Search

Double-physician couples being parents have been shown to face greater difficulties in combining their private and professional lives when compared to other couples. In the present study, we aimed to analyze how double-physician couples manage to arrange their roles in their private and professional lives and how compatible their individual idea of being a mother or a father is with their career as a physician. Fifteen couples being parents and consisting of either two surgeons or a surgeon and a nonsurgeon were asked to participate in a survey to determine the average maternity or paternity leave, the reduction of hours worked per week after the birth of a child, and the need for professional childcare and additional support in childcare from relatives or babysitters per week. Furthermore, the couples were asked to mark on a six-item Likert scale how compatible their professional life is with their idea of being parents. The average maternity or paternity leave was 13 ± 2 months per child and the mean reduction of hours worked per week was 30 ± 12%. The couples made use of professional childcare for 41 ± 6 h/week on average and needed additional support in childcare from relatives or babysitters for 5 ± 3 h/week. On the Likert scale from “completely incompatible (0)” to “perfectly compatible (5)”, the mean compatibility of professional and private lives was rated 2.5 ± 1.1. Becoming parents significantly influences the professional and private lives of double-physician couples. The relatively low compatibility of double-physician couples’ private and professional lives might lead to relevant work-home conflicts. Such conflicts have been proven to be associated with surgeons not recommending surgery as a career. Therefore, efforts should be made to improve the compatibility of parenthood and a medical career.

Fracture healing in the aged is associated with a reduced healing capacity, which often results in delayed healing or non-union formation. Many factors may contribute to this deterioration of bone regeneration, including a reduced 'angiogenic trauma response'. The phosphodiesterase-3 (PDE-3) inhibitor cilostazol has been shown to exert pro-angiogenic and pro-osteogenic effects in preclinical studies. Therefore, we herein analyzed in a stable closed femoral fracture model whether this compound also promotes fracture healing in aged mice. Forty-two aged CD-1 mice (age: 16–18 months) were daily treated with 30 mg/kg body weight cilostazol (n = 21) or vehicle (control, n = 21) by oral gavage. At 2 and 5 weeks after fracture, the femora were analyzed by X-ray, biomechanics, micro-computed tomography (µCT), histology, immunohistochemistry, and Western blotting. These analyses revealed a significantly increased bending stiffness at 2 weeks (2.2 ± 0.4 vs. 4.3 ± 0.7 N/mm) and an enhanced bone formation at 5 weeks (4.4 ± 0.7 vs. 9.1 ± 0.7 mm3) in cilostazol-treated mice when compared to controls. This was associated with a higher number of newly formed CD31-positive microvessels (3.3 ± 0.9 vs. 5.5 ± 0.7 microvessels/HPF) as well as an elevated expression of phosphoinositide-3-kinase (PI3K) (3.6 ± 0.8 vs. 17.4 ± 5.5-pixel intensity × 104) and runt-related transcription factor (RUNX)2 (6.4 ± 1.2 vs. 18.2 ± 2.7-pixel intensity × 104) within the callus tissue. These findings indicate that cilostazol accelerates fracture healing in aged mice by stimulating angiogenesis and the expression of PI3K and RUNX2. Hence, cilostazol may represent a promising compound to promote bone regeneration in geriatric patients. [ABSTRACT FROM AUTHOR]

The failure of fracture healing represents a substantial clinical problem. Moreover, aged patients demonstrate an elevated risk for failed bone healing. However, murine models to study the failure of fracture healing are established only in young adult animals. Therefore, the aim of this study was to develop a reliable model to study failed fracture healing in aged mice. After creation of a 1.8-mm segmental defect and periosteal resection, femora of aged mice (18-20 months) and young adult control mice (3-4 months) were stabilized by pin-clip fixation. Segmental defects were analyzed by means of biomechanics, x-ray, and micro-computed tomography, as well as histomorphometric, immunohistochemical, and Western blot analysis. After 10 weeks, all animals showed a complete lack of osseous bridging, resulting in fracture healing failure. Segmental defects in aged mice revealed a reduced bone formation and vascularization when compared to young adult mice. This was associated with a decreased expression of bone formation markers. In addition, we detected a reduced number of tartrate-resistant acid phosphatase-positive osteoclasts and an elevated osteoprotegerin/receptor activator of NF-ĸB ligand ratio in aged animals, indicating a reduced osteoclast activity. Moreover, aged animals showed also an enhanced inflammatory response, characterized by an increased infiltration of macrophages within the callus tissue. Taken together, we herein report for the first time a reliable model to study fracture healing failure in aged mice. In the future, the use of this model enables us to study novel therapeutic strategies and molecular mechanics of failed fracture healing during aging. [ABSTRACT FROM AUTHOR]

Purpose: In elderly patients with minimally displaced acetabulum fractures, the patients' inability to partially weight-bear and the need for early mobilisation may trigger the decision towards a treatment with higher primary stability. The purpose of this study was to compare open reduction and internal fixation (ORIF), closed reduction and percutaneous fixation (CRPIF) and non-operative treatment in geriatric minimally displaced acetabulum fractures with regard to complications and quality of reduction. Methods: Data from the prospective German Pelvic Injury Register collected between 2008 and 2018 were used to evaluate 608 geriatric patients with isolated minimally displaced (≤ 5 mm) acetabulum fractures. In total, 429 received non-operative treatment, 117 ORIF and 62 CRPIF. Demographics, injury severity, fracture pattern, complications and fracture displacement before and after treatment were analysed. Results: Both operative methods reduced fracture gap displacement. CRPIF was associated with lower blood loss and shorter operative time compared to ORIF (p < 0.001). Hospital stay was 12.9 days in the non-operative group, 16.8 with CRPIF and 23.6 with ORIF (p < 0.001). Non-surgical general complications were more likely to occur following ORIF (22.2%) compared to CRPIF (8.1%) and non-operative treatment (8.4%, p < 0.001). The rate of surgical complications was not different for ORIF and CRPIF (p = 0.122) Conclusion: Both operative treatments improve fracture displacement and joint congruency in elderly patients with minimally displaced acetabulum fractures. Compared to ORIF, CRPIF achieves similar quality of reduction but is associated with fewer complications, smaller intraoperative blood loss, shorter operative time and shorter length of hospital stay. [ABSTRACT FROM AUTHOR]

Purpose: External emergency stabilization (EES) of unstable pelvic fractures reduces haemorrhage and mortality. Available are non-invasive procedures (sheet sling and pelvic binder) and invasive procedures (external fixator and pelvic C-clamp). Nevertheless, there is no recommended standard as to which procedure for EES should be used. Methods: Prospectively collected data between 2007 and 2016 from the German Pelvic Trauma Registry were used to evaluate 989 patients with in-hospital EES. Besides age, gender and injury severity score (ISS), the fracture classification was evaluated. Furthermore, the frequency of used EES, time to application, their reported efficacy and the frequencies of change to another EES were investigated. Results: The use of pelvic binders increased up to 40% while all other procedures decreased in frequency over the 10-year period. The ISS was highest in patients treated with a pelvic C-clamp or combination of pelvic C-clamp and external fixator (p < 0.05). Non-invasive stabilization was applied significantly faster than invasive procedures (p < 0.0001). Overall, the reported efficacy was good (at least 70%) for all procedures but with poorest results for the pelvic binder and best for the external fixator (p < 0.00001). Most change to another EES was found for the sheet sling and pelvic binder. Conclusion: In case of suspected unstable pelvic fracture, an EES should be performed, in case of doubt with a non-invasive EES until imaging and final diagnosis. Which method should be used depends on the individual situation and the available information about the overall injury pattern. Invasive EES are preferable for treatment according to Damage Control Orthopaedics. [ABSTRACT FROM AUTHOR]

Severe bleeding is the major cause of death in unstable pelvic ring fractures. Therefore, a quick and efficient emergency stabilization and bleeding control is inevitable. C-clamp and pelvic binder are efficient tools for temporary bleeding control, especially from the posterior pelvic ring. Yet the C-clamp requires more user knowledge, training and equipment. However, whether this makes up for a more efficient bleeding control, is still under debate. Patients with a type-C pelvic ring fracture were identified from the German Pelvic Registry (GPR) and divided into three groups of 40 patients (1. no emergency stabilization, 2. pelvic binder, 3. C-clamp). The matching occurred according to the parameters age, gender, initial RR and initial HB. Complication—and mortality rates were compared especially regarding bleeding control. Regarding ISS and fracture dislocation there was no difference. The use of the C-clamp resulted in more complications, a higher mortality rate due to severe bleeding and more blood transfusions were admitted. Moreover the pelvic binder was established noticeably faster. However, the C-clamp was more often rated as effective. There is no evidence of advantage comparing the C-clamp to the pelvic binder, regarding bleeding control in type-C pelvic ring fractures. In fact, using the pelvic binder even showed better results, as the time until established bleeding control was significantly shorter. Therefore, the pelvic binder should be the first choice. The C-clamp should remain a measure for selected cases only, if an adequate bleeding control cannot be achieved by the pelvic binder. [ABSTRACT FROM AUTHOR]

Background: Pelvic fractures are rare but serious injuries. The influence of a concomitant abdominal trauma on the time point of surgery and the quality of care regarding quality of reduction or the clinical course in pelvic injuries has not been investigated yet. Methods: We retrospectively analyzed the prospective consecutive cohort from the multicenter German Pelvic Registry of the German Trauma Society in the years 2003–2017. Demographic, clinical, and operative parameters were recorded and compared for two groups (isolated pelvic fracture vs. combined abdominal/pelvic trauma). Results: 16.359 patients with pelvic injuries were treated during this period. 21.6% had a concomitant abdominal trauma. The mean age was 61.4 ± 23.5 years. Comparing the two groups, patients with a combination of pelvic and abdominal trauma were significantly younger (47.3 ± 22.0 vs. 70.5 ± 20.4 years; p < 0.001). Both, complication (21.9% vs. 9.9%; p < 0.001) and mortality (8.0% vs. 1.9%; p < 0.001) rates, were significantly higher. In the subgroup of acetabular fractures, the operation time was significantly longer in the group with the combined injury (198 ± 104 vs. 176 ± 81 min, p = 0.001). The grade of successful anatomic reduction of the acetabular fracture did not differ between the two groups. Conclusion: Patients with a pelvic injury have a concomitant abdominal trauma in about 20% of the cases. The clinical course is significantly prolonged in patients with a combined injury, with increased rates of morbidity and mortality. However, the quality of the reduction in the subgroup of acetabular fractures is not influenced by a concomitant abdominal injury. Trial registration: ClinicalTrials.gov, NCT03952026, Registered 16 May 2019, retrospectively registered [ABSTRACT FROM AUTHOR]

Purpose: Pelvic ring fractures in the elderly gain increasing importance. Nonetheless, data on factors influencing treatment decision in relation to fracture classification, age, and the resulting treatment are still rare.Methods: Prospectively collected data of the German Pelvic Injury Registry from patients aged over 65 years with a pelvic ring fracture were evaluated retrospectively. Acetabular fractures, as well as type A1 and A3 fractures, were excluded. The variables age, injury pattern, type of treatment, the reason for conservative treatment, and Orthopaedic Trauma Association (OTA)/Tile classification were analyzed. Furthermore, the fracture distribution was examined after dividing patients into six age groups.Results: A total of 1814 patients with a mean age of 80.7 ± 7.6 years, predominantly female (79.0%), were available for evaluation. The majority of patients suffered from isolated pelvic ring fractures (70.1%) and 8.2% were severely injured (ISS > 16). The most common fracture types were type A2 (35.4%), type B2 (38.0%), and type C1 (7.3%). Especially pelvic ring fractures of type A2 (96.9%) and type B2 (83.0%) were treated conservatively (overall 76.9%). Fracture instability according to the OTA/Tile classification increased the probability for an operative treatment (generalized odds ratio [OR] 6.90 [5.62; 8.52]). In contrary, increasing age independent of the fracture pattern decreased this probability (OR 0.47 [0.41-0.53]). With increasing fracture instability, general health conditions were up to 50% of the reasons for conservative treatment.Conclusion: The results of the present study underline the importance of the factors age and general health besides fracture classification for therapeutic decision-making in the treatment of pelvic ring fractures in the elderly. [ABSTRACT FROM AUTHOR]