European journal of trauma and emergency surgery : official publication of the European Trauma Society
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Eur J Trauma Emerg Surg · Feb 2021
Aggressive crystalloid adversely affects outcomes in a pediatric trauma population.
Crystalloid resuscitation for trauma patients is deleterious, and minimizing crystalloid use is advocated. The purpose of this study was to evaluate the adverse effects of high-volume resuscitation in pediatric blunt trauma patients. ⋯ Significant unfavorable outcomes were noted following excessive crystalloid resuscitation within the first 48 h among pediatric patients with blunt trauma. Our findings support the notion that excessive fluid resuscitation should be avoided.
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Eur J Trauma Emerg Surg · Feb 2021
Minimally invasive posterior locked compression plate osteosynthesis shows excellent results in elderly patients with fragility fractures of the pelvis.
Fragility fractures of the pelvis (FFP) are common in older patients. We evaluated the clinical outcome of using a minimally invasive posterior locked compression plate (MIPLCP) as therapeutic alternative. ⋯ We showed that MIPLCP osteosynthesis is a safe surgical alternative in patients with FFP 3 and FFP 4. This treatment is another way of maintaining a high level of stability in the osteoporotic pelvic ring with a relatively low complication rate, low radiation and moderate operation time and a good functional outcome.
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Eur J Trauma Emerg Surg · Feb 2021
Underlying disease determines the risk of an open abdomen treatment, final closure, however, is determined by the surgical abdominal history.
Temporary abdominal closure is frequently used in several situations such as abbreviated surgery in damage control situations or when closing is impossible due to organ distention or increased abdominal pressure. The ultimate goal is to eventually close the fascia; however, little is known about factors predicting abdominal closure. The purpose of this study was to identify characteristics associated with the need for open abdomen as well as indicating the possibility of delayed fascial closure after a period of open abdominal treatment. ⋯ In this study, male sex and physiological derangement, reflected by acidosis, were independent predictors of open abdominal treatment. Furthermore, the success of delayed fascial closure depends on number of abdominal surgical procedures. Moreover, based on our experiences, we suggest to change modalities early on, to prevent multiple fruitless attempts to close the abdomen.
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Eur J Trauma Emerg Surg · Feb 2021
The impact of polyethylene abrasion on the occurrence of periprosthetic proximal femoral fractures in patients with total hip arthroplasty.
In addition to abrasion-induced osteolysis and ensuing instabilities, the polyethylene (PE) abrasion of total hip arthroplasty (THA) inlays can also cause gait instability due to the decentralization of the hip joint. The current literature yields, as yet, insufficient findings whether these two factors are linked directly or indirectly to a higher risk for periprosthetic proximal femoral fractures (PPFF). The aim of our retrospective evaluation is to analyse the impact of PE abrasion on the pathology of PPFF in patients with THA. ⋯ PPFF patients showed significantly higher rates of inlay erosion, resulting in femoral head decentralization and osteolysis. The higher rate of fracture is likely caused by the increasing instability of the implant fixation due to abrasion-induced osteolysis and the associated degradation of bone quality. It is conceivable that the abrasion and decentralization of the THA can also lead to gait instability, and thus, a higher proneness to falls. Gait instability can also be aggravated by increased granulation tissue and effusion due to the inlay abrasion. Although this cannot be substantiated by the investigation. In patients with decentralization of the THA and osteolysis, a radiological follow-up should be performed, and in case of gait instability (femoral head and) inlay replacements should be considered.
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Eur J Trauma Emerg Surg · Feb 2021
Functional treatment strategy for fragility fractures of the pelvis in geriatric patients.
We propose a functional treatment strategy for fragility fractures of the pelvis (FFP) in geriatric patients; patients with such fractures normally undergo 10 days of conservative therapy with full-weight bearing within pain limits. Conservative therapy for FFP is continued for patients who can stand with assistance, and surgical stabilization is recommended for patients with difficulty in auxiliary standing at 10 day postadmission. This study aimed to compare the outcomes of functional treatment between geriatric patients with FFP type I/II and those with FFP type III/IV, as described by Rommens et al. METHODS: We conducted a retrospective study of 84 geriatric patients who underwent functional treatment for FFP. Based on the results of the first examination, the patients were allocated to the following FFP types: type I/II (n = 53) and type III/IV (n = 31). Change in functional mobility scale described by Graham et al. from before injury to the final follow-up were compared between the groups. ⋯ The outcomes of the functional treatment for FFP for the geriatric patients did not differ significantly between the radiographic classifications. Functional treatment could, therefore, be a treatment option for almost all radiographic types of FFP, especially for geriatric patients. Further investigations are warranted.