1
|
Scherer J, Canal C, Kaufmann E, Jensen KO, Pape HC, Neuhaus V. Pre-hospital and Hospital Trauma Care during the Covid-19 Lockdown - Experience in a Metropolitan European Level 1 Trauma Centre. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:283-288. [PMID: 37015269 DOI: 10.1055/a-2039-3162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
BACKGROUND Trauma case load is said to have declined during the Covid-19 pandemic, especially during the national lockdowns. Due to the altered frequency and changes in daily life, pre-hospital care (altered personal protective measurements) as well as mechanisms of trauma and initial trauma treatment may have changed. The purpose of this study was to assess differences in pre-hospital as well as initial treatment of trauma victims and trauma mechanisms during a national lockdown compared to the year before. MATERIAL AND METHODS Pre-hospital as well as clinical data from all trauma patients admitted to our metropolitan level 1 trauma center resuscitation room during the hard lockdown in Switzerland (March 17 to April 26, 2020) and the same time period in 2019 were analyzed retrospectively. RESULTS In total, we assessed 91 patients (51 lockdown cohort, 40 control cohort) with a mean age of 50.7 years. Significantly more trauma was sustained in the household environment during the lockdown (p = 0.015). Pre-hospital treatment remained similar between the two assessed groups. No difference was found in length of stay or mortality. In severely injured patients (ISS > 15), we found significantly fewer motor vehicle accidents (p = 0.018) and fewer horizontal decelerations (p = 0.006), but insignificantly more falls (p = 0.092) in the lockdown cohort. None of the patients in the lockdown cohort had a positive PCR test for Covid-19 on admission. CONCLUSION Trauma systems seem not to have changed during hard lockdowns in terms of pre-hospital treatment. Fewer severely injured patients due to motor vehicle accidents and horizontal decelerations, but more household-related injuries were seen in the lockdown cohort than in the control cohort. A qualitative analysis of treatment during the hard lockdown is needed to gain further insights into the effect of the pandemic on trauma care.
Collapse
Affiliation(s)
- Julian Scherer
- Department of Traumatology, University Hospital Zurich, Zurich, Switzerland
| | - Claudio Canal
- Department of Traumatology, University Hospital Zurich, Zurich, Switzerland
| | - Ernest Kaufmann
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Kai Oliver Jensen
- Department of Traumatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Valentin Neuhaus
- Department of Traumatology, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
2
|
Ayatizadeh SH, Borazjani R, Fereidooni R, Jamali K, Fard HA, Homaeifar R, Shayan L, Saadatjoo Z, Paydar S. Impact of COVID-19 pandemic on trauma mortality patients: A retrospective observational study in an Iranian level 1 trauma center. Health Sci Rep 2024; 7:e1883. [PMID: 38357493 PMCID: PMC10864731 DOI: 10.1002/hsr2.1883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/17/2023] [Accepted: 01/23/2024] [Indexed: 02/16/2024] Open
Abstract
Background and Aims The COVID-19 pandemic has reshaped the epidemiology of various clinical conditions, including trauma which is closely tied to social policies. This study examines and compares the characteristics of trauma mortality patients, and their initial prognostic trauma scores, in the pre-pandemic and pandemic periods. Methods We conducted a retrospective observational study involving patients who passed away at a level 1 trauma center from July 23, 2018, to February 19, 2020 (prepandemic), and from February 20, 2020, to September 22, 2021 (pandemic). A subgroup analysis that matched 12 of the same months of the year in the two periods was also done. Patients who arrived deceased or passed away immediately upon arrival were excluded from data analysis. We collected and analyzed demographic and clinical data, employing the Abbreviated Injury Score (AIS), Injury Severity Score (ISS), Revised Trauma Score (RTS), and Trauma and ISS (TRISS) to compare initial prognoses. Results Our study encompassed 1128 patients, with 529 in the prepandemic group and 599 in the pandemic group. Demographic characteristics showed no significant differences in the number of patients in the two periods. Motor vehicle accidents remained the predominant injury mechanism in both periods. While the mean ISS increased insignificantly (22.80 vs. 22.91, p = 0.902), the mean RTS decreased (6.32 vs. 5.82), and TRISS increased (23.97% vs. 28.93%) during the pandemic (p < 0.05). Hospital length of stay decreased in the pandemic period (15.57 vs. 12.54 days, p < 0.05). Subgroup analysis revealed increased ISS, decreased RTS, and increased TRISS during the pandemic (p < 0.05). Conclusion In conclusion, while overall demographics and injury mechanisms remained virtually unchanged, trauma patients during the pandemic displayed worse estimated clinical prognoses, particularly in physiological trauma scores. The heightened mortality rate was attributed to poorer clinical conditions of patients.
Collapse
Affiliation(s)
- Seyyed HamidReza Ayatizadeh
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
- Trauma Research Center, Rajaee (Emtiaz) Trauma HospitalShiraz University of Medical SciencesShirazIran
| | - Roham Borazjani
- Trauma Research Center, Rajaee (Emtiaz) Trauma HospitalShiraz University of Medical SciencesShirazIran
| | - Reza Fereidooni
- Health Policy Research Center, Institute of HealthShiraz University of Medical SciencesShirazIran
| | - Kazem Jamali
- Trauma Research Center, Rajaee (Emtiaz) Trauma HospitalShiraz University of Medical SciencesShirazIran
| | | | - Reza Homaeifar
- Trauma Research Center, Rajaee (Emtiaz) Trauma HospitalShiraz University of Medical SciencesShirazIran
| | - Leila Shayan
- Trauma Research Center, Rajaee (Emtiaz) Trauma HospitalShiraz University of Medical SciencesShirazIran
| | - Zohreh Saadatjoo
- Trauma Research Center, Rajaee (Emtiaz) Trauma HospitalShiraz University of Medical SciencesShirazIran
| | - Shahram Paydar
- Trauma Research Center, Rajaee (Emtiaz) Trauma HospitalShiraz University of Medical SciencesShirazIran
| |
Collapse
|
3
|
Effect of coronavirus (COVID-19) pandemic on orthopedic trauma patients presenting in the emergency department of a maximum care hospital and level 1 trauma center. Arch Orthop Trauma Surg 2023; 143:1231-1236. [PMID: 34751810 PMCID: PMC8576456 DOI: 10.1007/s00402-021-04234-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/19/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION While overcrowding of emergency departments was often reported in the recent years, during the early phase of the pandemic, a reduction in patient numbers was seen. The aim of the current study was to describe the orthopedic trauma patient cohort presenting to the emergency department (ED) during the early pandemic period as compared to the cohort from the analogue time period 2019. MATERIALS AND METHODS A single-center case-control study was performed. All the consecutive orthopedic trauma patients > 12 years presenting to the ED were included. Patients in the same time period in 2019 served as the control group. RESULTS Compared to 2019, in 2020, 33% less patients presented in the emergency department. Patients treated in 2020 were significantly older, significantly more often brought to ED by emergency medical services and significantly more often admitted. The number of fractures and diagnoses requiring surgical treatment decreased only slightly and the proportion of these patients among all the patients was significantly higher during the pandemic than in the control period. Furthermore, a higher percentage of polytrauma patients could be found in 2020 as well. Analysis of Manchester Triage System showed significantly less not urgent patients in 2020. CONCLUSION The present study shows a significant decline in the number of patients treated in the ED during the pandemic period but at the same time almost identical numbers of patients with fractures or diagnoses requiring surgical treatment. In the context of an overall decline in patient numbers, a stronger concentration on level 1 trauma centers seems to be evident during the pandemic.
Collapse
|
4
|
Cavalcanti Kußmaul A, Schwaabe F, Becker CA, Kleber C, Linhart C, Thorwächter C, Rubenbauer B, Böcker W, Greiner A. Does augmentation increase the pull-out force of symphyseal screws? A biomechanical cadaver study. Eur J Trauma Emerg Surg 2022; 48:4215-4221. [PMID: 35364692 PMCID: PMC9532288 DOI: 10.1007/s00068-022-01963-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/17/2022] [Indexed: 11/28/2022]
Abstract
Purpose Open reduction and internal fixation using anterior plate osteosynthesis currently represents the gold standard for the treatment of symphyseal disruptions. Since postoperative screw loosening with consequent implant failure is frequently observed, this study aims to evaluate if and to what extent augmentation can increase the pull-out force of symphyseal screws to improve the constructs stability. Methods Twelve human cadaveric anterior pelvic rings were separated at the symphyseal joint for bilateral testing, consequently achieving comparable sites. First, one non-augmented screw was drilled into the superior pubic ramus, whereas the contralateral side was primarily augmented. The screws were then withdrawn with a constant speed of 10 mm/min and the fixation strengths determined by the force (N) displacement (mm) curve. Finally, the primary non-augmented site was secondary augmented, representing revision surgery after initial implant failure, and the corresponding fixation strength was measured again. Results Augmentation compared to non-augmented screws displayed significantly higher pull-out forces with an increase in pull-out force by 377% for primary and 353% for secondary augmentation (p < 0.01). There was no significant difference in the pull-out force comparing primary and secondary augmentation (p = 0.74). Conclusions Primary and secondary augmentation significantly increases the stability of symphyseal screws and, therefore, potentially decreases rates of implant failure. Supplementary Information The online version contains supplementary material available at 10.1007/s00068-022-01963-6.
Collapse
Affiliation(s)
- Adrian Cavalcanti Kußmaul
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Fanny Schwaabe
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Christopher Alexander Becker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Christian Kleber
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Christoph Linhart
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Christoph Thorwächter
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Bianka Rubenbauer
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Wolfgang Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Axel Greiner
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| |
Collapse
|
5
|
Cavalcanti Kußmaul A, Schwaabe F, Kistler M, Gennen C, Andreß S, Becker CA, Böcker W, Greiner A. Novel minimally invasive tape suture osteosynthesis for instabilities of the pubic symphysis: a biomechanical study. Arch Orthop Trauma Surg 2022; 142:2235-2243. [PMID: 34052913 PMCID: PMC9381629 DOI: 10.1007/s00402-021-03968-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/18/2021] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Open book fractures are challenging injuries oftentimes requiring surgical treatment. The current treatment of choice is symphyseal plating, which requires extensive surgery and entirely limits physiological movement of the symphyseal joint, frequently resulting in implant failure. Therefore, we investigated the biomechanical properties of a semi-rigid implant (modified SpeedBridge™) as a minimally invasive tape suture construct for the treatment of open book fractures and evaluated the superiority of two techniques of implementation: criss-cross vs. triangle technique. MATERIALS AND METHODS Nine synthetic symphyseal joints were dissected creating an open book fracture. The different osteosynthesis methods (plating, modified SpeedBridge™ in criss-cross/triangle technique) were then applied. All constructs underwent horizontal and vertical loading, simulating biomechanical forces while sitting, standing and walking. For statistical analysis, dislocation (mm) and stiffness (N/mm) were calculated. RESULTS Symphyseal plating for the treatment of open book fractures proved to be a rigid osteosynthesis significantly limiting the physiological mobility of the symphyseal joint (dislocation: 0.08 ± 0.01 mm) compared to the tape sutures (dislocation: triangle technique 0.27 ± 0.07 mm, criss-cross technique 0.23 ± 0.05 mm) regarding horizontal tension (p < 0.01). Both modified SpeedBridge™ techniques showed sufficient biomechanical stability without one being superior to the other (p > 0.05 in all directions). Considering vertical loading, no statistical difference was found between all osteosynthesis methods (caudal: p = 0.41; cranial: p = 0.61). CONCLUSIONS Symphyseal plating proved to be the osteosynthesis method with the highest rigidity. The modified SpeedBridge™ as a semi-rigid suture construct provided statistically sufficient biomechanical stability while maintaining a minimum of symphyseal movement, consequently allowing ligamental healing of the injured joint without iatrogenic arthrodesis. Furthermore, both the criss-cross and the triangle technique displayed significant biomechanical stability without one method being superior.
Collapse
Affiliation(s)
- Adrian Cavalcanti Kußmaul
- grid.411095.80000 0004 0477 2585Department of General Trauma and Reconstructive Surgery, University Hospital LMU Munich, Munich, Germany
| | - Fanny Schwaabe
- grid.411095.80000 0004 0477 2585Department of General Trauma and Reconstructive Surgery, University Hospital LMU Munich, Munich, Germany
| | - Manuel Kistler
- grid.411095.80000 0004 0477 2585Department of Orthopedics, Physical Medicine and Rehabilitation, University Hospital LMU Munich, Munich, Germany
| | - Clara Gennen
- grid.411095.80000 0004 0477 2585Department of Obstetrics and Gynecology, University Hospital LMU Munich, Munich, Germany
| | - Sebastian Andreß
- grid.411095.80000 0004 0477 2585Department of General Trauma and Reconstructive Surgery, University Hospital LMU Munich, Munich, Germany
| | - Christopher A. Becker
- grid.411095.80000 0004 0477 2585Department of General Trauma and Reconstructive Surgery, University Hospital LMU Munich, Munich, Germany
| | - Wolfgang Böcker
- grid.411095.80000 0004 0477 2585Department of General Trauma and Reconstructive Surgery, University Hospital LMU Munich, Munich, Germany
| | - Axel Greiner
- grid.411095.80000 0004 0477 2585Department of General Trauma and Reconstructive Surgery, University Hospital LMU Munich, Munich, Germany
| |
Collapse
|
6
|
How relevant is lumbar bone mineral density for the stability of symphyseal implants? A biomechanical cadaver study. Eur J Trauma Emerg Surg 2021; 48:3101-3108. [PMID: 34881391 PMCID: PMC9360150 DOI: 10.1007/s00068-021-01850-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/26/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Osteoporotic bone tissue appears to be an important risk factor for implant loosening, compromising the stability of surgical implants. However, it is unclear whether lumbar measured bone mineral density (BMD) is of any predictive value for stability of surgical implants at the pubic symphysis. This study examines the fixation strength of cortical screws in human cadaver specimens with different BMDs. METHODS The lumbar BMD of ten human specimens was measured using quantitative computed tomography (qCT). A cut-off BMD was set at 120 mg Ca-Ha/mL, dividing the specimens into two groups. One cortical screw was drilled into each superior pubic ramus. The screw was withdrawn in an axial direction with a steady speed and considered failed when a force decrease was detected. Required force (N) and pull-out distance (mm) were constantly tracked. RESULTS The median peak force of group 1 was 231.88 N and 228.08 N in group 2. While BMD values differed significantly (p < 0.01), a comparison of peak forces between both groups showed no significant difference (p = 0.481). CONCLUSION Higher lumbar BMD did not result in significantly higher pull-out forces at the symphysis. The high proportion of cortical bone near the symphyseal joint allows an increased contact of pubic screws and could explain sufficient fixation. This condition is not reflected by a compromised lumbar BMD in a qCT scan. Therefore, site-specific BMD measurement could improve individual fracture management.
Collapse
|
7
|
Mills S, Ibarzábal-Gil A, Martínez-Diez JM, Pallarés-Sanmartín J, Kalbakdij-Sánchez C, Rubio-Suárez JC, Losantos-García I, Rodríguez-Merchán EC. SARS-CoV-2 outbreak impact on a trauma unit. World J Orthop 2021; 12:751-759. [PMID: 34754831 PMCID: PMC8554347 DOI: 10.5312/wjo.v12.i10.751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/17/2021] [Accepted: 08/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND From February 2020 onwards, our country has been hit by the coronavirus severe acute respiratory syndrome-2 (SARS-CoV-2) infection. At a glance, hospitals became overrun and had to reformulate all the assistance guidelines, focusing on the coronavirus disease 2019. One year after the start of the pandemic, we present the results of a morbimortality study.
AIM To analyze how our department was affected by the outbreak in terms of morbimortality, and to analyze demographic data, admission to hospital-related data, and subgroups analyses for patients with hip fractures and polytrauma.
METHODS We designed a study comparing data from patients who were admitted to our unit due to a lower limb fracture or a high energy trauma during the pandemic (from March to April 2020) to those admitted during the same period in 2019 before the pandemic. during the pandemic situation. Both cohorts completed a minimum of 6 mo of follow-up.
RESULTS The number of patients admitted to hospital in 2020 was nearly half of those in 2019. Hip fractures in the elderly represented 52 out of 73 of the admitted patients. Twenty patients had a positive test result for SARS-CoV-2 infection. Patients with SARS-CoV-2 infection were admitted to the hospital for a longer time than the non-infected (P < 0.001), and had a higher mortality rate during hospitalization and follow-up (P = 0.02). Patients with a hip fracture associated with a severe respiratory syndrome were mostly selected for conservative treatment (P = 0.03).
CONCLUSION Mortality and readmission rates were higher in the 2020 cohort and during follow-up, in comparison with the cohort in 2019.
Collapse
Affiliation(s)
- Sarah Mills
- Department of Orthopedic Surgery, La Paz University Hospital, Madrid, Spain
| | | | | | | | | | | | | | - E Carlos Rodríguez-Merchán
- Department of Orthopedic Surgery, La Paz University Hospital, Madrid, Spain
- Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research – IdiPAZ (La Paz University Hospital – Autonomous University of Madrid), Madrid, Spain
| |
Collapse
|