[While Others are Sleeping - Performance of Major Trauma Care at Night]

Introduction: The literature indicates that medical staff suffer from a decline in cognitive and physical performance at night. This study evaluates the process quality and outcomes of emergency care during night-time and daytime. Method: Out of 1,226 prospectively registered patients, 420 were included into this study (observation period: 76 months). Inclusion criteria were an ISS ≥ 16 and admission to trauma room during "DAY" (8 am to 4 : 49 pm) or "NIGHT" (9 pm to 5 : 59 am). The fundamental part was the 130 items of the TraumaRegister DGU. The additional 350 items contain data about prehospital treatment, trauma room management and intensive care. Data were collected by a research assistant over a 24-h period. Results: The study sample contained 268 DAY-patients and 152 NIGHT-patients. Patients admitted during night were injured more severely: ISS 34.9 (± 16.4) vs. 31.1 (± 14.2), p = 0.015 and younger: 33.3 (± 16.6) vs. 43.6 (± 22.3) years old, p < 0.001. However, this had no impact on outcome prediction scores like RISC, RISC2 or TRISS, p ≥ 0.775. Furthermore, no difference in process quality was observed like the time to gain an arterial access: NIGHT 4.5 (± 3.7) vs. DAY 5.0 (± 3.7) min, p = 0.116, time for splinting 3.8 (± 3.7) vs. 3.4 (± 3.1) min, p = 0.922, or other parameters, like time to CT: 26.9 (± 11.2) vs. 26.6 (± 14.5) min, p = 0.520. Nor was there any difference in outcome: 17.8 % of the NIGHT-patients (RISC-prognosis: 23.8 %, SMR 0.74) died in hospital, and 18.3 % of the DAY-patients (RISC-prognosis: 24.0 %, SMR 0.77), p = 0.894. As well the comparison of the Glasgow Outcome Scale revealed no difference: NIGHT 3.8 (± 1.5) vs. DAY 3.8 (± 1.6), p = 0.491. Discussion: Although evidence suggests a drop of performance by medical staff at night, this effect could not be demonstrated. Considering this, the level of process quality and outcome - regardless of the time of arrival - remained constant on a high level. These results might be attributable to the quality management and the standardisation of the treatment.

[Increasing Number of Road Traffic Fatalities in Germany - Turnaround or Snap-Shot]

Introduction: For the first time since 20 years, the number of road accident fatalities in 2011 increased on German roads compared to earlier periods. Methods and Results: The presented paper submitted by the expert group for accident prevention investigates and discusses possible reasons for the observed increase in road traffic fatalities. Results: Climate changes as well as changes in economic environment, and technological progress in car and passenger safety are identified as possible reasons for the observed increase. Discussion: Mentioning the "Decade of Action for Road Safety" initiated by the UNO and coordinated by the WHO, the overall goal is a worldwide reduction of accident related road fatalities. But prognostic calculations predict an asymptotic approximation to a limit of road fatalities. To achieve a reduction by half until 2020 intense collaboration and disproportional expenditure are necessary. Conclusion: From the authors' point of view the current increase of traffic fatalities in Germany is rated as a snapshot rather than a turnaround.

[Accidents, illness and injuries involved in road haulage : consequences for medical care and prevention]

This article reviews basic characteristics of road traffic crashes of heavy vehicles and the current health status of truck drivers. It summarises previous findings from research with a focus on orthopaedic diseases and injuries. These findings comprise a risky health behaviour and high prevalence of associated diseases which can be attributed to both the occupational framework and personal risk-taking behavioural patterns. These are of major importance given the increasing number of drivers and the consequences for acute care and prevention. On the other hand there is a substantial lack of medical care for the drivers on the road. Therefore this article presents the"DocStop Initiative" for medical care on the road, an initiative that runs an international network of care providers (http://www.docstop-online.eu).

[Road traffic crashes in developing countries]

Road traffic crashes pose a major threat to individuals and national health systems. Developing countries account for 48% of motorized vehicles, but for 91% of the 1.3 million fatalities per annum. While ranked ninth among the causes of disabilities adjusted life years lost in 2004, crash injuries are projected to rise to third position by 2030. This article reviews current prognoses of deaths and disabilities, the characteristics of crashes in low and middle income countries and evidence-based road safety interventions. This article is considered a wake-up call for trauma, orthopaedic, and emergency surgeons in high-income countries to join the global community in fighting the neglected yet potentially curable epidemic named road traffic injuries.

[Physicians in traumatology. Critically endangered? Results of an inquiry]

INTRODUCTION

The aim of this investigation was to describe the current situation and atmosphere among residents and consultants in traumatology, using the results of a questionnaire. Wishes and needs concerning training programs in traumatology were addressed.

METHODS

A questionnaire consisting of 25 items was distributed among members of the German Society of Traumatology (DGU) to document basic data concerning the state of residency and physicians' current workload. The participants were also asked about their personal interests and aims within traumatology. Finally, questions concerning educational programs, compensation, and work-life balance were addressed. The results were analysed descriptively.

RESULTS

The final analysis included 549 questionnaires. The mean age of the participants was 36 years (SD +/-7.5). Sixty percent (329) were residents, and 16% (88) served as consultants. The mean workload per week was 61 h (SD +/-10.8 h), and participants were on call seven times (SD +/-5.6) a month. The work-life balance was rated a mean of only 5 ("mediocre"). The majority of participants rejected working longer in order to reduce the duration of their educational program. On the other hand, most of the participants would also reject a reduction in working time accompanied by a reduced salary. Nevertheless, 78% (428) of the participants would, in retrospect, choose the same profession, and 85% (466) would even choose the same specialty.

DISCUSSION

The study reports on the atmosphere among residents and consultants in traumatology. Despite European regulations, the individual workload is exceptionally high. It is a clear task of hospital administrators to increase the attractiveness of hospital jobs in order to ensure qualified personnel in the future.

Devastating femoral osteomyelitis after anterior cruciate ligament reconstruction

Osteomyelitis following arthroscopic assisted anterior cruciate ligament (ACL) reconstruction has not been reported in literature. We describe an aggressive progression of septic arthritis and osteomyelitis leading to the complete destruction of the condylar region in a young non-immunosuppressed patient after reconstruction of the ACL. In addition we discuss the steps in diagnostics and our salvage procedures.

[Tree collisions in road traffic accidents - mechanism and pattern of injury]

INTRODUCTION

In Germany, the county of Mecklenburg-Vorpommern has got the highest frequency of traffic accidents. 42 % of all deadly injured car accident victims in Mecklenburg-Vorpommern sustained a tree collision. Aim of this study was to analyze tree collisions regarding typical pattern and severity of injury.

METHODS

During an on-going prospective, non-interventional accident survey within a defined area of the county of Mecklenburg-Vorpommern tree collisions with minimum one victim sustaining a Maximum Abbreviated Injury Scale of 1-6 injury were analyzed.

RESULTS

In between January 2001 and June 2004 287 accidents were documented. 19 % (54) were tree collisions. 81 % of drivers were male. 36 of 54 tree collisions (67 %) occurred on straight roadways. The mean ISS was 31.3 (SD +/- 29.8), 30 % (23) of the passengers died. 70 of 78 individuals sustained more than one injury. With that, the combination of head- and chest trauma was most frequent and associated with the highest injury severity.

DISCUSSION

Especially tree collisions lead to severe trauma. Interestingly, most accidents did occur on straight roadways.

Oldie but goldie: Bristow-Latarjet procedure for anterior shoulder instability

PURPOSE

To analyse the functional and radiological outcomes of the Bristow-Latarjet procedure in patients with recurrent anterior glenohumeral instability.

METHODS

Records of 29 patients were reviewed retrospectively. Date of first dislocation, injury mechanism, and number of recurring dislocations before and after surgery were recorded. The overall function and stability of the shoulder was evaluated.

RESULTS

24 (83%) of the glenohumeral instabilities were caused by trauma. The mean number of recurring dislocations was 8 (95% confidence interval [CI], 0-18); one patient had had 40 recurrences. No dislocation ensued postoperatively. The overall functional outcome was good, with a mean Rowe score of 90 points (95% CI, 78-100). Scores of 17 (59%) of the patients were excellent, 7 (24%) were good, 3 (10%) were fair, and 2 (7%) were poor.

CONCLUSION

The Bristow-Latarjet procedure is a good surgical treatment for recurrent anterior-inferior instability of the glenohumeral joint.

Does the frontal airbag avoid thoracic injury?

INTRODUCTION

The airbag is an established car safety device. However, recent studies pointed out that even the airbag might cause injuries. Nevertheless, most physicians do consider a lower risk in accident victims sustaining severe injury of the chest, when a deployed frontal airbag has been reported. We set out to verify the frequency and pattern of thoracic injury in car drivers protected by a frontal airbag during traffic accidents.

METHODS

This investigation was conducted as part of a prospective surveillance analyzing traffic accidents. Enrolled were car drivers included in a databank between January 2001 and December 2004 consecutively. The chance for sustaining chest injury with or without a frontal airbag was described using the relative risk.

RESULTS

A total of 188 car drivers were included in the analysis. In 54 (28.7%) cases a deployed airbag and in 134 (71.3%) the absence of an airbag has been documented. Out of those cases 16 (29.6%) drivers with airbag and 30 (22.4%) without airbag sustained a chest injury. The mean abbreviated injury scale (AIS) of chest injuries in drivers with deployed airbag was 2.3 (1-5; SD +/- 1.45; mean injury severity scale [ISS] 21.1 [SD +/- 17.18]), in drivers without airbag 1.6 (1-4; SD +/- 1.12; mean ISS 15.8 [SD +/- 20.6]). For belted drivers with an airbag the relative risk to sustain chest injury was 1.96 compared to those without an airbag.

CONCLUSIONS

The airbag does not avoid chest injury definitively. Much more, it has been demonstrated that the relative risk to sustain relevant thoracic injury seems to be almost higher in restrained drivers with a frontal airbag.

Ergebnisse nach Versorgung instabiler proximaler Humerusfrakturen mittels winkelstabiler Platte

BACKGROUND

Fixed-angle implants are being increasingly used in surgery of fractures of the proximal humerus. The aim of this retrospective investigation was to evaluate the outcome after fracture reduction utilizing a fixed-angle plate (Königsee).

MATERIALS AND METHODS

Between January 2003 and April 2004, 58 patients were operated, 52 of whom received a fixed-angle implant; 46 cases were harvested for a follow-up examination. Each patient was re examined clinically and radiologically at least 6 and 18 months after surgery. The functional outcome was evaluated using the Constant Score and the Simple Shoulder Test. The results were compared to results of other investigations.

RESULTS

The mean patient age was 68.8 years (34-94 years). Fractures were classified using the Neer Classification: 12 were classified as two-part, 25 as three-part, and 9 as four-part fractures. Three of the three-part and four of the four-part fractures were rated as luxation fractures. The overall functional outcome of all cases was good. More than 18 months after surgery the mean general "Constant Score" was 57; the mean side-related "Constant Score" was 89%. The Simple Shoulder Test revealed a pain-free range of motion in 41 (89.1%) of the individuals. The majority of the patients were satisfied with the results regarding remaining range of activity of the injured limb. In five cases significant complications occurred. In two cases the head of the humerus collapsed, and in one case a necrosis of the head occurred. In one individual the implant broke after an additional trauma. In this case a re-osteosynthesis utilizing a tibia plate was performed and the patient was excluded from further follow-up investigations. One soft tissue infection occurred after initial surgery.

CONCLUSION

It has been shown that results after fixation of proximal humerus fractures with fixed-angle implants are good. The functional outcome is good and complications are rare. Our results correlate with other investigations regarding fracture reduction using fixed-angle plates and nails.

Comparative flow cytometric study of clonal excess in leukaemic peripheral blood from patients suffering from chronic lymphocytic leukaemia (B-CLL) by different antibodies, staining techniques and the effects of blood storage

This investigation studied the effects of cell preparation methods, different antibody panels and blood storage on antigen expression of abnormal B lymphocytes from patients with B-CLL. Blood specimens collected in Heparin de novo were processed by using conventional Hypaque-Ficoll density gradient centrifugation and whole blood lysis. These were stored for 3 days at 4 degrees C, 24 degrees C and 30 degrees C. Although clonal excess was detected by all antibody panels, significant differences could be observed in terms of molecules of equivalent fluorochromes (MEF/MESF units). Evaluation of 'weak and strong' staining is dependent on the antibody panel used. Immunofluorescent values for CD19 and CD45 were unchanged at 4 degrees C and 24 degrees C but immunoglobulin staining showed best results when blood was stored at 4 degrees C. Storage at 30 degrees C produced unreliable results. Abnormal B lymphocytes should be analysed immediately after the specimen is obtained. If shipment is necessary they should be kept at 4 degrees C. Surface immunoglobulins are the 'antigens' most sensitive to storage alterations. Sample alterations alone are sufficient to the correct classification of NHL, especially in the case of low-grade NHL.

Lymphocyte gating of peripheral blood in patients with leukemic low-grade non-Hodgkin's lymphoma by multiparametric flow cytometry

The standardized fluorescence intensity as expressed in molecules of equivalent soluble fluorescence (MESF) of lymphocytes from normal individuals and patients suffering from low-grade non-Hodgkin's-lymphomas was obtained comparing different staining patterns of CD45(FITC) and CD20(PerCP). After standardization of the flow cytometer using standardized fluorescent particles ('beads') significant differences could be obtained for hairy cell leukemia, chronic lymphocytic leukemia and immunocytomas in the peripheral blood. In contrast, centroblastic-centrocytic as well as centrocytic lymphomas showed no significant variations as compared to normal peripheral blood lymphocytes. According to these results, a new lymphocyte gating procedure was established by adding CD14(PE) and three-color measurement by CD45/CD14/CD20 staining of peripheral blood using erythrocyte lysis. The established gating procedure leads to a crucial discrimination and quantification of abnormal and normal lymphocytes per one measurement, whereas the 'leucogate' as defined by CD45/CD14 staining alone was insufficient for correct lymphocyte gate setting. In conclusion, the different staining of CD45 and CD20 in leukemic peripheral blood should be considered when fluorescence intensity or atypical peaks occurred in flow cytometric histograms suggesting for abnormal cell populations. In addition, it is possible to use this information to classify low-grade lymphomas.