European journal of trauma and emergency surgery : official publication of the European Trauma Society
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Eur J Trauma Emerg Surg · Oct 2020
Limited value of the column concept in the operative management of posterior column tibial plateau fractures.
The three-column concept has been proposed as tool in surgical decision-making for treating tibial plateau fractures. Recent studies have underscored the negative effect of posterior column tibial plateau fractures on clinical outcome. The purpose of this study was to assess the value of the three-column concept and posterior plating in posterior column fractures. We hypothesized that treating patients according to the three-column concept improves functional outcome. ⋯ 3.
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Eur J Trauma Emerg Surg · Oct 2020
A mixed psychiatric and somatic care unit for trauma patients: 10 years of experience in an urban level I trauma center in the Netherlands.
A medical-psychiatric unit (MPU) is a special ward where staff is trained in caring for patients with psychiatric or behavioural problems that need hospitalisation for physical health problems. It is well known that these patients are at higher risk of complications and have a longer length of stay resulting in higher costs than patients without psychiatric comorbidity. The objective of this study was to analyse the trauma patient population of the first 10 years of existence of the MPU in a level I trauma center. ⋯ Trauma patients that were admitted to the MPU of an urban level I trauma center had serious psychiatric comorbidity as well as high injury severity. Penetrating injury was much more common than in the overall trauma patient population. A high complication rate was noted. The high psychiatric comorbidity and the complicated care warrants combined psychiatric and somatic (nursing) care for this subpopulation of trauma patients. This should be taken into account in the prehospital triage to a trauma center. The institution of a MPU in level I trauma centers is recommended.
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Eur J Trauma Emerg Surg · Oct 2020
Fracture patterns in patients with multiple fractures: the probability of multiple fractures and the most frequently associated regions.
Multiple fractures are of high clinical relevance, as a significant increase in mortality rate has been described. The purpose of this study was to evaluate differences in age and gender distribution in multiple fractures dependent on severity of trauma. Furthermore, affected anatomic regions and frequently associated fracture regions were investigated. ⋯ As a novelty, gender as well as age distributions in multiple fracture patients and a probability statement with the most affected anatomic regions, the risk of presence of further fractures for every region, and the frequently associated fracture regions including the percentage of occurrence are provided. These aspects yield new opportunities for clinical work and may reduce the high rate of overlooked fractures stated in the literature.
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Eur J Trauma Emerg Surg · Oct 2020
High prevalence of bacteria in clinically aseptic non-unions of the tibia and the femur in tissue biopsies.
There are several hints that bacterial colonization might be an often overseen cause of non-union. Modern procedures like PCR have been reported to diagnose bacterial colonization with a high degree of accuracy. While PCR is not ubiquitously available, we hypothesize that biopsies from the non-union site are comparable to PCR results reported in the literature. ⋯ The results confirm that the presence of bacteria in cases with no clinical signs of infection is a relevant issue. The prevalence of bacteria reported here is comparable that reported from cohorts tested with PCR or sonication. In most cases, there was only one positive biopsy, raising the question whether a contamination has been detected. Thus, to better understand the problem, it is necessary to gather more knowledge regarding the sensitivities and specificities of the different diagnostic procedures.
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Eur J Trauma Emerg Surg · Oct 2020
Surgical advantages of using 3D patient-specific models in high-energy tibial plateau fractures.
Treatment of tibial plateau fractures are difficult due to the intra-articular nature of the proximal tibia and extensive involvement of the soft tissue envelope. In this study, we investigated the surgical experience acquired using digitally designed life-size fracture models to guide as a template to place plates and screws in the treatment of tibial plateau fractures and anatomic reduction of joint. ⋯ The customized 3D model was user friendly, and it provided a radiation-free tibial screw insertion. The use of these models assisted surgical planning, maximized the possibility of ideal anatomical reduction and provided individualized information concerning tibial plateau fractures.