in Croatia.

PURPOSE: To determine the impact of an earthquake during COVID-19 lockdown on fracture admission at a tertiary trauma centre in Croatia. METHODS: A case-control study was performed at the tertiary trauma centre registry. Two different periods were studied. The case group included a period during COVID-19 lockdown right after the earthquakes until the end of the confinement period in Croatia. And the control group corresponded to the equivalent period in 2019. We identified all consecutive patients who were admitted due to urgent care requirements for the musculoskeletal trauma. Patient's demographic data and admitting diagnoses were assessed. Data were analyzed by statistical procedures using the program MedCalc statistical software version 16.4.3. RESULTS: We identified 178 emergency admissions due to musculoskeletal trauma. During the COVID-19 lockdown and post-earthquake period, there was a drastic reduction in total admissions (359 vs. 662; p < 0.0001) with an increased proportion of trauma admissions within the emergency admissions (34.9% vs. 26.5%; p = 0.02926, Z = -2.1825). Furthermore, in the case group there was a significant increase in hospital admissions due to ankle/foot trauma (11 vs. 2, p = 0.0126) and a trend towards a decrease in the admissions due to tibia fractures (5 vs. 12, p = 0.0896), however without statistical significance. Also, an increased proportion of women within the group of femoral fractures in both case group (81.6% vs. 52.6%, p = 0.00194, Z = 3.1033) and the control group (82.3% vs. 60.5%, p = 0.0232, Z = 2.2742) was observed. In both analyzed periods, the osteoporotic hip fracture was the most common independent admitting diagnosis. CONCLUSION: It is crucial to understand how natural disasters like earthquakes influence the pattern of trauma admissions during a coexisting pandemic. Accordingly, healthcare systems have to be prepared for an increased influx of certain pathology, like foot and ankle trauma.

[Voluven--third generation plasma expander]. / Voluven--plazmatski ekspander trece generacije.

Crystalloid solutions are considered a good choice for lower scale blood loss (up to 20%). The usage of colloids facilitates faster and more durable blood volume substitution. Besides, some colloids (HES 130/04) are considered to have a beneficial effect on microcirculation, capillary membrane integrity, inflammatory response and endothelium integrity. Colloid solutions characteristics as well as the possible side effects within their group vary. It is therefore important to know that HES 130/04, a new generation colloid solution, is linked to a lower frequency of side effects. Nonetheless, it seems that the individual approach and procedure-specific choices are more important than other factors.

Postnatal changes in the styloid process, vagina processus styloidei, and stylomastoid foramen in relation to the function of muscles originating from the styloid process.

We investigated age-related changes in the styloid process in 88 skulls, aged from 5 months to 85 years of age. The osseous styloid process was not well developed in children. Its length increased significantly with age (from 2.3 mm in 11-20 age group to 16.3 mm in 61-85 group). In adolescent specimens (11-20 years of age), the median distance from the styloid process to the stylomastoid foramen was 0.7-0.8 mm, whereas in adult and old age specimens the two structures were completely adjacent or very close, usually less than 0.2 mm. The process was missing in 5% of the adult specimens. There was a statistically significant positive association between the length of the styloid process with age (r = 0.3210, 95% CI 0.0817-0.5254; P = 0.0097), whereas the distance from the styloid process to the stylomastoid foramen significantly decreased with age (r = -0.4518, 95% CI -0.6167 to -0.2490; P = 0.0001). Changes in the length and shape of the styloid process reflected altered function of the three muscles originating from the styloid process-m. stylopharyngeus, m. stylohyoideus and m. styloglossus. They have a common function of lifting the aerodigestive elements upward and backward, after the descent of the aerodigestive tract and final morphological differentiation of the vocal system during puberty. Relationship between altered muscle function and the morphology of the styloid process are important for understanding the clinical syndromes related to the styloid process, such as Eagle's syndrome.

Postnatal changes in osseous and mucosal morphology of the hard palate.

We investigated the postnatal changes in the dimensions, configuration, and surface pattern of the hard palate in 68 skulls, ranging in age from birth to 90 years of age. The number of palatine rugae of the palatine mucosa was assessed in 168 living subjects aged 11-98 years. Before the first dentition appeared, the osseous palate was concave, smooth, and lacked alveolar processes. In maxillar specimens from the end of the first year to the end of the fourth year of life, balloon-like osseous formations, containing the elements of permanent teeth, appeared bilaterally behind the deciduous incisors. With age, the concavity of the palate diminished and became flat with the loss of the teeth. The presence of teeth was associated with the height of the alveolar ridge, which decreased from 7.3 +/- 4.4 mm in specimens with intact teeth to 4.7 +/- 4.1 mm in specimens without teeth (P = 0.020). Palatine rugae were a common finding in living subjects, but were more often absent in older age (2.2% in 11-50 age group vs. 12.8% in 51-98 age group, P = 0.0183). Our results suggest that the morphology of the hard palate rapidly changes during deciduous and permanent teeth eruption and is related to the presence of alveolar ridges and teeth in adults. Palate osseous morphology may be morphologically and functionally independent from its mucosal morphology. Changes in the morphology of the osseous palate are clinically relevant for dental prosthetics and tooth implantation.

Age-related changes in the anatomical landmarks of the osseous epipharynx.

We investigated age-related spatial relations of the osseous epipharynx--the region between the vomer and the anterior border of the great occipital foramen (basion) on 60 skulls of both sexes: 16 adult (age range 21-59 years), 19 aged (age range 60-86 years), and macerated occipital bones, sphenoid bones, and vomers in 25 specimens of children disarticulated skulls aged 1-15 years. We measured the distances basion-tuberculum pharyngeum, tuberculum pharyngeum-ala vomeris, tuberculum pharyngeum-crista choanalis vomeris, basion-crista choanalis vomeris, width of the pars basilaris at the level of the tuberculum pharyngeum, narrowest width of the pars basilaris, width at the level of pyramidal apexes; and width at the level of laminae mediates processus pterygoidei of the sphenoid bone. We found a statistically significant increase in the frontal and sagittal measurements of the osseous epipharynx increasing from childhood to adulthood, without further significant changes into old age. In the aged adult and skulls, the distance from the tuberculum pharyngeum to the basion was half the distance to the vomer, whereas in children the ratio of these distances was 1:3. The major difference in the bony landmarks of the osseous epipharynx between children and adults were the attachments of muscles, m. longus capitis and m. rectus capitis anterior. Whereas the most common morphological feature of the m. longus capitis attachment was a bony fossa lateral to the tuberculum pharyngeum, the muscle attached to a prominent crest in children. These previously unreported findings illustrate the role of muscle activity in the formation of osseous landmarks of the epipharynx.

Thermal changes during healing of distal radius fractures-Preliminary findings.

INTRODUCTION: The bone healing process is very complex. In simple terms, bone healing comprises three basic steps, the inflammation phase, the repair phase and the remodelling phase. The increase in blood flow around the fracture during the healing process increases the temperature of the surrounding tissue. Infrared thermography is a method of measuring body temperature that can detect temperature changes during bone healing. Studies on the application of thermography in traumatology are scarce, and there are no studies of thermal changes during normal bone healing. The authors have tried to determine the dynamics of thermal changes during bone healing. MATERIAL AND METHODS: The Flir ThermaCam B2 (FLIR Systems, Inc., Oregon, USA) was used for all measurements. Thermographic recordings were made one, three, five, 11 and 23 weeks after fracture. The contralateral, healthy, forearm was used for comparison. RESULTS: A total of 25 patients of mean age 65.9±10.4 years (range 50-80 years) with fracture of the distal radius were examined in this study. The mean temperature difference between healthy and fractured distal forearm one week after fracture was 1.20±0.48°C, three weeks after fracture was 1.42±0.54°C, five weeks after fracture was 1.04±0.53°C, 11 weeks after fracture was 0.50±0.30°C, and 23 weeks after fracture was 0.22±0.25°C. CONCLUSION: Preliminary findings during this research showed significant temperature changes during healing of distal radius fractures. Infrared thermography is a simple and reliable method in clinical practice that could be used as a good follow-up method in traumatology, but further investigations on more patients are needed.

Operative management of unstable ankle fractures in the elderly: our institutional experience.

Ankle fractures represent an exceptionally common injury within the elderly population. The total incidence of ankle fractures has been reported to be up to 184 fractures per 100,000 persons per year, of which 20 to 30 percent occur in the elderly. This study reports the results of operative management of ankle fractures in the elderly, with regard to functional outcome and complication rates. This was a retrospective, non-randomized observational study. Subjects were identified from a trauma registry kept in our Department and were tested for eligibility. Patients were then categorized into two groups according to their age: Group A included all patients less than 65 years of age and Group B included all patients over the age of 65. The outcome was measured using the AOFAS Ankle-Hindfoot score and a Linear analog scale. A total of 120 consecutive patients fulfilled the eligibility criteria and were included in our study (60 patients in each group). We detected statistically significant difference between the LAS score of the two groups (p=0.02), the alignment between the two groups (p=0.04) and the AOFAS score versus LAS score in Group B (p=0.03). Two patients from Group B had wound dehiscence, but finally their wounds healed uneventfully. We didn't observe any serious complications such as skin necrosis, deep infection, osteomyelitis and failure of metalwork. Our study suggests that the operative management of Weber B2 and B3 injuries can result in a favorable outcome. It is however of great importance that there are no delays in treatment, that the reduction is anatomical, that the fracture fixation is satisfactory and that the rehabilitation is commenced early.

A plea for Croatian trauma system.

This paper provides an insight into Croatian health system with special focus on trauma care. The current situation is explained from a domestic point of view, but an independent review by foreign observers is also included. Fragmented approach to the treatment of injured patients in Croatia should be replaced by networking of health care componenets into a unique chain of help. The concept and five methodological steps in the development of a succesfull trauma system are presented. A good start is definitely a reorganization of existing knowledge on the basis of internationally licesed courses and the adoption of trauma registry as a standard for future discussion. Individual components of the trauma system can not be separately "optimized" so clinical and financial decisions should be planned exclusively on the integral level.

Intraoperative measurement of bone electrical potential: a piece in the puzzle of understanding fracture healing.

INTRODUCTION: Bone electrical potentials change with the force applied. Also, fracture alters the bone electrical potential, so it becomes more electronegative. These potentials have an important role in fracture healing, bone growth and remodelling. Literature data on the influence of fracture operative treatment on bone electrical potentials, and possible consequences of this influence, are sparse. The objective of this study was to establish a method of intraoperative bone potential measurement, and to try to find a correlation between electrical potential and fracture type, osteosynthesis method and prognosis. PATIENTS AND METHODS: 52 patients with a pertrochanteric fracture were included in the study. Bone electrical potentials were measured intraoperatively using a thin Kirschner wire introduced through bone cortex at the selected point and pointed to opposite cortex, not penetrating it. Kirschner wires were connected using clamps to multimeter (YF-78 Multimeter) device. Neutral electrode (inductive rubber) was placed behind ipsilateral gluteus. RESULTS: Near the fracture site potentials of -199 up to -267 mV were recorded. Mean measured potential of bone plate after fixation was -240 mV. Bone potentials correlated with the subtype of fracture and early mobilisation of patients. CONCLUSIONS: Bone potentials, caused by fracture, can be measured intraoperatively; the operative procedure appears to influence their generation. Measured potentials depend on the fracture type, and could be correlated with prognosis.

Mathematical approximation of fibular malleolus curvature.

While there are several manuscripts describing the articular surfaces of the ankle joint and the fibula itself, there is no study describing the outer surface and the degree of curvature of the fibular malleolus. This paper aims to approximate the sagital curvature of the outer surface of the lateral malleolus mathematically. Such data would facilitate the design of the anatomic plate that can be used for the ostheosynthesis of the fibular malleolus fracture. 30 males who were examined in the emergency department due to ankle sprains, where they underwent a standard anteroposterior x-ray of the ankle in the neutral position were recruited. The radiographs which revealed no bony injury were digitized and statistically processed. A mathematical function for each separate fibula was obtained through the processing of the digitized x-rays. When all the functions were applied to one graph, common traits of all fibulas were noted. The mean value of all functions was obtained and it corresponds to the polynomial function of degree 6. Mathematical approximation of the curvature is a simple and reliable method that can be applied to other ellipsoid human bone structures besides the ankle, thus being a valuable method in anthropometric, radiological and virtual geometric calculations.