Publications by authors named "Frank J P Beeres"

59 Publications

Difference in Pain, Complication Rates, and Clinical Outcomes After Suprapatellar Versus Infrapatellar Nailing for Tibia Fractures? A Systematic Review of 1447 Patients.

J Orthop Trauma 2021 Aug;35(8):391-400

Department of Orthopaedic Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.

Objectives: To assess the effectiveness of suprapatellar (SP)-nailing versus infrapatellar (IP)-nailing of tibia fractures in anterior knee pain, complications (retropatellar chondropathy, infection, and malalignment) and physical functioning and quality of life. A clinical question-driven and thorough systematic review of current literature is provided.

Data Source: PubMed and Embase databases were searched for studies published between 2010 and 2020 relating to SP and IP-nailing of tibia fractures. The study is performed in concordance with PRISMA-guidelines.

Study Selection: Studies eligible for inclusion were randomized controlled trials, prospective and retrospective observational studies reporting on outcomes of interest.

Data Extraction: Data extraction was performed independently by 2 assessors. Methodological quality and risk of bias was assessed according to the guidelines of the McMaster Critical Appraisal.

Data Synthesis: Continuous variables are presented as means with SD and dichotomous variables as frequency and percentages. The weighted mean, standardized weighted mean differences, and 95% confidence interval were calculated. A pooled analysis could not be performed because of differences in outcome measures, time-points, and heterogeneity.

Results: Fourteen studies with 1447 patients were analyzed. The weighted incidence of anterior knee pain was 29% after SP-nailing and 39% after IP-nailing, without reported significance. There was a significant lower rate of malalignment after the SP-approach (4% vs. 26%) with small absolute differences in all planes. No substantial differences were observed in retropatellar chondropathy, infection, physical functioning, and quality of life.

Conclusions: This systematic review does not reveal superiority of either technique in any of the respective outcomes of interest. Definitive choice should depend on the surgeon's experience and available resources.

Level Of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/BOT.0000000000002043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8253504PMC
August 2021

Tibiotalocalcaneal Intramedullary Nailing for Unstable Geriatric Ankle Fractures.

Geriatr Orthop Surg Rehabil 2021 17;12:21514593211020705. Epub 2021 Jun 17.

Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland.

Background: Tibiotalocalcaneal (TTC) intramedullary nailing has been suggested as an alternative to open reduction and internal fixation (ORIF) for the primary treatment of unstable fragility ankle fractures with a poor soft tissue envelope. This study aims to investigate the clinical efficacy of TTC intramedullary nail fixation for the primary treatment of unstable ankle fractures in frail elderly patients with poor soft tissue condition, by assessing the number of postoperative complications and the patient-reported functional outcomes.

Methods: A retrospective cohort study was performed including patients with an unstable ankle fracture treated between 2015 and 2019 with TTC stabilization using a retrograde intramedullary hindfoot nail that was inserted without joint preparation and allowing immediate weight-bearing postoperatively. The primary outcome was the total number of postoperative complications.

Results: A total of 10 patients were included out of 365 operatively treated ankle fractures. The mean age was 85.2 years (range 66-92) with a mean follow-up of 11.2 months (range 6-16). Fracture types included AO/OTA 44-B2 (n = 1), 44-B3 (n = 6), 44-C1 (n = 2) and 44-C3 (n = 1). Postoperative complications were observed in 4 patients (40%), including 3 nonunions, 2 implant related complications and 1 wound infection. No wound healing disorder or below-the-knee amputation was observed. Four patients (40%) deceased between post-operative 6 to 16 months due to medical conditions unrelated to surgery. The mean Foot and Ankle Outcome Score was 52.6 (range 44.2-73.8).

Conclusion: Hindfoot nailingis a viable treatment option in selected high-risk patients with an advanced age, unstable ankle fractures with significant bone loss, poor soft tissue condition and/or severely impaired pre-injury mobility. In a frail geriatric population, hindfoot nailing may be a safe alternative fixation method with a low risk of wound complication or major amputation. However, unprepared joint may lead to symptomatic nonunion after TTC intramedullary nailing.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/21514593211020705DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8216405PMC
June 2021

Fear of Falling, Recurrence of Falls, and Quality of Life in Patients with a Low Energy Fracture-Part II of an Observational Study.

Medicina (Kaunas) 2021 Jun 7;57(6). Epub 2021 Jun 7.

Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, 6000 Luzern, Switzerland.

: Falls in elderly cause injury, mortality, and loss of independence, making Fear of Falling (FoF) a common health problem. FoF relates to activity restriction and increased fall risk. A voluntary intervention including fall risk assessment and prevention strategies was implemented to reduce falls in elderly patients with low energy fractures (LEF). The primary purpose of this study was to evaluate FoF and the number of subsequent falls in trauma patients one year after a LEF. The secondary aim was to examine how FoF affects patients' lives in terms of Quality of Life (QoL), mobility, and activity levels. Finally, participation in the voluntary fall prevention program (FPP) was evaluated. : Observational cohort study in one Swiss trauma center. LEF patients, treated between 2012 and 2015, were analyzed one year after injury. Primary outcomes were Falls-Efficacy Score-International (FES-I) and number of subsequent falls. Secondary outcomes were EuroQoL-5-Dimensions-3-Levels (EQ5D-3L), mobility, activity levels, and participation in the FPP. Subgroup analysis was performed for different age categories. : 411 patients were included for analysis. Mean age was 72 ± 9.3, mean FES-I was 21.1 ± 7.7. Forty percent experienced FoF. A significant negative correlation between FoF and QoL (R = 0.64; < 0.001) was found. High FoF correlated with lower activity levels (R= -0.288; < 0.001). Six percent visited the FPP. : At follow-up, 40% suffered from FoF which seems to negatively affect patients' QoL. Nevertheless, participation in the FPP was low. Simply informing patients about their susceptibility to falls and recommending participation in FPPs seems insufficient to motivate and recruit patients into FPPs. We suggest implementing repeated fall risk- and FoF screenings as standard procedures in the follow-up of LEF, especially in patients aged over 75 years.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/medicina57060584DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8226509PMC
June 2021

The spanning plate as an internal fixator in complex distal radius fractures: a prospective cohort study.

Eur J Trauma Emerg Surg 2021 Jun 29. Epub 2021 Jun 29.

Department of Orthopedic and Trauma Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland.

Objective: Minimal invasive temporary spanning plate (SP) fixation of the wrist has been described as an alternative treatment method in complex distal radius fractures (DRFs). The purpose of this study is to conduct an outcome analysis of all consecutive DRFs treated by SP fixation representing the so far largest published patient cohort outside the United States.

Methods: Indication for SP fixation include DRFs with severe metaphyseal comminution, radiocarpal fracture dislocations with concomitant ligamentous injuries and very distal intra-articular fractures lacking the possibility of adequate plate anchoring. All consecutive patients undergoing SP fixation of DRFs were prospectively included in a single level I trauma centre between 01/01/2018 and 31/12/2020. For functional and patient-rated outcome analysis only patients who completed the 12 month follow-up were included.

Results: In the mentioned timeframe, a total of 562 DRFs were treated operatively of which 28 underwent SP fixation. Average age was 58.1 years (range 22-95 years). The fracture type ranged from AO/OTA type B1.1 to C3.3 and included 8 fracture dislocations. SP removal was performed on average 3.7 months after the initial operation (range 1.4-6.5 months). Twenty-five patients completed the 12 month follow-up (mean 14.5 months, range 12-24). Radiological evidence of fracture healing appeared on average 9.9 weeks (range 5-28 weeks) after the initial operation. One patient experienced asymptomatic non-union. Mean radial inclination, volar tilt and ulnar variance at 1 year were all within the acceptable limit predictive of symptomatic malunion. Complications included two patients with tendon rupture and one patient with extensor tendon adhesions needing tenolysis at the time of plate removal leaving an overall complication rate of 12%. There was no implant failure and no infection. Mean satisfaction score was 8.3 (range 4-10) and mean visual analogue scale for resting pain was 0.8 (range 0-5). The mean PRWE score was 17.9 (range 0-59.5) and the mean DASH score was 16.6 (range 0-60.8). Grip strength averaged 23 kg (range 4-74 kg) amounting to 68% of the opposite side. Range of motion regarding the extension/flexion, radial/ulnar abduction and pronation/supination arc reached 72%, 77% and 95% compared to the unaffected side, respectively.

Conclusions: The radiological, functional and patient-rated outcomes in this study are remarkably good considering the complexity of the included fractures. Therefore, this method represents a valuable alternative for the treatment of complex DRFs in selected patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00068-021-01738-5DOI Listing
June 2021

Cement augmentation for trochanteric femur fractures: A meta-analysis of randomized clinical trials and observational studies.

PLoS One 2021 15;16(6):e0251894. Epub 2021 Jun 15.

Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.

Introduction: To date, it is unclear what the clinical benefit of cement augmentation in fixation for trochanteric fractures is. The aim of this meta-analysis is to compare cement augmentation to no augmentation in fixation of trochanteric femur fractures in the elderly patients (>65 years) following low energy trauma.

Methods: PubMed/Medline/Embase/CENTRAL/CINAHL were searched for both randomized clinical trials (RCT) and observational studies comparing both treatments. Effect estimates were pooled across studies using random effects models. Subgroup analysis was performed stratified by study design (RCTs and observational studies). The primary outcome is overall complication rate. Secondary outcomes include re-operation rate, mortality, operation duration, hospital stay, general quality of life, radiologic measures and functional hip scores.

Results: A total of four RCT's (437 patients) and three observational studies (293 patients) were included. The effect estimates of RCTs were equal to those obtained from observational studies. Cement augmentation has a significantly lower overall complication rate (28.3% versus 47.2%) with an odds ratio (OR) of 0.3 (95%CI 0.1-0.7). The occurrence of device/fracture related complications was the largest contributing factor to this higher overall complication rate in the non-augmented group (19.9% versus 6.0%, OR 0.2, 95%CI 0.1-0.6). Cement augmentation also carries a lower risk for re-interventions (OR 0.2, 95%CI 0.1-0.7) and shortens the hospital stay with 2 days (95%CI -2.2 to -0.5 days). The mean operation time was 7 minutes longer in the augmented group (95%CI 1.3-12.9). Radiological scores (lag screw/blade sliding mean difference -3.1mm, 95%CI -4.6 to -1.7, varus deviation mean difference -6.15°, 95%CI; -7.4 to -4.9) and functional scores (standardized mean difference 0.31, 95%CI 0.0-0.6) were in favor of cement augmentation. Mortality was equal in both groups (OR 0.7, 95%CI 0.4-1.3) and cement related complications were rare.

Conclusion: Cement augmentation in fixation of trochanteric femoral fractures leads to fewer complications, re-operations and shorter hospital stay at the expense of a slightly longer operation duration. Cementation related complications occur rarely and mortality is equal between treatment groups. Based on these results, cement augmentation should be considered for trochanteric fractures in elderly patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0251894PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8205169PMC
June 2021

Epidemiology of combined clavicle and rib fractures: a systematic review.

Eur J Trauma Emerg Surg 2021 Jun 1. Epub 2021 Jun 1.

Department of Surgery, University Medical Center Utrecht, 85500, 3508 GA, Utrecht, The Netherlands.

Purpose: The aim of this systematic review was to provide an overview of the incidence of combined clavicle and rib fractures and the association between these two injuries.

Methods: A systematic literature search was performed in the MEDLINE, EMBASE, and CENTRAL databases on the 14 of August 2020. Outcome measures were incidence, hospital length of stay (HLOS), intensive care unit admission and length of stay (ILOS), duration of mechanical ventilation (DMV), mortality, chest tube duration, Constant-Murley score, union and complications.

Results: Seven studies with a total of 71,572 patients were included, comprising five studies on epidemiology and two studies on treatment. Among blunt chest trauma patients, 18.6% had concomitant clavicle and rib fractures. The incidence of rib fractures in polytrauma patients with clavicle fractures was 56-60.6% versus 29% in patients without clavicle fractures. Vice versa, 14-18.8% of patients with multiple rib fractures had concomitant clavicle fractures compared to 7.1% in patients without multiple rib fractures. One study reported no complications after fixation of both injuries. Another study on treatment, reported shorter ILOS and less complications among operatively versus conservatively treated patients (5.4 ± 1.5 versus 21 ± 13.6 days).

Conclusion: Clavicle fractures and rib fractures are closely related in polytrauma patients and almost a fifth of all blunt chest trauma patients sustain both injuries. Definitive conclusions could not be drawn on treatment of the combined injury. Future research should further investigate indications and benefits of operative treatment of this injury.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00068-021-01701-4DOI Listing
June 2021

Screw-blade fixation systems for implant anchorage in the femoral head: Horizontal blade orientation provides superior stability.

Injury 2021 Jul 1;52(7):1861-1867. Epub 2021 May 1.

Department of Orthopaedics and Trauma Surgery, Lucerne Cantonal Hospital, Switzerland.

Objectives: Despite continual improvement in the methods and devices used for treatment of proximal femoral fractures, unacceptably high failure rates remain. Novel screw-blade implant systems, combining a lag screw with a blade - the latter adding rotational stability to the femoral head - offer improvement of osseous purchase, especially in osteoporotic bone. The aim of this study was to compare biomechanically the head element (HE) anchorage of two screw-blade implant systems differing in blade orientation in the femoral head - vertical versus horizontal.

Methods: Twenty paired human cadaveric femoral heads were assigned to four groups (n = 10), implanted with either Rotationally Stable Screw-Anchor HE (RoSA-HE, vertical blade orientation) or Gamma3 Rotation Control Lag Screw (Gamma-RC, horizontal blade orientation) in center or off-center position, and biomechanically tested until failure under progressively increasing cyclic loading at 2 Hz.

Results: Cycles to failure and failure load were significantly higher for Gamma-RC versus RoSA-HE in center position and not significantly different between them in off-center position, p = 0.03 and p = 0.22, respectively. In center position, the progression of both rotation around implant axis and varus deformation over time demonstrated superiority of the implant with horizontal versus vertical blade orientation. Compared with center positioning, off-center implant placement led to a significant decrease in stiffness, cycles to failure and failure load for Gamma-RC, but not for RoSA-HE, p < 0.01 and p = 0.99, respectively.

Conclusion: Horizontal blade orientation of screw-blade implant systems demonstrates better anchorage in the femoral head versus vertical blade orientation in center position. As the stability of the implant system with horizontal blade orientation drops sharply in off-center position, central insertion is its placement of choice.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.injury.2021.04.058DOI Listing
July 2021

The impact of loco-regional anaesthesia on postoperative opioid use in elderly hip fracture patients: an observational study.

Eur J Trauma Emerg Surg 2021 May 7. Epub 2021 May 7.

Department of Anesthesiology, Luzerner Kantonsspital, Luzern, Switzerland.

Purpose: Hip fractures are a common health problem among the elderly with an increasing incidence. They are associated with high mortality and morbidity. Optimal pain management remains challenging and inadequate pain control is known for negatively affecting outcomes. Loco-regional anaesthetics (LRA) have been proven to benefit pain management and to lower the risks of opioid use and -related side effects. We aimed to evaluate the use and efficacy of different LRA in elderly hip fracture patients.

Methods: Single-center cohort study of elderly hip fracture patients, who were treated in central Switzerland. We compared patients who received LRA in the form of a femoral nerve block (FNB) or a continuous femoral nerve catheter (CFNC) with patients who did not receive LRA. Primary outcomes were pain-as measured in perioperative morphine use-hospital length of stay (HLOS), postoperative complications, postoperative falls and mortality.

Results: 407 patients were included for analysis. Mean age was 85.2 (SD6.3). There was a significant difference in intraoperative morphine use between the groups (p = 0.007). Postoperative morphine use differed significantly and was lowest in patients with FNB and highest in patients without LRA (p < 0.001). The use of LRA was a significant predictor for postoperative morphine use for postoperative morphine use at the recovery room and for postoperative morphine use 48 h after surgery. No significant differences were found in postoperative complications, a significant difference was found in 1-year mortality.

Conclusions: This article shows that LRA in the form of FNB and CFNC causes a significant decrease in postoperative opioid consumption. Differences between single-shot FNB or CFNC were minimal. There were no significant differences in clinical outcomes such as HLOS, delirium, 30-day and 90-day mortality and postoperative falls. We suggest that use of LRA should be incorporated in the perioperative treatment of elderly patients with a hip fracture. For future research, we recommend evaluating the number of postoperative complications and mortality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00068-021-01674-4DOI Listing
May 2021

Temporary spanning plate wrist fixation of complex distal radius fractures: a systematic review of 353 patients.

Eur J Trauma Emerg Surg 2021 Apr 26. Epub 2021 Apr 26.

Department of Orthopedic and Trauma Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland.

Purpose: Temporary spanning plate fixation of the wrist has been described as an alternative treatment method for complex distal radius fractures (DRfs). This systematic review aims to gain insight on clinical and radiological outcomes of this technique currently published in literature.

Methods: A comprehensive literature search of Pubmed, Embase, CENTRAL and CINAHL databases was conducted on November 5th 2020. All studies reporting on complications, functional, patient-rated and radiological outcomes of temporary spanning plate wrist fixation of DRFs in adult patients were included.

Results: Two prospective and eight retrospective cohort studies were included encompassing 353 patients with of 357 DRFs. The overall mean age was 53 years (range 19-95 years). Overall mean follow-up ranged from 6 months to 8.8 years. The union rate was 99.4%. Plate removal was performed on average 4.5 months after initial operation (range 1.1-28.9 months). The most frequently reported complication was implant failure with an incidence of 3.1%. Mean flexion/extension, pronation/supination and radial/ulnar inclination arc averaged 96.6°, 151.5° and 36.5°, respectively. Grip strength averaged 79.7% of the contralateral side. Mean DASH and PRWE scores were 22.9 and 16 points, respectively. Radiological indices were all within the acceptable limits.

Conclusions: Temporary spanning plate wrist fixation is a safe method for the treatment of complex DRFs. This technique can exploit the advantages of temporary wrist immobilization without the disadvantages of external fixation. With these aspects in mind, the spanning plate can serve as a valuable tool in the treatment of complex intra-articular DRFs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00068-021-01656-6DOI Listing
April 2021

Application of Pelvic Circumferential Compression Devices in Pelvic Ring Fractures-Are Guidelines Followed in Daily Practice?

J Clin Med 2021 Mar 21;10(6). Epub 2021 Mar 21.

Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, 6000 Luzern, Switzerland.

Early administration of a pelvic circumferential compression device (PCCD) is recommended for suspected pelvic trauma. This study was conducted to evaluate the prevalence of PCCD in patients with pelvic fractures assigned to the resuscitation room (RR) of a Level I trauma center. Furthermore, correct application of the PCCD as well as associated injuries with potential clinical sequelae were assessed. All patients with pelvic fractures assigned to the RR of a level one trauma center between 2016 and 2017 were evaluated retrospectively. Presence and position of the PCCD on the initial trauma scan were assessed and rated. Associated injuries with potential adverse effects on clinical outcome were analysed. Seventy-seven patients were included, of which 26 (34%) had a PCCD in place. Eighteen (23%) patients had an unstable fracture pattern of whom ten (56%) had received a PCCD. The PCCD was correctly placed in four (15%) cases, acceptable in 12 (46%) and incorrectly in ten (39%). Of all patients with pelvic fractures ( = 77, 100%) treated in the RR, only one third ( = 26, 34%) had a PCCD. In addition, 39% of PCCDs were positioned incorrectly. Of the patients with unstable pelvic fractures ( = 18, 100%), more than half either did not receive any PCCD ( = 8, 44%) or had one which was inadequately positioned ( = 2, 11 %). These results underline that preclinical and clinical education programs on PCCD indication and application should be critically reassessed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm10061297DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8003916PMC
March 2021

Is a chest radiograph indicated after chest tube removal in trauma patients? A systematic review.

J Trauma Acute Care Surg 2021 Feb 16. Epub 2021 Feb 16.

Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands Department of Surgery, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands Department of Orthopedics and Trauma Surgery, Luzerner Kantonsspital, Luzern, Switzerland Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.

Purpose: The aim of this systematic review was to assess the necessity of routine chest radiographs after chest tube removal in ventilated and non-ventilated trauma patients.

Methods: A systematic literature search was conducted in MEDLINE, EMBASE, CENTRAL and CINAHL on May 15th, 2020. Quality assessment was performed using the MINORS criteria. Primary outcome measures were abnormalities on post-removal chest radiograph (e.g. recurrence of a pneumothorax, hemothorax, pleural effusion) and reintervention after chest tube removal. Secondary outcome measures were emergence of new clinical symptoms or vital signs after chest tube removal.

Results: Fourteen studies were included, consisting of seven studies on non-ventilated patients and seven studies on combined cohorts of ventilated and non-ventilated patients, all together containing 1855 patients. Non-ventilated patients had abnormalities on post-removal chest radiograph in 10% (range across studies 0 - 38%) of all chest tubes and 24% (range 0 - 78%) of those underwent reintervention. In the studies that reported on clinical symptoms after chest tube removal, all patients that underwent reintervention also had symptoms of recurrent pathology. Combined cohorts of ventilated and non-ventilated patients had abnormalities on post-removal chest radiograph in 20% (range 6 - 49%) of all chest tubes and 45% (range 8 - 63%) of those underwent reintervention.

Conclusion: In non-ventilated patients, one in ten developed recurrent pathology after chest tube removal, with almost a quarter of them underwent reintervention. In two studies that reported on clinical symptoms, all reinterventions were performed in patients with symptoms of recurrent pathology. In these two studies, omission of routine post-removal chest radiograph seemed safe. However, current literature remains insufficient to draw definitive conclusions on this matter and future studies are needed.

Level Of Evidence: IV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/TA.0000000000003118DOI Listing
February 2021

MIPO versus nailing for humeral shaft fractures: a meta-analysis and systematic review of randomised clinical trials and observational studies.

Eur J Trauma Emerg Surg 2021 Jan 15. Epub 2021 Jan 15.

Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse 16, 6000, Luzern, Switzerland.

Purpose: There is no consensus on the optimal operative technique for humeral shaft fractures. This meta-analysis aims to compare minimal-invasive plate osteosynthesis (MIPO) with nail fixation for humeral shaft fractures regarding healing, complications and functional results.

Methods: PubMed/Medline/Embase/CENTRAL/CINAHL were searched for randomized clinical trials (RCT) and observational studies comparing MIPO with nailing for humeral shaft fractures. Effect estimates were pooled across studies using random effects models and presented as weighted odds ratio (OR), risk difference (RD), mean difference (MD) and standardized mean difference (SMD) with corresponding 95% confidence interval (95%CI). Analyses were repeated stratified by study design (RCTs and observational studies).

Results: A total of 2 RCTs (87 patients) and 5 observational studies (595 patients) were included. The effects estimated in observational studies and RCTs were similar in direction and magnitude for all outcomes except operation duration. MIPO has a lower risk for non-union (RD 7%; OR 0.2, 95% CI 0.1-0.5) and re-intervention (RD 13%; OR 0.3, 95% CI 0.1-0.8). Functional shoulder (SMD 1.0, 95% CI 0.2-1.8) and elbow scores (SMD 0.4, 95% CI 0-0.8) were better among patients treated with MIPO. The risk for radial nerve palsy following surgery was equal (RD 2%; OR 0.6, 95% CI 0.3-1.2) and nerve function recovered spontaneously in all patients in both groups. No difference was detected with regard to infection, time to union and operation duration.

Conclusion: MIPO has a considerable lower risk for non-union and re-intervention, leads to better shoulder function and, to a lesser extent, better elbow function compared to nailing. Although nailing appears to be a viable option, the evidence suggests that MIPO should be the preferred treatment of choice. The learning curve of minimal-invasive plating should, however, be taken into account when interpreting these results.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00068-020-01585-wDOI Listing
January 2021

Role of a spanning plate as an internal fixator in complex distal radius fractures.

Oper Orthop Traumatol 2021 Feb 27;33(1):77-88. Epub 2020 Nov 27.

Klinik Orthopädie und Unfallchirurgie, Luzerner Kantonsspital Luzern, Spitalstrasse I, 6000, Luzern 16 I, Switzerland.

Objective: Minimally invasive temporary internal wrist arthrodesis as an alternative treatment method in complex distal radius fractures.

Indications: Complex distal radius fractures with dorsal and/or palmar comminution and little to no reconstruction possibilities, radiocarpal ligamentous injury, need for early weight bearing through the affected wrist (walking aids).

Contraindications: Complex hand injuries limiting the possibility to safely secure the plate at either the metacarpal or the radial shaft.

Surgical Technique: Percutaneous or open reduction and fixation of the distal radius fracture. Determine the location for the two stab incisions under fluoroscopy; one over the distal radial diaphysis and one over the second or third metacarpal. A third incision over Lister's tubercle allows transposition of the extensor pollicis longus (EPL) tendon, excision of the posterior interosseous nerve and dorsal arthrotomy. Retrograde insertion of the spanning plate. Placement of a first nonlocking screw through the glide hole into the metacarpal shaft. Under traction, a proximal screw hole is filled with a nonlocking screw into the radial diaphysis. Tightening of the cortical screws under lateral fluoroscopic view. The remaining screw holes at both the distal and proximal ends of the plate are filled with locking screws. Layered wound closure.

Postoperative Management: A removable wrist splint is worn during 2 weeks. Weight bearing through the injured wrist is immediately allowed. Removal of the spanning plate is scheduled at 3 months after radiographic evidence of fracture consolidation.

Results: In total, twelve distal radius fractures were treated by dorsal spanning plate fixation between January 2018 and January 2019. Average age was 53.3 ± 24.5 years (range 22-95 years). Both 3.5 mm and 2.4/2.7 mm plates were used. All twelve fractures were healed after 3 months. The mean Disabilities of Arm, Shoulder and Hand (DASH) score was 36.4 (range 8.3-70.0). There was one EPL tendon rupture, one case with extensor tendon adhesions, one periosteosynthetic fracture of the radial shaft and one complex regional pain syndrome. There was no implant failure and no infection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00064-020-00686-4DOI Listing
February 2021

Minimally invasive plate osteosynthesis: An update of practise.

Injury 2021 Jan 5;52(1):37-42. Epub 2020 Nov 5.

Lucerne Cantonal Hospital, Department of Orthopaedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland.

Since its conception in 1989, minimally invasive plate osteosynthesis (MIPO) has gained widespread popularity. It has been studied in over forty countries with most of the publications originating from Asia, Europe and North America. This review aims to describe the scientific path of MIPO from the very beginning to where it stands in current day times; study the pattern and contributing factors influencing its global spread. Finally, the up to date evidence is discussed with regard to several anatomical regions in which MIPO is mostly used. In the meantime, MIPO treads steadily towards accomplishing the same or better outcomes for more and more indications with the goal to leave a smaller surgical footprint to allow for undisturbed bone healing.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.injury.2020.11.003DOI Listing
January 2021

Long-term quality of life and functional outcome after rib fracture fixation.

Eur J Trauma Emerg Surg 2020 Sep 2. Epub 2020 Sep 2.

Department of Orthopedic and Trauma Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland.

Purpose: The primary aim of this study was to assess the long-term quality of life and functional outcome after rib fracture fixation for patients with multiple rib fractures or flail chest. Secondarily, this study sought to identify risk factors associated with the quality of life.

Methods: A retrospective cohort study with a follow-up by questionnaire was performed at a level-1 trauma center in Switzerland. All adult patients with three or more rib fractures treated with rib fixation between 2010 and 2018 were eligible for inclusion. All outcomes were independently assessed for patients with multiple rib fractures and patients with a flail chest. The outcome measures were quality of life, level of dyspnea, return to work, implant irritation, and implant removal after a minimum of 12 months of follow-up. Quality of life was assessed using the EuroQol five-dimensional five-level questionnaire (EQ-5D-5L) and level of dyspnea was determined with the modified Medical Research Council dyspnea (mMRC) scale.

Results: The survey was completed by 74 out of 102 patients (73%) at a median follow-up of 26 months (IQR 15-37). The median EQ-5D utility index score was 0.91 (0.89-1.0), which was equivalent to the reference population (0.902, p = 0.523). The vast majority of patients experienced 'no problems' or 'slight problems' in any of the EQ-5D-5L dimensions. The complication rate associated with rib fracture fixation was low, implant-related irritation was the most common long-term sequela and occurred in 31% of patients. In multivariable regression analyses, total length of stay on the intensive care unit (ICU-LOS) was independently associated with a worse quality of life.

Conclusions: Patients who underwent rib fracture fixation for multiple rib fractures or flail chest after severe chest trauma experienced a good quality of life at least 1 year after surgery. A longer ICU-LOS was independently associated with impaired quality of life. In addition, there were no significant differences in the long-term quality of life and functional outcome between patients with multiple rib fractures and a flail chest. Implant-related irritation was the most important long-term sequela and occurred in one-third of patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00068-020-01470-6DOI Listing
September 2020

Minimally invasive double-plating osteosynthesis of the distal femur.

Oper Orthop Traumatol 2020 Dec 16;32(6):545-558. Epub 2020 Jun 16.

Department of Orthopedic and Trauma Surgery, Luzerner Kantonsspital, Luzern, Switzerland.

Objective: Technical description of minimally invasive double-plating of the distal femur.

Indications: Peri- and interprosthetic distal femur fractures with limited (periprosthetic) bone stock in geriatric patients. Re-operations (delayed and non-unions; infected non-unions) of the distal femur. Distal femoral fractures or femoral shaft fractures that do not qualify for femoral nailing and where the patient is unable to comply with weight-bearing restrictions.

Contraindications: Peri- and interprosthetic femoral fractures with unstable knee prosthesis and local soft tissue infection. Peri- and interprosthetic fractures of the proximal femur.

Surgical Technique: Supine position on a radiolucent table with both legs draped free. Support the knee to release traction on the distal fragment by the gastrocnemius muscle. Reduction and fixation of the fracture using a minimally invasive lateral approach. To reduce stress riser zones in interprosthetic fractures, the fixation device should overlap both the prosthesis by at least twice the diameter of the femoral diaphysis. Control plate position and reduction with special emphasis on length, rotation and longitudinal axes, using the healthy side as a reference. After sufficient reduction and fixation of the fracture, one proceeds to the medial plate fixation of the femur. Pre- or intraoperative contouring of a narrow large fragment locking compression plate into a helical shaped plate should be performed, using bending irons and a saw bone of a standard femur. The helical shaped plate is introduced submuscular and epiperiosteal in a minimally invasive fashion and fixed with bicortical locking screws.

Postoperative Management: Unrestricted weight bearing with walker or crutches under supervision of physiotherapist.

Results: Between 2015 and December 2018, minimally invasive double-plate osteosynthesis using a medial helical shaped plate was performed in 11 patients. In 6 cases it was applied in patients (81 years ± 7 SD) with a supracondylar peri- or interprosthetic femoral fracture. No implant failure or loss of reduction was seen after postoperative unrestricted weight bearing. In the additional 5 cases double-plating was used in salvage procedures ([infected] non-unions, hardware failure). One of these patients developed a fracture-related infection for which all material was removed. The fracture healed after a new attempt of antegrade nailing combined with an additional locking plate. In the remaining patients complete bone healing without hardware failure was seen.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00064-020-00664-wDOI Listing
December 2020

Epidemiology and outcome of rib fractures: a nationwide study in the Netherlands.

Eur J Trauma Emerg Surg 2020 Jun 6. Epub 2020 Jun 6.

Department of Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.

Purpose: Rib fractures following thoracic trauma are frequently encountered injuries and associated with a significant morbidity and mortality. The aim of this study was to provide current data on the epidemiology, in-hospital outcomes and 30-day mortality of rib fractures, and to evaluate these results for different subgroups.

Methods: A nationwide retrospective cohort study was performed with the use of the Dutch Trauma Registry which covers 99% of the acutely admitted Dutch trauma population. All patients aged 18 years and older admitted to the hospital between January 2015 and December 2017 with one or more rib fractures were included. Incidence rates were calculated using demographic data from the Dutch Population Register. Subgroup analyses were performed for flail chest, polytrauma, primary thoracic trauma, and elderly patients.

Results: A total of 14,850 patients were admitted between 2015 and 2017 with one or more rib fractures, which was 6.0% of all trauma patients. Of these, 573 (3.9%) patients had a flail chest, 4438 (29.9%) were polytrauma patients, 9273 (63.4%) were patients with primary thoracic trauma, and 6663 (44.9%) were elderly patients. The incidence rate of patients with rib fractures for the entire cohort was 29 per 100.000 person-years. The overall 30-day mortality was 6.9% (n = 1208) with higher rates observed in flail chest (11.9%), polytrauma (14.8%), and elderly patients (11.7%). The median hospital length of stay was 6 days (IQR, 3-11) and 37.3% were admitted to the intensive care unit (ICU).

Conclusions: Rib fractures are a relevant and frequently occurring problem among the trauma population. Subgroup analyses showed that there is a substantial heterogeneity among patients with rib fractures with considerable differences regarding the epidemiology, in-hospital outcomes, and 30-day mortality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00068-020-01412-2DOI Listing
June 2020

Compartment syndrome of the leg after thyroid hormone withdrawal; two cases and a systematic review of the literature.

BMC Endocr Disord 2020 Jun 5;20(1):80. Epub 2020 Jun 5.

Department of Orthopedic and Trauma Surgery, Luzerner Kantonsspital Luzern, P.O. Box, Spitalstrasse, 6000, Lucerne, Switzerland.

Background: Acute compartment syndrome is a rare complication of severe hypothyroidism. If the symptoms are not recognized promptly and treatment initiated immediately, there is a high risk of permanent damage. Only few other cases of compartment syndrome due to hypothyroidism have been published and the exact pathophysiological mechanism remains unknown.

Case Presentations: A 59 year old male developed acute compartment syndrome of his right lower leg after thyroid hormone withdrawal prior to radioiodine remnant ablation after total thyroidectomy for follicular thyroid cancer. He underwent emergency fasciotomy of all four compartments of the lower leg. The muscle tissue in the anterior and lateral compartment was necrotic and was therefore excised. The second patient was a 62 year old female with Hashimoto's thyroiditis, who developed acute compartment syndrome of both lower legs after thyroid hormone withdrawal due to non-compliance. Emergency fasciotomy of all four compartments of both legs was performed. The muscle tissue was viable in all compartments.

Conclusion: Although compartment syndrome due to hypothyroidism is uncommon, it is a complication physicians should be aware of. The majority of reported cases are caused by an acute withdrawal of thyroid hormones and not by undetected hypothyroidism. No previous case of compartment syndrome caused by an iatrogenic hormone withdrawal in preparation for radioactive iodine has been published. However, as shown in this report, it may be beneficial to inform patients of this rare complication prior to hormone withdrawal in preparation for remnant ablation after thyroidectomy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12902-020-00555-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7275613PMC
June 2020

Operative vs Nonoperative Treatment of Distal Radius Fractures in Adults: A Systematic Review and Meta-analysis.

JAMA Netw Open 2020 04 1;3(4):e203497. Epub 2020 Apr 1.

Department of Orthopedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, Boston.

Importance: No consensus has been reached to date regarding the optimal treatment for distal radius fractures. The international rate of operative treatment has been increasing, despite higher costs and limited functional outcome evidence to support this shift.

Objectives: To compare functional, clinical, and radiologic outcomes after operative vs nonoperative treatment of distal radius fractures in adults.

Data Sources: The PubMed/MEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases were searched from inception to June 15, 2019, for studies comparing operative vs nonoperative treatment of distal radius fractures.

Study Selection: Randomized clinical trials (RCTs) and observational studies reporting on the following: acute distal radius fracture with operative treatment (internal or external fixation) vs nonoperative treatment (cast immobilization, splinting, or bracing); patients 18 years or older; and functional outcome. Studies in a language other than English or reporting treatment for refracture were excluded.

Data Extraction And Synthesis: Data extraction was performed independently by 2 reviewers. Effect estimates were pooled using random-effects models and presented as risk ratios (RRs) or mean differences (MDs) with 95% CIs. Data were analyzed in September 2019.

Main Outcomes And Measures: The primary outcome measures included medium-term functional outcome measured with the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) and the overall complication rate after operative and nonoperative treatment.

Results: A total of 23 unique studies were included, consisting of 8 RCTs and 15 observational studies, that described 2254 unique patients. Among the studies that presented sex data, 1769 patients were women [80.6%]. Overall weighted mean age was 67 [range, 22-90] years). The RCTs included 656 patients (29.1%); observational studies, 1598 patients (70.9%). The overall pooled effect estimates the showed a significant improvement in medium-term (≤1 year) DASH score after operative treatment compared with nonoperative treatment (MD, -5.22 [95% CI, -8.87 to -1.57]; P = .005; I2 = 84%). No difference in complication rate was observed (RR, 1.03 [95% CI, 0.69-1.55]; P = .87; I2 = 62%). A significant improvement in grip strength was noted after operative treatment, measured in kilograms (MD, 2.73 [95% CI, 0.15-5.32]; P = .04; I2 = 79%) and as a percentage of the unaffected side (MD, 8.21 [95% CI, 2.26-14.15]; P = .007; I2 = 76%). No improvement in medium-term DASH score was found in the subgroup of studies that only included patients 60 years or older (MD, -0.98 [95% CI, -3.52 to 1.57]; P = .45; I2 = 34%]), compared with a larger improvement in medium-term DASH score after operative treatment in the other studies that included patients 18 years or older (MD, -7.50 [95% CI, -12.40 to -2.60]; P = .003; I2 = 77%); the difference between these subgroups was statically significant (test for subgroup differences, P = .02).

Conclusions And Relevance: This meta-analysis suggests that operative treatment of distal radius fractures improves the medium-term DASH score and grip strength compared with nonoperative treatment in adults, with no difference in overall complication rate. The findings suggest that operative treatment might be more effective and have a greater effect on the health and well-being of younger, nonelderly patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamanetworkopen.2020.3497DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7180423PMC
April 2020

Complications and outcome after rib fracture fixation: A systematic review.

J Trauma Acute Care Surg 2020 08;89(2):411-418

From the Department of Surgery (J.P.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Orthopaedic Surgery (J.P.), Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery, University Medical Center Utrecht (R.B.B., F.H.), Utrecht, The Netherlands; Department of Orthopaedic Surgery (M.H.), Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery (M.B.D.J.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Orthopedic and Trauma Surgery (F.J.P.B.), Cantonal Hospital Lucerne, Lucerne, Switzerland; Department of Surgery (L.P.H.L.), University Medical Center Utrecht, Utrecht; Department of Clinical Epidemiology (R.H.H.G.), Leiden University Medical Center, Leiden; and Department of Surgery (R.M.H.), University Medical Center Utrecht, Utrecht, The Netherlands.

Background: In recent years, there has been a growing interest in operative treatment for multiple rib fractures and flail chest. However, to date, there is no comprehensive study that extensively focused on the incidence of complications associated with rib fracture fixation. Furthermore, there is insufficient knowledge about the short- and long-term outcomes after rib fracture fixation.

Methods: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The MEDLINE, EMBASE, and Cochrane databases were searched to identify studies reporting on complications and/or outcome of surgical treatment after rib fractures. Complications were subdivided into (1) surgery- and implant-related complications, (2) bone-healing complications, (3) pulmonary complications, and (4) mortality.

Results: Forty-eight studies were included, with information about 1,952 patients who received rib fracture fixation because of flail chest or multiple rib fractures. The overall risk of surgery- and implant-related complications was 10.3%, with wound infection in 2.2% and fracture-related infection in 1.3% of patients. Symptomatic nonunion was a relatively uncommon complication after rib fixation (1.3%). Pulmonary complications were found in 30.9% of patients, and the overall mortality was 2.9%, of which one third appeared to be the result of the thoracic injuries and none directly related to the surgical procedure. The most frequently used questionnaire to assess patient quality of life was the EuroQol-5D (EQ-5D) (n = 4). Four studies reporting on the EQ-5D had a weighted mean EQ-5D index of 0.80 indicating good quality of life after rib fracture fixation.

Conclusion: Surgical fixation can be considered as a safe procedure with a considerably low complication risk and satisfactory long-term outcomes, with surgery- and implant-related complications in approximately 10% of the patients. However, the clinically most relevant complications such as infections occur infrequently, and the number of complications requiring immediate (surgical) treatment is low.

Level Of Evidence: Systematic Review, level III.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/TA.0000000000002716DOI Listing
August 2020

Conservative vs. operative treatment for humeral shaft fractures: a meta-analysis and systematic review of randomized clinical trials and observational studies.

J Shoulder Elbow Surg 2020 Jul 3;29(7):1493-1504. Epub 2020 Apr 3.

Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.

Background: This meta-analysis aimed to compare conservative vs. operative treatment for humeral shaft fractures in terms of the nonunion rate, reintervention rate, permanent radial nerve palsy rate, and functional outcomes. Secondarily, effect estimates from observational studies were compared with estimates of randomized clinical trials (RCTs).

Methods: The PubMed/Medline, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases were searched for both RCTs and observational studies comparing conservative with operative treatment for humeral shaft fractures.

Results: A total of 2 RCTs (150 patients) and 10 observational studies (1262 patients) were included. The pooled nonunion rate of all studies was higher in patients treated conservatively (15.3%) vs. operatively (6.4%) (risk difference, 8%; odds ratio [OR], 2.9; 95% confidence interval [CI], 1.8-4.5; I = 0%). The reintervention rate was also higher for conservative treatment (14.3%) than for operative treatment (8.9%) (risk difference, 6%; OR, 1.9; 95% CI, 1.1-3.5; I = 30%). The higher reintervention rate was predominantly attributable to the higher nonunion rate in patients treated conservatively. The permanent radial nerve palsy rate was equal in both groups (OR, 0.6; 95% CI, 0.2-1.9; I = 18%). There appeared to be no difference in mean time to union and mean Disabilities of the Arm, Shoulder and Hand scores between the treatment groups. No difference was found between effect estimates form observational studies and RCTs.

Conclusion: This systematic review shows that satisfactory results can be achieved with both conservative and operative management; however, operative treatment reduces the risk of nonunion compared with conservative treatment, with comparable reintervention rates (for indications other than nonunion). Furthermore, operative treatment results in a similar permanent radial nerve palsy rate, despite its inherent additional surgery-related risks. No difference in mean time-to-union and short-term functional results was detected.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jse.2020.01.072DOI Listing
July 2020

[Reduction and fixation of tibia plateau fractures : Tips and tactics based on the 3-column concept].

Oper Orthop Traumatol 2020 Apr 27;32(2):139-157. Epub 2020 Mar 27.

Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, 6000, Luzern 16, Schweiz.

Objective: The surgical management of tibial plateau fractures remains a challenge. The aim of surgery is the anatomical reconstruction of the joint surface with correct length, axis and rotation. The goal of osteosynthesis is to maintain a stable reduction to allow bone healing and functional aftercare. The continued advancements in 3D computed tomography has changed, the classification systems and, in parallel, the treatment strategies significantly changed. The 3‑column concept of Luo et al. has proven to be advantageous for planning of access, reduction and stabilisation.

Indications: Taking into consideration patient-specific factors. most displaced tibia plateau fractures are treated by surgery. However, no clear treatment recommendations exist in literature. In our clinical practice, joint displacement of more than 2 mm is generally not tolerated and surgical therapy is advised.

Operation Technique: The surgical technique is preceded by the surgical strategy, which is based on the soft tissue situation and imaging results. The gold standard in imaging is computed tomography. Timing of surgery, patient positioning, surgical approaches as well as the implants are individually adapted to the fracture pattern.

Results: The postoperative results are strongly influenced by fracture type, soft tissue condition, patient-specific factors, treatment method, and successful joint reconstruction. The functional postoperative results are often satisfactory even after complex tibia plateau fractures. In the literature, development of posttraumatic arthritis is reported to be 23-44%. In a study by Mehin et al. joint replacement of the knee was performed in 4.5% of cases following the surgical treatment of tibia plateau fractures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00064-020-00655-xDOI Listing
April 2020

Routine follow-up imaging has limited advantage in the non-operative management of blunt splenic injury in adult patients.

Injury 2020 Apr 19;51(4):863-870. Epub 2020 Feb 19.

Department of Orthopedic and Trauma Surgery, Cantonal Hospital of Lucerne, Switzerland.

Background: To date, limited evidence exists regarding follow-up imaging during the non-operative management (NOM) of blunt splenic injury (BSI), especially concerning ultrasound as first-line imaging modality. The aim of this study was to investigate the incidence and time to failure of NOM as well as to evaluate the relevance of follow-up imaging.

Methods: All adult patients with BSI admitted to our level I trauma center, including two associated hospitals, between 01/01/2010 and 31/12/2017 were retrospectively analyzed. Demographic data, comorbidities, injury pattern, trauma mechanism, Injury Severity Score, splenic injury grade and free intra-abdominal fluid were reviewed. Additional analysis of indication, frequency, modality, results and consequences of follow-up imaging was performed. Risk factors for failure of NOM were evaluated using fisher's exact test.

Results: A total of 122 patients with a mean age of 43.8 ± 20.7 years (16-84 years) met inclusion criteria. Twenty patients (16.4%) underwent immediate intervention. One-hundred-and-two patients (83.6%) were treated by NOM. Failure of NOM occurred in 4 patients (3.9%). Failure was significantly associated with active bleeding (3 of 4 [75%] failures vs. 8 of 98 [8.2%] non-failures, OR 33.75, 95% CI 3.1, 363.2, p = 0.004), and liver cirrhosis (2 of 4 [50%] failures vs. 0 of 98 [0%] non-failures, OR 197, 95% CI 7.4, 5265.1, p = 0.001). Eighty patients (78.4%) in the NOM-Group received follow-up imaging by ultrasound (US, n = 51) or computed tomography (CT, n = 29). In 57 cases, routine imaging examinations were conducted (43 US and 14 CT scans) without prior clinical deterioration. Fifty-fife (96.4%) of these imaging results revealed no new significant findings. Every failure of NOM was detected following clinical deterioration in the first 48 h.

Conclusion: To our knowledge this study includes the largest single centric patient cohort undergoing ultrasound as first-line follow-up imaging modality in the NOM setting of BSI in adult patients. The results indicate that a routine follow-up imaging, regardless of the modality, has limited therapeutic advantage. Indication for radiological follow-up should be based on clinical findings. If indicated, a CT scan should be used as preferred imaging modality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.injury.2020.02.089DOI Listing
April 2020

Primary or secondary wound healing of the pin sites after removal of the external fixator: study protocol for a prospective, randomized controlled, monocenter trial.

Trials 2020 Feb 19;21(1):205. Epub 2020 Feb 19.

Lucerne Cantonal Hospital, Orthopedic and Trauma Surgery, Lucerne, Switzerland.

Background: Temporary fixation with an external fixator is used for numerous indications in orthopedic trauma surgery. It is unclear whether primary wound healing or secondary open-wound healing after removal of the external fixator should be advocated for the pin site. This study compares primary wound closure with secondary wound healing for the pin site. The primary aim is to compare pin-site infection rates. The secondary aim is to compare time to wound healing and esthetic outcome. The hypothesis was that primary wound closure does not lead to more infections than secondary wound healing.

Methods And Design: This is a prospective, randomized controlled, blinded, monocenter study based on a non-inferiority design. To obtain an equal patient population and groups, all pin-entry sites of the patients are treated alternately at the time of removal of the external fixator with primary wound closure and secondary wound healing. Patients are randomized according to whether the proximal pin-entry site is treated with wound closure or by secondary open-wound healing, from which the further sequence develops. The pre- and postoperative protocol is standardized for all pin-entry sites. A photo documentation of the pin-entry sites takes place 2 and 52 weeks postoperatively during the routine clinical follow-up visits. Further controls take place at 6, 12 and 26 weeks after pin removal. The primary outcome was to demonstrate the non-inferiority of primary wound closure compared to secondary wound healing in terms of postoperative wound infections according to the Center of Disease Control and Prevention (CDC) definitions. The secondary outcomes are time to complete wound healing (days) and esthetical outcome (subjective preference of patients and Vancouver Scar Scale score).

Discussion: This study aims to answer how to deal with the pin site after removal of the external fixator. To date, no routine and generally accepted protocol exists for the management of pin sites after removal of the external fixator. This prospective, randomized controlled, blinded monocenter trial should determine whether primary wound closure or secondary wound healing should be advocated after removal of the external fixator.

Trial Registration: ClinicalTrials.gov, ID: NCT03842956. Registered retrospectively on 13 February 2019.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13063-020-4087-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7031911PMC
February 2020

Compartment syndrome of the forearm caused by contrast medium extravasation: A case report and review of the literature.

Clin Imaging 2020 May 15;61:58-61. Epub 2020 Jan 15.

Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern 16, Switzerland. Electronic address:

Compartment syndrome is a rare but serious complication of contrast medium extravasation. To avoid permanent damage, it is important to recognize the symptoms quickly and immediately initiate treatment. We report a patient, who developed compartment syndrome of the forearm after extravasation of contrast medium and review the available literature on this subject. To our knowledge this is the first reported case of compartment syndrome of the forearm due to contrast medium application for a trauma CT in a patient that had no direct trauma to the affected limb.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clinimag.2020.01.013DOI Listing
May 2020

Swiss chocolate and free beverages to increase the motivation for scientific work amongst residents: a prospective interventional study in a non-academic teaching hospital in Switzerland.

Trials 2020 Jan 13;21(1):74. Epub 2020 Jan 13.

Department of Traumatology and Orthopaedic Surgery, Cantonal Hospital Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland.

Background: The success of a clinical trial depends on its recruitment of eligible patients; therefore, the recruitment period requires special attention. We hypothesized that with a new approach focused on continuous information and gratification, resident motivation to participate in scientific work will increase and recruitment rates will improve.

Methods: Our new recruitment approach was applied to the recruitment phase of two prospective randomized trials (registered at the German Clinical Trials Register). Randomization of these trials was performed first using blinded envelopes; later a soft drink machine was used as the delivery tool of randomization as a lighthearted motivation to join scientific work and to reward the resident with free soft drinks for each recruitment. Residents were informed about the trial via a lecture and by mail. To increase interest everyone received Swiss chocolate. With a multiple choice survey we investigated the success of our actions at 6 and 12 months. Recruitment rates of the trials were evaluated and associated with the motivational approaches.

Results: Our residents rated their awareness of the trials with median 9 (IQR 7;9) during the first and 8 (IQR 5;9) during the second survey and their interest in scientific work with median 7 (IQR 4;8) and 6 (IQR 5;8). The percentage of residents feeling highly motivated improved from 58% to 70%. The recruitment rates stayed stably high over time with 73% and 72% in trial 1 and 90% and 85% in trial 2; 24% of residents stated their motivation could be increased by gratifications.

Conclusions: After implementation of our new recruitment approach we found positively motivated residents and high recruitment rates in the corresponding trials. We propose this procedure may help to ensure the successful initiation of clinical trials. Larger studies testing this approach are warranted.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13063-019-3956-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6958759PMC
January 2020

Team-based learning for teaching musculoskeletal ultrasound skills: a prospective randomised trial.

Eur J Trauma Emerg Surg 2020 Jan 10. Epub 2020 Jan 10.

Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstreet, 6000, Lucerne, Switzerland.

Objective: The aim of this prospective randomised trial was to assess the impact of the team-based learning approach on basic musculoskeletal ultrasound skills in comparison to both peer-assisted and conventional teaching and to examine the influence of gender and learning style on learning outcomes.

Methods: In this prospective randomised trial, we randomly assigned 88 students to 3 groups: team-based learning (n = 19), peer-assisted learning (n = 36) and conventional teaching (n = 33). Pre-existing knowledge was assessed using a multiple-choice (MC) exam. Student performance after completing the course was measured using an Objective Structured Clinical Examination (OSCE) and a second MC exam. Students were asked to complete Kolb's Learning Style Inventory and to evaluate the course.

Results: There was a significant gain in theoretical knowledge for all students (p < 0.001). The team-based learning groups' performance proved to be significantly superior on the OSCE (p = 0.001). As gender had no significant effect on practical or theoretical performance, learning style was linked to differences in the practical outcome. An evaluation showed overall satisfaction with the course and with the respective teaching methods.

Conclusion: Team-based learning proved to be superior to peer-assisted and conventional teaching of musculoskeletal ultrasound skills.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00068-019-01298-9DOI Listing
January 2020

International survey evaluating treatment of primary superficial skin abscesses.

Eur J Trauma Emerg Surg 2019 Dec 6. Epub 2019 Dec 6.

Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, Spitalstrasse 16, P.O. Box 6000, 6000, Lucerne, Switzerland.

Introduction: Skin and soft-tissue infections (SSTI) present regularly as cutaneous abscesses which require surgical drainage. These abscesses often affect younger patients and interfere with their independency substantially. Existing guidelines display heterogeneous recommendations concerning surgical aftercare. Primary aim of this survey was to present a nomogram for standard abscess therapy based on international expert opinions.

Method: An online survey dealing with standard of care protocols for cutaneous abscesses concerning surgical treatment and aftercare was created. The survey was conducted in 2017 during two international conferences held in Switzerland.

Result: 490 surgeons originating from 66 nations participated in this survey with the majority coming from Europe and Asia. Indication for surgery, operation type, and wound rinsing were answered homogeneously. Perioperative setting (45% sterile, 55% semi-sterile), anesthesia (45% local, 55% general), antibiotic therapy (38% always, 35% never, 27% other), irrigation fluid (54% sterile, 32% non-sterile, 14% antiseptic), irrigation frequency (55% once daily, 30% twice daily), and wound dressing (69% packing, 31% coverage) were heterogeneously answered topics.

Conclusion: Treatment and aftercare of simple primary skin abscesses are processed heterogeneously throughout the world. Focus should be on optimal patient focused treatment with minimal socio-economic impact. Future studies should focus on the validation of the different postoperative treatment options with the aim to develop a socio-economically accepted algorithm.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00068-019-01279-yDOI Listing
December 2019
-->