Analysis of mortality between 2019-2020 at the Neuroorthopedic and Traumatic Orthopedic Departments

The number of deaths from skeletal injuries is still significant, but is declining with advances in emergency medicine. The adopted principles of emergency procedures and the availability of specialist centres enable the treatment to be effective.

AIM

The aim of the study was to analyse the deaths of patients with spine and limb injuries who required surgery.

MATERIALS AND METHODS

The analysis covered 22 deaths in the years 2019-2020. The assessment took into account: the cause of admission, the condition of the patient and comorbidities, the medical scales which were used to assess the possible risk of complications, the diagnostic correctness and qualification for surgical treatment, the waiting time for surgery and the cause of death and prior course of action.

RESULTS

It can be stated that in 2019, the mortality rate was 0.21 (10 deaths out of 4658 hospitalized), in 2020, the mortality rate was 0.31 (12 deaths out of 3852 hospitalized). The mortality rate in the Department of Traumatic Orthopedics was: 0.30 in 2019 (8 deaths out of 2625 hospitalized) and 0.39 in 2020 (8 deaths in 2020 hospitalized). 10 patients with hip fractures (trochanteric and femoral neck) underwent surgery within 2.7 days (from 1 to 4 days). The causes of death within 1-9 days (average 4.86 days) from admission in this group were complex, and associated with the presence of chronic diseases, including: circulatory failure (9), septic shock (1), heart rhythm disturbances (7), renal failure (6), pulmonary congestion (4), hyperkalemia (1), coagulation disorders (1). In patients after spinal injury with quadriplegia, decompression (1), stabilization (1) and disc removal (1) were performed on the day of admission to the hospital. The patients were hospitalized in the ICU, and deaths occurred on days 9, 15 and 187 from admission due to respiratory and circulatory failure and sudden cardiac arrest. Patients after arthroplasty of the knee (1) and hip (2) were operated on day 2 from admission, and deaths occurred on day 4, 22 and 53 due to: sepsis (1), pulmonary embolism (1), respiratory failure in the course of pneumonia (1).

CONCLUSIONS

The deceased were admitted in a serious general condition, burdened with numerous concomitant chronic diseases and their age ranged from 66 to 97 years. The surgical treatment was undertaken for life saving reasons but 5 of the deceased did not undergo surgery due to the extreme general condition leading to respiratory and circulatory failure.

Post-traumatic bilateral scapular and thoracic vertebral body fractures - a case report

The simultaneous fracture of both scapulae with coexisting fracture of the thoracic vertebral body is observed extremely rarely and is fully dependent on the mechanism that caused them.

A CASE REPORT

The 59-year-old patient was admitted to the trauma and orthopedic department because of back pain and the inability to move independently. A few hours earlier he suffered bludgeoning trauma from a thick branch falling from a tree. During the physical examination significant limitation the range of motion in shoulder joints with was found. <15 ° flexion and <30 ° abduction, with limited external rotation in the right shoulder joint, and <15 ° flexion and <15 ° abduction, with significant external rotation deficiency. Normal range of motion in both hands was preserved. No sensory deficits or paresis were observed. Radiographic examination revealed the presence of a multifragmentary fracture of both scapulae and a fracture of the Th9 vertebral body, which was confirmed by computed tomography of the chest. The patient was qualified for conservative treatment of scapular fractures and was fitted with an abduction splint for the left shoulder. The Th9 vertebral body required surgical approach. The patient underwent transpedicular stabilization of the Th7,8,9,10 vertebrae with precontoured rods for the kyphotic deformation of the spine. After the procedure, the patient was provided with Javette's brace strengthening the spine correction and discharged for further outpatient observation.

CONCLUSIONS

Fracture of the scapula is one of the most demanding fractures to diagnose in the classic radiological examination. CT scans with 3D reconstruction can be considered to be the "gold standard". Surgical procedures is indicated for patients with severe comminution of fracture fragments and neurological symptoms. Minor fracture displacements can be conservatively treated. Coexisting Th9 vertebra fracture in this case required surgery by posterior transpedicular stabilization.

[Thrombosis of the medial artery imitating the symptoms of carpal tunnel syndrome - a case report]

Carpal tunnel cyndrome is a condition resulting from the compression of the median nerve in the wrist canal. Thrombosis of the medial artery can exceptionally rarely mimic the symptoms of carpal tunnel syndrome.

A CASE REPORT

The 46-year-old woman reported with typical symptoms of carpal tunnel syndrome. The performed ultrasound examination did not confirm the suppression of the median nerve in the wrist canal. However, the median artery filled with a thrombus was described. After conservative treatment with heparin, the small-molecule discomfort in the patient subsided within 3 weeks.

CONCLUSIONS

The rare causes of median nerve compression symptoms should be taken into account during ultrasound diagnostics of the carpal tunnel cyndrome using Doppler technique.

[Analysis of pre-operative loads and their relation to postoperative mortality in patients with proximal femur fracture]

Good functional efficiency of patients after surgical treatment of proximal femur fracture may be associated with the presence of preoperative loads.

AIM

The aim of the study was to analyze the impact of preoperative loads on the functional outcome of surgical treatment and the presence of complications observed in the perioperative period in patients with previous BKKU fractures.

MATERIALS AND METHODS

A retrospective analysis included 202 patients with proximal femur fractures undergoing surgery, including 146 women aged 80.1 +/- 15.4 years and 56 men aged 74.3 +/- 13.2 years. The patients were divided according to the type of fracture into two groups. The first group consisted of 120 patients (91 women and 29 men) with intertrochanteric fractures and the second group consisting of 82 patients (55 women and 27 men) with femoral neck fractures. The analysis takes into account the influence of chronic co-morbidities on the treatment method used and the outcome of the treatment, taking into account the greatest possible independence in the daily activities of the operated patients.

RESULTS

In 85% of surgical patients treated for proximal femur fractures, concomitant diseases were observed in the pre-operative period. 28 of them were disqualified from surgery. In the remaining 38 patients perioperative complications were observed, including prolonged bleeding, infection and exacerbation of renal failure. The most unfavorable complication in the analysis was renal failure.

CONCLUSIONS

Patients in the age group predisposing to proximal femur fractures should be carefully monitored for co-morbid chronic diseases. This action may reduce the percentage of disqualification from surgical treatment and the risk of perioperative complications.

[Analiza postępowania w złamaniach okołoprotezowych kości udowej po endoprotezoplastyce stawu biodrowego]

Fracture around the femoral shaft after hip arthroplasty is rarely trauma. On the other hand, the surgical supply of this fracture is a very demanding process, because we deal with older, often patients with risk factors, with poor bone quality and a broken bone canal filled with a prosthesis stem.

AIM

The aim of the study is to analyze the frequency of these fractures over the years 2005-2011 and examples of surgical solutions (plate fixation, revision stems).

MATERIALS AND METHODS

In the discussed period, 12 patients were treated for periprosthetic fracture of the femur. The analysis excluded patients with intraoperative fractures performed during primary arthroplasty. The analysis involved the mechanism of injury, the primary cause of the prosthesis, the fracture morphology (according to Vancouver classification).

RESULTS

11 patients were treated surgically and 1 conservatively. In 10 cases, a good or very good treatment result was obtained. In 2 patients, complications occurred and surgical treatment was necessary.

CONCLUSIONS

Periprosthetic fractures are characterized by a high percentage of failures (18%) requiring reoperation.