Effects of a simple home exercise program and vitamin D supplementation on health-related quality of life after a hip fracture: a randomized controlled trial.

PURPOSE: To test the effects of vitamin D intervention and a simple home exercise program (HE) on health-related quality of life (HRQL) in the first 12 months after hip fracture. METHODS: HRQL was reported in 173 acute hip fracture patients (mean age 84 years, 79% females, 77% community dwelling) who were enrolled in the 12-month 2 × 2 factorial Zurich Hip Fracture Trial. Pre-fracture HRQL was assessed at baseline (4.2 ± 2.2 days post-surgery) and then again at 6 and 12 months after hip fracture surgery by the EuroQol EQ-5D-3L index value (EQ-5D-3L questionnaire). The effects of vitamin D intervention (2000 vs. 800 IU vitamin D3) and exercise (HE vs. no HE) or of the combined interventions on HRQL were assessed using multivariable-adjusted repeated-measures linear mixed-effects regression models. RESULTS: The EQ-5D-3L index value significantly worsened from 0.71 pre-fracture to 0.57 over 12 months, but the degree of worsening did not differ between individual or combined interventions. However, regarding only the late recovery between 6 and 12 months, the group receiving neither intervention (800 IU/day and no HE) experienced a significant further decline in the EQ-5D-3L index value (adjusted mean change = 0.08 [95% CI 0.009, 0.15], p = 0.03) while all other groups remained stable. CONCLUSION: Hip fractures have a long-lasting negative effect on HRQL up to 12 months after hip fracture. However, HE and/or 2000 IU vitamin D per day may help prevent a further decline in HRQL after the first 6 months following the acute hip fracture event.

Impact of a Patient Blood Management monitoring and feedback programme on allogeneic blood transfusions and related costs.

A Patient Blood Management programme was established at the University Hospital of Zurich, along with a monitoring and feedback programme, at the beginning of 2014 with a first analysis reported in 2015. Our study aimed to investigate the further impact of this Patient Blood Management monitoring and feedback programme on transfusion requirements and related costs. We included adult patients discharged between 2012 and 2017. A total of 213,882 patients underwent analysis: 66,659 patients in the baseline period (2012-2013); 35,309 patients in the year after the introduction of the Patient Blood Management monitoring and feedback programme (2014) and 111,914 patients in the continued sustainability period (2015-2017). The introduction of the Patient Blood Management monitoring and feedback programme reduced allogeneic blood product transfusions by 35%, from 825 units per 1000 hospital discharges in 2012 to 536 units in 2017. The most sustained effect was an approximately 40% reduction in red blood cell transfusions, from 535 per 1000 discharges to 319 units. Fewer patients were transfused in the periods after the introduction of the Patient Blood Management monitoring and feedback programme (6251 (9.4%) vs. 2932 (8.3%) vs. 8196 (7.3%); p < 0.001). Compared with 2012, the yearly OR for being exposed to any blood transfusion declined steadily after the introduction of the Patient Blood Management monitoring and feedback programme to 0.64 (95%CI 0.61-0.68; p < 0.001) in 2017. For patients requiring extracorporeal membrane oxygenation, transfusion requirements were also sustainably reduced. This reduction in allogeneic blood transfusions led to savings of 12,713,754 Swiss francs (£ 9,497,000 sterling; EUR 11,100,000; US$ 12,440,000) in blood product acquisition costs over 4 years. In-hospital mortality was not affected by the programme. The Patient Blood Management monitoring and feedback programme sustainably reduced transfusion requirements and related costs, without affecting in-hospital mortality.

CT-based evaluation of volumetric bone density in fragility fractures of the pelvis-a matched case-control analysis.

This matched case-control study compared the computed tomography (CT)-based regional bone density of patients with fragility fractures of the sacrum to a control without fracture. Patients with a sacral fracture demonstrated a significantly lower regional bone density of the sacrum, the sacral bone density not being correlated with the BMD by DXA of the spine. INTRODUCTION: The aim of this study is to compare the computed tomography-based regional bone density measured by Hounsfield units (HUs) in patients with and without fragility fractures of the sacrum. METHODS: Patients aged ≥ 50 years with a fragility fracture of the sacrum were compared to patients of similar age and gender who had a fall from standing height without fracture (n = 46). A matched case-control analysis was conducted by retrospective chart review and assessment of areal bone mineral density by lumbar DXA and by volumetric regional HU measurements in uncalibrated CT scans of the sacrum. RESULTS: Patients with a sacral fracture (age 74 ± 11 years) showed a lower bone density in the body of S1 (HU 85 ± 22) when compared to the matched control group without fracture (age 73 ± 10 years, HU 125 ± 37, p < 0.001). The CT-based bone density of S1 did not correlate with the DXA values of the lumbar spine (r = 0.223, p = 0.136), and lumbar spine T-scores did not differ between the groups (- 2.0 ± 1.3 vs. - 1.9 ± 1.2, p = 0.786). All measurements are based on uncalibrated scans, and absolute HU values are restricted to scans made on Siemens SOMATOM Force or SOMATOM Edge scanners. CONCLUSIONS: Patients with fragility fractures of the sacrum demonstrated a lower regional volumetric bone density of the sacrum when compared to a cohort without a fracture. Local sacral volumetric bone density as measured by CT seems to be independent from the areal BMD as measured by DXA of the lumbar spine. LEVEL OF EVIDENCE: level III.

Cannabinoid CB1 receptors in distinct circuits of the extended amygdala determine fear responsiveness to unpredictable threat.

The brain circuits underlying behavioral fear have been extensively studied over the last decades. Although the vast majority of experimental studies assess fear as a transient state of apprehension in response to a discrete threat, such phasic states of fear can shift to a sustained anxious apprehension, particularly in face of diffuse cues with unpredictable environmental contingencies. Unpredictability, in turn, is considered an important variable contributing to anxiety disorders. The networks of the extended amygdala have been suggested keys to the control of phasic and sustained states of fear, although the underlying synaptic pathways and mechanisms remain poorly understood. Here, we show that the endocannabinoid system acting in synaptic circuits of the extended amygdala can explain the fear response profile during exposure to unpredictable threat. Using fear training with predictable or unpredictable cues in mice, combined with local and cell-type-specific deficiency and rescue of cannabinoid type 1 (CB1) receptors, we found that presynaptic CB1 receptors on distinct amygdala projections to bed nucleus of the stria terminalis (BNST) are both necessary and sufficient for the shift from phasic to sustained fear in response to an unpredictable threat. These results thereby identify the causal role of a defined protein in a distinct brain pathway for the temporal development of a sustained state of anxious apprehension during unpredictability of environmental influences, reminiscent of anxiety symptoms in humans.

[Evaluation of a simple screening tool for ambulant fall prevention]. / Evaluation eines einfachen Testverfahrens in der ambulanten Sturzprävention.

BACKGROUND: An individual's risk of falling is generally difficult to detect and it is likely to be underestimated. Thus, preventive measures are challenging and they demand sufficient integration and implementation into aftercare and outpatient management. The Aachen Falls Prevention Scale (AFPS) is a quick and easy tool for patient-driven fall risk assessment. Older adults' risk of falling is identified in a suitable manner and they then have the opportunity to independently assess and monitor their risk of falling. OBJECTIVES: The aim of the current study was to evaluate the AFPS as a simple screening tool in geriatric trauma patients via the identification of influencing factors, e.g. objective or subjective fall risk, fear of falling (FOF) and demographic data. In this context, we investigated older adults' willingness to take part in special activities concerning fall prevention. METHODS: Retrospectively, all patients over 70 years of age who received in-hospital fracture treatment between July 2014 and April 2016 were analyzed at a level I trauma center. After identification of 884 patients, participants completed a short questionnaire (47 questions, yes/no, Likert scale) comprising the AFPS. A history of falls in the past year was considered an indicator of a balance disorder. In addition, ambulant patients were invited to participate between July and August 2016. RESULTS: In total, 201 patients (mean 80.4 years, range 63-97 years) performed a self-assessment based on the AFPS. After steps 1 and 2 of the AFPS had been completed, 95 (47%) participants rated their subjective risk of falling as high (more than 5 points). Of the participants 84 (42%) were objectively classified as "fallers" with significant effects on their AFPS evaluation and rating of their subjective risk of falling. Furthermore, 67% of the participants identified a general practitioner as their main contact person, and 43% of the respondents viewed the AFPS as a beneficial screening tool in fall risk evaluation (8% negative attitudes). Only 12% of the participants could imagine using the AFPS app version as a feasible option. CONCLUSION: It would be advantageous to pretest at-risk individuals in their environment using a simple self-assessment approach, with the main purpose of identifying potential balance problems. With this approach, cost savings in the healthcare system are possible, combined with a higher health-related quality of life in the geriatric population.

[Abdominal injuries in polytraumatized adults : Systematic review]. / Abdominalverletzungen des polytraumatisierten Erwachsenen : Systematischer Überblick.

Abdominal injuries are potentially life-threatening and occur in 20-25% of all polytraumatized patients. Blunt trauma is the main mechanism. The liver and spleen are most commonly injured and much less often the intestines. The clinical evaluation proves equivocal in many cases; therefore, the gold standard is computed tomography (CT), which has been increasingly used even in hemodynamically weakly stable or sometimes even unstable patients because it promptly provides precise diagnostic findings, which present the basis for successful therapy. Hemodynamically unstable patients always need an exploratory laparotomy (EL). An EL should also be carried out with a positive focused assessment with sonography for trauma (FAST) or CT for severe parenchymal lesions, hollow organ lesions, intraperitoneal bladder lesions, peritonitis and organ evisceration, impalement injuries and lesions of the abdominal fascia. Hemodynamically stable patients without signs of peritonitis and a lack of such findings can often be treated conservatively irrespective of the extent of an injury. Angiography (and if needed embolization) can additionally be diagnostically and therapeutically utilized.

[Bootcamp: longitudinal gender-based surgical and clinical skills training]. / Bootcamp ­ Longitudinaler "Skills-Kurs" zur Vermittlung klinischer und operativer Fertigkeiten : Unter Berücksichtigung geschlechtsspezifischer Unterschiede.

BACKGROUND: Sex parity of medical students has increased to the degree that approximately 50 % of medical students are women. Orthopedic and trauma surgery, however, has not managed to keep up with this trend and women are still grossly underrepresented. OBJECTIVES: Description of an innovative longitudinal gender-based surgical and clinical skills training course. METHODS: An elective 5-day modular skills course is offered for third to fifth year medical students. Module 1 aims at teaching basic surgical and communication skills involving local and regional anesthesia, initial experience with arthroscopy, fracture fixation, emergency measures as well as communication skills training using standardized patients. The subsequent modules cover surgical knowledge and skills of increasing complexity. The main goals are to increase the interest in orthopedic trauma surgery and to reduce concerns regarding discrimination and gender-related issues. Learning outcomes are assessed using a 6-item multiple choice questionnaire (MCQ) and a 3-stage objective structured clinical examination (OSCE) regarding induction of anesthesia, arthroscopy simulation and communication skills. RESULTS: A total of 52 second year medical students (39 females, 13 males) completed module I. There were no differences between men and women with regard to the MCQ and anesthesia and communication skills; however, male students scored significantly higher in the arthroscopy test. All students rated the course as being highly effective in terms of acquisition of knowledge and skills. Almost all participants would recommend the course to fellow students and 70 % of participants stated they would participate in the advanced courses. Female participants in particular reported a marked increase in interest in orthopedic trauma surgery and less concerns regarding discrimination and gender-related issues. CONCLUSION: The effectiveness of the approach will have to be proven by further evaluation, especially with respect to assessment of career development and application rates of participants. Adaptation of environmental and working conditions to suit women's needs seem to play an important role in promoting new surgery residents.

[Chronic instability of the pubic symphysis : Etiology, diagnostics and treatment management]. / Die Chronische Symphyseninstabilität : Ätiologie, Diagnostik und Behandlungsmanagement.

The most frequent causes of chronic instability of the pubic symphysis are sports-related continual overload and traumatic symphyseal injuries. Acute injury of the pubic symphysis may be the result of external forces acting on the anterior pelvic ring or the result of internal forces, such as those arising during parturition. The postpartum form of instability following a complication-free birth is reversible and usually returns to normal within a few months through strengthening of the pelvic floor muscles. Residual instability of the pubis symphysis is on the whole a rare complication. Although established therapy options for acute symphyseal separation can be found in the literature, there are only a few case reports on chronic symphyseal instability. There are no guidelines on standardized therapy options. This review article examines the etiology, clinical findings, diagnostic techniques and management options for patients suffering from chronic symphyseal instability.

[Diagnostics and treatment decisions in acute compartment syndrome. Results of a survey in German hospitals]. / Diagnostik und Therapieentscheidung beim akuten Kompartmentsyndrom. Ergebnisse einer Umfrage in deutschen Kliniken.

BACKGROUND AND OBJECTIVES: The presented survey was intended to evaluate whether a standardization of diagnostics and therapy for acute compartment syndrome has been achieved. MATERIALS AND METHODS: University hospitals, academic teaching hospitals, and county hospitals in Germany were included. RESULTS: A total of 38% (n=120) of all contacted hospitals participated in this study with questions mainly answered by consulting physicians (68%). In general the importance of the clinical examination was considered as being more important than other diagnostic measures. In cases where further diagnostics were necessary, the intramuscular pressure measurement was used most frequently. Of the participants 50% performed surgical fasciotomy based on the clinical examination in combination with the intramuscular pressure measurement; however, there were considerable differences between the participating hospitals with respect to the anatomical position of intramuscular measurements, the limiting value of the intramuscular pressure and the surgical technique for performing fasciotomy. CONCLUSION: According to the presented analysis the diagnosis and indications for surgical treatment in patients developing an acute compartment syndrome do not seem to be sufficiently clarified. The establishment of unified treatment guidelines could help to reduce the number of delayed diagnoses of compartment syndrome.

Neurosteroids increase tonic GABAergic inhibition in the lateral section of the central amygdala in mice.

Neurosteroids are formed de novo in the brain and can modulate both inhibitory and excitatory neurotransmission. Recent evidence suggests that the anxiolytic effects of neurosteroids are mediated by the amygdala, a key structure for emotional and cognitive behaviors. Tonic inhibitory signaling via extrasynaptic type A γ-aminobutyric acid receptors (GABA(A)Rs) is known to be crucially involved in regulating network activity in various brain regions including subdivisions of the amygdala. Here we provide evidence for the existence of tonic GABAergic inhibition generated by the activation of δ-subunit-containing GABA(A)Rs in neurons of the lateral section of the mouse central amygdala (CeAl). Furthermore, we show that neurosteroids play an important role in the modulation of tonic GABAergic inhibition in the CeAl. Taken together, these findings provide new mechanistic insights into the effects of pharmacologically relevant neurosteroids in the amygdala and might be extrapolated to the regulation of anxiety.

Substance P excites GABAergic neurons in the mouse central amygdala through neurokinin 1 receptor activation.

Substance P (SP) is implicated in stress regulation and affective and anxiety-related behavior. Particularly high expression has been found in the main output region of the amygdala complex, the central amygdala (CE). Here we investigated the cellular mechanisms of SP in CE in vitro, taking advantage of glutamic acid decarboxylase-green fluorescent protein (GAD67-GFP) knockin mice that yield a reliable labeling of GABAergic neurons, which comprise 95% of the neuronal population in the lateral section of CE (CEl). In GFP-positive neurons within CEl, SP caused a membrane depolarization and increase in input resistance, associated with an increase in action potential firing frequency. Under voltage-clamp conditions, the SP-specific membrane current reversed at -101.5 ± 2.8 mV and displayed inwardly rectifying properties indicative of a membrane K(+) conductance. Moreover, SP responses were blocked by the neurokinin type 1 receptor (NK1R) antagonist L-822429 and mimicked by the NK1R agonist [Sar(9),Met(O2)(11)]-SP. Immunofluorescence staining confirmed localization of NK1R in GFP-positive neurons in CEl, predominantly in PKCδ-negative neurons (80%) and in few PKCδ-positive neurons (17%). Differences in SP responses were not observed between the major types of CEl neurons (late firing, regular spiking, low-threshold bursting). In addition, SP increased the frequency and amplitude of GABAergic synaptic events in CEl neurons depending on upstream spike activity. These data indicate a NK1R-mediated increase in excitability and GABAergic activity in CEl neurons, which seems to mostly involve the PKCδ-negative subpopulation. This influence can be assumed to increase reciprocal interactions between CElon and CEloff pathways, thereby boosting the medial CE (CEm) output pathway and contributing to the anxiogenic-like action of SP in the amygdala.

Local inflammation in fracture hematoma: results from a combined trauma model in pigs.

Background. Previous studies showed significant interaction between the local and systemic inflammatory response after severe trauma in small animal models. The purpose of this study was to establish a new combined trauma model in pigs to investigate fracture-associated local inflammation and gain information about the early inflammatory stages after polytrauma. Material and Methods. Combined trauma consisted of tibial fracture, lung contusion, liver laceration, and controlled hemorrhage. Animals were mechanically ventilated and under ICU-monitoring for 48 h. Blood and fracture hematoma samples were collected during the time course of the study. Local and systemic levels of serum cytokines and diverse alarmins were measured by ELISA kit. Results. A statistical significant difference in the systemic serum values of IL-6 and HMGB1 was observed when compared to the sham. Moreover, there was a statistical significant difference in the serum values of the fracture hematoma of IL-6, IL-8, IL-10, and HMGB1 when compared to the systemic inflammatory response. However a decrease of local proinflammatory concentrations was observed while anti-inflammatory mediators increased. Conclusion. Our data showed a time-dependent activation of the local and systemic inflammatory response. Indeed it is the first study focusing on the local and systemic inflammatory response to multiple-trauma in a large animal model.

Open versus Percutaneous Stabilization of Thoracolumbar Spine Fractures: A Short-Term Functional and Radiological Follow-up.

PURPOSE OF THE STUDY: A prospective cohort study evaluates the functional and radiological outcome of thoracolumbar spine fractures treated either with open or percutaneous dorsal instrumentation. In recent years, several studies advocate percutaneous stabilization of spinal fractures in patients without neurological deficits. However, it is still debated whether percutaneous stabilization is superior to open dorsal instrumentation in spinal trauma. MATERIAL AND METHODS: This study was performed between 2010 and 2012 at a Level 1 trauma center. Patients treated either with an open or a percutaneous dorsal instrumentation for traumatic fractures of the thoracolumbar spine (T11 to L2) were included. Fracture morphology, screw positioning and clinical parameters were analyzed. Standardized questionnaires (VAS-spine-score; Oswestry-disability-score; SF-36) and follow up radiographs were performed. RESULTS: Overall 72 patients (29 percutaneous; 43 open) could be included. The surgical and the early postsurgical course were similar between both groups. Furthermore the operative approach had no influence on the functional and radiological outcome one year after surgery, but the questionnaires showed moderate impairments within both groups. Also both groups showed a significant loss of reduction after the first postoperative month (p < 0.01). Within the open group a significantly higher amount of fracture reduction (p < 0.01) and a significantly reduced intraoperative radiation exposure was seen (open 105.9 sec.; percutaneous 143.1 sec; p < 0.05); whereas the percutaneous approach was associated with significantly reduced intraoperative blood loss (open 2.2 g/dl; percutaneous 1.2 g/dl; p < 0.001). CONCLUSION: The functional and the radiological outcome of both groups was comparable one year after trauma. Minor advantages of the percutaneous system was less blood loss, whereas the open approach was associated with a significantly higher amount of initial reduction and significantly less intraoperative radiation exposure. Independent from the type of posterior fixation loss of reduction was already significant in the early postoperative course.

Measurement of compartment elasticity using pressure related ultrasound: a method to identify patients with potential compartment syndrome.

PURPOSE OF THE STUDY Decision-making in treatment of an acute compartment syndrome is based on clinical assessment, supported by invasive monitoring. Thus, evolving compartment syndrome may require repeated pressure measurements. In suspected cases of potential compartment syndromes clinical assessment alone seems to be unreliable. The objective of this study was to investigate the feasibility of a non-invasive application estimating whole compartmental elasticity by ultrasound, which may improve accuracy of diagnostics. MATERIAL AND METHODS In an in-vitro model, using an artificial container simulating dimensions of the human anterior tibial compartment, intracompartmental pressures (p) were raised subsequently up to 80 mm Hg by infusion of saline solution. The compartmental depth (mm) in the cross-section view was measured before and after manual probe compression (100 mm Hg) upon the surface resulting in a linear compartmental displacement (Δd). This was repeated at rising compartmental pressures. The resulting displacements were related to the corresponding intra-compartmental pressures simulated in our model. A hypothesized relationship between pressures related compartmental displacement and the elasticity at elevated compartment pressures was investigated. RESULTS With rising compartmental pressures, a non-linear, reciprocal proportional relation between the displacement (mm) and the intra-compartmental pressure (mm Hg) occurred. The Pearson's coefficient showed a high correlation (r2 = -0.960). The intraobserver reliability value kappa resulted in a statistically high reliability (κ = 0.840). The inter-observer value indicated a fair reliability (κ = 0.640). CONCLUSIONS Our model reveals that a strong correlation between compartmental strain displacements assessed by ultrasound and the intra-compartmental pressure changes occurs. Further studies are required to prove whether this assessment is transferable to human muscle tissue. Determining the complete compartmental elasticity by ultrasound enhancement, this application may improve detection of early signs of potential compartment syndrome. Key words: compartment syndrome, intra-compartmental pressure, non-invasive diagnostic, elasticity measurement, elastography.

[Fractures of the proximal humerus in the elderly : Osteosynthesis versus joint replacement]. / Frakturen des proximalen Humerus im hohen Lebensalter : Osteosynthese versus Gelenkersatz.

BACKGROUND: Expected changes in population demographics will have significant implications for society and health care provision for the treatment of proximal humeral fractures in the elderly. OBJECTIVES: This article presents the incidence and clinical characteristics of geriatric fractures of the proximal humerus, a description of therapeutic options and treatment recommendations. METHODS: The published scientific data were reviewed and current opinion available to guide patient care are presented. RESULTS: The majority of fractures of the proximal humerus that require operative treatment are amenable to reconstruction. Primary arthroplasty is usually reserved for comminuted fractures with delayed presentation, head-splitting fractures or those in which the humeral head is devoid of soft tissue attachments. Secondary replacement may be required in cases of fixation failure and symptomatic avascular necrosis. CONCLUSION: Decision-making is dependent on the fracture pattern as well as on patient and surgeon-related factors.

[New from old : relevant factors for fracture healing in aging bone]. / Aus alt mach neu : Relevante Faktoren bei der Frakturheilung im Alter.

BACKGROUND: Fracture healing is a complex biological process with specific temporal expression patterns. During this process new bone tissue is formed, which is similar to the original bone in quality and structure. This occurs in four phases: inflammation, formation of a soft tissue callus, formation of a bony callus and remodelling of the bony callus. This needs the precise orchestration of each cell type involved. OBJECTIVES: This article presents details of the fracture healing phases and the relevant factors. During the aging process there is an increase of reactive oxygen species and a change in expression pattern of growth factors that have a negative effect on the fracture healing process. METHODS: A selective review of the literature was carried out in PubMed concerning the influence of aging on fracture healing. CONCLUSION: The healing process is regulated by systemic and local factors. An understanding of these processes and the changes during aging is necessary in order to improve the knowledge of delayed or lack of fracture healing during aging to decide when an intervention is needed.

[Fractures of the knee joint in the elderly: osteosynthesis versus joint replacement]. / Frakturen des Kniegelenks im hohen Lebensalter : Osteosynthese vs. Gelenkersatz.

BACKGROUND: The aim of open reduction and internal fixation (ORIF) of fractures around the knee joint is the exact anatomic reconstruction of joint surfaces in order to achieve an early and load stable bone situation. Primary endoprosthetics as the initial treatment can represent an alternative treatment option for a closely selected number of geriatric patients. OBJECTIVES: The chances and risks of primary endoprosthetics in comparison to ORIF as the gold standard for initial treatment of fractures close to the knee joint in the elderly are presented MATERIAL AND METHODS: A selective search of the literature was carried out in consideration of national recommendations and own experience gained as head of a center for geriatric traumatology. RESULTS: If the soft tissue coverage is not damaged by the injury, primary endoprosthetics can offer advantages compared to ORIF when a load stable joint is indispensable due to poor compliance, pre-existing arthritis and advanced age. DISCUSSION: The risk of postoperative loss of correction is minimized by the prosthesis but the revision possibilities are very limited due to voluminous prostheses with a high degree of coupling. The indications for primary prosthesis implantation for acute treatment of fractures close to the knee should therefore be closely controlled because this should be the first and last intervention for fracture treatment in geriatric patients.

[Cost analysis of emergency room patients in the German diagnosis-related groups system. A practice relevant depiction subject to clinical parameters]. / Kostenanalyse von Schockraumpatienten im DRG-System. Eine praxisnahe Abbildung in Abhängigkeit klinischer Parameter.

BACKGROUND: Since the implementation of the diagnosis-related system there has been a continuous lack of finances in the treatment of multiple injured patients. The current investigation summarizes consecutive patients from a level I trauma centre and tests the hypothesis that an injury severity score (ISS) based reimbursement would be an improvement in the cost-effectiveness of this patient population. METHODS: The study is based on multiple injured patients admitted to the emergency department in 2009. The ISS, intensive care unit (ICU) stay and cost data were recorded for every patient and two subgroups were formed: group I ISS < 16 and group II ISS ≥ 16. RESULTS: A total of 442 patients with an average age of 40.5 ± 9.1 years (ISS 12) were included. The average amount of coverage during an average length of stay of 13.15 ± 6.3 was -2,752 per patient. Patients in group I (n = 296, ISS 6.3) showed a value of -1,163 with an average length of stay of 8 ± 4.6 days. In group II (n = 146, ISS 23.6) the average amount of coverage was -5,973 during an average hospital stay of 23 ± 8.7 days. CONCLUSION: Improvements have been made with the recent adjustment of the reimbursement within the last year. Nevertheless, several factors identified in this study require additional adjustment: the ISS, the requirement of blood transfusion and the presence of additional chest trauma should be weighted in the calculation of reimbursement.

[Acute extremity compartment syndrome: current concepts in diagnostics and therapy]. / Das akute Kompartmentsyndrom der Extremitäten: Diagnostik und Behandlungsmanagement.

Acute compartment syndrome of the upper and lower limbs is observed following trauma, reperfusion or as an intraoperative complication caused by positioning. The pathophysiology of the disorder has been extensively described and is well known as a loss of perfusion due to rising compartmental pressures. It is a serious and potentially limb- and life-threatening complication. Early diagnosis is made primarily based on clinical findings. Early and focused therapy is crucial to prevent the devastating complications of this acute condition. However, diagnosis can be difficult, particularly in unconscious patients. Thus, in uncertain cases, pressure measurements are essential. Dermato-fasciotomy is the routine method to decompress the compartmental space. This review article examines the clinical findings, diagnostic techniques, and management options for the patient with musculoskeletal injuries.

[Biomarkers in pediatric polytrauma]. / Biomarker beim kindlichen Polytrauma.

BACKGROUND: Trauma represents one of the leading causes of death in children. Beside an injury pattern that differs from adult trauma patients, children seem to develop multiple organ dysfunction syndrome (MODS) less frequently. Compared to adult MODS, pediatric MODS has also been described to occur earlier in the posttraumatic course. METHOD: Biomarkers for early identification of patients at high-risk for posttraumatic complications are of high clinical relevance. However, little is known from clinical studies about the relevance of biomarkers during the posttraumatic course. AIM: Therefore, the purpose of this review is to summarize current knowledge on this topic in order to investigate the prognostic significance of different parameters.