Injury
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The ankylosed spine is prone to trauma even with after application of force at low energy levels. Multi-level vertebral bony fusions produce long lever arms, susceptible to fracture, with an increased risk of neurological injury. Additional problems result from delayed presentation and osteoporosis. These patients are also often at high risk of complications, making conventional open spinal surgery less appealing. We present the outcomes of percutaneous fixation and its advantages in this high risk group of patients. ⋯ Even minor trauma can result in fracture in the ankylosed spine, requiring a high index of suspicion from the physician. The risks of missing such a fracture are significant neurological injury. The biomechanics of the spine are significantly altered, and treatment is demanding. We propose that minimally invasive spinal surgery can achieve good outcomes, low complication rates and high rates of satisfaction.
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Comparative Study
Pre-hospital rescue times and actions in severe trauma. A comparison between two trauma systems: Germany and the Netherlands.
The aim of this study was to compare the effect of national pre-hospital rescue strategies on the status of severely injured patients at the time of admission to a Trauma Center (TC) in Germany or the Netherlands. ⋯ Many differences in the national pre-hospital strategy were demonstrated but the effect on patient's status at the time of admission to trauma room remains unclear. A follow-up study, which mitigates the now known injury patterns has to be initiated to further substantiate the findings of this study.
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Trauma related injuries are a main cause for long-lasting morbidity and disability especially in younger patients with their productive years ahead. On a routine basis, we assessed health related quality of life two years after trauma of severely injured patients at our level-I trauma centre via posted survey. ⋯ Our results demonstrate that multiple trauma patients two years after injury suffer from impairments including persisting pain, functional deficits, mental and socioeconomic deficits. The 'Trauma Outcome Profile' instrument seems a proper tool to discover impairments in trauma patients early on and guide proper rehabilitation resources to the best of the patient.
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Due to the orientation of the sacroiliac joint (SIJ), as the symphysis widens in an open-book pelvic ring disruption, it should displace inferiorly. The purposes of this study were to reconfirm this inferior displacement and to evaluate the relative contributions of the pubic symphysis (PS), the sacrotuberous/sacrospinous ligament complex (STL/SSL) and the anterior sacroiliac ligament (ASIL) to pelvic ring stability in a rotationally unstable open-book injury. ⋯ The PS and ASIL are important in maintaining pelvic ring external rotational stability. However, the SSL/STL has little, if any, effect in this regard. Due to the orientation of the SIJ, external rotation of the hemipelvis, as in open-book injury, will show inferior vertical, as well as horizontal, displacement on the AP radiograph, despite the PSIL being intact.
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Review
The ATLS(®) classification of hypovolaemic shock: A well established teaching tool on the edge?
Uncontrolled bleeding is the leading cause of shock in trauma patients and delays in recognition and treatment have been linked to adverse outcomes. For prompt detection and management of hypovolaemic shock, ATLS(®) suggests four shock classes based upon vital signs and an estimated blood loss in percent. Although this classification has been widely implemented over the past decades, there is still no clear prospective evidence to fully support this classification. ⋯ Considering these potential deficits associated with the ATLS(®) classification of hypovolaemic shock, an online survey among 383 European ATLS(®) course instructors and directors was performed to assess the actual appreciation and confidence in this tool during daily clinical trauma care. Interestingly, less than half (48%) of all respondents declared that they would assess a potential circulatory depletion within the primary survey according to the ATLS(®) classification of hypovolaemic shock. Based on these observations, a critical reappraisal of the current ATLS(®) classification of hypovolaemic seems warranted.