Search

Copyright of Die Unfallchirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Intracapsular proximal femoral fracture is a frequent injury in elderly patients, often associated with low-energy trauma and reduced bone mass. In young patient, it is uncommon, usually caused by high-energy trauma and accompanied by damage to the adjacent soft tissues. However, reports of open intracapsular proximal femoral fracture due to indirect trauma are rare in the orthopedic literature. In the present article, we describe a case of this injury in a 35-year-old man involved in a car accident. The proximal femur was exposed at the gluteal region due to a mechanism similar to dislocation of the posterior hip. We describe the initial treatment and subsequent management until achieving a definitive solution using total hip arthroplasty and muscle transfer to reconstruct the abductor mechanism of the hip. At 10 months of follow-up, the patient presented good functional outcome, with gradual recovery of the abductive strength and a Harris Hip Score of 91 points. In addition, a radiographic study showed that the cemented total prosthesis was well-positioned. This therapeutic strategy (total hip arthroplasty with muscle transfer to reconstruct the abductor musculature) was successful to treat an intracapsular proximal femoral fracture with bone exposure.

Open pelvic fractures are devastating injuries, rare, and with high mortality. Leading causes of mortality are: haemorrhage, infection and associated injuries. The aim of this paper is to point out methods of treating these injuries and great number of prognostic mortality factors. Material - in period from January 2011 to December 2015, 221 patients with pelvis ringfracture were treated in three large clinical centers of Serbia, of which 13(5%) had an open fracture type. We have classified pelvic ring fractures according to the Young - Burgess classification. We have classified injuries according to Gustilo at I, II, and III degree, and the location of the wound according to Faringer classification was distributed in zone I, II and III. Urogenital and intra-abdominal injuries were monitored, and severity of injuries was determined according to Severity Score Injury (ISS) and Trauma Score (TS). Results - there were 6(46%) women and 7(54%) men at the average age of 41(13 - 76). Injuries from traffic trauma are dominant. The most common cause of pelvic ring fracture is an anterior posterior compression - 6(46%), lateral compression - 4(31%) and vertical force in 3 (23%) patients. Dominant injuries are type I and II according to Gustilo, and zone I according to Faringer classification. There were 6 (46%) patients with urogenital injuries, and the same number with intra-abdominal injuries, of which 3(23%) patients have been treated with colon resection and diversion. Due to abundant hemorrhage and hypovolemic shock 2 patients died, and another one died after three days due to sepsis and multisystem organ failure (MSOF). Conclusion - Open pelvic fractures have high mortality rate, due to: haemorrhage, infection, associated abdominal and genitourinary tract injuries, ISS> 25, TS 65 years.

Objectives: To evaluate a new triage workflow aimed at improving time to intravenous antibiotics in open fractures to under less than 60 minutes of arrival to the Pediatric Emergency Department., Design: A prospective, multidisciplinary, quality improvement project., Setting: A tertiary care, Level 1 pediatric trauma hospital in New York., Patient Selection Criteria: Patients ages 17 years and younger with long bone open fractures between June 1, 2020, and May 31, 2021, excluding those transferred from an outside hospital, with nonlong bone fractures and nonfractured, injured extremities., Outcome Measures and Comparisons: The new workflow involved splint removal and skin assessment during triage to identify open fractures. The aim of serial Plan-Do-Study-Act cycles was to refine this workflow and reduce antibiotic administration time. Primary outcome: percentage of patients with open fracture receiving intravenous antibiotics within 60 minutes. Secondary outcome: assessment of triage documentation regarding splint presence and removal. An exact Wilcoxon two-sample test compared time from patient arrival (quick registration) with antibiotic administration before, during, and after workflow implementation on June 1, 2020., Results: A total of 51 patients (33 male) ages 17 years and younger, with open fractures, were reviewed: 25 during the preintervention phase January 1, 2018 to May 31, 2020; 14 during the intervention phase June 1, 2020 to May 31, 2021; and 12 during the postintervention phase June 1, 2021 to November 30, 2021. Continuous improvement efforts through Plan-Do-Study-Act cycles focusing on education, reinforcement, recognition, and barrier identification increased the percentage of patients receiving antibiotics within 60 minutes from 36% to 87.5%. The median time and interquartile range (interquartile range: 25th percentile-75th percentile) from quick registration to administration was 86 minutes (interquartile range: 51-147) before June 1, 2020, and 34 minutes (interquartile range: 16-42) thereafter., Conclusion: The implemented triage workflow led to improved time to antibiotics to within 60 minutes for patients with long bone open fractures in the pediatric emergency department., Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: The authors report no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

ABSTRACT Introduction: open tibial fractures are challenging due to the frequent severe bone injury associated with poor soft tissue conditions. This is relevant in low- and middle-income countries, mainly related to delayed definitive fixation and lack of adequate training in soft tissue coverage procedures. Due to these factors, open tibial fracture is an important source of disability for Latin American countries. Herein we sought to provide an epidemiological overview of isolated open tibial shaft fracture across seven hospitals in southern cone of Latin America. The secondary goal was to assess the impact on quality of life based on return-to-work rate (RWR). Methods: patients with an isolated open tibial shaft fracture treated in seven different hospitals from Brazil and Argentina from November 2017 to March 2020 were included in the study. Clinical and radiographic results were evaluated throughout the 120-day follow-up period. Final evaluation compared RWR with the SF-12 questionnaire, bone healing, and gait status. Results: Seventy-two patients were treated, 57 followed for 120 days and 48 completed the SF-12 questionnaire. After 120 days, 70.6% had returned to work, 61.4% had experienced bone healing. Age, antibiotic therapy, type of definitive treatment, and infection significantly influenced the RWR. Gait status exhibited strong correlations with RWR and SF-12 physical component score. Conclusions: Isolated open tibial shaft fractures are potentially harmful to the patient’s quality of life after 120 days of the initial management. RWR is significantly higher for younger patients, no history of infection, and those who could run in the gait status assessment.