Effect of C-Clamp Application on Hemodynamic Instability in Polytrauma Victims with Pelvic Fracture

Efficacy and outcomes of rescue screws in unstable pelvic ring injuries - A retrospective matched cohort study

PURPOSE

The emergency treatment of unstable pelvic ring injuries is still a challenge and requires surgical and anesthesiological resuscitation. Emergency fixation of the unstable pelvic ring with percutaneous sacroiliac (SI) screws, also known as "Rescue Screws", is an established treatment method. The aim of our study was to compare the outcome and complication rates of "Rescue Screws" with elective SI-screw fixations.

METHODS

A 1:1 ratio nearest-neighbor matched, retrospective cohort study of trauma patients with acute pelvic ring injuries at a level one trauma center was performed. Patients ≥ 15 years, treated with SI-screw fixation were included.

EXCLUSION CRITERIA

pathologic fractures, missing consent and navigated procedures. The primary outcome parameters was defined as SI-screw revision operations. Patients were stratified according to treatment strategy (RS: Rescue Screws; EL: elective SI-screws).

RESULTS

From 392 patients identified between 11/2014 and 08/2021, 186 met the inclusion criteria with 41 in the RS Group and 145 in the EL group. After matching, 41 patients were included in each group with similar baseline characteristics except persistent hemodynamic shock (RS: n = 22 (53.37%) vs. EL: n = 1 (4.3%), p < 0.001). Surgical characteristics were comparable in terms of instrumentation levels and insertion-sites. No significant differences were observed in the outcome parameters (revisions, reoperations, implant-associated complications, LOS and mortality) between both groups.

CONCLUSION

Treatment of unstable pelvic ring fractures with Rescue Screws appears as a feasible treatment option for emergency stabilization. Rescue Screws are not associated with elevated revision rates and increased complications rates. This minimally invasive technique enables safe emergency stabilization of the posterior pelvic ring. Prospective or randomized clinical trials are required to directly compare Rescue Screws with other competing emergency stabilization techniques.

Availability and use of resources for emergency fracture care of pelvic trauma associated with haemorrhagic shock in Latin America: A cross-sectional study

Determining the true availability of resources and understanding the level of training of surgeons involved in the treatment of patients with pelvic fractures and haemorrhagic shock is critical. In the herein study, the availability of technical, technological, and human resources for the care of this injury in Latin America region was analysed, and the preferences of orthopaedic trauma surgeons when performing interventions for the diagnosis and treatment of patients with pelvic trauma and associated haemorrhagic shock was described. A cross sectional web-based survey containing questions on knowledge, attitudes, and practices with respect to imaging resources, emergency pelvic stabilization methods, and interventions used for bleeding control was sent to 948 Latin America orthopaedic trauma surgeons treating pelvic fractures in the emergency department. Differences between regional clusters, level of training, type of hospital, and pelvic surgery volume were assessed. 368 responses were obtained, with 37.5% of respondents reporting formal training in pelvic surgery and 36.0% having available protocol for managing these patients. The most frequently used interventions were the supra-acetabular pelvic external fixator and pelvic packing. Limited hospital and imaging resources are available for the care of patients with pelvic trauma and associated haemorrhagic shock throughout Latin America. In addition, the training of orthopaedic trauma surgeons dealing with this type of injury and the volume of pelvic surgeries per year is heterogeneous. It should be urgently considered to develop management protocols adapted to Latin America according to the availability of resources, as well as to promote training in this severe life-threatening traumatic condition.

Application of Multidimensional Structural Equations in the Emergency Management of Coal Mine Accidents

The use of coal as a source of energy is crucial for the growth of the national economy, but mining poses numerous risks and a potential for significant disasters. Coal mine safety is the prerequisite and guarantee for coal industry to achieve new industrialization and sustainable development. Therefore, it is crucial to predict a safety accident in the coal mine in advance. In order to facilitate the early warning of coal mine safety accidents, this study seeks to present a prediction model based on emergency management of safety accidents, which is a fusion model of principal component analysis (PCA) and long short-term memory neural network. According to the results, the correlation coefficients of risk identification and monitoring (a11), safety inspection and warning (a12), emergency planning and training (a13), material and technical support (a15), and macroenvironmental management (a21) were 0.718, 0.653, 0.628, 0.444, and 0.553, respectively, after the PCA dimensionality reduction process, demonstrating that the previous principal component analysis had a better effect. The absolute relative errors of each evaluation index of safety accident emergency management did not exceed the limit of 5%, including a15 and a21, whose values were 4.5% and −3.8%, while the relative errors of the remaining indicators were kept at a relatively low level. In conclusion, it is clear that the algorithm model suggested in this research improved the warning capabilities of safety accident emergency risk.