European Journal of Trauma and Emergency Surgery最新文献

{"title":"Outcomes of popliteal artery injuries in a level 1 trauma centre: a 6-year review.","authors":"Kewen van Rensburg, Wilme Steyn, Ismail Cassimjee, Maeyane Stephens Moeng","doi":"10.1007/s00068-024-02691-9","DOIUrl":"10.1007/s00068-024-02691-9","url":null,"abstract":"<p><strong>Purpose: </strong>To determine modifiable and non-modifiable factors contributing to limb loss in PAI the relevance and accuracy of published scoring systems for PAI within a South African State hospital.</p><p><strong>Methodology: </strong>Retrospective review of patients (> 18 years) with PAI, presenting to CMJAH trauma unit from 1 January 2017 to 31 December 2022.</p><p><strong>Results: </strong>Sixty-four patient records were analysed. Thirty (46.9%) had blunt trauma and thirty-four (53.1%) had penetrating trauma. Gunshot wounds (GSW) were the most common mechanism of injury (MOI). Blunt PAI had a 40% amputation rate and penetrating trauma, 33.3%. Forty-seven (73.4%) had a delay to surgery of > 6 h. The mean time to arrival at our emergency department was 478 min, and the mean time from arrival to surgery was 368 min (total delay of 838 min). The primary amputation rate was 28.6%, and 63.5% had successful limb salvage surgeries. The secondary amputation rate was 7.8%.</p><p><strong>Conclusion: </strong>Compared to international literature, our rate of primary amputation is high (10% vs. 28.8%) and prolonged ischaemia is the likely cause. Only 17 (26.6%) patients presented before 6 h. Of the 45 patients that had an attempt at revascularisation, 7.8% had a secondary amputation. Thus, despite prolonged ischaemia, revascularisation should be attempted in patients with at least two viable compartments on fasciotomy. The MESS and POPSAVEIT scoring systems should not be relied on in patients with delayed presentations. Strengthening referral triage for suspected PAI to Level 1 Trauma centres directly will decrease the delays and likely improve the outcomes.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"63"},"PeriodicalIF":1.9,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11761999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037641","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":"Type B ankle fractures with additional medium-sized posterior fragment: mid-term functional and radiological outcome after fixation versus no fixation of the posterior fragment.","authors":"A L Franx, J M Hoogendoorn, E L L Twiss, P Krijnen, S M Verhage","doi":"10.1007/s00068-024-02696-4","DOIUrl":"10.1007/s00068-024-02696-4","url":null,"abstract":"<p><strong>Purpose: </strong>Guidelines for treatment of medium-sized posterior fragments in trimalleolar fractures are scarce and show varying advice. Recent trials comparing fixation and no fixation of posterior fragments, show no difference in outcomes one year postoperatively. This study compares functional outcome and development of osteoarthritis in patients with fixation of a posterior malleolar fracture to patients without fixation of the posterior malleolus fracture.</p><p><strong>Methods: </strong>This retrospective cohort study included patients operated for type B ankle fractures with medium-sized (5-25% of joint surface) posterior malleolar fragments in a Dutch level-1 trauma center between 2014 and 2018. ORIF of posterior fragments (FIX) was compared to no fixation (NO-FIX). Choice of treatment was based on the surgeon's preference. Functional outcome was assessed using the AOFAS-score, OMAS-score and VAS-pain. Development of osteoarthritis was assessed on radiographs. A linear regression analysis was performed to identify risk factors for worse functional outcome and osteoarthritis.</p><p><strong>Results: </strong>27 patients were included in the FIX group and 58 patients in the NO-FIX group. After a median follow-up of 74 months (range 50-108), no difference was observed for functional outcome and pain (median AOFAS 90 vs. 95, OMAS 85 vs. 88, VAS-pain 1 vs. 1; all p > 0.05). Osteoarthritis rates were comparable (grade ≥ 2: 22% in FIX vs. 21% in NO-FIX, p = 0.87). Median fragment size was 15.7% versus 13.6% of the tibial articular surface after FIX and NO-FIX respectively. Median postoperative step-off on radiograph was 0.0 mm after FIX and 0.8 mm after NO-FIX (p = 0.20). Complication rates, including infection, secondary operation and hardware removal, were comparable. Postoperative step-off > 1 mm increased the risk of osteoarthritis (odds ratio 3.9, 95% CI 1.2-12.7).</p><p><strong>Conclusion: </strong>The value of fixation of medium-sized posterior fragments in type B ankle fractures seems limited after mid-term follow-up, although functional impairment caused by osteoarthritis might develop in the long-term. Because postoperative step-off > 1 mm increases the risk of osteoarthritis, restoration of the tibial plafond seems essential.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"79"},"PeriodicalIF":1.9,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037708","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":"Minimal clinically important difference (MCID), patient-acceptable symptom state (PASS), and substantial clinical benefit (SCB) following surgical knee ligament reconstruction: a systematic review.","authors":"Filippo Migliorini, Nicola Maffulli, Madhan Jeyaraman, Luise Schäfer, Björn Rath, Thorsten Huber","doi":"10.1007/s00068-024-02708-3","DOIUrl":"https://doi.org/10.1007/s00068-024-02708-3","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>This study was conducted according to the 2020 PRISMA statement. In January 2024, the following databases were accessed: PubMed, Web of Science, and Embase. No time constraint was set for the search. All the clinical studies investigating tools to assess the clinical relevance of PROMs in knee ligament surgery were accessed. Only studies which evaluated the MCID, PASS, and SCB were eligible. The PROMs of interest were: International Knee Document Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS) and its related subscales activity of day living (ADL), pain, quality of life (QoL), sport and recreational, and symptoms (Roos et al. in J Orthop Sports Phys Ther 28:88-96, 1998), Lysholm knee scoring scale, Short Form 12 (SF-12) and its related mental and physical component subscales, Tegner Activity Scale.</p><p><strong>Results: </strong>Seven non-RCT investigations, three with a prospective and four with a retrospective study design, were selected for inclusion in the present review, including 1,414 patients. The overall risk of bias was low to moderate in 71.4% (5 of 7) and serious in 28.6% (2 of 7) of the studies assessed in the present investigation, indicating a broadly acceptable methodological quality. The IKDC reported an MCID of 13.8/100, the KOOS 8.0/100, the Lysholm 9.9/100, and the Tegner Activity Scale 0.5/10.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"32"},"PeriodicalIF":1.9,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022563","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":"Tranexamic acid: single topical application for femoral neck fractures treated with arthroplasty results in lowest blood loss.","authors":"Kurnoth Anna, Timon Röttinger, Leonhard Lisitano, Nora Koenemann, Stefan Förch, Edgar Mayr, Annabel Fenwick","doi":"10.1007/s00068-024-02675-9","DOIUrl":"10.1007/s00068-024-02675-9","url":null,"abstract":"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>A retrospective single centre cohort study (level I trauma centre) with 2008 patients treated operatively for a proximal femur fracture between January 2016 and January 2022 was performed. 1 g of tranexamic acid was applied in 314 cases (systemic, topic or combined application) if patients consented. Patient data, surgical procedure, complications, and mortality were assessed. Haemoglobin levels, blood loss and transfusion rates were compared amongst application methods.</p><p><strong>Results: </strong>For 884 femoral neck fractures treated with arthroplasty blood loss was significantly reduced by tranexamic acid which 314 had received in total (1151.0 ml vs 738.28 ml; p < 0.001). 151 patients received 1 g of tranexamic acid systemically which reduced blood loss from 1151 to 943.25 ml. Combined application of 1 g i.v. and 1 g topically reduced blood loss even further to 869.79 ml and topical application achieved the lowest total blood loss at 391.59 ml (average reduction of 759.41 ml compared to without tranexamic acid), p < 0.001. Transfusion rate and amount of RBC units transfused were the lowest for topical use and showed the highest hemoglobin levels postoperatively. Complication rates did not differ for adverse vascular events.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"31"},"PeriodicalIF":1.9,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11750898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002768","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":"Surgical intervention in traumatic brain injury: a systematic review and meta-analysis of decompressive craniotomy.","authors":"Mubarak Algahtany, Amit Kumar, Malik Algahtany, Maan Alqahtani, Musaab Alnaami, Aws Algahtany, Majed Aldehri, Ibrahim Alnaami","doi":"10.1007/s00068-024-02725-2","DOIUrl":"https://doi.org/10.1007/s00068-024-02725-2","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>A systematic search was conducted across six electronic databases to identify relevant randomized controlled trials (RCTs) examining decompressive craniotomy (DC) and traumatic brain injury (TBI) from database inception until March 2021. The pooled risk ratio was estimated for categorical outcomes, while the pooled standardized mean difference with a 95% confidence interval was calculated for continuous outcomes. Statistical analysis software, including RevMan 5.4 and STATA version 17, was employed to perform this meta-analysis. The protocol for this study is registered with the OSF registry, ensuring transparency and reproducibility.</p><p><strong>Results: </strong>A total of 656 studies were screened, and five RCTs involving 665 subjects (334 in the DC group and 331 in the control group) were included in this meta-analysis. Our meta-analysis revealed a non-significant trend towards a higher rate of favorable clinical outcomes in subjects who underwent DC compared to those in the medical treatment (MT) group (risk ratio (RR) 1.20, 95% confidence interval (CI) 0.70 to 2.08, P = 0.50). In contrast, the mortality rate was significantly lower in patients treated with DC compared to those receiving MT alone (RR 0.58, 95% CI 0.47 to 0.73, P < 0.001). Additionally, intracranial pressure (ICP) levels were significantly lower in subjects who underwent DC compared to those receiving MT alone (standardized mean difference (SMD): - 0.87, 95% CI - 1.58 to - 0.16, P = 0.02). Furthermore, there was a statistically significant reduction in the duration of stay in the DC group compared to the MT alone group (SMD: - 1.18, 95% CI - 1.49 to - 0.86, P < 0.001).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"30"},"PeriodicalIF":1.9,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002767","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":"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.","authors":"Taina Mueller, Barbara Weiß, Thomas Wirth, Francisco F Fernandez","doi":"10.1007/s00068-024-02728-z","DOIUrl":"https://doi.org/10.1007/s00068-024-02728-z","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Material and methods: &lt;/strong&gt;All patients that suffered a PFNF or an AVN following a PFNF in the last 15 years that were treated at a university-level hospital with a minimum of 12 months follow-up were included in this retrospective study. Patients with a pathological fracture or closed epiphysis were excluded. Radiological outcome was evaluated based on Ratcliff criteria. The association of possible risk factors such as age, gender, traumatic mechanism, fracture type, degree of dislocation, time to surgery or type of surgical intervention with AVN was analyzed. Since not all fractures could be assigned to an exact fracture type, a new fracture type was included in the subgroup analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We included 37 patients in the study population. The mean age at the time of the diagnosis was 11.5 years (ranging 5-16 years). Mean follow-up was 30 months. 75% of the cases were diagnosed on the day of the trauma. Nine patients had a delayed diagnosis of which eight had a previous neurological disease (eg. cerebral palsy). A previous illness was significantly associated with a late diagnosis (p &lt; 0.001). 17 patients suffered a high velocity trauma. 35 patients were treated operatively, the majority with a closed reduction (81%) and an internal fixation with cannulated screws (75%). In 24 patients (65%) an additional puncture of the hip joint was performed. Ten patients developed AVN, two of them ultimately had to be treated with a total hip arthroplasty. Female gender was associated with AVN, though not significantly (p = 0.051). A Delbet type IV injury and a high velocity trauma were significantly associated with an AVN (p = 0.020, p = 0.030 respectively). A type IIR fracture was significantly more likely to develop AVN compared to a Delbet type II fracture. Age, polytrauma, degree of dislocation, time to diagnosis, time to surgery and type of treatment was found were not significantly associated with AVN.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;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 im","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"28"},"PeriodicalIF":1.9,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002764","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":"From the last 100 to the first 100-outcome after a manufacturer change in reverse fracture arthroplasty.","authors":"Johannes Gleich, Evi Fleischhacker, Christopher Lampert, Georg Siebenbürger, Ben Ockert, Wolfgang Böcker, Tobias Helfen","doi":"10.1007/s00068-024-02724-3","DOIUrl":"10.1007/s00068-024-02724-3","url":null,"abstract":"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>The last 100 patients before and the first 100 after manufacturer change in reverse fracture arthroplasty were evaluated at a level one trauma center, all treated by only 3 senior shoulder surgeons. Clinical as well as radiographic outcome parameters were assessed, perioperative up to 24 months after surgery.</p><p><strong>Results: </strong>Mean age in both groups was nearly 80 years with comparable distribution of gender and comorbidities. A trend to shorter duration of surgery was observed after the change, mainly according to an uncemented fixation of the stem. During follow-up no significant differences, beneficial as well as negative, could be observed regarding clinical and radiographic outcome.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"29"},"PeriodicalIF":1.9,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002756","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":"Optimal timing of stabilization and operative technique for extremity fractures in polytrauma patients: a systematic review and meta-analysis.","authors":"Eva Steinfeld, Klemens Horst, Kelly Ansems, Karolina Dahms, Julia Dormann, Heidrun Janka, Maria Inti-Metzendorf, Carina Benstoem, Frank Hildebrand, Nils Becker","doi":"10.1007/s00068-024-02762-x","DOIUrl":"10.1007/s00068-024-02762-x","url":null,"abstract":"<p><strong>Purpose: </strong>In polytrauma patients, injuries involving the extremities are frequently seen. Treatment concepts vary from early definitive care to temporary fixation and delayed definite stabilization. This analysis therefor aims to illuminate the impact of timing for operative stabilization of extremity fractures on outcome factors in adult polytrauma patients.</p><p><strong>Methods: </strong>We searched PubMed and Cochrane CENTRAL to identify studies from inception of each database to 14 September 2022. We included systematic reviews and RCTs comparing immediate versus delayed operative fracture stabilization and early definite care versus primary external fixation in adult polytrauma patients.</p><p><strong>Results: </strong>Five randomized controlled trials were included, with a total of 335 patients. The analysis found no statistically significant difference in overall mortality or improvement in ICU admission between early (< 24 h) and late fracture stabilization. Comparing femoral nailing and external fixation, findings showed that femoral nailing reduce ICU length of stay and duration of invasive mechanical ventilation.</p><p><strong>Conclusion: </strong>The results indicate that immediate surgical treatment by nailing is superior to delayed treatment or a staged surgical approach in stable polytrauma patients with long-bone fractures. As there is a lack of clear evidence regarding the optimal timing for definitive operative stabilization of extremity fractures in polytrauma patients, further high-quality studies are essential to enhance the certainty of evidence and provide more conclusive treatment algorithms.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"27"},"PeriodicalIF":1.9,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11742870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002761","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":"Effectiveness of a co-management program with internal medicine on hip fracture patients at a regional hospital in northwest Spain. Co-inter-Monf study.","authors":"Ana Rodríguez Álvarez, José López-Castro, Javier Cambón Cotelo, Victor Quevedo Vila, Álvaro Marchán-López","doi":"10.1007/s00068-024-02737-y","DOIUrl":"https://doi.org/10.1007/s00068-024-02737-y","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Aim: </strong>This study aims to evaluate whether the previously observed benefits of co-management can be achieved when such a program is implemented in a rural-based district hospital.</p><p><strong>Methods: </strong>A prospective, single-center observational study was conducted on hip fracture patients hospitalized for hip fracture. Patients were either co-managed by an internal medicine specialist with part-time dedication or not co-managed. The study was conducted in a rural hospital located in Galicia, Northwestern Spain, which serves a population of 45,000.</p><p><strong>Results: </strong>A total of 207 patients were included in the study, of whom 97 received co-management. The majority of the patients who were co-managed were female (69.1%) and had a median age of 88 years (interquartile range 83-92). The study showed a high burden of comorbidity with a median Charlson index of 6 points, along with high prevalence rates of dementia (46%), functional disability (50%), and chronic anticoagulant therapy (25%). Despite no differences in age, sex, or preadmission cognitive or functional status, the study found lower 30-day postdischarge mortality in co-managed patients (9.3%) compared with the 110 controls (20.0%, p = 0.049). The prevalence of osteoporosis treatment, both calcium/vitamin D (87.8% vs. 60.7%, p < 0.001) and bisphosphonates/denosumab/teriparatide (42.4% vs. 15.7%, p < 0.001), was higher in the co-managed patients at 30 days after discharge. No differences were observed between the two groups in terms of in-hospital mortality and length of stay.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"23"},"PeriodicalIF":1.9,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002753","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":"Mild acute biliary pancreatitis: still a surgical disease. A post-hoc analysis of the MANCTRA-1 international study.","authors":"Stefano Piero Bernardo Cioffi, Andrea Spota, Francesco Virdis, Michele Altomare, Andrea Mingoli, Stefania Cimbanassi, Francesca Laura Nava, Silvana Nardi, Marcello Di Martino, Salomone Di Saverio, Benedetto Ielpo, Francesco Pata, Gianluca Pellino, Massimo Sartelli, Dimitris Damaskos, Federico Coccolini, Adolfo Pisanu, Fausto Catena, Mauro Podda","doi":"10.1007/s00068-024-02748-9","DOIUrl":"10.1007/s00068-024-02748-9","url":null,"abstract":"<p><strong>Background: </strong>The current standard of care for mild acute biliary pancreatitis (MABP) involves early laparoscopic cholecystectomy (ELC) to reduce the risk of recurrence. The MANCTRA-1 project revealed a knowledge-to-action gap and higher recurrence rates in patients admitted to medical wards, attributable to fewer ELCs being performed. The project estimated a 35% to 70% probability of narrowing this gap by 2025. This study evaluates the safety of suboptimal ELC implementation and identifies risk factors for recurrent acute biliary pancreatitis (RAP) in patients not undergoing ELC after an MABP episode.</p><p><strong>Methods: </strong>We conducted a post-hoc analysis of the MANCTRA-1 registry, including MABP patients who did not undergo ELC during the index hospitalization, excluding those with related complications. The primary outcome was the 30-day hospital readmission rate due to RAP. We performed multivariable logistic regression to find risk factors associated with the primary outcome.</p><p><strong>Results: </strong>Between January 2019 and December 2020, 1920, MABP patients from 150 centers were included in the study. The 30-day readmission rate due to RAP was 6%. Multivariable logistic regression found the admission to a medical ward (internal medicine or gastroenterology) (OR = 1.95, p = 0.001) and a positive COVID-19 test (OR = 3.08, p = 0.029) as independent risk factors for RAP.</p><p><strong>Conclusion: </strong>Our analysis offers valuable insights into the management of MABP, particularly in centers where ELC cannot be fully implemented due to logistical and clinical constraints, worsened by the COVID-19 pandemic. Regardless of the admitting ward, prompt access to surgical care is crucial in reducing the risk of early recurrence, highlighting the need to implement surgical consultation pathways within MABP care bundles.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"24"},"PeriodicalIF":1.9,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11742350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002758","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}