[Pedelec users get more severely injured compared to conventional cyclists]. / Pedelec-Fahrer werden bei Unfällen schwerer verletzt als konventionelle Radfahrer.

BACKGROUND: For years e­bike (Pedelec) sales have been steadily increasing. Therefore, the incidence of e­bike-related injuries and deaths has been growing. Due to clinical experience, emergency personnel are suspecting that e­bikers might be injured more severely compared to conventional bicyclists suffering from an accident. This topic has not yet been analyzed for Germany. OBJECTIVE: Analysis of injury severity and mortality following e­bike and conventional bicycle accidents in a level I trauma center in Germany. MATERIAL AND METHODS: Data of patients treated after a bicycle accident at the accident and emergency department as well as the clinic for traumatology and orthopedics of the Evangelical Hospital (Evangelisches Krankenhaus) Oldenburg were gathered from 1 March 2017 to 1 March 2019. RESULTS: In this study 59 electric bicycle users (e-bikers) and 164 conventional cyclists were included. The average age of e­bikers was 62 years compared to 48 years in the group of conventional cyclists. Comorbidities were significantly more frequent in the e­bike group compared to classical cyclists. The e­bikers were found to be significantly more severely injured than conventional bicyclists, the mean injury severity scores (ISS) were 5.2 and 3.4, respectively. E­bikers were admitted to the hospital more often and for longer periods than the control group. There was no significant difference in mortality. CONCLUSION: E­bikers are more severely injured in accidents compared to conventional cyclists. Due to older age and comorbidity they form a sensitive trauma subgroup. Based on demographics, an increase of old age, more frail cyclists and a growing incidence of serious e­bike accidents is to be expected. Preventive measures, such as helmet usage and riding lessons should be introduced, especially in e­bikers. E­bikers in the emergency department should be examined and treated with special care and aggressive diagnostics. A low threshold for an initial interdisciplinary assessment (shock room management) is advised.

[Challenges in the diagnostic management of fat embolism syndrome - from divergence in clinical presentation to diagnosis]. / Diagnostische uitdagingen van het vetemboliesyndroom.

This article discusses the diagnosis and management of two patients with cerebral fat embolism syndrome after traumatic femoral fractures. Fat embolism syndrome is a condition which is caused by fat globules in the systemic circulation; it most often occurs in patients with femoral fractures. Patients develop systemic dysfunction, particularly a triad of a petechial rash, respiratory and neurological dysfunction. The syndrome is characterized by a diverse clinical presentation which often necessitates a wide differential diagnosis. The pathogenesis of fat embolism syndrome has not yet been fully elucidated. Although it has been a formally recognised clinical diagnosis for years, new diagnostic imaging capabilities have provided a shift towards a visualisable disorder. Presently, there is no clear evidence and indication for dedicated treatment and therefore supportive measures remain the only treatment modality.

[E-bikers are more often seriously injured in bicycle accidents: results from the Groningen bicycle accident database]. / E-bikers raken vaker ernstig gewond na fietsongeval.

OBJECTIVE: Analysing injury types, injury severity and mortality in victims of accidents with electric bicycles in comparison with conventional bicycles. DESIGN: Prospective cohort study. METHOD: Data of patients treated at the Accident & Emergency Department of the University Medical Center Groningen after a bicycle accident are being entered in a database since 2014. We have analysed this database for accidents with electric bicycles (e-bikes) and conventional bicycles occurring among adult patients for the period of July 2014 to May 2016. 'Propensity score matching' was used to match e-bikers to conventional cyclists, based on age, gender and the presence of comorbidities. RESULTS: 107 of the 475 included victims were riding an e-bike. Average age of e-bikers and conventional cyclists was 65 years and 39 years respectively. Comorbidity was more common in e-bikers. E-bikers were injured significantly more severely than conventional cyclists. They had more severe injuries of the head and face, and upper and lower extremities. E-bikers were also admitted to the hospital more often, and for longer periods, and they underwent surgery more often. Mortality was the same. Propensity score matching revealed that e-bikers had multiple severe injuries (ISS > 15) twice as often as conventional cyclists, that they had more severe head injuries and were admitted for longer periods than conventional cyclists. CONCLUSION: E-bikers who had a bicycle accident had more severe injuries, more frequently had multiple injuries and had more severe head injuries than conventional cyclists. This resulted in a greater need for care. Preventive measures such as riding lessons and helmet use should be encouraged. Care providers should pay extra attention to the possibility of severe injuries when a patient had a bicycle accident with an e-bike.

Early mobilization after ilio-inguinal lymph node dissection for melanoma does not increase the wound complication rate.

AIM: Ilio-inguinal lymph node dissection for stage III melanoma is accompanied by a substantial amount of wound complications. Our treatment protocols changed in time in terms of postoperative bed rest prescriptions, being in chronological order Group A: 10 days with a Bohler Braun splint, Group B: 10 days without splint, and Group C: 5 days without splint. The aim of this study was to evaluate the effect of bed rest prescriptions on wound complications. METHODS: For this study, we included all patients who underwent ilio-inguinal dissection for stage III melanoma in the period 1989-2011. Both univariate and multivariable analysis were performed to identify factors that were associated with occurrence of wound complications defined as wound infection, wound necrosis, and seroma. RESULTS: Of the 204 patients analyzed, 99 suffered one or more wound complications: 51 wound infection, 29 wound necrosis, and 39 seroma. A wound complication occurred in 26 out of 64, 51 out of 89, and 22 out of 51 patients for Group A, B, and C, respectively. Univariate analysis showed age >55 (p = 0.001) and presence of comorbidity (p = 0.002) to be associated with higher incidence of wound complications. The 5 day bed rest protocol used in group C did not significantly increase the incidence of wound complications (ref = Group A: OR = 1.18; 95%CI = 0.52-2.68, p = 0.698). CONCLUSION: Early mobilization did not significantly increase the overall wound complication rate after ilio-inguinal lymph node dissection for melanoma. Age >55 and comorbidity were risk factors in univariate analysis.

Therapeutic lymph node dissection in melanoma: different prognosis for different macrometastasis sites?

BACKGROUND: The prognostic significance of primary tumor location, especially the poor prognosis for melanomas in the scalp and neck region, is well established. However, the prognosis for different sites of nodal macrometastasis has never been studied. This study investigated the prognostic value of the location of macrometastasis in terms of recurrence and survival rates after therapeutic lymph node dissection (TLND). METHODS: All consecutive FDG-PET-staged melanoma patients with palpable and cytologically proven lymph node metastases operated at our clinic between 2003 and 2011 were included. Disease-free survival and disease-specific survival (DSS) were compared for nodal metastases in the groin, axilla, and neck regions by multivariable analysis. RESULTS: A total of 149 patients underwent TLND; there were 70 groin (47 %), 57 axillary (38 %), and 22 neck (15 %) dissections. During a median follow-up of 18 (range 1-98) months, 102 patients (68 %) developed recurrent disease. Distant recurrence was the first sign of progressive disease in 78, 76, and 55 % of the groin, axilla, and neck groups, respectively (p = 0.26). Low involved/total lymph nodes (L/N) ratio (p < 0.001) and absence of extranodal growth pattern (p = 0.05) were independent predictors of a longer disease-free survival. For DSS, neck site of nodal metastasis (p = 0.02) and low L/N ratio (p < 0.001) were independent predictors of long survival. The estimated 5-year DSS for the groin, axilla, and neck sites was 28, 34, and 66 %, respectively. CONCLUSIONS: There seems significantly longer DSS after TLND for nodal macrometastases in the neck compared to axillary and groin sites, although larger series should confirm this finding.

Therapeutic groin dissection for melanoma: risk factors for short term morbidity.

AIMS: Ilio-inguinal lymph node dissection for stage III melanoma is often complicated by wound healing disturbances. A retrospective study was performed to investigate the wound healing disturbances after therapeutic ilio-inguinal lymph node dissection. PATIENTS AND METHODS: Between 1989 and 2007, 139 consecutive patients, 73 females (53%) and 66 males (47%), median age 55 (range 20-86) years underwent a therapeutic ilio-inguinal lymph node dissection. Data were recorded on early complications: haematoma, wound infection, wound necrosis and seroma. Univariate and multivariate logistic regression analyses were used to evaluate the influence of a wide range of variables on postoperative complications. RESULTS: Seventy-two patients had one or more early wound complications (49.7%). These complications comprised haematoma (n=3, 2.1%), wound infection (n=30, 20.7%), wound necrosis (n=25, 17.5%) and seroma (n=31, 21.8%). Wound infections were significantly more common in patients with a body mass index (BMI) of >25 (p=0.019). Wound necrosis developed significantly more often if the Bohler Braun splint was not used postoperatively (p=0.002). The occurrence of one or more early complications was significantly associated with the non-use of a Bohler Braun splint (p=0.026) and age of >55 years (p=0.015). CONCLUSIONS: High BMI was significantly correlated with the occurrence of wound infections. Bed with of the hip and knee in flexion using a Bohler splint improved wound healing after therapeutic ilio-inguinal lymph node dissection.