Does a prehospital applied pelvic binder improve patient survival?

INTRODUCTION

Pelvic fractures are serious and oftentimes require immediate medical attention. Pelvic binders have become a critical tool in the management of pelvic injuries, especially in the prehospital setting. Proper application of the pelvic binder is essential to achieve the desired result. This study evaluates the effectiveness of prehospitally applied pelvic binders in improving outcomes for patients with pelvic fractures.

METHODS

This retrospective cohort study analyzed 66 patients with unstable pelvic ring fracture classified as AO61B or 61C, who were treated at a Level I hospital in the emergency room between January 2014 and December 2018. The ideal position for a pelvic binder was determined, and patients were divided into three sub-groups based on whether they received a pelvic binder in the ideal position, outside the optimal range, or not at all. The primary outcome measure was the survival rate of the patients.

RESULTS

66 trauma patients with unstable pelvic fractures were enrolled, with a mean age of 53.8 years, who presented to our ER between 2014 and 2018. The mean ISS score was 21.9, with 60.3 % of patients having a moderate to severe injury (ISS > 16 points). Pelvic binder usage did not differ significantly between patients with an ISS < or ≥ 16 points. A total of 9 patients (13.6 %) died during hospitalization, with a mean survival time of 8.1 days. The survival rate did not differ significantly between patients with or without a pelvic binder, or between those with an ideally placed pelvic binder versus those with a binder outside the ideal range. The ISS score, heart rate, blood pressure at admission, and hemoglobin level were significantly different between the group of patients who died and those who survived, indicating their importance in predicting outcomes.

CONCLUSION

Our study found that prehospital pelvic binders did not significantly impact patient outcomes for unstable pelvic fractures, with injury severity score (ISS) being the strongest predictor of survival. Assessing injury severity and managing blood loss remain crucial for these patients. While pelvic binders may not impact survival significantly, they still play a role in stabilizing pelvic fractures and managing blood loss.

[Infectious, pathologic humeral fracture in a patient with sickle cell disease-A rare case?]

The vaso-occlusive crises of sickle cell disease are accompanied by bone necrosis, which favors endogenous bacterial colonization and thus osteomyelitis. This poses a major challenge for eradication and fracture management.A 22-year-old patient with sickle cell disease sustained a multifragmentary, humeral shaft fracture. During surgical management, pus drained from the fracture site and further diagnostic work-up revealed osteomyelitis with evidence of Klebsiella aerogenes. Septicemia due to Klebsiella aerogenes had been treated 5 months prior to the accident, which occured because of a vaso-occlusive crisis. This is associated with clustered bone necrosis and endogenous germ colonization. Eradication of the germs and fracture care become a challenge. Repeated surgical procedures with segmental transfer can be a successful treatment option.

Anticoagulation management in elderly patients with proximal femur fractures - overview of current concepts

Objectives

Proximal femur fractures (PFF) are common injuries in elderly patients and can have considerable effects on their quality of life, morbidity, and mortality. Due to pre-existing comorbidities, the prevalence of anticoagulated patients is increasing. The right timing for surgery and perioperative anticoagulation treatment remains controversial.

Content

This overview aims to summarize current practices in the pre- and postoperative anticoagulation management and the recommended time to surgery in elderly patients with PFF.

Summary and Outlook

Time to surgery for anticoagulated patients is often prolonged due to worries about serious perioperative bleeding and higher transfusion demands. But the delay of surgical PFF treatment increases the risk for perioperative complications like pulmonary embolism, pneumonia, deep vein thrombosis and urinary tract infections. Early surgery can be achieved with a consistent and interdisciplinary perioperative anticoagulation management. Antiplatelets do not have to be discontinued and surgery should be performed early without delay. For patients taking vitamin K antagonists (VKA) an INR less than 1.5 is recommended prior to surgery, which can be achieved by pausing VKA intake or by administering vitamin K, prothrombin complex concentrate (PCC) or fresh frozen plasma (FFP). For the treatment with direct oral anticoagulants (DOAC) a plasma drug level of under 50 pg/mL is considered safe for surgery. If the plasma level can not be determined, a gap of 24 h between the last DOAC dose and surgery is recommended. The systemic administration of tranexamic acid can reduce overall blood loss and transfusion rates in anticoagulated patients with PFF. Surgical treatment of PFF should be performed within 24 h, as delayed surgery increases the risk for perioperative complications. This also applies to anticoagulated patients, when clinically appropriate. International and interdisciplinary guidelines are necessary to ensure early and appropriate treatment of anticoagulated elderly patients with PFF.

Does the COVID-19 personal protective equipment impair the surgeon's performance?

INTRODUCTION

Despite increasing vaccination rates, new viral variants of SARS-CoV-2 (severe acute respiratory syndrome coronavirus type 2) are advancing the COVID 19 (coronavirus disease 2019) pandemic and continue to challenge the entire world. Surgical care of SARS-CoV-2 positive patients requires special protective measures. We hypothesized that "COVID-19" personal protective equipment (PPE) during surgery of SARS-CoV-2 positive or potentially positive patients would negatively affect the surgeon and thus the surgical outcome.

MATERIALS AND METHODS

Ten experienced trauma surgeons participated in the study. Each surgeon performed two simulated surgeries of a distal tibial fracture on a Sawbone® under standardized conditions either wearing regular PPE or special COVID-19 PPE. Baseline values at rest were acquired for heart rate, blood pressure, saturation of peripheral oxygen (SpO₂), respiratory rate and capillary blood gas (CBG) analysis including capillary partial pressure of oxygen (pO₂) and carbon dioxide (pCO₂), followed by four different standardized tests of attentional performance (TAP). Subsequently, the surgeon performed the first surgery according to a randomly determined order, with regular or COVID-19 PPE conditions in an operation theatre. After each surgery vital signs were acquired and CBG and TAP were performed again.

RESULTS

In our simulated surgical procedure heart rate, respiratory rate, systolic and diastolic blood pressure did not show relevant differences. Percutaneously measured SpO₂ decreased with additional layers of PPE, while CBG parameters were not affected. TAP tests showed a significant impairment of attention if PPEs were compared to the baseline, but both PPEs had similar results and no meaningful differences could be measured.

CONCLUSIONS

According to our results, for surgical procedures additional PPE required during COVID-19 pandemic does not relevant affect the surgeon's mental and physical performance. Surgeries under COVID-19 PPE conditions appear safe and do not increase patient risk.

LEVEL OF EVIDENCE

Level I.

Orthopädie und Unfallchirurgie – Zehnkampf der Medizin

BACKGROUND

When the specialties of orthopedics and trauma surgery were merged in 2006 in Germany, the learning content significantly increased while the training time remained the same. Less and less junior doctors learn the whole spectrum of orthopedics and trauma surgery for diagnosis, treatment and aftercare options.

OBJECTIVE

How can continuing education concepts be designed to meet the wide range of theoretical and practical content required in residency training to become an orthopedic and trauma surgeon?

RESULTS AND CONCLUSION

Orthopedics and trauma surgery is one of the most diverse specialties in terms of patients, clinical pictures and fields of activity. Accordingly, residency training must also be broadly based. This can be achieved through structured and well-planned training concepts. Furthermore, digital simulators could be used to prepare residents for working with patients. Rotation models in the outpatient area could also be beneficial in order to gain an insight into the outpatient care of musculoskeletal diseases. In addition to the active involvement of the resident in the training, the interest and participation of the trainers is also important in order to actively promote junior physicians and prepare them for their later work.

Soft Skills und Kompetenzen in der Weiterbildung sowie in der persönlichen Entwicklung

BACKGROUND

In addition to the content of orthopedic and trauma surgery training, which is recorded in the logbook in black and white, there seems to be more content for being a good physician. The so-called soft skills are currently discussed regularly but the perspective of the younger generation is rarely presented.

OBJECTIVE

Do soft skills and communication techniques support us in the continuing education and development to a good leader?

RESULTS AND CONCLUSION

Competence is defined as the combination of cognitive abilities and skills required to perform a specific task or role. These are modifiable and, more importantly, learnable. Successful leadership competence consists of motivating members of the team to achieve common goals and giving them the space to evolve and develop themselves. This requires well thought out, respectful and structured teamwork. A good error culture, open and appreciative communication within the team and in this respect the requirement to be informed about various social, societal and political issues are important. In addition, creativity and independence as well as critical questioning should already be trained during the medical studies through participatory teaching; however, intergenerational dialogue is particularly important in order to share perspectives and competencies and to jointly develop effective future perspectives and plans. The substantive values and competencies attributed to a leader are not static but dynamic and should therefore be redefined taking into account political, societal, social, infrastructural aspects and current developments.

[Cognitive and psychological effects on the population of a cardiac emergency campaign]

The major part of the delay from onset of symptoms of acute myocardial infarction to arrival in hospital is caused by patients' delayed reporting. Therefore, a media campaign was initiated by the Swiss Heart Foundation with the goal of informing people about the seriousness of chest pain and about the importance of proper action in these situations. An initial 2 months' national campaign was followed by a 3 weeks' intensive local campaign in a mixed urban/suburban area in central Switzerland. The aim of the study was to evaluate the effects of this media campaign on patients information and reaction in case of cardiac emergency, and to study the possible impact of this campaign on anxiety levels and other emotions. Telephone interviews were performed before and after both the national and the local campaign using a cohort of 500 persons in a longitudinal and 4 x 500 persons in a cross-sectional study. The information had reached about 50% of the population by the end of the local campaign. The percentage of persons who would call the emergency medical services immediately in case of chest pain increased from 40% to 57% in the cross-sectional and from 48% to 65% in the longitudinal study (p < 0.001), and the percentage of persons who would call the ambulance team immediately on witnessing a person with a heart attack increased from 25 to 92% in the cross-sectional and to 96% in the longitudinal study (p < 0.001). Anxiety levels and other negative emotions decreased slightly during the campaign (p < 0.05), whereas feelings of personal safety revealed a slight increase (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)