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
Dual-energy CT in diagnosing sacral fractures: assessment of diagnostic accuracy and intra- and inter-rater reliabilities.
Evaluating sacral fractures is crucial in fragility fractures of the pelvis. Dual-energy CT (DECT) is considered useful for diagnosing unclear fractures on single-energy CT (SECT). This study aims to investigate the effectiveness of DECT in diagnosing sacral fractures. ⋯ Combined use of DECT with SECT improved the detection rate of sacral fractures and enhanced intra-rater and inter-rater reliability. High diagnostic accuracy was achieved regardless of the observer's experience. These results indicate that DECT is a useful imaging modality for diagnosing sacral fractures.
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Eur J Trauma Emerg Surg · Jan 2025
Review Meta AnalysisAccuracy of GFAP and UCH-L1 in predicting brain abnormalities on CT scans after mild traumatic brain injury: a systematic review and meta-analysis.
Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. In recent years, blood biomarkers including glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) have shown a promising ability to detect head CT abnormalities following TBI. This review aims to combine the existing research on GFAP and UCH-L1 biomarkers and examine how well they can predict abnormal CT results after mild TBI. ⋯ Present results suggest that GFAP and UCH-L1 have the clinical potential for screening mild TBI patients for intracranial abnormalities on head CT scans.
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Eur J Trauma Emerg Surg · Jan 2025
Review Practice GuidelineInitial surgical management of spinal injuries in patients with multiple and/or severe injuries- the 2022 update of the German clinical practice guideline.
Our aim was to update evidence-based and consensus-based recommendations for the initial surgical management of spinal (cord) injuries 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. (1) Patients with spinal injuries or deformities with confirmed or assumed neurological deficits which can be treated operatively should undergo surgery as soon as possible (ideally on day 1) if their other medical conditions permit. (2) If suggested by fracture morphology with spinal canal compression or translational injury and if spinal neurological damage cannot be ruled out, assume the presence of spinal neurological damage until it can be ruled out. (3) In the absence of neurological signs and/or symptoms, unstable spinal injuries should be treated by early surgical stabilization based on the patient's overall condition. (4) Depending on the injury, an anterior and/or posterior approach or, in exceptional cases, a halo fixation device can be used to stabilize the cervical spine. (5) Posterior internal fixation should be used as the primary surgical technique for stabilizing injuries to the thoracic and lumbar spine.
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Eur J Trauma Emerg Surg · Jan 2025
ReviewPreventing confounding in observational studies in orthopedic trauma surgery through expert panels: a systematic review.
Confounding in observational studies can be mitigated by selecting only those patients, in whom equipoise of both treatments is secured by experts' disagreement over optimal therapy. ⋯ With this review we aim to provide insight into this study design and to stimulate discussions about the potential of expert panels to control for confounding in studies of medical treatments.
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Eur J Trauma Emerg Surg · Jan 2025
Multicenter Study Comparative Study Observational StudyPattern of injury in polytrauma compared to single limb related Lisfranc joint fractures.
Midfoot fractures in polytrauma patients are often an underappreciated injury relative to their other major injuries sustained. In this study, our aim was to explore the mechanisms and patterns of injury in polytrauma related midfoot fractures as compared to single limb injuries. ⋯ Polytrauma related Lisfranc joint midfoot injuries have a higher prevalence of medial and lateral column injury than non-polytrauma Lisfranc joint midfoot injuries. Non-polytrauma injuries can, however, have an equally significant force involved as polytrauma patients, with over 50% occurring as the result of high velocity injury. A high index of suspicion should be maintained for midfoot injuries in high velocity mechanisms, regardless of other injuries sustained.