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Monarchi G, Girotto R, De Feudis F, Racano C, Balercia P. Retrospective Study over 15-years Period on Zygomathic arch Fractures: A Single Center Experience. Indian J Otolaryngol Head Neck Surg 2024; 76:5359-5363. [PMID: 39559006 PMCID: PMC11569375 DOI: 10.1007/s12070-024-04977-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 08/05/2024] [Indexed: 11/20/2024] Open
Abstract
The purpose of this study was to do a retrospective analysis about patients with zygomatic arch who were treated at the department of Maxillofacial Surgery, Regional University Hospital of Ancona, Italy, between 2007 and 2021. Patients were evaluated based on various parameters including age, sex, aetiology, symptoms, comorbidity, clinical findings, zygomatic arch fracture type, other facial fractures, treatment, waiting time before the operation, complications and sequelae. In the period described we recorded 103 zygomatic arch fractures. Of the patients, 64 were male (65,92%) and 39 were female (34,08%). The average age of the patients was 47,02 years (ranging from 8 to 93 years). The leading cause of these fractures was sports-related injury (n = 24; 23,30%), and isolated zygomatic arch fractures were the most frequent (63,1%). The most common clinical signs and symptoms were, pain, depression of the facial profile, difficulty in chewing, limitation of the buccal opening, difficulty in protrusion movements and mandibular lateralization. 93% of patients underwent surgery under local anesthesia, almost exclusively patients undergoing an open approach to internal fixation. The successful and effective management of zygomatic arch fractures requires a solid understanding of its anatomy, pathophysiology and related biomechanical structures and forces. The continuous research in epidemiology, aetiology, materials and techniques will further refine our treatments which are nowadays more and more customized according to the type of trauma.
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Kosińska A, Mrózek M, Łopyta-Mirocha M, Tomsia M. The smallest traces of crime: Trace elements in forensic science. J Trace Elem Med Biol 2024; 86:127527. [PMID: 39288558 DOI: 10.1016/j.jtemb.2024.127527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 09/06/2024] [Accepted: 09/06/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND Securing the evidence in various investigative situations is often associated with trace analysis, including fingerprints or blood groups. However, when classic and conventional methods fail, trace elements, such as copper, zinc, fluorine, and many others found in exceedingly insignificant amounts in organisms, may prove useful and effective. METHODS The presented work reviews articles published between 2003 and 2023, describing the use of trace elements and the analytical methods employed for their analysis in forensic medicine and related sciences. RESULTS & CONCLUSION Trace elements can be valuable as traces collected at crime scenes and during corpse examination, aiding in determining characteristics like the sex or age of the deceased. Additionally, trace elements levels in the body can serve as alcohol or drug poisoning markers. In traumatology, trace elements enable the identification of various instruments and the injuries caused by their use.
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Vanderzwalm-Gouvernaire A. The traumatized immature permanent incisor with pulpal involvement: what conservative treatment options? Orthod Fr 2024; 95:299-303. [PMID: 39041540 DOI: 10.1684/orthodfr.2024.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
Introduction Traumatology is the second most common dental pathology, after caries and before periodontal pathologies. It is currently accepted that one child in two suffers an alveolar-dental trauma before leaving school, with a peak incidence between the ages of 8 and 12, all types of trauma combined. The maxillary central incisors are most affected (79.6%), with mainly "simple" or "complex" coronal fractures when the pulp is involved. The main objective in managing these complex fractures is to preserve pulpal vitality within an acceptable timeframe. Material and Method The author presents three pulp vitality preservation therapies involving tissue preservation and regeneration techniques using bioactive materials applied directly to the pulp. Materials and clinical protocols are described. Conclusion Knowledge of pulp biology and healing processes has led to the development of vitality-preserving therapeutic strategies that have become essential in the management of traumatized teeth in children and adolescents. The regenerative potential of immature tooth pulp is considerable, enabling dentine repair through the use of bioactive materials. These therapies require a rigorous surgical approach that determines prognosis, and precise monitoring to ensure that any complications are intercepted.
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Prangenberg C, Zellner AA, Roos J, Zalepugas D, Ossendorff R, Ben Amar S, Cucchi D, Scheidt S. Open sternal fracture with bilateral dislocation of the sternoclavicular joints after a high-speed bicycle accident: a case report. J Med Case Rep 2024; 18:528. [PMID: 39522043 PMCID: PMC11550534 DOI: 10.1186/s13256-024-04877-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 10/04/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND Only a few cases of bilateral traumatic sternoclavicular dislocations have been reported in the literature. This injury is considered one of the rarest injuries of the human musculoskeletal system. Therefore, we present the first documented case of a cyclist with a third-degree open thoracic trauma (Gustilo-Anderson 3a) associated with a dislocated manubrium sterni fracture in the upper thoracic aperture, bilateral anterior dislocations of the sternoclavicular joints, rib fractures, and pleural ruptures. CASE PRESENTATION The patient, a 27-year-old Caucasian male, incurred this injury while participating in a professional cycling race at Nürburgring, Germany and received immediate interdisciplinary surgical treatment and has encountered no complications. We conducted a 1-year follow-up and present the clinical findings of this follow up. Additionally, we conducted a comprehensive review of the existing literature on this injury. CONCLUSIONS Immediate interdisciplinary intervention, including surgical repair and meticulous postoperative care, facilitated successful patient recovery. This underscores the critical role of comprehensive trauma management in complex polytrauma cases. In conclusion, this case report highlights the rarity and complexity of a traumatic injury involving bilateral sternoclavicular dislocation, with this case being the first case reported with concomitant open thorax trauma. Our patient benefited greatly from immediate air-bound transportation to an interdisciplinary care provider, which houses both thoracic and trauma surgery departments.
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Ortega-Yago A, Barrés-Carsí M, Balfagón-Ferrer A. [Translated article] Surgical treatment of ipsilateral bifocal tibial fractures: A challenge for the surgeon. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024:S1888-4415(24)00186-3. [PMID: 39521121 DOI: 10.1016/j.recot.2024.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/03/2024] [Accepted: 06/10/2024] [Indexed: 11/16/2024] Open
Abstract
INTRODUCTION The association of ipsilateral tibia fractures has a low incidence, being up to 3.2% of total tibia fractures. Currently there is no gold standard regarding the ideal surgical treatment. The objective of this study is to analyze the surgical treatment and the radiographic and functional results, as well as the associated complication rate of ipsilateral bifocal tibia fractures. MATERIAL AND METHODS Retrospective observational study in our hospital from 2010 to 2022 of 24 patients who underwent bifocal fracture of the ipsilateral tibia. Demographic and surgical data and complications during follow-up were included. RESULTS The 24 patients were classified into Group 1 when they presented a fracture of the plateau and distal tibia (25%), Group 2 with a fracture of the plateau and diaphysis (33%) and Group 3 with a fracture of the diaphysis and distal tibia (42%). Three patients underwent surgery with 1 implant and 21 patients with 2 implants. The average follow-up time in outpatient clinics was 2 and a half years. At one year, 22 patients (92%) had full weight bearing and 2 patients had partial weight bearing (8%) due to the sequelae of the fractures. The average time for consolidation of the diaphysis was 7.75±2 months, with no significant differences observed between Group 2 and Group 3 (p=0.06). The average time for consolidation of the metaphysis was 3.50±1.5 months, with no significant differences observed between Group 1 and Group 2 (p=0.065). Seven patients (30%) had complications during follow-up. CONCLUSIONS Bifocal tibia fractures can be treated using a combination of intramedullary nailing and plate osteosynthesis with good long-term results, obtaining an optimal union rate and low complications. In addition, it facilitates the reduction of the fracture, thus facilitating the patient's recovery and obtaining good long-term functional results.
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Dionne A, Fournier A, Richard-Denis A, Briand MM, Mac-Thiong JM. How do early perioperative changes in AIS grade correlate with long-term neurological recovery? A retrospective cohort study. J Spinal Cord Med 2024; 47:987-995. [PMID: 37436114 PMCID: PMC11533234 DOI: 10.1080/10790268.2023.2232577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
Context/Objective: Providing accurate counseling on neurological recovery is crucial after traumatic spinal cord injury (TSCI). The early neurological changes that occur in the subacute phase of the injury (i.e. within 14 days of early decompressive surgery) have never been documented. The objective of this study was to assess peri-operative neurological improvements after acute TSCI and determine their relationship with long-term neurological outcomes, measured 6-12 months following the injury.Methods: A retrospective cohort study of 142 adult TSCI patients was conducted. Early peri-operative improvement was defined as improvement of at least 1 AIS grade between the pre-operative and follow-up (6-12 months post-TSCI) assessment. neurological improvement of at least 1 AIS grade.Results: Out of the 142 patients, 18 achieved a peri-operative improvement of at least 1 AIS grade. Presenting a pre-operative AIS grade B and having shorter surgical delays were the main factors associated with stronger odds of achieving this outcome. Out of the 140 patients who still had potential for improvement at the time of the post-operative assessment, 44 achieved late neurological recovery (improvement of at least 1 AIS grade between the post-operative assessment and follow-up). Patients who presented a perioperative improvement seemed more likely to achieve later neurological improvement as well, although this was not statistically significant.Conclusion: Our results suggest that it is important to assess early perioperative neurological changes within 14 days of surgery because it can provide beneficial insight on long-term neurological outcomes for some patients. In addition, earlier surgery may promote early neurological recovery.
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Kohut P, Mezera V, Langenhan R, Reimers N, Kilper A. Proximal femoral fractures in patients with COVID-19 : Pneumonia and admission from a nursing home are the strongest predictors of mortality. Z Gerontol Geriatr 2024; 57:556-562. [PMID: 38831113 DOI: 10.1007/s00391-024-02317-0] [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: 02/02/2024] [Accepted: 05/06/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Proximal femoral fractures are severe injuries in geriatric patients. Additionally, geriatric patients are at a high risk of death due to coronavirus disease 2019 (COVID-19). OBJECTIVE To identify predictors of mortality in geriatric patients with COVID-19 and concurrent proximal femoral fractures. MATERIAL AND METHODS Patients who underwent surgical treatment for proximal femoral fractures and also tested positive for COVID-19 were included. The age, gender, the American Society of Anesthesiology (ASA) score and the admission from a nursing home were considered as variables. The rate of reoperations, the mortality at 3 months and discharge home were evaluated as outcomes. RESULTS In this study 46 patients with COVID-19 (female/male 31/15, median age 87.0 years with an interquartile range [IQR] of 9.8 years) met the inclusion criteria. Of these, 32 patients (69.6%) had to be cared for in the intensive care unit and 26 patients (56.5%) had a severe course of COVID-19 with pneumonia. The median length of hospital stay for survivors was 19 (IQR 17.5) days and 4 of the patients (8.7%) required surgical revision. The in-hospital and 3‑month mortality were 40.0% (n = 17) and 43.5% (n = 20), respectively. The factors which influenced the in-hospital and 3‑month mortality rates were admission from a nursing home, the presence of pneumonia (increased the risk of death) and female gender (protective). CONCLUSION The occurrence of COVID-19 in patients with proximal femoral fractures has a high mortality. Admission from a nursing home and the presence of pneumonia increased the risk of death, whereas women were at lower risk.
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Golder W. [Medical practice in Ancient Greece : The orthopaedic and trauma surgery case reports of the Hippocratic Corpus]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:876-882. [PMID: 39259340 DOI: 10.1007/s00132-024-04563-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/14/2024] [Indexed: 09/13/2024]
Abstract
OBJECTIVES Which theoretical and practical competences do the orthopaedic and trauma surgery reports of the Hippocratic Corpus reveal? MATERIALS The 431 Hippocratic case histories have been studied for reports and communication on diagnostics, therapy and prognosis of orthopaedic diseases and traumatic lesions. RESULTS The seven books of the Hippocratic "Epidemics" describe a total of 26 patients with orthopaedic diseases and traumatic lesions. In the field of orthopaedic diseases, arthritis, myo- and tenopathia and gangrene play a prominent role, among the consequences of injury the fracture of the skull (n = 10) is in first place. Mainly individuals, but also groups of patients are reported. The clients' information on the course of the disease was often cautious. Diagnostics were limited to inspection and palpation. In addition to the measures of conservative treatment, four trepanations are described. The majority of traumatic brain lesions resulted in death. DISCUSSION The Hippocratic doctor was faced with a variety of orthopaedic disases and traumatic lesions. Within the case reports, the subjective complaints, the objective findings and the course of the treatment are described in detail. Among the ailments of the musculoskeletal system, spinal disorders, especially hypercyphosis and scoliosis play an important role. The variety of reduction techniques reported suggests that most of the fractures detected were dislocated. Post-traumatic tetanus can be readily identified in several followup observations due to the development of opisthotonus. No other surgical intervention is discussed by Hippocrates as often and as variously as trepanation. It can be concluded with some certainty that perforating injuries of the skull were a common challenge in the life of a surgeon of classic antiquity.
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Baldini N. A comparison of ear amputations replantation techniques. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101497. [PMID: 37178870 DOI: 10.1016/j.jormas.2023.101497] [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: 03/21/2023] [Revised: 04/12/2023] [Accepted: 05/10/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND The management of traumatic ear amputations remains a rare and difficult occurrence for surgeons. This is due to the fact that the chosen replantation technique must ensure the best vascular supply and the surrounding tissues have to be preserved as to not jeopardize a future auricular reconstruction in the event of replantation failure. OBJECTIVE This study aimed to review and synthesize the literature about the different surgical techniques described to date in the management of traumatic ear amputations (partial or total). MATERIALS AND METHODS Relevant articles were searched on PubMed, ScienceDirect, and Cochrane Library databases in accordance with the PRISMA statement guidelines. RESULTS A total of 67 articles was retained. When possible, microsurgical replantation enabled the best cosmetic result but required important care. CONCLUSION Pocket techniques and local flaps should not be performed because of the lower cosmetic result and the use of the surrounding tissues. However, they could be reserved for patients without access to advanced reconstructive techniques. When possible, microsurgical replantation can be attempted after patient consent for blood transfusions, postoperative care and hospital stay. Simple reattachment for earlobe amputations and ear amputations up to one third is recommended. When microsurgical replantation cannot be attempted, and if the amputated segment is viable and bigger than one third, simple reattachment may be attempted with an increased risk of replantation failure. In case of failure, an auricular reconstruction by an experienced microtia surgeon or prosthesis may be considered.
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Colangeli W, Ferragina F, Kallaverja E, Celano C, Cristofaro MG. Orbital fractures treated in a university hospital of southern Italy: epidemiology, outcomes and prognostic factors resulting from 538 retrospectively analyzed cases. Oral Maxillofac Surg 2024; 28:1219-1225. [PMID: 38556588 PMCID: PMC11330396 DOI: 10.1007/s10006-024-01236-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 03/11/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE Orbital fractures are common injuries and represent an interesting chapter in maxillofacial surgery. This retrospective study analyses data collected from 528 patients surgically treated at the University Hospital "Magna Graecia", Catanzaro, Italy, from 1st January 2007 to 31st January 2021. METHODS The inclusion criteria were a diagnosis of orbital bone fracture, complete clinical and radiological records, and a minimum follow-up of 12 months. We analyzed gender, age, etiology, fracture type, treatment, timing of repair, and associated complications. RESULTS The most frequent cause of trauma was road accidents (37.88%), followed by domestic accidents (25.95%). The manifestation of diplopia (72.35%), infraorbital nerve hypoesthesia (53.41%), extrinsic eye movement limitation (51.70%), and enophthalmos (41.29%), determined the indication for surgery. Our trauma team preferred the sub-eyelid approach (79.36%). The study shows a statistical significance in the correlation between the severity of the herniation of the lower rectus muscle and the presence of preoperative diplopia (p-value = 0.00416); We found the same statistical significance for the post-postoperative diplopia (p-value = 0.00385). Patients treated two weeks after the trauma show a higher rate of diplopia and a greater limitation of long-term post-operative eye movements than those treated within two weeks (diplopia 23.08% vs. 15.56%; eye movements limitation 13.33% vs. 7.69%). Early surgical treatment (> 14 days) reduces the likelihood of functional and structural damage to the lower rectus muscle. CONCLUSION Our data will support future maxillofacial traumatology studies, and the education and prevention measures taken will reduce the incidence of orbital trauma.
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Meisgeier A, Pienkohs S, Moosdorf L, Neff A. Impact of the COVID-19 pandemic on maxillofacial trauma surgery in Germany - implications from the national DRG database. Oral Maxillofac Surg 2024; 28:1241-1250. [PMID: 38600413 PMCID: PMC11330376 DOI: 10.1007/s10006-024-01248-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/29/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE The COVID-19 pandemic has affected the personal and social lives of millions of people and also impacted the etiological factors of midfacial trauma such as falls, interpersonal violence or traffic accidents. The aim of this study was to analyze the influence of the COVID-19 pandemic on maxillofacial trauma surgery in the German healthcare system. METHODS Nationwide data regarding the national diagnosis-related-group (DRG) inpatient billing system used in all German hospitals was received from the German Federal Statistical Office. Various trauma-associated procedures of the Operation and Procedure Classification System (OPS), a German modification of the International Classification of Medical Procedures (ICPM), were statistically associated with different epidemiological factors between 2012 and 2021. RESULTS A statistically significant decrease (p < 0.05) in surgeries regarding maxillofacial fractures was registered during the years 2020 and 2021. Young male patients had the largest decline in maxillofacial trauma surgeries during this period (p < 0.05). In contrast. elderly patients 80 years and older showed a dramatic increase in the frequency of fractures in both the midface and the mandible (p < 0.05). CONCLUSIONS During the COVID 19 pandemic there has been a shift in the number, composition and etiology of maxillofacial fracture surgeries. Measures of social distancing and personal risk avoidance had a societal positive effect on the frequency of facial injuries. This stands in contrast to the drastic increase in fractures of elderly people who should be protected primarily by the measures taken. These results can help to understand these influences better in future pandemics. TRIAL REGISTRATION German Clinical Trials Register No: DRKS00032778.
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Jeyaraman M, Jeyaraman N, Ramasubramanian S, Balaji S, Nallakumarasamy A, Patro BP, Migliorini F. Ozone therapy in musculoskeletal medicine: a comprehensive review. Eur J Med Res 2024; 29:398. [PMID: 39085932 PMCID: PMC11290204 DOI: 10.1186/s40001-024-01976-4] [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: 11/28/2023] [Accepted: 07/14/2024] [Indexed: 08/02/2024] Open
Abstract
Musculoskeletal disorders encompass a wide range of conditions that impact the bones, joints, muscles, and connective tissues within the body. Despite the ongoing debate on toxicity and administration, ozone demonstrated promise in managing several musculoskeletal disorders, modulating pain and inflammation. A literature search was conducted. The research design, methods, findings, and conclusions of the studies were then examined to evaluate the physiological effects, clinical application, controversies, and safety of the application of ozone in musculoskeletal medicine. Ozone application demonstrates considerable therapeutic applications in the management of musculoskeletal disorders, including fractures, osteoarthritis, and chronic pain syndromes. Despite these advantages, studies have raised concerns regarding its potential toxicity and emphasized the importance of adhering to stringent administration protocols to ensure safety. Additionally, heterogeneities in patient reactions and hazards from oxidizing agents were observed. Given its anti-inflammatory and analgesic qualities, ozone therapy holds potential in the management of several musculoskeletal disorders. Additional high-quality research with long follow-up is required to refine indications, efficacy and safety profile. Finally, for wider clinical acceptability and utilization, the development of international recommendations is essential.
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Ricciardi G, Martinez O, Cabrera J, Matta J, Davila V, Jimenez JM, Vilchis H, Tejerina V, Perez J, Cabrera JP, Yurac R. Spinal gunshot wounds: A retrospective, multicenter, cohort study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:328-335. [PMID: 37423382 DOI: 10.1016/j.recot.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/27/2023] [Accepted: 07/02/2023] [Indexed: 07/11/2023] Open
Abstract
INTRODUCTION AND OBJECTIVE To describe the demographic and clinical characteristics and treatment of patients with spinal gunshot wounds across Latin America. MATERIAL AND METHODS Retrospective, multicenter cohort study of patients treated for gunshot wounds to the spine spanning 12 institutions across Latin America between January 2015 and January 2022. Demographic and clinical data were recorded, including the time of injury, initial assessment, characteristics of the vertebral gunshot injury, and treatment. RESULTS Data on 423 patients with spinal gunshot injuries were extracted from institutions in Mexico (82%), Argentina, Brazil, Colombia, and Venezuela. Patients were predominantly male civilians in low-risk-of-violence professions, and of lower/middle social status, and a sizeable majority of gunshots were from low-energy firearms. Vertebral injuries mainly affected the thoracic and lumbar spine. Neurological injury was documented in n=320 (76%) patients, with spinal cord injuries in 269 (63%). Treatment was largely conservative, with just 90 (21%) patients treated surgically, principally using posterior open midline approach to the spine (n=79; 87%). Injury features distinguishing surgical from non-surgical cases were neurological compromise (p=0.004), canal compromise (p<0.001), dirty wounds (p<0.001), bullet or bone fragment remains in the spinal canal (p<0.001) and injury pattern (p<0.001). After a multivariate analysis through a binary logistic regression model, the aforementioned variables remained statistically significant except neurological compromise. CONCLUSIONS In this multicenter study of spinal gunshot victims, most were treated non-surgically, despite neurological injury in 76% and spinal injury in 63% of patients.
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Ricciardi G, Cabrera JP, Martínez Ó, Cabrera J, Matta J, Dávila V, Jiménez JM, Vilchis H, Tejerina V, Pérez J, Yurac R. Spinal gunshot wounds: A retrospective, multicenter, cohort study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T328-T335. [PMID: 38325575 DOI: 10.1016/j.recot.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/27/2023] [Accepted: 07/02/2023] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION AND OBJECTIVE To describe the demographic and clinical characteristics and treatment of patients with spinal gunshot wounds across Latin America. MATERIAL AND METHODS Retrospective, multicenter cohort study of patients treated for gunshot wounds to the spine spanning 12 institutions across Latin America between January 2015 and January 2022. Demographic and clinical data were recorded, including the time of injury, initial assessment, characteristics of the vertebral gunshot injury, and treatment. RESULTS Data on 423 patients with spinal gunshot injuries were extracted from institutions in Mexico (82%), Argentina, Brazil, Colombia, and Venezuela. Patients were predominantly male civilians in low-risk-of-violence professions, and of lower/middle social status, and a sizeable majority of gunshots were from low-energy firearms. Vertebral injuries mainly affected the thoracic and lumbar spine. Neurological injury was documented in 320 (76%) patients, with spinal cord injuries in 269 (63%). Treatment was largely conservative, with just 90 (21%) patients treated surgically, principally using posterior open midline approach to the spine (79; 87%). Injury features distinguishing surgical from non-surgical cases were neurological compromise (P = 0.004), canal compromise (P < 0.001), dirty wounds (P < 0.001), bullet or bone fragment remains in the spinal canal (P < 0.001) and injury pattern (P < 0.001). After a multivariate analysis through a binary logistic regression model, the aforementioned variables remained statistically significant except neurological compromise. CONCLUSIONS In this multicenter study of spinal gunshot victims, most were treated non-surgically, despite neurological injury in 76% and spinal injury in 63% of patients.
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Covarrubias-Rodríguez AA, Durán-Castillo C, León-Madrid MI, Elías-Ángel JA, Hernández-Gonzalez MA, Bonilla-Salcedo RÁ, Sosa-Aquino MA, Vallejo-Hernández MÁ. [Detection of ionizing radiation in operating room and hospital areas]. REVISTA MEDICA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL 2024; 62:1-6. [PMID: 39541221 DOI: 10.5281/zenodo.11396957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/22/2024] [Indexed: 11/16/2024]
Abstract
Background The implementation of new medical techniques and technologies has increased occupational exposure to ionizing radiation and consequently the development of neoplasia and adverse effects on health personnel. Objective Have real information on the absorbed dose by healthcare personnel exposed to ionizing radiation in an operating room. Material and methods TLD 100 dosimeters were used to measure absorbed doses by brightness curves. 42 surgical interventions in different specialties were monitored, in each intervention a minimum of 4 dosimeters were used, with the objective of analyzing the dose based on the participation role of the individual within the operating room. Results A database was created with the 42 monitored surgeries, for each one a minimum of 4 analyzed data were obtained (one for each participant in the surgical procedure, that is, one for each dosimeter). The highest absorbed dose was for the specialty of traumatology, followed by otorhinolaryngology, neurosurgery and finally ophthalmology. Conclusions It was possible to use an adequate monitoring system to measure the dose of absorbed ionizing radiation during different surgical procedures. Based on the results, constant dosimetry follow-up monitoring of trauma specialty personnel is recommended.
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Campos-Iglesias D, Montero AA, Rodríguez F, López-Otín C, Freije JM. Loss of ADAM29 does not affect viability and fertility in mice but improves wound healing. iScience 2024; 27:110135. [PMID: 38966569 PMCID: PMC11223086 DOI: 10.1016/j.isci.2024.110135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/28/2023] [Accepted: 05/27/2024] [Indexed: 07/06/2024] Open
Abstract
ADAM29 (a disintegrin and metalloprotease domain 29) is a member of the membrane-anchored ADAM family of proteins, which is highly expressed in testis and may mediate different physiological and pathological processes. Although the functions of many ADAM family members have been well characterized, the biological relevance of ADAM29 has remained largely unknown. Here, we report the generation of an Adam29-deficient mouse model to delve deeper into the in vivo functions of this ADAM family member. We show that ADAM29 depletion does not affect mice viability, development, or fertility, but somehow impinges on metabolism and energy expenditure. We also report herein that ADAM29 deficiency leads to an accelerated wound healing process, without affecting cell reprogramming in mouse-derived fibroblasts. Collectively, our findings provide new insights into ADAM29 biological functions, highlighting the importance of non-catalytic ADAM proteases.
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Ortega-Yago A, Barrés-Carsí M, Balfagón-Ferrer A. Surgical treatment of ipsilateral bifocal tibial fractures: a challenge for the surgeon. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024:S1888-4415(24)00094-8. [PMID: 38878887 DOI: 10.1016/j.recot.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/03/2024] [Accepted: 06/10/2024] [Indexed: 07/05/2024] Open
Abstract
INTRODUCTION The association of ipsilateral tibia fractures has a low incidence, being up to 3.2% of total tibia fractures. Currently there is no gold standard regarding the ideal surgical treatment. The objective of this study is to analyze the surgical treatment and the radiographic and functional results, as well as the associated complication rate of ipsilateral bifocal tibia fractures. MATERIAL AND METHODS Retrospective observational study in our hospital from 2010 to 2022 of 24 patients who underwent bifocal fracture of the ipsilateral tibia. Demographic and surgical data and complications during follow-up were included. RESULTS The 24 patients were classified into group 1 when they presented a fracture of the plateau and distal tibia (25%), group 2 with a fracture of the plateau and diaphysis (33%) and group 3 with a fracture of the diaphysis and distal tibia (42%). 3 patients underwent surgery with 1 implant and 21 patients with 2 implants. The average follow-up time in outpatient clinics was 2 and a half years. At one year, 22 patients (92%) had full weight bearing and 2 patients had partial weight bearing (8%) due to the sequelae of the fractures. The average time for consolidation of the diaphysis was 7.75±2 months, with no significant differences observed between group 2 and group 3 (p=0.06). The average time for consolidation of the metaphysis was 3.50±1.5 months, with no significant differences observed between group 1 and group 2 (p=0.065). 7 patients (30%) had complications during follow-up. CONCLUSIONS Bifocal tibia fractures can be treated using a combination of intramedullary nailing and plate osteosynthesis with good long-term results, obtaining an optimal union rate and low complications. In addition, it facilitates the reduction of the fracture, thus facilitating the patient's recovery and obtaining good long-term functional results.
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Favreau H, Tamir M, Adam P, Ollivier M, Bonnomet F, Ehlinger M. Osteosynthesis by locking plate for proximal tibial fractures. Injury 2024; 55 Suppl 1:111407. [PMID: 39069349 DOI: 10.1016/j.injury.2024.111407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/16/2024] [Accepted: 01/27/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION Treatment of proximal tibial fractures is known to be difficult. We report our own experience of the treatment of these fractures and evaluate our results. The hypothesis was that the clinical and radiological results were good. MATERIAL AND METHOD From January 2004 to October 2008, fourteen AO-type 41A2-3 and C1 fractures have been treated with a LCP locking plate (8 women and 6 men, average age 60.42). Plating was performed either with an open approach or a minimal invasive approach. Clinical and radiological follow-up was carried out looking for range of motion of the knee joint and autonomy level. RESULTS Mean follow-up was 32.63 months (12-70). Range of motion was maintained with a mean arch of 117.5° Autonomy was maintained in all cases. Professional, domestic and sports activities were unchanged. No infection or general complication occurred. Bone fusion was obtained in all cases after an average of 13.28 weeks. 6° of valgus deformation, already seen immediately postoperatively was observed once. Secondary displacement was observed in 6 cases, with an average of 2.83° DISCUSSION-CONCLUSION: We report good radiological results, with only one initial malalignment. The hypothesis was confirmed. However, X-ray analysis at consolidation shows 6 secondary displacements, without any satisfactory explanation. Though the clinical consequences of these malunions are minimal. Osteosynthesis with plate, in the sight of this study, yields good clinical results. Radiological evolution concerning the evolution of bone axes puts the emphasis on careful operative technique and adequate time to weight bearing. LEVEL OF EVIDENCE retrospective study, IV.
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Vanmierlo B, Eijnde BO, Duerinckx J, Goubau J. Intramedullary headless compression screw fixation of the middle phalanx: tips, tricks, and pitfalls. HAND SURGERY & REHABILITATION 2024; 43:101720. [PMID: 38782360 DOI: 10.1016/j.hansur.2024.101720] [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: 05/09/2024] [Revised: 05/13/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024]
Abstract
This report emphasizes careful consideration of surgical technique for intramedullary screw fixation in middle phalanx fractures. Highlighting pitfalls, particularly with K-wire placement, it suggests the antegrade trans-articular approach as superior, urging further research for improved patient outcomes.
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Delbast L, Koneazny C, Baroan C, Niéto H. Results of transosseous suture fixation in four-part valgus impacted fractures of the proximal humerus. Injury 2024; 55 Suppl 1:111345. [PMID: 39069340 DOI: 10.1016/j.injury.2024.111345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/13/2023] [Accepted: 01/14/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND The osteonecrosis ratio in valgus impacted fractures of the proximal humerus is low (<10 %), giving osteosynthesis all its meaning. However, the optimal fixation technique remains controversial. After recentering the humeral head, osteosuture is stable enough to allow bone healing in an adequate position as well as a good long-term shoulder functionality. METHODS Our cohort included 22 patients with a mean age of 65 (28-83). Patients were placed in a beach-chair position. Surgical exposure was done through an anterolateral, transdeltoid approach. Stay sutures were placed on both tuberosities. Elevation of the humeral head was obtained for 9 patients using iliac crest bone graft, for 7 patients using bone substitutes, for 6 without any graft needed. Both tuberosities were approximated and tied together using two horizontal non-absorbable double-threaded sutures. The whole head was also tied to the humeral metaphysis by cerclage wiring using the same suture. Patients were immobilized in a sling for 4 weeks with no passive or active mobilization; then began rehabilitation starting with passive and active-assisted mobilization. Functional outcome was assessed with the Constant score. Radiographic follow-up was used for fracture healing and osteonecrosis signs. RESULTS All fractures united within the first 3 months. One patient had radiographic signs of osteonecrosis and one had a secondary displaced fracture without osteonecrosis. At an average follow-up of 35 months, the median Constant score was 83.7 % (63-100) in comparison to the uninjured side. DISCUSSION A preserved posteromedial periosteal hinge in a valgus impacted fracture of the proximal humerus is key to the success of osteosuture. This hinge provides mechanical stability to the humeral head once elevated, as well as blood-supply from the branches of the posterior circumflex humeral artery. Computed Tomography with Three-Dimensional reconstructed images allow for a precise analysis of this hinge as well as the vascularity of the humeral head. Osteosuture being a minimally invasive surgical procedure plays a predominant role in sparing the remaining vascularization of the humeral head. CONCLUSION Osteosuture in four-part valgus impacted fractures of the proximal humerus is a minimally invasive procedure as well as a reliable technique yielding good long-term results.
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Petrocelli M, Ruggiero F, Allegri D, Cutrupi S, Baietti AM, Salzano G, Maglitto F, Manfuso A, Copelli C, Barca I, Cristofaro MG, Galvano F, Loche VP, Gemini P, Tewfik K, Burlini D, Bernardi M, Bianchi FA, Catanzaro S, Ascani G, Consorti G, Balercia P, Braconi A, Scozzaro C, Catalfamo L, De Rinaldis D, De Ponte FS, Tarabbia F, Biglioli F, Giovacchini F, Tullio A, Cama A, Di Emidio P, Ferrari S, Perlangeli G, Rossi MB, Biglio A, De Riu G, Califano L, Vaira LA. Changes in hospital admissions for facial fractures during and after COVID 19 pandemic: national multicentric epidemiological analysis on 2938 patients. Oral Maxillofac Surg 2024; 28:753-759. [PMID: 38093155 DOI: 10.1007/s10006-023-01201-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 12/07/2023] [Indexed: 06/04/2024]
Abstract
PURPOSE The objective of this multicenter study was to examine the differences in maxillo-facial fractures epidemiology across the various phases of the SARS-CoV-2 pandemic. METHODS This is a retrospective study on patients who underwent surgery for facial bone fractures in 18 maxillo-facial surgery departments in Italy, spanning from June 23, 2019, to February 23, 2022. Based on the admission date, the data were classified into four chronological periods reflecting distinct periods of restrictions in Italy: pre-pandemic, first wave, partial restrictions, and post-pandemic. Epidemiological differences across the groups were analysed. RESULTS The study included 2938 patients. A statistically significant difference in hospitalization causes was detected between the pre-pandemic and first wave groups (p = 0.005) and between the pre-pandemic and partial restriction groups (p = 0.002). The differences between the pre- and post-pandemic groups were instead not significant (p = 0.106). Compared to the pre-pandemic period, the number of patients of African origin was significantly higher during the first wave and the post-pandemic period. No statistically significant differences were found across the periods concerning gender, age, fracture type, treatment approach, and hospital stay duration CONCLUSIONS: The COVID-19 pandemic brought about significant changes in fracture epidemiology, influenced by the restrictive measures enforced by the government in Italy. Upon the pandemic's conclusion, the fracture epidemiology returned to the patterns observed in the pre-pandemic period.
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Ghanem M, Seemann R, Fröhlich S, Heyde CE, Roth A. [The new medical licensing regulations (ÄApprO) : Status and expected challenges]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:311-316. [PMID: 38546842 DOI: 10.1007/s00132-024-04495-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 05/04/2024]
Abstract
BackgroundThe amendment to the medical licensing regulations (ÄApprO) was decided at the federal level in the version of the "Master Plan for Medical Studies 2020" passed in 2017. In addition to the organizational effort involved in redesigning the curricular teaching, the expected costs associated with the implementation of the new licensing regulations due to the necessary additional time and, therefore, personnel expenditure are of particular importance. Taking into account the different forms of study and the 20% scope for study-design provided to the individual faculties, the process of transferring the teaching content to the new modules confronts us with an enormous organizational challenge.Significance of O&UDiseases of the musculoskeletal system are of particular medical, social and economic importance. Therefore, the training of future physicians in the field of orthopedics and traumatology must be taken into account. The visibility of the field of orthopedics and traumatology must not be lost with the introduction of the new medical licensing regulations (ÄApprO).ImplementationThe implementation of the new medical licensing regulations at German universities will be costly and necessitates an increased number of staff. However, there is a great opportunity to position orthopedics and traumatology as a "central player" in the modular, interdisciplinary and interprofessional course landscape. It is, therefore, important to take on concrete responsibility for the design of the new teaching programs and to bring in our specialist and interdisciplinary skills wherever sensible and possible.
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Matzopoulos R, Marineau L, Mhlongo S, Ketelo A, Prinsloo M, Dekel B, Martin LJ, Jewkes R, Lombard C, Abrahams N. Who is killing South African men? A retrospective descriptive study of forensic and police investigations into male homicide. BMJ Glob Health 2024; 9:e014912. [PMID: 38599664 PMCID: PMC11015244 DOI: 10.1136/bmjgh-2023-014912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/14/2024] [Indexed: 04/12/2024] Open
Abstract
Not much is known about the perpetrators of male homicide in South Africa, which has rates seven times the global average. For the country's first ever male homicide study we describe the epidemiology of perpetrators, their relationship with victims and victim profiles of men killed by male versus female perpetrators. We conducted a retrospective descriptive study of routine data collected through forensic and police investigations, calculating victim and perpetrator homicide rates by age, sex, race, external cause, employment status and setting, stratified by victim-perpetrator relationships. For perpetrators, we reported suspected drug and alcohol use, prior convictions, gang-involvement and homicide by multiple perpetrators. Perpetrators were acquaintances in 63% of 5594 cases in which a main perpetrator was identified. Sharp objects followed by guns were the main external causes of death. The highest rates were recorded in urban informal areas among unemployed men across all victim-perpetrator relationship types. Recreational settings including bars featured prominently. Homicides clustered around festive periods and weekends, both of which are associated with heavy episodic drinking. Perpetrator alcohol use was reported in 41% of homicides by family members and 50% by acquaintances. Other drug use was less common (9% overall). Of 379 men killed by female perpetrators, 60% were killed by intimate partners. Perpetrator alcohol use was reported in approximately half of female-on-male murders. Female firearm use was exclusively against intimate partners. No men were killed by male intimate partners. Violence prevention, which in South Africa has mainly focused on women and children, needs to be integrated into an inclusive approach. Profiling victims and perpetrators of male homicide is an important and necessary first step to challenge prevailing masculine social constructs that men are neither vulnerable to, nor the victims of, trauma and to identify groups at risk of victimisation that could benefit from specific interventions and policies.
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Lainé G, Mezjan I, Masson D, Civit T, Mansouri N. Risk factors for kyphosis recurrence after implant removal in percutaneous osteosynthesis for post-traumatic thoracolumbar fracture. 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; 33:1597-1606. [PMID: 37606724 DOI: 10.1007/s00586-023-07895-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 07/07/2023] [Accepted: 08/07/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE Short-segment minimally invasive percutaneous spinal osteosynthesis has now become one of the treatments of choice to treat thoracolumbar fractures. The question of implant removal once the fracture has healed is still a matter of debate since this procedure can be associated with loss of sagittal correction. Therefore, we analyzed risk factors for kyphosis recurrence after spinal implants removal in patients treated with short-segment minimally invasive percutaneous spinal instrumentation for a thoracolumbar fracture. METHODS A total of 32 patients who underwent implant removal in percutaneous osteosynthesis for post-traumatic thoracolumbar fracture were enrolled in our study. Patient's medical record, operative report and imaging examinations carried out at the trauma and during the follow-up were analyzed. RESULTS Every patient experienced fracture union. Vertebral kyphotic angle (VKA) and Cobb angle (CA) improved significantly after stabilization surgery. VKA, CA, upper disk kyphotic angle (UDKA) and lower disk kyphotic angle (LDKA) significantly gradually decreased during follow-up. Traumatic disk injury (p: 0.001), younger age (p: 0.01), canal compromise (p: 0.04) and importance of surgical correction (p < 0.001) were significantly associated with kyphosis recurrence after implant removal. Anterior body augmentation did not affect loss of correction (CA and VKA) during the follow-up period (p: 0.57). CONCLUSION Despite correction of the fracture after stabilization, we observed a progressive loss of correction over time appearing even before implant removal. Particular attention should be paid to post-traumatic disk damage or canal invasion, to young patients and to surgical overcorrection of the traumatic kyphosis.
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Gruendel MS, Brenneisen W, Wollborn J, Haaker G, Meersch M, Gurlit S, Goebel U. Perioperative point-of-care-testing of plasmacholinesterases identifies older patients at risk for postoperative delirium: an observational prospective cohort study. BMC Geriatr 2024; 24:136. [PMID: 38321383 PMCID: PMC10848373 DOI: 10.1186/s12877-023-04627-1] [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: 09/30/2023] [Accepted: 12/20/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Postoperative delirium (POD) is a severe perioperative complication that may increase mortality and length-of-stay in older patients. Moreover, POD is a major economic burden to any healthcare system. An altered expression of Acetylcholine- and Butyrylcholinesterases (AChE, BuChE) due to an unbalanced neuroinflammatory response to trauma or an operative stimulus has been reported to play an essential role in the development of POD. We investigated if perioperative measurement of cholinesterases (ChEs) can help identifying patients at risk for the occurrence of POD in both, scheduled and emergency surgery patients. METHODS This monocentric prospective observational cohort study was performed in a tertiary hospital (departments of orthopaedic surgery and traumatology). One hundred and fifty-one patients aged above 75 years were enrolled for scheduled (n = 76) or trauma-related surgery (n = 75). Exclusion criteria were diagnosed dementia and anticholinergic medication. Plasma samples taken pre- and postoperatively were analysed regarding AChE and BuChE activity. Furthermore, perioperative assessment using different cognitive tests was performed. The type of anaesthesia (general vs. spinal anaesthesia) was analysed. Primary outcome was the incidence of POD assessed by the approved Confusion Assessment Method (CAM) in combination with the expression of AChE and BuChE. RESULTS Of 151 patients included, 38 (25.2%) suffered from POD; 11 (14%) in scheduled and 27 (36%) in emergency patients. AChE levels showed no difference throughout groups or time course. Trauma patients had lower BuChE levels prior to surgery than scheduled patients (p < 0.001). Decline in BuChE levels correlated positively with the incidence of POD (1669 vs. 1175 U/l; p < 0.001). Emergency patients with BuChE levels below 1556 U/L were at highest risk for POD. There were no differences regarding length of stay between groups or incidence of POD. The type of anaesthesia had no influence regarding the incidence of POD. Only Charlson Comorbidity Index and Mini Nutrition Assessment demonstrated reliable strength in respect of POD. CONCLUSIONS Perioperative measurement of BuChE activity can be used as a tool to identify patients at risk of POD. As a point-of-care test, quick results may alter the patients' course prior to the development of POD. TRIAL REGISTRATION https://drks.de/search/de/trial/DRKS00017178 .
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