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Pfeifer R, Klingebiel FKL, Balogh ZJ, Beeres FJ, Coimbra R, Fang C, Giannoudis PV, Hietbrink F, Hildebrand F, Kurihara H, Lustenberger T, Marzi I, Oertel MF, Peralta R, Rajasekaran S, Schemitsch EH, Vallier HA, Zelle BA, Kalbas Y, Pape HC. Early major fracture care in polytrauma-priorities in the context of concomitant injuries: A Delphi consensus process and systematic review. J Trauma Acute Care Surg 2024; 97:639-650. [PMID: 39085995 PMCID: PMC11446538 DOI: 10.1097/ta.0000000000004428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/08/2024] [Accepted: 05/29/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND The timing of major fracture care in polytrauma patients has a relevant impact on outcomes. Yet, standardized treatment strategies with respect to concomitant injuries are rare. This study aims to provide expert recommendations regarding the timing of major fracture care in the presence of concomitant injuries to the brain, thorax, abdomen, spine/spinal cord, and vasculature, as well as multiple fractures. METHODS This study used the Delphi method supported by a systematic review. The review was conducted in the Medline and EMBASE databases to identify relevant literature on the timing of fracture care for patients with the aforementioned injury patterns. Then, consensus statements were developed by 17 international multidisciplinary experts based on the available evidence. The statements underwent repeated adjustments in online- and in-person meetings and were finally voted on. An agreement of ≥75% was set as the threshold for consensus. The level of evidence of the identified publications was rated using the GRADE approach. RESULTS A total of 12,476 publications were identified, and 73 were included. The majority of publications recommended early surgery (47/73). The threshold for early surgery was set within 24 hours in 45 publications. The expert panel developed 20 consensus statements and consensus >90% was achieved for all, with 15 reaching 100%. These statements define conditions and exceptions for early definitive fracture care in the presence of traumatic brain injury (n = 5), abdominal trauma (n = 4), thoracic trauma (n = 3), multiple extremity fractures (n = 3), spinal (cord) injuries (n = 3), and vascular injuries (n = 2). CONCLUSION A total of 20 statements were developed on the timing of fracture fixation in patients with associated injuries. All statements agree that major fracture care should be initiated within 24 hours of admission and completed within that timeframe unless the clinical status or severe associated issues prevent the patient from going to the operating room. LEVEL OF EVIDENCE Systematic Review/Meta-Analysis; Level IV.
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Gomez GI, Li GQ, Valido AA, Stoner AJ, Bromley-Dulfano RA, Sheira D, Gonzalez CA, Khan SI, Choi J, Zygourakis CC, Weiser TG. Thoracic and Lumbar Spine Injury: Evidence-Based Diagnosis, Management, and Outcomes. Am Surg 2024; 90:902-910. [PMID: 37983195 DOI: 10.1177/00031348231216479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
BACKGROUND Traumatic thoracolumbar spine injuries are associated with significant morbidity and mortality. Targeted for non-spine specialist trauma surgeons, this systematic scoping review aimed to examine literature for up-to-date evidence on presentation, management, and outcomes of thoracolumbar spine injuries in adult trauma patients. METHODS This review was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. We searched four bibliographic databases: PubMed, EMBASE, Web of Science, and the Cochrane Library. Eligible studies included experimental, observational, and evidence-synthesis articles evaluating patients with thoracic, lumbar, or thoracolumbar spine injury, published in English between January 1, 2010 and January 31, 2021. Studies which focused on animals, cadavers, cohorts with N <30, and pediatric cohorts (age <18 years old), as well as case studies, abstracts, and commentaries were excluded. RESULTS A total of 2501 studies were screened, of which 326 unique studies were fully text reviewed and twelve aspects of injury management were identified and discussed: injury patterns, determination of injury status and imaging options, considerations in management, and patient quality of life. We found: (1) imaging is a necessary diagnostic tool, (2) no consensus exists for preferred injury characterization scoring systems, (3) operative management should be considered for unstable fractures, decompression, and deformity, and (4) certain patients experience significant burden following injury. DISCUSSION In this systematic scoping review, we present the most up-to-date information regarding the management of traumatic thoracolumbar spine injuries. This allows non-specialist trauma surgeons to become more familiar with thoracolumbar spine injuries in trauma patients and provides a framework for their management.
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Affiliation(s)
- Giselle I Gomez
- Stanford University School of Medicine, Stanford, CA, USA
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
| | - Guan Q Li
- Stanford University School of Medicine, Stanford, CA, USA
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
| | - Austin A Valido
- Stanford University School of Medicine, Stanford, CA, USA
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
| | | | - Rebecca A Bromley-Dulfano
- Stanford University School of Medicine, Stanford, CA, USA
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
| | - Dina Sheira
- Stanford University School of Medicine, Stanford, CA, USA
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
| | - Cayo A Gonzalez
- Stanford University School of Medicine, Stanford, CA, USA
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
| | - Suleman I Khan
- Stanford University School of Medicine, Stanford, CA, USA
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
| | - Jeff Choi
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, CA, USA
| | | | - Thomas G Weiser
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, CA, USA
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Herren C, Jarvers JS, Jung MK, Blume C, Meinig H, Ruf M, Weiß T, Rüther H, Welk T, Badke A, Gonschorek O, Heyde CE, Kandziora F, Knop C, Kobbe P, Scholz M, Siekmann H, Spiegl U, Strohm P, Strüwind C, Matschke S, Disch AC, Kreinest M. Paediatric spine injuries in the thoracic and lumbar spine-results of the German multicentre CHILDSPINE study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1574-1584. [PMID: 37466720 DOI: 10.1007/s00586-023-07822-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/25/2023] [Accepted: 06/07/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Paediatric thoracolumbar spine injuries are rare, and meaningful epidemiological data are lacking. OBJECTIVES The aim of this study was to provide epidemiological data for paediatric patients with thoracolumbar spinal trauma in Germany with a view to enhancing future decision-making in relation to the diagnostics and treatment of these patients. MATERIALS AND METHODS A retrospective multicentre study includes patients up to 16 years of age who were suffering from thoracolumbar spine injuries who had been treated in six German spine centres between 01/2010 and 12/2016. The clinical database was analysed for patient-specific data, trauma mechanisms, level of injury, and any accompanying injuries. Diagnostic imaging and subsequent treatment were investigated. Patients were divided into three age groups for further evaluation: age group I (0-6 years), age group II (7-9 years) and age group III (10-16 years). RESULTS A total of 153 children with 345 thoracolumbar spine injuries met the inclusion criteria. The mean age at the time of hospitalization due to the injury was 12.9 (± 3.1) years. Boys were likelier to be affected (1:1.3). In all age groups, falls and traffic accidents were the most common causes of thoracolumbar spine injuries. A total of 95 patients (62.1%) were treated conservatively, while 58 (37.9%) of the children underwent surgical treatment. Minimally invasive procedures were the most chosen procedures. Older children and adolescents were likelier to suffer from higher-grade injuries according to the AOSpine classification. The thoracolumbar junction (T11 to L2) was the most affected level along the thoracolumbar spine (n = 90). Neurological deficits were rarely seen in all age groups. Besides extremity injuries (n = 52, 30.2%), head injuries represented the most common accompanying injuries (n = 53, 30.8%). Regarding spinal injuries, most of the patients showed no evidence of complications during their hospital stay (96.7%). CONCLUSIONS The thoracolumbar junction was more frequently affected in older children and adolescents. The majority of thoracolumbar spinal column injuries were treated conservatively. Nevertheless, 37.9% of hospitalized children had to be treated surgically, and there was an acceptable complication rate for the surgeries that were performed.
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Affiliation(s)
- Christian Herren
- Department of Orthopedic Trauma Surgery, University Hospital RWTH Aachen, Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Jan-Sven Jarvers
- Universitätsklinikum Leipzig, Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Leipzig, Germany
| | - Matthias K Jung
- BG Klinik Ludwigshafen, Zentrum für Wirbelsäulenchirurgie, Ludwigshafen Am Rhein, Germany
| | - Christian Blume
- Uniklinik RWTH Aachen, Klinik für Neurochirurgie, Aachen, Germany
| | - Holger Meinig
- SRH Klinikum Karlsbad-Langensteinbach, Zentrum für Wirbelsäulenchirurgie, Orthopädie und Unfallchirurgie, Karlsbad, Germany
| | - Michael Ruf
- SRH Klinikum Karlsbad-Langensteinbach, Zentrum für Wirbelsäulenchirurgie, Orthopädie und Unfallchirurgie, Karlsbad, Germany
| | - Thomas Weiß
- BG Unfallklinik Murnau, Abteilung Wirbelsäulenchirurgie, Staffelsee, Germany
| | - Hauke Rüther
- Universitätsmedizin Göttingen, Zentrum für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Göttingen, Germany
| | - Thomas Welk
- SRH Klinikum Karlsbad-Langensteinbach, Abteilung für Radiologie und Neuroradiologie, Karlsbad, Germany
| | - Andreas Badke
- BG Klinik Tübingen, Abteilung für Wirbelsäulenchirurgie, Tübingen, Germany
| | - Oliver Gonschorek
- BG Unfallklinik Murnau, Abteilung Wirbelsäulenchirurgie, Staffelsee, Germany
| | - Christoph E Heyde
- Universitätsklinikum Leipzig, Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Leipzig, Germany
| | - Frank Kandziora
- BG Unfallklinik Frankfurt, Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Frankfurt Am Main, Germany
| | - Christian Knop
- Klinikum Stuttgart, Klinik für Unfallchirurgie und Orthopädie, Stuttgart, Germany
| | - Philipp Kobbe
- Department of Orthopedic Trauma Surgery, University Hospital RWTH Aachen, Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Matti Scholz
- BG Unfallklinik Frankfurt, Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Frankfurt Am Main, Germany
| | - Holger Siekmann
- Ameos Klinik Halberstadt, Klinik für Unfall, Hand- und Wiederherstellungschirurgie, Halberstadt, Germany
| | - Ulrich Spiegl
- Universitätsklinikum Leipzig, Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Leipzig, Germany
| | - Peter Strohm
- Klinikum Bamberg, Klinik für Orthopädie und Unfallchirurgie, Bamberg, Germany
| | - Christoph Strüwind
- BG Unfallklinik Murnau, Abteilung Wirbelsäulenchirurgie, Staffelsee, Germany
| | - Stefan Matschke
- ATOS Klinik Heidelberg, Praxis für Wirbelsäulenchirurgie, Heidelberg, Germany
| | - Alexander C Disch
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, UniversitätsWirbelsäulenzentrum (UCSC), UniversitätsCentrum für Orthopädie, Unfall- and Plastische Chirurgie, Dresden, Germany
| | - Michael Kreinest
- BG Klinik Ludwigshafen, Zentrum für Wirbelsäulenchirurgie, Ludwigshafen Am Rhein, Germany
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Wendt K, Nau C, Jug M, Pape HC, Kdolsky R, Thomas S, Bloemers F, Komadina R. ESTES recommendation on thoracolumbar spine fractures : January 2023. Eur J Trauma Emerg Surg 2023:10.1007/s00068-023-02247-3. [PMID: 37052627 DOI: 10.1007/s00068-023-02247-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/08/2023] [Indexed: 04/14/2023]
Affiliation(s)
- Klaus Wendt
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Christoph Nau
- University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Marko Jug
- University Medical Centre Ljubljana, University of Ljubljana, Ljubljana, Slovenia
| | | | - Richard Kdolsky
- University Clinic for Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Frank Bloemers
- Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Radko Komadina
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
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New Diagnostic and Therapeutic Approaches for the Care of the Severely Injured Patient. J Clin Med 2020; 9:jcm9113468. [PMID: 33126502 PMCID: PMC7693027 DOI: 10.3390/jcm9113468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 11/17/2022] Open
Abstract
Severe trauma remains a leading cause of death, especially in the younger population [...].
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