European journal of trauma and emergency surgery : official publication of the European Trauma Society
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Eur J Trauma Emerg Surg · Dec 2022
Observational StudyConservative treatment of displaced isolated proximal humerus greater tuberosity fractures: preliminary results of a prospective, CT-based registry study.
Isolated greater tuberosity fractures are uncommon and account for approximately 2-19% [Emerg Radiol. 2018;25(3):235-246] of all proximal humerus fractures. Surgical treatment is the prevailing recommendation in cases of displacement of more than 5 mm for the general healthy population, while conservative treatment is considered to result in inferior outcomes and is not recommended. However, high-grade evidence is lacking for these recommendations. ⋯ The outcomes of conservatively treated displaced isolated greater tuberosity fractures are underestimated, and current indications for surgical treatment should be questioned. Further studies with larger numbers of patients and longer lengths of follow-up are needed. The protocol of this observational study is registered at ClinicalTrials.gov (NCT03060876). Date of registration: June 8, 2016.
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Eur J Trauma Emerg Surg · Dec 2022
Perioperative and oncologic outcomes of interval colectomy performed by acute care surgeons after stenting as a bridge to surgery for left-sided malignant colonic obstruction are non-inferior to the outcomes of colorectal surgeons in the elective setting: single center experience.
To analyze if perioperative and oncologic outcomes with stenting as a bridge to surgery (SEMS-BS) and interval colectomy performed by acute care surgeons for left-sided occlusive colonic neoplasms (LSCON) are non-inferior to those obtained by colorectal surgeons for non-occlusive tumors of the same location in the full-elective context. ⋯ Perioperative and oncologic outcomes of a strategy with SEMS-BS for LSCON are non-inferior to those obtained in the elective setting for non-occlusive neoplasms in the same location. Technical and oncologic safety of interval colectomy performed on a semi-scheduled situation by acute care surgeons is absolutely warranted.
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Eur J Trauma Emerg Surg · Dec 2022
Spinal infection with intraspinal abscess or empyema and acute myelopathy: comparative analysis of diagnostics, therapy, complications and outcome in primary care.
This study on pyogenic spinal infections with intraspinal epidural involvement (PSI +) compared the outcome of patients with spinal cord injury (SCI) to those without (noSCI) taking diagnostic algorithm, therapy, and complications into account. ⋯ PSI + are associated with higher in-hospital mortality, particularly when multiple spinal segments are involved. However, survival is similar with (SCI) or without myelopathy (noSCI). If SCI develops, the rate of disease complications is higher and early specialized SCI care might be substantial to reduce complication rates.
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Eur J Trauma Emerg Surg · Dec 2022
Complications following regional anesthesia versus general anesthesia for the treatment of distal radius fractures.
Open reduction and internal fixation (ORIF) are commonly utilized for the repair of distal radius fractures (DRF). While general anesthesia (GA) is typically administered for ORIF, recent studies have also demonstrated promising results with the usage of regional anesthesia (RA) in the surgical treatment of distal radius fractures. This study will compare complication rates between the use of RA versus GA for ORIF of DRFs. ⋯ With similar safety profiles, RA is a safe and reasonable alternative to GA when managing DRFs surgically. RA may be the preferred anesthetic technique for ORIF of DRFs in patients at high risk with GA, such as those with reactions to GA in the past or with significant cardiopulmonary risk factors.
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Eur J Trauma Emerg Surg · Dec 2022
Endotracheal intubation in trauma patients with isolated shock: universally recommended but rarely performed.
The indication for pre-hospital endotracheal intubation (ETI) must be well considered as it is associated with several risks and complications. The current guidelines recommend, among other things, ETI in case of shock (systolic blood pressure < 90 mmHg). This study aims to investigate whether isolated hypotension without loss of consciousness is a useful criterion for ETI. ⋯ Decision making for pre-hospital intubation in trauma patients is challenging in front of a variety of factors. Despite the presence of a guideline recommendation, ETI is not always executed. Patients presenting with shock as remaining indication and subsequent intubation showed a decreased outcome. Thus, isolated shock does not appear to be an appropriate indication for pre-hospital ETI, but clearly remains an important surrogate of trauma severity and the need for trauma team activation.