Factors Associated With Major Complications and Mortality During Hospitalization in Patients With Ankylosing Spondylitis Undergoing Surgical Management for a Spine Fracture.

STUDY DESIGN: Retrospective study. OBJECTIVES: To analyze factors associated with major complications (MC) in patients with ankylosing spondylitis (AS) undergoing surgical management for a spine fracture. METHODS: Included were all persons with spine fractures and AS in a teriary health care center between 2003 and 2019. Clinical data and MC were characterized with descriptive characteristics. Multivariable analyses were used to find factors associated with MC. RESULTS: In total, 174 traumatic fracture incidents in 166 patients with AS were included, with a mean patient age of 70.7 ± 13.1 years. The main reason for spine fracture was minor trauma (79.9%). Spinal cord injuries (SCI) were described in 36.7% of cases. The majority of patients (54.6%) showed more than one fracture of the spine, with cervical fractures being the most common (50.5%). Overall, the incidences of surgical site infection, implant failure, nosocomial pneumonia (NP), and mortality were 17.2%, 9.2%, 31%, and 14.9%, respectively. ICU stay > 48 hours was associated with MC (including death). Posterior approach for spondylodesis, ICU stay > 48 hours and cervical SCI were related to MC (excluding death). Age > 70 years, NP and Charlson comorbidity index > 5 points were associated with in-hospital mortality. CONCLUSIONS: Patients with AS and surgical treatment of spine fractures are at high risk for MC. Therefore, our results might give physicians better insight into the incidence and sequelae of major complications and therefore might improve patient and family expectations.

Tibiocalcaneal arthrodesis using the Ilizarov fixator in compromised hosts: an analysis of 19 patients.

INTRODUCTION: Salvage of joint destruction of the tibiotalar and subtalar joint with necrosis or infection of the talus in compromised hosts is a challenging problem. In these cases, tibiocalcaneal arthrodesis using the Ilizarov external fixator represents a possible alternative to amputation. This retrospective study presents the results and complications of this salvage procedure. MATERIALS AND METHODS: Between 2005 and 2015, 19 patients were treated with tibiocalcaneal arthrodesis using the Ilizarov external fixator. Ten patients received tibiocalcaneal arthrodesis due to an acute or chronic infection with joint destruction. The other nine patients presented posttraumatic necrosis of the talus or Charcot arthropathy. In addition to demographic data, the time spent in the fixator, the major and minor complications and the endpoint of the consolidation were evaluated retrospectively. Furthermore, clinical outcomes were measured using the modified American Orthopedic Foot and Ankle Society (AOFAS) score. RESULTS: The average time spent in the fixator was 22 (range 14-34) weeks. The average follow-up in 17 patients was 116 (range 4-542) weeks. Two patients were lost to follow-up. Complete osseous consolidation was achieved in 14 out of 19 patients. One patient presented partial consolidation, and in four patients, pseudarthrosis could be detected. The mean modified AOFAS score at the final follow-up was 53 out of 86 possible points. CONCLUSION: Tibiocalcaneal arthrodesis using the Ilizarov fixator is a possible salvage procedure even in compromised hosts. However, the healing rates are below the rates reported in the literature for tibiotalar arthrodesis in comparable clinical situations.

Injuries after Forklift Trucks Accidents - Injury Patterns, Therapy and Outcome in the Context of the Statutory Accident Insurance. / Gabelstaplerunfälle ­ Verletzungsmuster, Therapie und Outcome im berufsgenossenschaftlichen Kontext.

INTRODUCTION: The use of forklift trucks during work has a high accident potential. The aim of this study is to describe injury patterns, treatment and outcome after forklift truck accidents in the context of the employers' liability insurance association. METHODS: Retrospective data collection of all cases between 2004 and 2019. Excluded were patients < 18 years, without follow-up or with definitive external treatment. Trauma mechanism, injury patterns and distribution, treatment, complications, time of incapacity for work, return to work and impairment of earning capacity were recorded. RESULTS: Of 109 patients with 110 injuries, 52.7% showed isolated injuries and 47.3% combined injuries, which affected the lower extremity in 95 cases. There were fractures in 85.5%, including 32.7% in open form. The mean length of stay was 29.1 days (range 1 - 129); an indication for surgery was seen in 80.9%. Surgical treatment required an average of 3 interventions, with significantly more operations for soft tissue closure than for the fractures (p ≤ 0.023). Amputations were necessary in 8 cases; complications occurred in 29.1%. Return to work was possible in 90%, after a mean period of incapacity for work of 33.6 weeks. A total of 40% showed a pensionable impairment of earning capacity. CONCLUSION: Accidents with forklift trucks result in complex lower extremities injuries with the need of multi-stage treatment and show relatively high complication rates. A return to work is often possible after a long period of convalescence, and a pensionable impairment of earning capacity often persists.

Reconstruction of Septic Tibial Bone Defects With the Masquelet Technique and External Ring Fixation-A Low Healing Rate and High Complication and Revision Rates.

OBJECTIVES: To evaluate the results of a series of septic tibial bone defects treated with the Masquelet technique and external ring fixation as a standardized treatment procedure. DESIGN: Retrospective study. SETTING: Level one trauma center. PATIENTS/PARTICIPANTS: All patients 18 years of age or older with septic diaphyseal bone defects of the tibia who underwent induced membrane treatment with ring fixation at our institution between June 1, 2012, and November 31, 2017. INTERVENTION: Staged management as described by Masquelet using an external ring fixator for definitive fixation. MAIN OUTCOME MEASUREMENTS: Bony healing at the last follow-up and the time to healing in months. Functional results were assessed according to the scoring system of the Association for the Study and Application of Methods of Ilizarov. The secondary outcome measures were treatment failure and complications. RESULTS: Thirty-one patients were treated, with a mean follow-up period of 33 months (range, 13-69 months). Overall, among 14 patients assessed as having achieved bone healing, an average of 3.7 surgical revisions were required. The mean healing time was 15.5 months (range, 6-49 months). According to the Association for the Study and Application of Methods of Ilizarov criteria, 7 patients were rated as "excellent" and 6 patients were rated as "good"; one patient showed "poor" functional results. A total of 17 cases of treatment failure and 36 complications were detected. CONCLUSIONS: The combination of the Masquelet technique and external fixation yielded a low healing rate and was associated with a significant number of cases of treatment failure. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Arthrodesis of the Infected Knee Joint with the Ilizarov External Fixator: an Analysis of 13 Cases. / Die septische Kniegelenksarthrodese mit dem Ilizarov-Ringfixateur: eine Analyse von 13 Fällen.

BACKGROUND: Knee joint infections with pronounced joint destruction, soft tissue and bone involvement are serious diseases in which not only the joint but also the entire extremity are directly endangered. What results can be achieved with the Ilizarov external fixator for septic knee arthrodesis? PATIENTS AND METHODS: Between 2005 and 2017, 13 patients (4 women and 9 men, mean age 46 years) with acute joint and concomitant bone and soft-tissue infections were treated with Ilizarov knee joint arthrodesis. In addition to demographic data, the time spent in the fixator, major and minor complications were retrospectively evaluated. RESULTS: The average time spent in the Ilizarov external fixator was 27 weeks (min. 13, max. 68). Arthrodesis and infection repair were primarily achieved in 12 out of 13 patients. In one patient, a delayed healing of the arthrodesis zone could be cured by iliac crest bone grafting, so that eventually a bony knee arthrodesis was achieved in all patients. Pin infects as a minor complication during the time spent in the fixator were common and could be treated by stab incision and antibiotics. Major complications occurred in 3 cases (2 femoral fractures peri-implant, 1 nonunion in the arthrodesis area), which were treated by dilatation of the Ilizarov external fixator and finally plate osteosynthesis or by resection of the pseudarthrosis and iliac crest bone grafting. CONCLUSION: The knee joint arthrodesis with the Ilizarov external fixator is a salvage procedure for limb preservation in fulminant knee joint and concomitant soft tissue infections. The advantages lie in the possibility of osteosynthesis in the acute infection and/or chronic osteomyelitis and the direct full load capacity. Disadvantages are long and complicated treatment times in the fixator with limited patient comfort.

Haemophilia A in a major trauma patient.

Haemophilia A is a coagulopathy with an absence or functional deficiency of coagulation factor VIII. The disease can be subdivided into a congenital form (incidence 1:10,000-1:20,000) and an acquired form (incidence 1:1,000,000). Both forms present an increased risk of bleeding even in low-impact trauma in severe cases of haemophilia A. The course of a man with haemorrhagic shock after a fall from a height of more than 3 m is described. After the secondary survey in the intensive care unit, several interventions (laparotomy, mass transfusion) were performed to stop the bleeding. A history of haemophilia was belatedly reported by relatives. The activity of factor VIII was determined, and substitution was initiated. No recurrent signs of bleeding occurred. The patient survived in good condition and presented for follow-up 3 years later with no disabilities.