European Journal of Trauma and Emergency Surgery最新文献

{"title":"Comparison of elastic stable intramedullary nailing versus retrograde screw fixation for pubic ramus fractures-a biomechanical study.","authors":"Julian Scherer, Yasmin Youssef, Toni Wendler, Benjamin Fischer, Stefan Schleifenbaum, Georg Osterhoff","doi":"10.1007/s00068-025-02791-0","DOIUrl":"10.1007/s00068-025-02791-0","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous minimally invasive retrograde screw fixation is a widely accepted treatment strategy for patients with superior ramus fractures and has shown good biomechanical stability compared to plating. Recently, elastic stable intramedullary nailing (ESIN) devices have been proposed as an alternative in the treatment of superior ramus fractures. However, biomechanical studies on this new treatment are lacking. Thus, the aim of this study was to compare the biomechanical stability of ESIN in pubic ramus fractures versus retrograde screw fixation.</p><p><strong>Methods: </strong>Standardized pubic ramus fractures (Nakatani type II) were created in fresh-frozen paired hemipelves. Fractures were either stabilized with a 6.5 mm cannulated screw (n = 4) or a 3.5 mm Stainless Steel Elastic Nail System (n = 4). In a validated setup, a cyclic loading protocol was applied with increasing axial force (1500 cycles, 250-750 N). Outcome parameters were fracture mobility over time, fracture displacement and construct survival. Descriptive and opto-metric methods were used to describe the mode of failure.</p><p><strong>Results: </strong>Amongst all tested hemipelves (n = 8), no construct failure was observed. There was no significant difference in mean vertical fracture displacement between the groups (ESIN 0.07 mm, SD 0.12 versus screw 0.04 mm, SD 0.05; p = 0.773). After 500 cycles at 250 N, mean vertical fracture displacement was 0.09 mm (SD 0.16) in the ESIN group and 0.03 mm (SD 0.04) in the screw group (p = 0.773). After subsequent 500 cycles at 500 N in the vertical plane, mean fracture displacement increased to 0.35 mm (SD 0.31) in the ESIN group and to 0.14 mm (SD 0.17) in the screw group (p = 0.281). With a maximum load of 750 N, after 500 cycles, mean fracture displacement was 0.58 mm (SD 0.51) in the ESIN group and 0.31 mm (SD 0.26) in the screw group (p = 0.376). There was no difference between the implants regarding the accumulated fracture movement over time (ESIN 494 mm*cycles, SD 385 versus screw 220 mm*cycles, SD 210; p = 0.259).</p><p><strong>Conclusions: </strong>In this in-vitro biomechanical study, fixation of superior ramus fracture using ESIN was not different in construct survival, relative motion to fracture, and fracture displacement when compared to retrograde screw fixation.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"129"},"PeriodicalIF":1.9,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11890244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomic distribution and analysis of influencing factors on deep vein thrombosis in patients with spinal fractures caused by high-energy injuries.","authors":"Haiying Wang, Bing Lv, Wei Li, Jingjing Xu, Ce Ma, Tao Yu, Zhanlei Shi","doi":"10.1007/s00068-025-02801-1","DOIUrl":"https://doi.org/10.1007/s00068-025-02801-1","url":null,"abstract":"<p><strong>Purpose: </strong>To analyze the anatomic distribution and influencing factors on deep vein thrombosis (DVT) in patients with spinal fractures caused by high-energy injuries.</p><p><strong>Methods: </strong>A retrospective analysis was performed on 302 patients of lower extremity DVT who were admitted to our hospital from January 2018 to December 2023. All patients underwent ultrasonography of DVT before and after surgery. The thrombus location and clinical data of thrombus were recorded in detail. Logistic regression was used to analyze the influencing factors on thrombus distribution.</p><p><strong>Results: </strong>There were 27 cases of central DVT and 261 cases of peripheral DVT before surgery, 90 cases of central DVT and 212 cases of peripheral DVT after surgery. There were statistically significant differences in the types of thrombus during perioperative period among patients with cervical, thoracic, and lumbar fractures. After surgery, there were 120 cases of thrombus progression, 33 cases of thrombus regression, and 149 cases of thrombus without change. The intermuscular veins account for 75.57%. The time from injury to surgery and D-dimer at admission were influencing factors for preoperative DVT distribution while blood loss, time from injury to surgery and post 3-D-dimer were influencing factors for postoperative DVT distribution.</p><p><strong>Conclusions: </strong>The proportion of postoperative thrombus progression was relatively high, with only a small portion experiencing thrombolysis. Patients with cervical fractures were more prone to central DVT. The intermuscular vein was the most common vein for thrombosis. The time from injury to surgery, D-dimer at admission, blood loss and post 3-D-dimer were influencing factors for DVT distribution.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"128"},"PeriodicalIF":1.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical stabilization of posterior rib fractures involving the costotransverse joint.","authors":"Astrid Carolina Álvarez-Ortega, Jose Alejandro Posso-Nuñez, Nicolás Felipe Torres-España, Carlos Alejandro García-González, Álvaro I Sánchez-Ortiz, Mauricio Velásquez-Galvis","doi":"10.1007/s00068-025-02797-8","DOIUrl":"https://doi.org/10.1007/s00068-025-02797-8","url":null,"abstract":"<p><strong>Purpose: </strong>Surgical stabilization of posterior rib fractures involving the costotransverse joint is debated, with most patients managed non-operatively. However, surgery may be indicated for respiratory failure due to altered mechanics or severe pain leading to functional limitations. Long-term outcomes related to quality of life and pulmonary function in these patients are underreported. This study aimed to describe our unique experience with the surgical stabilization of posterior rib fractures involving the costotransverse joint and to report the associated outpatient clinical outcomes.</p><p><strong>Methods: </strong>An observational descriptive study was conducted at a tertiary care institution in Colombia during 2020-2024. Patients with posterior rib fractures involving the costotransverse joint who underwent surgery were included. Data collected included demographics, trauma severity, and complication rates. Primary outcomeswere mortality, postoperative complications, and implant failure.</p><p><strong>Results: </strong>Eleven patients were included, with a median age of 42 years (interquartile range [IQR] 35-53). The median Injury Severity Score was 26 [IQR 21-35]. The median hospital length of stay was 13 days [IQR 10-17], Intensive care unit stay was 7 days [IQR 4-10], and invasive mechanical ventilation duration was 4 days [IQR 3-4]. One patient (9.1%) experienced a postoperative surgical site infection. Pulmonary function tests revealed a median forced vital capacity at 66% of the predicted value [IQR: 63-73%] and a median forced expiratory volume in the first second at 65% of the predicted value [IQR: 64-70%]. Quality of life assessments indicated acceptable outcomes, with a median score of 60 points [IQR 50-75].</p><p><strong>Conclusion: </strong>Surgical stabilization of posterior rib fractures involving the costotransverse joint is feasible and yields favorable outcomes, overcoming many technical hurdles. Larger studies with standardized follow-up are needed to validate these findings and establish definitive management guidelines.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"127"},"PeriodicalIF":1.9,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Which side should be taken care of when positioning a lag screw in intertrochanteric femoral fracture: right or left?","authors":"Min Uk Do, Kyeong Baek Kim, Sang-Min Lee, Hyun Tae Koo, Won Chul Shin","doi":"10.1007/s00068-025-02790-1","DOIUrl":"https://doi.org/10.1007/s00068-025-02790-1","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to demonstrate which side should be taken care of when fixating an intramedullary nail with a lag screw for an intertrochanteric fracture under the influence of clockwise torque.</p><p><strong>Methods: </strong>From 2021 to 2023, 63 patients who underwent surgery for intertrochanteric fractures were divided into two groups: Group A (45 patients with left-side fractures) and Group B (18 patients with right-side fractures). We evaluated intraoperative images before fixation and postoperative radiographs to assess anteromedial cortical support. Clinically, the time to union and union rate were evaluated, and the complications, reoperation, and Koval score at one year were reviewed.</p><p><strong>Results: </strong>Pre-fixation reduction quality showed no significant difference between groups. However, in terms of postoperative reduction quality on the lateral view, Group A had the highest incidence of neutral anterior cortical support (ACS) (62%), whereas Group B had the highest incidence of negative ACS (78%) (p < 0.001). Bone union occurred in 98% of Group A cases and 78% of Group B cases (p = 0.021). The mean time to union was shorter in Group A (5.2 months) compared to Group B (5.8 months) (p = 0.004). The mean Koval score was also better in Group A (2.4 vs. 2.0, p = 0.031).</p><p><strong>Conclusion: </strong>When fixating intertrochanteric fractures with an intramedullary nail using a lag screw, right-sided fractures tended to exhibit negative ACS on lateral radiographs by clockwise torque. Therefore, particular attention should be paid to maintaining proper reduction while fixating right-sided intertrochanteric fractures.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"125"},"PeriodicalIF":1.9,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive ability of frailty scores in surgically managed patients with traumatic spinal injuries: a TQIP analysis.","authors":"Maximilian Peter Forssten, Lovisa Ekestubbe, Yang Cao, Ahmad Mohammad Ismail, Ioannis Ioannidis, Babak Sarani, Shahin Mohseni","doi":"10.1007/s00068-025-02775-0","DOIUrl":"10.1007/s00068-025-02775-0","url":null,"abstract":"<p><strong>Purpose: </strong>Frailty has gained recognition as a crucial determinant of patient outcomes following traumatic spinal injury (TSI), particularly due to its increasing incidence in elderly populations. The aim of the current investigation was therefore to compare the ability of several frailty scores to predict adverse outcomes in surgically managed isolated TSI patients without spinal cord injury.</p><p><strong>Methods: </strong>All adult patients (18 years or older) who suffered an isolated TSI due to blunt trauma, and required surgical management, were extracted from the 2013-2021 Trauma Quality Improvement Program database. The ability of the Orthopedic Frailty Score (OFS), the Hospital Frailty Risk Score (HFRS), the 11-factor (11-mFI) and 5-factor (5-mFI) modified frailty index, as well as the Johns Hopkins Frailty Indicator to predict adverse outcomes was compared based on the area under the receiver-operating characteristic curve (AUC). Subgroup analyses were also performed on patients who were ≥ 65 years old and those who were injured due to a ground-level fall (GLF).</p><p><strong>Results: </strong>A total of 39,449 patients were selected from the TQIP database. The 5-mFI and 11-mFI outperformed all other frailty scores when predicting in-hospital mortality (5-mFI AUC: 0.73) (11-mFI AUC: 0.73), any complication (5-mFI AUC: 0.65) (11-mFI AUC: 0.65), and FTR (5-mFI AUC: 0.75) (11-mFI AUC: 0.75). Among the 14,257 geriatric patients, however, the OFS demonstrated the highest predictive ability for in-hospital mortality (AUC: 0.65). The OFS (AUC: 0.64) also performed on the same level as both the 5-mFI (AUC: 0.63) and the 11-mFI (AUC: 0.63) when predicting FTR in this population. Among the 9616 patients who were injured due to a GLF, the OFS performed on par with the 5-mFI and 11-mFI when predicting in-hospital mortality and FTR.</p><p><strong>Conclusion: </strong>Simpler scores like the 5-factor modified Frailty Index and Orthopedic Frailty Score outperform or perform on par with more complicated frailty scores when predicting mortality, complications, and failure-to-rescue in surgically managed isolated traumatic spinal injury patients without spinal cord injury, particularly among geriatric patients and those injured in a GLF.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"126"},"PeriodicalIF":1.9,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11880054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Significantly increased bone volume in a critical-sized defect model in the rat animal model by transplantation of a stand-alone vascularized periosteal flap.","authors":"Florian Wichlas, Maximilian Wenzel, Valeska Hofmann, Klemens Trieb, Amelie Deluca, Herbert Tempfer, Andrea Wagner, Andreas Traweger, Sascha Senck, Christian Deininger","doi":"10.1007/s00068-025-02770-5","DOIUrl":"10.1007/s00068-025-02770-5","url":null,"abstract":"<p><strong>Purpose: </strong>The repair of bony non-unions remains challenging and often requires graft material due to limited availability of autologous bone. The aim of this study was to investigate the potency of a stand-alone pedicled periosteal flap (PF) versus a ligated periosteal flap (PFx), an empty defect and a crossover group in terms of newly formed bone in a 5 mm critical-sized defect in the rat femur diaphysis.</p><p><strong>Methods: </strong>The following 4 treatment groups were formed out of a total of 36 male Sprague Dawley rats: Pedicled periosteal flap, ligated periosteal flap, crossover (each n = 10) and empty defect group (n = 6). A prospective randomized plate osteosynthesis was performed. The periosteal flap was dissected along with the supplying vessel from the medial femoral condyle with the aid of magnifying glasses and fixed to the plate and to the defect with a suture. Regular radiographic and µ-CT examinations were performed to determine bone volume inside the defect, as well as descriptive histological examinations.</p><p><strong>Results: </strong>Newly formed bone tissue was measured by Bone Volume / Tissue Volume. The significant highest ratio to the control group was detected in the PF group after 10 weeks (18.77%) compared to the crossover- (11.28%; p = 0.0436), the PFx- (10.98%; p = 0.0411), and the control group (10.47%; p = 0.0293). No relevant differences were found in the descriptive histological examination.</p><p><strong>Conclusion: </strong>According to the observed results, bony healing of non-union defects can be supported with a pedicled periosteal flap. The superiority of the pedicled compared to the ligated periosteal flap suggests that the improved blood flow within the defect area is an essential component of the healing phase itself.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"121"},"PeriodicalIF":1.9,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11870878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study of bone-tendon interface healing in an animal model using a synthetic scaffold and PRP.","authors":"Xavier Llorens Martínez, Leonardo Ruiz Macarrilla, Sergi Rey-Viñolas, Miguel A Mateos-Timoneda, Elisabeth Engel, J M Mora Guix","doi":"10.1007/s00068-025-02796-9","DOIUrl":"https://doi.org/10.1007/s00068-025-02796-9","url":null,"abstract":"<p><strong>Purpose: </strong>Biological matrices have been used to reinforce large rotator cuff tear repairs. However, rapid resorption and initial immune reactions presented challenges in clinical practice. This study evaluates whether a resorbable synthetic matrix (scaffold), used alone or with platelet-rich plasma (PRP), impacts repair processes at microscopic, ultrasound, and biomechanical levels in a rabbit model of induced tendon-bone interface injury.</p><p><strong>Methods: </strong>An experimental study was performed on 24 rabbits. Two experimental groups (n = 12 each) and a control group (n = 24) were defined. In the first group (BioP), the internal gastrocnemius tendon was sectioned and repaired to bone using double-row sutures, reinforced with a PLC (poly-L-lactic-co-ε-caprolactone) and PLA (polylactic acid) scaffold. In the second group (BioP + PRP), autologous PRP was added to the repair. The control group received no scaffold or PRP. Euthanasia was performed at 8 weeks, followed by microscopic, ultrasound, and biomechanical evaluations.</p><p><strong>Results: </strong>Microscopically, a granulomatous reaction limited to the foreign body was observed in both scaffold groups. The healing process was not altered in any group, showing good biocompatibility of the scaffold. Echographically, a greater sagittal diameter was observed in the group without PRP compared to the other groups. Biomechanically, no significant differences in rupture zones were found across groups, but the scaffold-only group required a higher maximum applied force before rupture.</p><p><strong>Conclusions: </strong>At 8 weeks, using a degradable synthetic PLC and PLA scaffold as support at the bone-tendon interface did not significantly alter the normal repair process, showed echographic and biomechanical benefits, and PRP did not show additional benefits in our experimental model.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"124"},"PeriodicalIF":1.9,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical strategy for chest wall reconstruction secondary to cardiopulmonary resuscitation versus post-traumatic.","authors":"Corinna Carla Dobroniak, Valeska Lesche, Ulrike Olgemöller, Paula Beck, Wolfgang Lehmann, Christopher Spering","doi":"10.1007/s00068-025-02799-6","DOIUrl":"10.1007/s00068-025-02799-6","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;In mechanically cardiopulmonary resuscitated (CPR) patients, chest compressions at the level of the 3rd to 5th rib on the sternum result in reproducibly similar injury patterns: parasternal osteochondral dissociation (OCS) on both sides in combination with a sternal fracture with or without an additional serial rib fracture in the anterolateral column (ALS). This injury biomechanically impairs physiological breathing, resulting in an inverse breathing pattern. Trauma patients, on the other hand, often show a mixed pattern depending on the location of the main energy. The aim of the study was to evaluate the surgical technique of chest wall reconstruction (CWR) using transsternal refixation of the 5th rib on both sides in combination with plate osteosynthesis of the sternum and to analyze its success in comparison to the surgical strategy of CWR in the context of a traumatic genesis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;Data acquisition was performed using medical records of a Level I Trauma Centre in Germany and compare patients with radiologically or clinically diagnosed flail chest as a result of cardiopulmonary mechanical resuscitation (CPR). The retrospective study included patients in the period 2018-2023 after surgical CWR. The patients were either post-CPR (n = 29; CPR) or trauma patients (n = 36; trauma). The collective was described and analyzed using the digital patient file, as well as data on ICU stay and duration of ventilation or conversion to assisted ventilation modes, reason for chest wall instability, time of surgery, length of stay and mortality. As a long-term follow-up, body plethysmography was analyzed comparatively. Primary endpoints were mean length of stay in ICU, time to surgery, ventilator dependency and mortality rate. Secondary endpoints were time to transfer to rehabilitation, ventilation disorders and long term outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In the period 65 patients (48 m, 17w) were included, 29 of whom had been mechanically resuscitated (CPR), 36 formed to post-traumatic cohort (trauma). The CPR were significantly older (69 vs. 58 years; p-value 0.003). The duration from CPR to surgery was on average significantly longer than trauma to surgery (16.76 vs. 4.11 days). The mean length of stay in ICU were 30 days (trauma) and 45 days for CPR (significantly longer, p-value 0.0008). The mean duration of ventilation was 188 h for trauma and 593 h for CPR. Extubation or conversion to assisted, relevant de-escalating ventilation modes was possible in both groups after a mean of 38 h post-OP. Among the CPR patients, 4 died in hospital (hospital mortality: CPR 20.7% vs. trauma 5.6%), 7 (30%) were transferred to an early clinical rehabilitation and 10 were discharged to home or follow-up treatment. In the case of trauma, 5 (14.7%) were transferred to an early clinical rehabilitation and 20 were discharged to home or follow-up treatment. Bodyplethysmography 6 months after CPR / trauma showed no","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"122"},"PeriodicalIF":1.9,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11870994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of myocardial injury in trauma patients: proposed phenotypes for future research.","authors":"Jett Karolewski, Jodie-Kate Williams, Natasha Weaver, Simone Meakes, Karen Gane, Zsolt J Balogh","doi":"10.1007/s00068-025-02798-7","DOIUrl":"10.1007/s00068-025-02798-7","url":null,"abstract":"<p><strong>Purpose: </strong>To describe the epidemiology of myocardial injury in trauma patients, in doing so informing design for future multicentre prospective studies.</p><p><strong>Method: </strong>A one-year retrospective study ending on 31/08/2023 was conducted at a Level-1 Trauma Centre. All adult trauma resuscitation patients with elevated Troponin serum concentration were included. Patient demographics, medical history, mechanism, injury severity, laboratory data, cardiac investigations, LOS, ICU admission and mortality were collected. Patients were categorised into three pragmatic groups based on the timing of their Troponin peak (Group1:<12 h; Group2:12-24 h; Group3:>24 h).</p><p><strong>Results: </strong>From 1408 admissions, 97(7%) patients [Age:57(35,80); Male:71%; ISS:18(9-33); LOS:9(4,16.5); ICU:66%; Mortality:16.5%] had elevated Troponin. Group 1 [n = 37; Age:47(24,70); Male:76%; ISS:9(4,22); LOS:7(3,14); ICU:51%; Mortaliy:5.4%]; Group 2 [n = 32; Age:53.5(26,74); Male:78%; ISS:27(12.5,53.5); LOS:10(5,17); ICU:84%; Mortaliy:25%] and Group 3 [n = 28; Age:78(62,84); Male:57%; ISS:19(9.5,47.5); LOS:12.5(6,19.5); ICU:64%; Mortaliy:21%]. 64% of patients had thoracic injuries, which was consistent among the three groups. Group 3 had most frequent ECG (61%) and echocardiography (25%) findings.</p><p><strong>Conclusion: </strong>Troponin elevation occurs in 7% of all trauma admissions and it identifies the seriously injured high-risk cohort. The timing of the maximum Troponin concentration seems to describe three distinct phenotypes. \"Hyperacute\" with most favourable outcomes, \"Subacute\" with severe trauma and tissue injury requiring major resource utilisation and associated with the highest mortality rate, and \"Late\" characterised by ECG and ECHO changes suggesting primary ischaemic cardiac pathology.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"123"},"PeriodicalIF":1.9,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11870892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The distribution of lateral rib fractures: a validation and further development of the AO/OTA classification system in patients with fractures at the rib shaft.","authors":"Johannes Groh, Florian Kern, Johannes Krause, Mario Perl, Stefan Schulz-Drost","doi":"10.1007/s00068-025-02795-w","DOIUrl":"10.1007/s00068-025-02795-w","url":null,"abstract":"<p><strong>Introduction: </strong>Rib fractures are prevalent and clinically significant injuries, often associated with thoracic trauma. Despite their frequency, the precise distribution and characteristics of rib shaft fractures remain underexplored. This study investigates the distribution, location, and classification of lateral rib fractures using the AO/OTA classification, focusing on fracture patterns and the relationship to neighbored ribs.</p><p><strong>Methods: </strong>The study retrospectively analyzed 116 patients with 617 isolated rib fractures treated at a Level 1 trauma center over seven years. Using CT scans, fractures between the tubercle and osteochondral junction of the rib shaft were examined. Fracture type, dislocation, and location were categorized according to AO standards. The 116 patients underwent detailed statistical analysis to identify distribution patterns and correlations between fracture characteristics.</p><p><strong>Results: </strong>The fractures predominantly occurred between the fifth and seventh ribs, with a focus in the anterolateral to lateral region (40°-69°). Type A fractures were more anteriorly located, while type B fractures and dislocations shifted posteriorly. A regression analysis confirmed the significance of fracture type and dislocation in determining fracture position. Moreover, fractures showed clustering patterns, with adjacent ribs more likely to be injured. A caudal shift in fracture density and localization from the cranial to the caudal thorax was also observed.</p><p><strong>Discussion and conclusion: </strong>The findings validate the AO/OTA classification for rib fractures, highlighting the need for refined subsegmental divisions within the rib shaft for more precise clinical application. The study underscores the relationship between fracture location, type, and associated injuries, advocating for multicenter studies and a comprehensive classification system for thoracic trauma. This could enhance our understanding of injury patterns and inform treatment strategies.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"120"},"PeriodicalIF":1.9,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11847753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}