Consistently High Frequency of Scooter Injuries in Children-Retrospective Data Analysis in a Level I Trauma Centre.

The aim of this retrospective study was to present an epidemiological overview of paediatric nonelectric-scooter-related injuries, focusing on changes in injury mechanism and frequency. A retrospective, descriptive data analysis at a Level I trauma centre, including patients aged from 0 to 18 years injured by riding nonelectric scooters, was performed. The observation period ranged from January 2015 to December 2022. The total study population consisted of 983 (mean age: 7.9 ± 4.0 years) children and adolescents, with most patients being male (800/983; 81.4%). The frequency of nonelectric scooter injuries was relatively consistent over the observation period. Patients sustained mostly minor injuries (lacerations, bone contusions, sprains) (527/983; 53.6%), followed by head injuries (238/983; 24.5%), limb fractures (166/983; 16.9%) and trunk injuries (52/983; 5.3%). However, a few patients sustained severe injuries, including skull fractures (7/238; 2.9%), intracranial haematoma (4/238; 1.7%) or lacerations of abdominal organs (4/52; 7.7%). This study presented a consistently high frequency of scooter injuries in children. Children under 15 years were the most affected by scooter-related injuries. Although most injuries were minor, serious injuries occurred that should not be underestimated. Hence, we emphasise the use of protection gear and recommend raising awareness among parents and children.

Correlation of Fall Height, Fracture Severity and Clinical Outcome in Pediatric Supracondylar Fractures-A Retrospective Analysis with an Observation Period of 20 Years.

The most common cause leading to supracondylar humerus fractures in children is falling onto an outstretched arm. A correlation between fall height and fracture severity may be assumed but has not yet been described. The aim of this study was to show that fracture severity increases with fall height. Furthermore, the correlation between fracture severity and outcome was examined. A total of 971 children with supracondylar humerus fractures between January 2000 and December 2019 were included in this study. The correlations between fall height and fracture severity and between fracture severity and outcome were assessed. Increasing fall height correlates with fracture severity (p < 0.001; r = 0.24). Furthermore, the incidence of complications increases with fracture severity and a correlation was present accordingly (p < 0.001; r = 0.28). A total of 30 (3.1%) patients showed limitations in range of motion and/or persistent neurologic deficits at the latest follow-up. Type I fractures rarely lead to subsequent limitations. The correlation between increasing fall height and fracture severity was significant. Furthermore, children with type III and IV supracondylar fractures are more likely to develop complications or restrictions in movement than children with type I and II fractures. Hence, the initial fall height may be an indirect indicator of a more or less favorable outcome.

Management of Traumatic Brain Injury in Patients with DOAC Therapy-Are the "New" Oral Anticoagulants Really Safer?

(1) Background: In recent years, "new" direct oral anticoagulants (DOAC) have gradually replaced other antithrombotic therapies. The international literature agrees on the increased mortality for traumatic brain injury (TBI) patients using vitamin K antagonists (VKA), but thus far, there are insufficient data on the influence of DOAC on the outcome of TBI. (2) Methods: We retrospectively analyzed data from all patients who presented with head trauma using antithrombotic therapy. Outcome parameters were the presence of pathologies on the initial CT, occurrence of delayed intracranial hemorrhage, surgical intervention, and death. (3) Results: In total, data of 1169 patients were reviewed. Of those, 1084 (92.7%) had a mild TBI, 67 (5.7%) moderate TBI, and 17 (1.5%) severe TBI. In total, 456 patients (39%) used DOAC and 713 patients (61%) used VKA, antiplatelet therapy, or prophylactic doses of low molecular weight heparin at the time of trauma. The groups showed no significant differences in age, injury mechanisms, or GCS at presentation. Overall, the initial cranial CT showed pathologies in 85 patients (7.3%). Twenty-five patients with head trauma and DOAC therapy had pathological findings on CT (5.5%), 11 patients with VKA (4.8%), and 48 patients with antiplatelet therapy (10.6%). There was a statistically significant difference in occurrence of CT pathologies between DOAC alone compared to acetylsalicylic acid (4.9 vs. 10.5%, p = 0.04). Delayed intracranial hemorrhage after an initially negative CT during in-hospital observation occurred in one patient (0.2%) in the DOAC group, two patients (0.9%) in the VKA group, and four patients (0.9%) in the antiplatelet group without statistical significance. Head trauma related surgery was performed in three patients (0.7%) in the DOAC group, two patients (0.9%) in the VKA group, and six patients (1.3%) in the antiplatelet group without statistical significance. Death due to head trauma occurred in four patients (0.9%) of the DOAC group compared to one patient (0.4%) of the VKA group and five patients (1.1%) of the antiplatelet group without statistical significance. (4) Conclusions: Our data suggest a comparable risk of pathological CT findings, delayed intracranial hemorrhage, surgical interventions, and death after blunt head trauma for patients with DOAC compared to VKA, but a lower risk for pathological CT findings compared to platelet inhibitors. As VKA are known to increase mortality, our data suggest that similar caution should be used when treating patients with head trauma and DOAC, but the overall numbers of serious or severe courses after simple falls remain low. We recommend routine CT for all head trauma patients with antithrombotic therapy but the role of in-hospital observation for patients with mild TBI remains a matter of debate.

Course of Treatment and Short-Term Outcome of Surgically Treated Paediatric Upper Limb Fractures during the COVID-19 Pandemic-Experiences of a Level 1 Trauma Centre in Central Europe.

The COVID-19 pandemic and the resulting restrictions led to a reduced number of surgeries. This study examines its impact on the course of treatment and clinical outcome of surgically treated paediatric upper limb fractures during that specific period. This retrospective cohort study evaluated all children aged 0-18 years presenting with an upper limb fracture treated surgically at the level 1 trauma centre of the University Clinic of Orthopaedics and Trauma Surgery of Vienna within lockdown from 16 March to 29 May 2020 (definition applied through corresponding legislation) compared to the same period from 2015 to 2019. A total number of 127 children (m:63; f:44) were included. The lockdown did not lead to a significant increase in complications during and after initial surgery. Time until removal of implant was not significantly prolonged (p = 0.068; p = 0.46). The clinical outcome did not significantly differ compared to previous years. The experience of a level 1 trauma centre showed that despite reduced surgical capacity during the COVID-19 pandemic, no negative differences concerning course of treatment and clinical outcome of surgically treated paediatric upper limb fractures were present. These findings are still of importance since the COVID-19 pandemic continues and several countries in Central Europe are currently under their fourth lockdown.

Maintaining Medical Resources to Treat Paediatric Injuries during COVID-19 Lockdown Is Essential-An Epidemiological Analysis of a Level 1 Trauma Centre in Central Europe.

BACKGROUND: This study examined the effect of the COVID-19 pandemic and the resulting decrease in the incidence of various categories of injuries, with the main focus on fractures and mild traumatic brain injuries in a paediatric population. METHODS: This retrospective cohort study evaluated all children from 0 to 18 years of age presenting with an injury at the level 1 trauma centre of the University Clinic of Orthopaedics and Trauma Surgery in Vienna during the lockdown from 16 March to 29 May 2020 compared to records over the same timeframe from 2015 to 2019. RESULTS: In total, 14,707 patients with injuries were included. The lockdown did not lead to a significant decrease in fractures but, instead, yielded a highly significant increase in mild traumatic brain injuries when compared to all injuries that occurred (p = 0.082 and p = 0.0001) as well as acute injuries (excluding contusions, distortions and miscellaneous non-acute injuries) (p = 0.309 and p = 0.034). CONCLUSIONS: The percentage of paediatric fractures did not decrease at the level 1 trauma centre, and a highly significant proportional increase in paediatric patients with mild traumatic brain injuries was observed during the COVID-19 lockdown. Therefore, medical resources should be maintained to treat paediatric trauma patients and provide neurological monitoring during pandemic lockdowns.

Fractures of the trochanteric region in children and young adolescents-a treatment algorithm for a rare injury.

For femoral fractures of the trochanteric region in children and adolescents, only two mechanisms have been identified to cause a fracture of the proximal femur: high-energy trauma or predisposing bone pathologies with inadequate trauma (e.g., simple fall, movement). We identified 20 patients between 1993 and 2018 with a trochanteric fracture under the age of 18 (12 males; 8 females; mean age, 12 years; range, 4-17 years) who were treated operatively at our department. The mean follow-up of all patients was 50.06 months. All 20 patients were treated operatively. Complications occurred after a mean time of 6.27 months (range, 0.47 to 12.07 months) in two patients. Harris Hip Score was evaluated in all patients with a mean score of 94.16 (range 11 to 100). Eighty-five percent of the patients reached an excellent clinical outcome after treatment. Trochanteric femoral fractures in children and adolescents are very rare accounting for only 1% of all trochanteric fractures. Excellent long-term results can be achieved with an adequate fracture reduction.Conclusion: Physicians treating pediatric trauma have to be aware of other predisponding diseases when low-energy trauma leads to a trochanteric fracture as in this study, 50% of the trochanteric fractures were associated with bone pathologies. What is Known: • Trochanteric femoral fractures in children and adolescents are very rare • In all patients with trochanteric femoral fractures, malignancies have to be ruled out What is New: • Awareness of an underlying bone pathology in a high number of cases • Awareness for necessity of a good fracture reduction leading to highly satisfactory results.

Delayed Intracranial Hemorrhage in Patients with Head Trauma and Antithrombotic Therapy.

BACKGROUND: Delayed intracranial hemorrhage can occur up to several weeks after head trauma and was reported more frequently in patients with antithrombotic therapy. Due to the risk of delayed intracranial hemorrhage, some hospitals follow extensive observation and cranial computed tomography (CT) protocols for patients with head trauma, while others discharge asymptomatic patients after negative CT. METHODS: We retrospectively analyzed data on patients with head trauma and antithrombotic therapy without pathologies on their initial CT. During the observation period, we followed a protocol of routine repeat CT before discharge for patients using vitamin K antagonists, clopidogrel or direct oral anticoagulants. RESULTS: 793 patients fulfilled the inclusion criteria. Acetylsalicylic acid (ASA) was the most common antithrombotic therapy (46.4%), followed by vitamin K antagonists (VKA) (32.2%) and Clopidogrel (10.8%). We observed 11 delayed hemorrhages (1.2%) in total. The group of 390 patients receiving routine repeat CT showed nine delayed hemorrhages (2.3%). VKA were used in 6 of these 11 patients. One patient needed an urgent decompressive craniectomy while the other patients were discharged after an extended observation period. The patient requiring surgical intervention due to delayed hemorrhage showed neurological deterioration during the observation period. CONCLUSIONS: Routine repeat CT scans without neurological deterioration are not necessary if patients are observed in a clinical setting. Patients using ASA as single antithrombotic therapy do not require in-hospital observation after a negative CT scan.

Growth potential of different zones of the growth plate-an experimental study in rabbits.

Despite clinical efforts to treat growth disturbances only little is known about the growth potential of the different zones of the growth plate. The aim of this study was to investigate the growth potential of different zones of the growth plate. A total of 20 New Zealand White rabbits were used for this experiment. The right and left ulna of each animal were used resulting in a total of 40 ulnae. Animals were assigned into five groups. In groups I and II resection of the metaphyseal (n = 12) or the epiphyseal (n = 6) segment of the growth plate was performed. In group III resection of the growth plate and re-implantation was performed (n = 6). In group IV the growth plate was resected and re-implanted after a 180° rotation (n = 6). Animals in group V served as controls. Histologic and radiologic examinations were performed to evaluate the growth process at 1, 2, 4, and 12 weeks following surgery. In group I, III, and IV temporary growth disturbance which was compensated within a short time was observed. Resection of the epiphyseal part resulted in growth arrest of the distal ulna in combination with normal growth of the radius which led to and valgus deformity of the limb. The results of this study indicate the importance of the reserve zone for the functioning of the growth plate.

Epidemiological and economic aspects of polytrauma management in Austria.

INTRODUCTION: In Austria, treatment of multiple trauma patients has developed into an established nationwide trauma center specialty with its own unique identity. Although it represents a substantial financial investment, it ensures supply at international standards. The question of whether multiple trauma patients should be treated only in specialized trauma centers or in several hospitals remains controversial on both national and international grounds. The aim of this study was to assess Austrian trauma departments for international comparison. MATERIAL AND METHODS: We performed a survey of all 54 Austrian trauma departments by collecting data through questionnaires. The number of staff, potential of infrastructure, and treatment strategies were obtained. RESULTS: 93.3% of the trauma departments responded to the questionnaires. In level I trauma centers the amount of trauma beds reached 11% of the total bed capacity, 13% in level II, and 18% in level III units. Level I centers showed an average of 35% of intensive care beds for trauma patients. 53% and 51% were the proportions for level II and III centers. Level I hospitals displayed an average of 28.3 trauma surgeons, while level II and III units had less doctors at their disposal in the trauma departments. On average, 94% of the patients arrived by emergency medical support at the hospital. 94% of the trauma departments used chest tubes, 70% performed craniotomies and neurovascular reconstruction. 33% of the centers were equipped to perform replantations. DISCUSSION: The data demonstrate the broad spectrum of polytrauma treatment in Austrian trauma centers. The discussed need for centralization of polytrauma care cannot be justified based on these data. Limiting from a medical perspective, however, is the lacking comparability of quality of care due to the currently missing objective quality criteria.

The effect of drilling and screw fixation of the growth plate--an experimental study in rabbits.

Injury of the growth plate is a specific problem in traumatology and can cause limb deformity and length discrepancy as a result of growth arrest. The purpose of this study was to evaluate alterations of the growth plate after artificially created injuries. A total of 14 New Zealand White rabbits were used for this experiment. The right and left ulna of each animal was used resulting in a total of 28 ulnae. In six animals drill holes were driven into the growth plate either from the distal/epiphyseal side or from the proximal/metaphyseal side of the physis. In six animals a fracture of the distal ulna corresponding to a Salter-Harris fracture type IV was created. This fracture was fixed by screws from either the epiphyseal or the metaphyseal side. Two animals served as controls. Histologic and radiologic examinations were performed to evaluate the growth process at 1, 2, 4, and 12 weeks following surgery. Drilling or fixation of the growth plate from the metaphyseal side resulted in temporary growth disturbance which was compensated within a short time. In contrast fixation from the epiphyseal side caused severe growth disturbances. Based on our findings K-wires or screws should be inserted from the metaphyseal side and be placed in the center of the growth plate.

Fractures of the head and neck of the femur in children: an outcome study.

Fractures of the head and neck of the femur in children are very rare, occurring only after a high-velocity trauma, e.g. a fall from a height. This analysis shows the clinical course of traumatic femoral head and neck fractures in paediatric patients. Predisposing factors for poor outcome or fracture complications, such as non-union or femoral head necrosis, are described. Between 1993 and 2006, 16 paediatric patients with proximal femoral fractures were treated at the Level One Trauma Centre of the Medical University of Vienna. The minimum follow-up was two years. Inclusion criteria were age less then 16 years, intact growth plate and a proximal femoral fracture according to the classification by Delbet and Colonna. Exclusion criteria were pathological fractures or fractures of the subtrochanteric region (6/16). Ten patients met the inclusion criteria. Two patients were lost to follow-up. Therefore eight patients were included in the study. All patients except one were operated upon within 48 h after the injury ("primary") and healed without further complications. A single case was managed by "secondary" surgical treatment, two weeks after the initial trauma resulting in femoral head necrosis that healed without any subjective complaints. This case series confirms the importance of early surgical fixation of proximal femoral fractures in paediatric patients. An operative intervention later then 48 h after the initial trauma may increase the risk of complications such as femoral head necrosis, particularly in Delbet type I fractures (traumatic slipped capital femoral epiphysis).

[Occult scaphoid-lunate dissociation in distal radius fractures]. / Okkulte skapholunäre Dissoziation bei distaler Radiusfraktur.

INTRODUCTION: The aim of this study was to investigate the clinical consequences of scapholunate dissociation associated with fractures of the distal radius and the impact on wrist function. Fractures of the distal radius and scapholunate dissociation overlap in pathomechanics. The diagnosis however is frequently missed initially. PATIENTS AND METHODS: We reviewed 45 consecutive patients with closed distal radius fractures with a mean follow up of 48 months. Ten patients underwent surgery and 35 patients were treated by fracture reduction and cast immobilization during 4.5 (range 3 to 8) weeks. All patients were re-examined clinically and radiographs of both wrists were compared. RESULTS: Four patients showed evidence of SLD in the scapholunate joint region based on specific criteria (scapholunate gaps > 2 mm on anterior-posterior radiograph and the scapholunate angle > 60 degrees on lateral radiograph). All patients with SLD showed a poor radioulnar deviation. Three patients reported mild to moderate pain. DISCUSSION: The difficulties in management of SLD may be avoided by early detection and treatment. In all investigated patients the diagnosis was missed after the initial trauma. Untreated SLD can lead to carpal collapse and arthrosis of the wrist, and ultimately to scapholunate advanced collapse.