European journal of trauma and emergency surgery : official publication of the European Trauma Society最新文献

{"title":"Improved outcomes for severely injured children in designated pediatric trauma centers in the Netherlands.","authors":"Sem A M Jansen, Manouk Backes, Dominique B Buck, Anneliese Nusmeier, Lucas Timmermans, Stefan W A M van Zutphen, Michael J R Edwards, Erik Hermans, Stijn D Nelen","doi":"10.1007/s00068-025-02916-5","DOIUrl":"10.1007/s00068-025-02916-5","url":null,"abstract":"<p><strong>Purpose: </strong>Pediatric trauma centers (PTCs) have been associated with lower mortality rates and increased use of non-operative management. While not formally designated, six trauma centers in the Netherlands meet PTC criteria and are referred to as designated pediatric trauma centers (dPTCs). This study aimed to evaluate the impact of treatment at dPTCs versus adult trauma centers (ATCs) on outcomes in severely injured pediatric patients in the Netherlands.</p><p><strong>Methods: </strong>Data were obtained from the Dutch National Trauma Registry for patients aged ≤ 16 years with an Injury Severity Score (ISS) ≥ 16, admitted between January 1, 2015, and December 31, 2022. Multivariable logistic regression was performed to assess the impact of treatment at a dPTC on in-hospital mortality and Glasgow Outcome Scale (GOS) scores.</p><p><strong>Results: </strong>In total, 2,378 patients were included: 63% were treated in dPTCs, 17% in ATC-I, and 20% in ATC-II/III. Mortality rates were 13.1% in dPTCs, 12.6% in ATC-I, and 2.1% in ATC-II/III (p < 0.001). For children under 12 years of age, treatment at a dPTC was independently associated with a lower risk of in-hospital mortality compared to ATC-I (odds ratio [OR] 1.99, p = 0.017). dPTC treatment was also associated with more favorable GOS outcomes compared to ATC-I (OR 0.68, p = 0.022) and ATC-II/III (OR 0.34, p < 0.001).</p><p><strong>Conclusion: </strong>Treatment at dPTCs is associated with a reduced risk of mortality for patients under 12 years of age and improved functional neurological outcomes. These findings support the further centralization of pediatric trauma care in the Netherlands.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"51 1","pages":"253"},"PeriodicalIF":0.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12259715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144639496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of chest radiography on patient management in acute trauma care- observation from a level-1 trauma center.","authors":"Arthur A R Sweet, Sophie L van Wolfswinkel, Tim Kobes, Kim E M Benders, Roderick M Houwert, Luke P H Leenen, Pim A de Jong, Wouter B Veldhuis, Falco Hietbrink, Mark C P M van Baal","doi":"10.1007/s00068-025-02929-0","DOIUrl":"10.1007/s00068-025-02929-0","url":null,"abstract":"<p><strong>Purpose: </strong>This study evaluates the impact of chest radiography on acute interventions in the trauma bay.</p><p><strong>Methods: </strong>This cross-sectional study was performed on trauma patients admitted to the University Medical Center Utrecht, a level-1 trauma center, during a one-year period. All adult (≥ 16 years) trauma patients who underwent chest radiography in the trauma bay and were subsequently admitted to the hospital were eligible. Patients with non-blunt trauma, initial primary survey in another center, or initial chest radiography obtained outside the shock room were excluded. Patients were categorized as hemodynamically and respiratory compromised or non-compromised patients, and based on symptoms of chest injuries. Descriptive analyses were used.</p><p><strong>Results: </strong>This study included 780 patients, with a median age of 51 years (IQR 32-68), and 66.2% were male. Comorbidities (ASA 3-4) were seen in 12.8% and the median ISS was 10 (IQR 5-18). There were 382 hemodynamically and respiratory non-compromised patients without symptoms of chest injuries, of whom 255 underwent a subsequent chest CT. No acute interventions were performed in these patients. In symptomatic but hemodynamically and respiratory non-compromised patients (n = 289) there were 15 (5.2%) non-urgent chest tube placements prior to CT. Among 109 hemodynamically or respiratory compromised patients there were 16 (14.7%) chest tube placements and five (4.6%) resuscitation surgeries prior to the chest CT.</p><p><strong>Conclusion: </strong>Omission of chest radiography in hemodynamically and respiratory non-compromised trauma patients presenting in the trauma bay seems safe, provided that a chest CT is already indicated.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"51 1","pages":"254"},"PeriodicalIF":0.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12259803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144639498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of sex-specific outcomes and mortality in polytrauma: a demographic and epidemiologic analysis by injury severity score.","authors":"Vesta Brauckmann, Sophie R Enke, Anna K I M Dietrich, Claudia Neunaber, Sabine Roth, Michaela Wilhelmi","doi":"10.1007/s00068-025-02930-7","DOIUrl":"10.1007/s00068-025-02930-7","url":null,"abstract":"<p><strong>Purpose: </strong>This study evaluates an updated demographic and epidemiological analysis of polytrauma patients, examining sex-specific outcomes, age distribution, and injury severity measured by the Injury Severity Score (ISS).</p><p><strong>Methods: </strong>This retrospective observational cohort analysis at a level I trauma center in Germany analyzed data from polytrauma patients with an ISS > 16, which were treated in an ICU between 2018 and 2021. Parameters collected included injury scores, pre-hospital data, and clinical outcomes. Assessed was distribution and correlation in pre-hospital and in-hospital outcomes.</p><p><strong>Results: </strong>In a cohort of 87 polytrauma patients (78.2% male, mean age 45.6 years, mean ISS of 35.4) thoracic injuries were the most frequent (83.9%), followed by injuries of the lower extremity, head, and upper extremity. Females had higher Apache scores and more severe head and neck injuries (p < 0.05). Mortality was 15%, deceased patients showing significantly higher ISS. Younger patients had longer hospital stays, averaging 26.1 days. Complications occurred in 90% of patients, predominantly SIRS, followed by kidney failure, ARDS, and sepsis. Prehospital care, including on-scene time, showed no overall correlation with outcomes, except chest drainage, which was associated with higher ARDS and MODS rates. Females received more platelet concentrates, FFPs and TXA.Higher ISS correlated with increased Apache, SOFA, lactate levels and required more blood transfusions and coagulation therapy (p < 0.001).</p><p><strong>Conclusion: </strong>Sex and age were shown to be associated with variations in injury severity, physical response and coagulation management, with females showing distinct injury patterns and physiological burdens. These findings highlight the importance of demographic factors in optimizing polytrauma management and guiding future evidence-based approaches to improve patient care.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"51 1","pages":"250"},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12234584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonoperative treatment of proximal humerus fractures in the elderly.","authors":"Sam Razaeian, Christian Krettek","doi":"10.1007/s00068-025-02912-9","DOIUrl":"10.1007/s00068-025-02912-9","url":null,"abstract":"<p><p>Proximal humerus fractures are common and occur in approximately 70% of the cases beyond the age of 60 with a peak incidence over the age of 80. A number of randomized studies and meta-analyses have so far failed to demonstrate the superiority of surgery over nonoperative treatment in the elderly. In addition, according to the latest systematic Cochrane Review, evidence still reveals that surgery might be associated with higher complication, and revision surgery rates. However, it remains unclear how exactly this evidence out of \"controlled\" trial conditions can be incorporated into a decision aid suitable for everyday clinical practice. The following review article aims to present a possible treatment algorithm that takes current best evidence into account, and provides guidance on how this steadily increasing type of injury might be successfully treated nonoperatively in the elderly in daily clinical practice.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"51 1","pages":"248"},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12234611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does damage control surgery for abdominal trauma have a real impact on survival benefit in major trauma patients? A systematic review of literature with meta-analysis.","authors":"Michele Altomare, Andrea Spota, Stefano Piero Bernardo Cioffi, Silvia Gianola, Greta Castellini, Antonello Napoletano, Daniela Coclite, Primiano Iannone, Stefania Cimbanassi, Andrea Mingoli, Osvaldo Chiara","doi":"10.1007/s00068-025-02874-y","DOIUrl":"https://doi.org/10.1007/s00068-025-02874-y","url":null,"abstract":"<p><strong>Background: </strong>Trauma remains a principal cause of mortality across all age groups, particularly in cases of major abdominal trauma and hemorrhage, which can lead to the 'lethal triad' of coagulopathy, metabolic acidosis, and hypothermia. This systematic review explores the efficacy of Damage Control Laparotomy (DCL) compared to definitive surgery (DEF) in major abdominal trauma.</p><p><strong>Methods: </strong>A systematic literature search following PRISMA and MOOSE guidelines was conducted across Medline, Cochrane Library, and Embase databases.</p><p><strong>Results: </strong>Seven studies were found, including one randomized controlled trial (RCT) and six observational studies (OS). Mortality rates varied, with one observational study indicating higher 24-h mortality in the DCS group (OR 1.49, 95% CI 0.48, 4.68, I² = 86%), while the RCT showed a significantly lower 30-day mortality rate (OR 0.05 (95% CI 0.00, 0.99 P = 0.010). Notably, major complications did not differ significantly between the two approaches (RCT OR 0.75, 95% CI 0.20, 2.77; OS OR 0.75, 95% CI 0.20, 2.77). The overall certainty of evidence was rated low, reflecting heterogeneous outcomes and inconsistent reporting.</p><p><strong>Conclusion: </strong>Although DCS is frequently utilized in trauma care, its superiority over definitive surgery remains unestablished, with ethical considerations complicating randomized trials. This review suggests that while DCS may be beneficial under specific conditions, robust multicentric studies are essential to clarify its impact on mortality and health outcomes compared to conventional surgery in abdominal trauma.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"51 1","pages":"247"},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lag screw versus no lag screw in surgery for Weber B ankle fractures: impact on recovery and surgical outcomes.","authors":"Wouter J Joosten, Margot H M Heijmans, William A van Dijk, Coen C M M Jaspars, Percy V van Eerten","doi":"10.1007/s00068-025-02928-1","DOIUrl":"10.1007/s00068-025-02928-1","url":null,"abstract":"<p><strong>Purpose: </strong>A lag screw is not always used in treating unstable Weber B ankle fractures, and evidence supporting its necessity remains limited. Therefore, recovery and surgical outcomes will be compared between surgery with and without a lag screw in patients with a Weber B ankle fracture.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted, including patients with a Weber B fracture who underwent surgery at Máxima Medical Center between 2012 and 2022. Surgery duration, complications, recovery, and reoperation rate and reasons were compared between patients treated with and without a lag screw. A questionnaire, including the Foot and Ankle Outcome Score, was sent to the same cohort to assess current ankle functionality and treatment satisfaction.</p><p><strong>Results: </strong>A total of 302 patients were included, of which 194 with a lag screw. The overall complication rate did not differ (p=0.87), while the distribution of complications did (p=0.01). More wound complications were observed in the no lag screw group (14.8% vs 9.3%), whereas less nerve injuries (0.0% vs 4.6%) and implant complaints (0.9% vs 3.1%) were observed. Surgery duration, recovery, reoperation rate and reasons did not differ between the groups. The questionnaire was completed by 141 patients, of which 92 with a lag screw. Foot and Ankle Outcome subscale scores and treatment satisfaction did not differ between the groups.</p><p><strong>Conclusion: </strong>This study demonstrates that the use of a lag screw is not essential in treating Weber B ankle fractures, as no differences in recovery and surgical outcomes were found between the two groups.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"51 1","pages":"249"},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12234606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standardized clinical examination of maxillofacial injury: fracture diagnostic accuracy across experience levels.","authors":"Pieter Date van der Zaag, Romke Rozema, Inge H F Reininga, Baucke van Minnen","doi":"10.1007/s00068-025-02927-2","DOIUrl":"10.1007/s00068-025-02927-2","url":null,"abstract":"<p><strong>Purpose: </strong>To determine whether physicians can accurately assess maxillofacial injury patients for the presence of fractures using a standardized clinical examination protocol, and to evaluate differences in assessment accuracy across experience levels.</p><p><strong>Method: </strong>A prospective observational cohort study was conducted in four hospital emergency departments of patients with maxillofacial injuries. Physicians rated fracture probability twice on a 0-10 scale: first based on visual signs before the clinical examination, and again after the standardized clinical examination consisting of 15 midfacial or 14 mandibular parameters. The assessors were categorized as medical intern in training, junior resident, senior resident, or consultant. The patients were classified into four groups: midfacial or mandibular injury, with or without a fracture, as determined by radiographic results. The fracture probability ratings before and after the clinical examination were compared.</p><p><strong>Results: </strong>Of 556 patients, 499 (90%) had midfacial injuries and 57 (10%) mandibular injuries. For midfacial injuries, greater variability in probability ratings and more incorrect assessments were observed compared to mandibular injuries. The intra-assessor analysis of fracture probability ratings before and after the clinical examination showed significant improvement in the direction of the eventual radiological diagnosis in three of the four patient groups for junior and senior residents, whereas the consultants, whose assessment was already proficient, only improved for one group, and none for interns. The inter-assessor analysis of fracture probability ratings showed no significant differences between the assessors.</p><p><strong>Conclusion: </strong>Midfacial injuries are more difficult to assess than mandibular injuries, and junior and senior residents benefited the most from the standardized clinical examinations.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"51 1","pages":"251"},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12234616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intensivist performed compression ultrasound (IPCUS) for screening and early detection of deep venous thrombosis in trauma intensive care unit: a prospective study.","authors":"Ahmad Kloub, Nuri Abdurraheim, Ahmed Ramzee, Naushad Ahmad Khan, Mushreq Alani, Suhail Hakim, Zeenat Bakhsh, Ibrahim Taha, Basil Younis, Gustav Strandvik, Tariq Siddiqui, Yousif Ibrahim, Mohamed Nasr, Sherwan Khoschnau, Khalid Ahmed, Ahad Kanbar, Ashok Parchani, Amor Kilani, Ala' Suliman, Motasem Awwad, Sana'a Odeh, Lady Faye Estalilla, Ana Giurgea, Abdul Nasar Avayil, Jenalyn Salvador, Jennely Dayandante, Greesha Alias, Sandro Rizoli, Ayman El-Menyar, Hassan Al-Thani","doi":"10.1007/s00068-025-02920-9","DOIUrl":"10.1007/s00068-025-02920-9","url":null,"abstract":"<p><strong>Introduction: </strong>Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a critical complication in trauma patients, contributing to considerable morbidity and mortality. Multiple factors in trauma pose a challenge to the early initiation of VTE chemoprophylaxis, thereby underscoring the benefit of early detection strategies for DVT. This study evaluated the feasibility of intensivist-performed Compression Ultrasound (IPCUS) for screening of proximal lower limbs for DVT in the trauma intensive care unit (TICU).</p><p><strong>Methods: </strong>We conducted a prospective study at a level 1 trauma center from November 2021 to May 2023 to assess the utility of IPCUS at the TICU. The study cohort included 800 multi-trauma patients aged 14 years and older admitted to trauma intensive care and step-down units. IPCUS was performed using a three-point compression technique at multiple post-injury time points. Positive or equivocal findings were validated by duplex ultrasonography (DUS). Patients were followed up for one month after discharge.</p><p><strong>Results: </strong>The cohort was predominantly male (94.2%), with a mean injury severity score of 20. The overall incidence of VTE within the cohort was 3%. VTE chemoprophylaxis was administered to 60% of patients within the first 48 h. IPCUS identified DVT in 10 patients, with a sensitivity of 89% and specificity of 100%. There was no clinical evidence of missed proximal lower limb DVTs. There was a moderate agreement (Cohen's Kappa score of 0.46) between IPCUS and radiographer-performed DUS.</p><p><strong>Conclusion: </strong>IPCUS is a feasible and effective screening method for proximal lower limb DVT in trauma patients with high diagnostic accuracy. Enhanced ultrasonography training for intensivists could further improve screening outcomes, reducing the number of equivocal cases. Larger studies are warranted to confirm these findings and establish standardized training protocols for IPCUS in trauma care settings.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"51 1","pages":"245"},"PeriodicalIF":0.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12227448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The neuroprotective role of riluzole in spinal cord injury: a systematic review and meta-analysis.","authors":"Hamed Zarei, Seyedhesamoddin Khatami, Mohammadsadegh Faghihi, Kimia Bagheri, Hannanehsadat Khatami, Haniyeh Ghorbanibaroogh, Amirmohammad Toloui, Hamzah Adel Ramawad, Mahmoud Yousefifard","doi":"10.1007/s00068-025-02907-6","DOIUrl":"10.1007/s00068-025-02907-6","url":null,"abstract":"<p><p>We systematically reviewed the evidence for the efficacy of riluzole on functional recovery and lesion size following spinal cord injury (SCI). The search was conducted on Medline, Embase, Scopus, and Web of Science by November 2024 for studies evaluating the utility of riluzole administration following SCI in rodents and humans. Neurological and histopathological outcomes were extracted for subjects treated and not treated with Riluzole. Pooled effect estimates were calculated using the random-effects model. Heterogeneity was assessed using the I² and Chi2 tests. Fifteen preclinical studies were included. Meta-analysis demonstrated that riluzole significantly improves locomotion recovery (standardized mean difference (SMD) = 0.70; 95% confidence interval (CI): 0.46, 0.95; p < 0.0001; I² = 0.00%) and subsides the lesion size (SMD = -1.74; 95% CI: -2.47 to -1.01; p < 0.0001; I² = 55.84%). The improvement in locomotion was not significantly different between mild to moderate and severe injuries (meta-regression coefficient = -0.22; 95% CI: -0.74, 0.30; p = 0.403). Notably, riluzole significantly improves motor function and reduces lesion size in animals with acute traumatic SCI. The improvement only occurs with multi-dose administration of riluzole (SMD = 0.76; 95% CI: 0.49, 1.03; p < 0.0001), and no significant effect was observed with single-dose therapies (SMD = 0.49; 95% CI: -0.05, 1.02; p = 0.074). Most human studies also report motor function improvements, further suggesting riluzole's potential as a therapeutic agent in SCI. These findings support further research and trials to confirm its efficacy in clinical settings.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"51 1","pages":"246"},"PeriodicalIF":0.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proximal humerus fractures in the elderly: is there (still) a role for plate osteosynthesis?","authors":"Charlotte M Lameijer, Leanne Blaas, Robert Jan Derksen, Klaus Wendt","doi":"10.1007/s00068-025-02923-6","DOIUrl":"10.1007/s00068-025-02923-6","url":null,"abstract":"<p><strong>Introduction: </strong>Proximal humeral fractures (PHFs) are among the most common fractures in the elderly population resulting from low energy trauma. The primary aim of this review is to assess the role of primary locking plate osteosynthesis in elderly patients with complex PHFs and highlight key surgical techniques to optimize outcomes. A literature overview and two illustrative cases are presented.</p><p><strong>Conclusion: </strong>Treating PHFs in elderly patients requires careful patient selection, adequate patient informed consent and shared decision making. Fit elderly (60-75 years) patients with complex 3- or 4-part PHF may benefit from plate osteosynthesis. For best outcomes, optimal anatomical and stable reconstruction of the medial hinge and tuberosities is mandatory and use of non-absorbable sutures for the rotator cuff is highly important. Augmentation with a fibula strut or cement could be considered to achieve optimal outcomes. In less fit elderly patients, with a complex 3- or 4- part fracture, reverse shoulder arthroplasty (RSA) may be preferable. It is important to provide both plate osteosynthesis and RSA options in practice.</p>","PeriodicalId":520620,"journal":{"name":"European journal of trauma and emergency surgery : official publication of the European Trauma Society","volume":"51 1","pages":"244"},"PeriodicalIF":0.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12227513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}