European journal of trauma and emergency surgery : official publication of the European Trauma Society
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Eur J Trauma Emerg Surg · Jan 2025
ReviewMinimal clinically important difference (MCID), patient-acceptable symptom state (PASS), and substantial clinical benefit (SCB) following surgical knee ligament reconstruction: a systematic review.
The minimal clinically important difference (MCID), patient-acceptable symptom state (PASS), and substantial clinical benefit (SCB) are designed to prioritise clinically significant outcomes that demonstrate true clinical benefit rather than relying solely on statistical significance. These instruments aid clinicians in understanding the patient's perspective, allowing healthcare professionals to set treatment goals that align with patients' desires and expectations. This systematic review analysed tools to estimate the clinical relevance of the most commonly used PROMs to assess patients following surgical knee ligament reconstruction. ⋯ This systematic review demonstrated that more dependable scientific data, appropriate study methodology, and adequate reporting of MCID, SCB, and PASS in surgical knee ligament reconstruction is necessary. The IKDC score, the Lysholm score, and the Tegner activity scale were the only instruments with multiple studies reporting values. Level of evidence Level IV, systematic review and meta-analysis.
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Eur J Trauma Emerg Surg · Jan 2025
Review Meta AnalysisSurgical intervention in traumatic brain injury: a systematic review and meta-analysis of decompressive craniotomy.
Traumatic brain injury (TBI) is considered a major cause of death globally, resulting from trauma. Decompressive craniectomy (DC) may improve functional outcomes in patients with TBI and its associated complications. This study was designed to determine safety and efficacy of DC in improving clinical outcomes in TBI patients compared to standard therapy. ⋯ This study presents evidence suggesting that DC is linked to a lower mortality rate, decreased ICP, and shorter hospital stays among patients with moderate to severe TBI. However, it did not show a significant impact on improving favorable clinical outcomes.
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Eur J Trauma Emerg Surg · Jan 2025
Tranexamic acid: single topical application for femoral neck fractures treated with arthroplasty results in lowest blood loss.
Tranexamic acid is widely accepted for hip fractures but there is no agreement about dose or application method and the use is still off label for hip fractures. The aim of our study was to find the best application method of tranexamic acid in patients with femoral neck fractures comparing total blood loss, hemoglobin and transfusion rate. ⋯ Tranexamic acid effectively reduces blood loss and transfusion rates and shows higher hemoglobin levels postoperatively, without increasing the risk of thromboembolic events after proximal femoral fractures. Single topic application of 1 g for arthroplasty treatment of femoral neck fractures has better results for blood loss reduction than single i.v. or combined application.
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Eur J Trauma Emerg Surg · Jan 2025
Risk factors of avascular femoral head necrosis after a pediatric femoral neck fracture: a 15-year follow up and an adjustment to the Delbet classification.
Pediatric femoral neck fractures (PFNF) are rare but associated with a high rate of serious complications such as avascular femoral head necrosis (AVN). Major risk factors and prognostic tools for an AVN are still unclear. As AVN is a devastating complication, this study aims to evaluate the predictors for AVN following a PFNF. ⋯ Neurologically impaired patients are prone to a late diagnosis of a femoral neck fracture, mainly due to both cognitive and motor impairments. High velocity trauma is a significant risk factor for developing AVN. In contrast to literature, a Delbet type IV fracture was significantly associated with AVN. A type IIR fracture has a higher possibility to develop AVN than a normal Delbet type II fracture. As the incidence of pediatric femoral neck fractures is low, the size of a study population is limited. Nevertheless, AVN is still a life altering complication leading to additional surgical treatments, hospital stays and impairment of daily life activities. Therefore, further research is needed to better understand the mechanisms of underlying risk factors and to develop strategies for the prevention and management of AVN in the pediatric population. Hence multicenter studies with a bigger study population are crucial.
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Eur J Trauma Emerg Surg · Jan 2025
From the last 100 to the first 100-outcome after a manufacturer change in reverse fracture arthroplasty.
If surgery is indicated for elderly patients suffering a proximal humerus fracture, reverse fracture arthroplasty became the preferred type of treatment due to its good and reliable outcomes over the last decade. Surgeons could choose from a wide range of implants and up to now there was no evaluation, if a change of the manufacturer affects patients` outcome. ⋯ A manufacturer change on the fly is possible without negative consequences for patients` outcome. Expertise of the whole OR-team as well as standardized training with the new implant seems to be a more important factor than a specific type of implant.