[Patient safety in differentiated (in-hospital) activation of the resuscitation room for severely injured patients]

BACKGROUND AND OBJECTIVE

Providing trauma services demands high personnel resources and structural costs. The goal of this study was to show if the assignment of trauma patients to a defined A or B resuscitation room treatment as a modified management concept is safe and feasible.

MATERIAL AND METHODS

Between May 2020 and January 2021, all resuscitation room trauma patients were included in this single center prospective observational study. All patients admitted to the resuscitation room underwent a classification according to the German S3 guidelines grade of recommendation GoR A and GoR B in polytrauma and the status of the ABCDE sequence to an A and B resuscitation room. The classification was performed by the senior consultant on call via telephone after consultation and discussion of clinical findings.

RESULTS

All 135 resuscitation room patients were included in the study of whom 42 trauma patients were assigned to the A resuscitation room (A-SR) and 93 were assigned to the B resuscitation room (B-SR). The comparison of the two groups showed that patients in the A‑SR group are more likely to be accompanied by a prehospital emergency physician (80.5%) than patients in the B‑SR group (55.5%). Patients in the B‑SR group showed a significantly higher Glasgow coma scale (GCS). Using the eFAST emergency ultrasound protocol, 2.4% of the A‑SR and 4.3% of the B‑SR patients had trauma-associated pathologies, 26% of the A‑SR and only 3.2% of the B‑SR patients had to be admitted to the ICU, 21.4% of the A‑SR and 1% of the B‑SR patients died within 30 days after trauma. The injury severity scores (ISS) of the A‑SR patients were significantly higher than in the B‑SR group (ISS 28.3 vs. 6.8).

CONCLUSION

The study confirmed that the assignment by the emergency department consultant according to the German S3 guideline in combination with the ABCDE sequence into resuscitation room A or B treatment is feasible, does not compromise the quality of care and is efficient in the use of the personnel resources.

Influence of surface modifications on the degradation of standard-sized magnesium plates and healing of mandibular osteotomies in miniature pigs

Biodegradable magnesium alloys are suitable osteosynthesis materials. Despite the alloy composition, surface modifications appear to have an influence on the degradation process and biocompatibility. The aim of this study was to investigate the impact of hydrogenation and fluoridation of the surface in a mandibular osteotomy model. Standard-sized plates and screws were implanted in an osteotomy at the mandibular angle in nine miniature pigs. The plates and screws were harvested together with the adjacent tissues at 8 weeks after surgery and were investigated by micro-computed tomography and histological analysis. The bone healing of the osteotomy was undisturbed, independent of the surface properties. The adjacent bone tissue showed new bone formation at the implant surface; however, formation of some lacunae could be observed. The corrosion was between 9.8% and 11.6% (fluoridated<hydrogenated<non-modified) in histological specimens, while radiologically neither the volume nor the density of the osteosynthesis material was reduced in any treatment group. The soft tissues exhibited full biocompatibility with every surface property. In summary, surface modification by hydrogenation and fluoridation did not significantly influence bone healing, biocompatibility, or corrosion kinetics of the magnesium osteosynthesis at the mandibular angle.

[Fixed angle carbon fiber reinforced polymer composite plate for treatment of distal radius fractures : Pilot study on clinical applications]

BACKGROUND

The clinical implementation of a new carbon-fiber-reinforced polyetheretherketon (PEEK) plate for distal radius fractures might offer advantageous properties over the conventional metallic devices. This includes similar elastic modulus to cortical bone, radiolucency, low artifacts on MRI scans and the lack of metal allergies.

OBJECTIVE

The aim of this study was to evaluate the clinical results at 6-week and 12-month follow-up using either a new fixed angle (monoaxial) PEEK plate system or a fixed angle (polyaxial) titanium plate.

METHODES

We included 26 patients (mean age 59.3) with displaced fractures of the distal radius (all AO types). Radiological and functional outcomes were measured prospectively at a 6-week and 12 month follow-up.

RESULTS

We documented no cases of hardware breakage or significant loss of the surgically achieved fracture reduction with the usage oft the new PEEK device. Operating time was 101.0 min using PEEK versus 109.3 min in titanium plates, recorded times were including preparation, draping, and postoperative processing (ns, p 0.156). At the 6-week follow up the PEEK plate showed a trend for better range of motion and functional results (DASH-score, Mayo-wrist score, VAS) with no statistical significance. Results of 12 month follow up with PEEK showed comparable results with corresponding studies examining titanium plate after this period.

CONCLUSION

First experience with PEEK plate osteosynthesis demonstrate quick clinical implementation with good clinical outcome and the advantage of excellent postoperative radiological assessment. At early follow-up PEEK even showed a trend for improved functional results.

[Injuries of major tendons : Review of current diagnostic and surgical standards]

Chronic degenerative tendon injuries as well as injuries due to acute high-energy trauma and incisional injuries are a significant aspect in the emergency surgery department. As a result of anatomical characteristics and exposure certain tendons are particularly vulnerable to injury. These include the biceps brachialis, quadriceps femoris, patella, achilles and tibialis anterior tendons. Besides the broad spectrum of non-surgical treatment, surgeons should have knowledge of the various surgical techniques including suturing, anchor refixation and reconstruction techniques. The indications for surgery are of particular importance for the clinical outcome of tendon injuries. The therapeutic approach should consider the patients biological age, functional requirements and pre-existing comorbid pathologies. Finally, adequate aftercare has been shown to significantly determine the surgical outcome.

IL-10 reduces apoptosis and extracellular matrix degradation after injurious compression of mature articular cartilage

OBJECTIVE

The aim of this study was to examine whether anti-inflammatory interleukin-10 (IL-10) exerts chondroprotective effects in an in vitro model of a single mechanical injury of mature articular cartilage.

METHOD

Articular cartilage was harvested from the femoro-patellar groove of adult cows (Bos taurus) and cultured w/o bovine IL-10. After 24 h of equilibration explants were subjected to an axial unconfined compression (50% strain, velocity 2 mm/s, held for 10 s). After 96 h cell death was measured histomorphometrically (nuclear blebbing, NB) and the release of glycosaminoglycans (GAG, DMMB assay) and nitric oxide (NO, Griess-reagent) were analyzed. mRNA levels of matrix degrading enzymes and nitric oxide synthetase were measured by quantitative real time PCR. Differences between groups were calculated using a one-way ANOVA with a Bonferroni post hoc test.

RESULTS

Injurious compression significantly increased the number of cells with NB, release of GAG and nitric oxide and expression of MMP-3, -13, ADAMTS-4 and NOS2. Administration of IL-10 significantly reduced the injury related cell death and release of GAG and NO, respectively. Expression of MMP-3, -13, ADAMTS-4 and NOS2 were significantly reduced.

CONCLUSION

Joint injury is a complex process involving specific mechanical effects on cartilage as well as induction of an inflammatory environment. IL-10 prevented crucial mechanisms of chondrodegeneration induced by an injurious single compression. IL-10 might be a multipurpose drug candidate for the treatment of cartilage-related sports injuries or osteoarthritis (OA).

[Knee joint infections]

Knee joint infection represents an emergency case at every age. Joint infection occurs frequently after trauma or joint surgery. The infection can be caused by numerous bacteria, viruses, or yeasts; however, Staphylococcus aureus is identified as the cause in 85-95 % of joint infections. Early treatment is important for patient outcome. In addition to synovectomy and therapeutic arthroscopy, antibiotic therapy is essential and should be started after sample recovery.