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Rochus I, Daemen JHT, van Vugt R, Hulsewé KWE, Vissers YLJ, de Loos ER. Delayed presentation of manubriosternal dislocation after thoracolumbar spondylodesis in a polytrauma patient - a case report. Acta Chir Belg 2023; 123:559-562. [PMID: 35369855 DOI: 10.1080/00015458.2022.2061120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/28/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Manubriosternal dislocations are a rare entity and frequently associated with thoracic spine fractures and, in minority of cases, with cervical or thoracolumbar fractures. METHODS Our case represents a 38-year-old male who fell from a height resulting in multiple fractures, amongst others of the first lumbar vertebra. At primary survey and computed tomography scan no manubriosternal injury was apparent. After posterior stabilization of the thoracolumbar vertebrae a manubriosternal dislocation was identified and stabilized using plate-and-screw fixation. RESULTS Clinical findings of a manubriosternal dislocation are not always obvious, allowing them to be missed at initial assessment. CONCLUSIONS Manubriosternal dislocations can be missed at the initial investigation, even on cross-sectional imaging, and only become visible after spine stabilization because of the tight relationship between sternum and vertebrae in the thoracic cage. There is no unanimity in literature for surgical treatment of manubriosternal dislocations, although plate fixation is generally considered a safe and effective treatment option.
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Affiliation(s)
- Ine Rochus
- Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Jean H T Daemen
- Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Raoul van Vugt
- Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Karel W E Hulsewé
- Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Yvonne L J Vissers
- Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Erik R de Loos
- Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
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Sermon A, Rochus I, Smeets B, Metsemakers WJ, Misselyn D, Nijs S, Hoekstra H. The implementation of a clinical pathway enhancing early surgery for geriatric hip fractures: how to maintain a success story? Eur J Trauma Emerg Surg 2018; 45:199-205. [PMID: 30327836 DOI: 10.1007/s00068-018-1034-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 10/09/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Timing of surgery in geriatric hip fracture treatment remains controversial. Early surgery is acknowledged as a quality indicator and NICE guidelines recommend surgery within 0-48 h from admission. In 2014 we implemented the indicator of early surgery in our institution, enhancing operative treatment within the next calendar day. We aimed to evaluate the implementation, define the room for improvement and provide strategies to maintain the quality indicator. METHODS Clinical outcome of 744 patients (January 2011-December 2013) before early surgery was implemented, compared to 817 patients (June 2014-May 2017) after implementation of early surgery with a follow-up of 6 months. Data-analysis was done by Pearson's Chi-square test and Mann-Whitney U test. RESULTS Early surgery was achieved in 47.6% and 85.7% in the preimplementation and postimplementation group, respectively (P < 0.001). Both 30 days and 6 months mortality were similar (6.0% vs. 5.4%, P = 0.573 and 18.7% vs. 16.9%, P = 0.355, preimplementation vs. postimplementation, respectively). Early surgery resulted in a significantly shorter total length-of-stay (14 vs. 12 days, P < 0.001, preimplementation vs. postimplementation, respectively). Early surgery did not reduce the readmission rate. CONCLUSIONS The indicator of early surgery has been successfully implemented. Early surgery resulted in a significantly shorter LOS. No significant reduction in 30 days and 6 months mortality, and 90 days readmission was observed. To maintain early surgery, continuous engagement and monitoring is required by all shareholders involved and if necessary, adjustment of the clinical route is appropriate.
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Affiliation(s)
- An Sermon
- Department of Trauma Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, University of Leuven, 3000, Leuven, Belgium
| | - Ine Rochus
- Department of Trauma Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Bart Smeets
- University Hospitals Leuven, Management Information and Reporting, 3000, Leuven, Belgium
| | - Willem-Jan Metsemakers
- Department of Trauma Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, University of Leuven, 3000, Leuven, Belgium
| | - Dominique Misselyn
- Department of Trauma Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, University of Leuven, 3000, Leuven, Belgium
| | - Stefaan Nijs
- Department of Trauma Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, University of Leuven, 3000, Leuven, Belgium
| | - Harm Hoekstra
- Department of Trauma Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. .,Department of Development and Regeneration, KU Leuven, University of Leuven, 3000, Leuven, Belgium.
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Rochus I, Coosemans W, Van Veer H. P-212INITIAL EXPERIENCE WITH THE ABRAMSON PROCEDURE: A NEW TECHNIQUE FOR TREATMENT OF PECTUS CARINATUM. Interact Cardiovasc Thorac Surg 2017. [DOI: 10.1093/icvts/ivx280.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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