European journal of trauma and emergency surgery : official publication of the European Trauma Society
-
Eur J Trauma Emerg Surg · Jan 2025
Observational StudyEffectiveness of a co-management program with internal medicine on hip fracture patients at a regional hospital in northwest Spain. Co-inter-Monf study.
Hip fractures represent a serious public health problem with a high burden of mortality, morbidity, and resource use. Co-management has proven to enhance the clinical outcomes of hip fracture patients hospitalized in various settings. ⋯ The implementation of internal medicine co-management for hip fracture patients resulted in enhanced outcomes, particularly in the reduction of mortality within 30 days of discharge as well as in the prevalence of osteoporosis treatment.
-
Eur J Trauma Emerg Surg · Jan 2025
Biomechanics of flail chest injuries: tidal volume and respiratory work changes in multiple segmental rib fractures.
Flail chest (FC) injuries are segmental osseous injuries of the thorax that typically result from high-energy blunt trauma and regularly occur in multiple trauma (MT) patients. FC injuries are associated with paradoxical chest wall movements and, thus, have a high risk of respiratory insufficiency or even death. An increasing number of studies recommend an early surgical stabilization of FC injuries, but a definite trigger that would indicate surgery has, thus far, not been identified. ⋯ This study presents an FE model of the thorax of a patient who presented to our clinic as an MT patient with an FC injury. The FE model fulfills physiologic active breathing patterns and simulates an FC injury's paradoxical movement, realistically depicting clinical observations. The FE model showed that the number of consecutive ribs involved in the flail segment and the length of the flail segment significantly impacted active breathing concerning tidal volumes and respiratory work. With this, we have made the first step to define a trigger for surgery.
-
Eur J Trauma Emerg Surg · Jan 2025
ReviewOpen lower limb fracture reconstruction in the elderly population: the experience of a major trauma centre.
Management of the elderly patients presenting with open lower limb fractures is challenging due to physiological changes and pre-existing co-morbidities. The aim of this study was to assess the compliance with the British Orthopaedic Association's Standards for Trauma Number 4 (BOAST 4) guidelines in this patient group. ⋯ Our study suggests that BOAST 4 compliance in the population > 65 years is comparable to the younger population. It is likely that the lower energy injury profile enables early definitive management even in the presence of age related co-morbidities.
-
Eur J Trauma Emerg Surg · Jan 2025
ReviewEndovascular management of haemorrhage and vascular lesions in patients with multiple and/or severe injuries: a systematic review and clinical practice guideline update.
Our aim was to update evidence-based and consensus-based recommendations for the inhospital endovascular management of haemorrhage and vascular lesions in patients with multiple and/or severe injuries based on current evidence. This guideline topic is part of the 2022 update of the German Guideline on the Treatment of Patients with Multiple and/or Severe Injuries. ⋯ The following key recommendations are made. Whole-body contrast-enhanced computed tomography should be used to detect bleeding and vascular injuries. Blunt thoracic and abdominal aortic injuries should be managed using TEVAR/EVAR. If possible, endovascular treatment should be delayed beyond 24 h after injury. Bleeding from parenchymatous abdominal organs should be controlled using transarterial catheter embolisation. Splenic injuries that require no immediate intervention can be managed with observation.
-
Eur J Trauma Emerg Surg · Jan 2025
Multicenter Study Observational StudyClinical presentation, acute care management and discharge information of patients with thoracic trauma in South Africa and Sweden: a prospective multicenter observational study.
Thoracic trauma causes pain and hospitalisation. Middle- and high-income countries have different trauma contexts and populations. To report patients' clinical presentation (pain and shortness of breath) and its influence on hospital length of stay (LOS), acute care management, and discharge destinations in South Africa (SA) and Sweden. ⋯ Priority care is indicated for those who are older and have blunt thoracic injury to prevent pulmonary complications and prolonged hospitalisation.