Magyar Traumatológia Ortopédia Kézsebészet Plasztikai Sebészet

Treatment of blunt thoracic trauma in a Level 1 Trauma Center

sze, 15 máj 2024 13:50:10 +0000

Blunt chest trauma has a significant high morbidity and mortality rate. In general, the treatment is conservative; in the case of hemothorax, pneumothorax, and hemopneumothorax chest tube drainage is often required. Immediate surgery is indicated in massive bleeding, tracheal and oesophageal injuries, and pericardial tamponade. Elective surgery should be performed in the case of retained hematoma, unresolved pneumothorax and flail chest. The first prioritized procedure is video-assisted thoracoscopy. The aim of this study is to analyze the treatment options and therapeutic results in reviewing 8,108 patients afflicted with blunt thoracic trauma. In over a three-year period 7,853 patients’ data were analyzed. Altogether 1,624 (20.68%) patients suffered severe injuries, such as sternal or rib fracture(s), pleural or lung injuries. In this group, a simple rib fracture (1-3) was diagnosed in 1,466 (90.27%), unilateral serial rib fracture (≥4) in 84 (5.17%), bilateral rib fracture in 16 (0.99%) and flail chest in 47 (2.89%) patients. In 11 (0.68%) cases, only parenchymal injuries without rib fracture were found. Altogether, 190 (11.70%) patients were afflicted with pneumothorax, hemothorax, or both, and only 86 (45.26%) of these cases required chest tube drainage. One immediate thoracotomy was needed to staunch massive bleeding and elective video-assisted thoracoscopy was performed in 6 cases. Lung contusion was diagnosed in 57 (3.51%) patients. The most frequent complication was pneumonia with a rate of 0.19% (15 patients). Empyema (3 patients), unresolved pneumothorax (1 patient), and retained hematoma (4 patients) occurred in 0.04%, 0.01% and 0.05% of the cases, respectively. Altogether, 13 (0.17%) patients succumbed at a mean age of 63.54±21.92 years. Three of these cases (23.08%) experienced multiple trauma and 12 (92.31%) suffered from concomitant chronic diseases. Patients with blunt chest trauma rarely required immediate operation. Overall, in the case of unresolved pneumothorax and retained hematoma, surgery is indicated, in which these cases video-assisted thoracoscopy is the first and primary option.

Chronic anticoagulation therapy and acute hip trauma

Sarah Cathrine Becken, George Ayerh, Sandor Mester, Norbert Wiegand — sze, 15 máj 2024 00:00:00 +0000

Regardless of the association between hip fracture surgery and mortality, morbidity and bleeding risks, there are still significant contradictions in various published articles concerning hip fracture surgery outcomes when patients are prescribed anticoagulant medication. The primary objective of this study was to investigate if patients prescribed anticoagulants experienced delayed surgery when compared to non-users. The secondary goal was to investigate if patients prescribed anticoagulants underwent an extended hospital stay and complications such as increased bleeding, mortality and a higher rate of comorbidities when compared to non-users. Data from proximal hip fracture patients were prospectively collected at a level I university trauma center. From 1 January, 2020, through 1 January, 2021, 519 eligible patients were identified. Anticoagulant medication upon admission, time prior to surgery, hospitalized days, 30-day mortality rates, 1-year mortality, blood transfusion requirement and various comorbidities were noted. 222 of the 519 hip fracture patients were prescribed anticoagulants. Of the 222 patients, 75% were females and 25% were males. In total, 46% required a blood transfusion, with no significant differences between the anticoagulated and non-anticoagulated patients. 50% of the anticoagulated group and 42% of the control group required perioperative blood transfusion. Neither the 30-day nor the 1-year mortality rate showed statistically significant differences between the groups. However, the time to surgery and the length of hospital stay was significantly longer in the anticoagulated group. Comorbidities were found in 87% of the patients: in 95% of the anticoagulated group and in 81% of the non-anticoagulated group. Patients prescribed anticoagulants at the time of hip fracture experienced delayed surgery, longer hospital stays and more comorbidities when compared to patients not on anticoagulants. Neither a blood transfusion requirement, 30-day mortality rate nor a 1-year mortality rate showed no significant difference between the two cohorts.

Emergency thoracostomy as a safe and effective intervention in prehospital trauma

sze, 15 máj 2024 00:00:00 +0000

Traumatic tension pneumothorax is one of the most frequent causes of early mortality among the severely injured. Different methods are recommended for chest decompression. The aim of this study is to examine whether emergency thoracostomy can improve the real 30-day survival compared to the expected Revised Trauma Score (RTS) based survival, the Return of Spontaneous Circulation (ROSC) rate in Traumatic Cardiac Arrest (TCA), reduce the occurrence of tension pneumothorax (tPTX) and to determine the complication rate of the intervention.

Psychological treatment of neurotraumatic injuries – crisis intervention in acute care

Noemi Monika Szeifert — sze, 15 máj 2024 15:06:01 +0000

Patients who have suffered a neurotraumatic injury undergo severe physical and psychological trauma, which in many cases also traumatizes their relatives. Severe physical trauma and its long-term consequences have a significant impact on the lives of the people affected and their relatives. Acute health care, as well as the various periods of prolonged hospitalization, are a major physical and psychological challenge for both patients and their relatives. Patients who have suffered severe physical trauma are cared for by a multidisciplinary trauma team, which includes psychological support, too, in line with international professional guidelines. The involvement of psychologists and psychiatrists should be an integral part of acute care in the case of acute stress disorder and early-onset depression. The acute onset of psychological symptoms and the potential for long-term psychological disturbances warrant crisis intervention as close as possible in time and space to the critical event following the traumatic event. In the case of severe somatic trauma, combined therapy (pharmacotherapy and psychotherapy) can be used to relieve these symptoms and timely crisis intervention can reduce psychological symptoms and prevent the development of more serious psychopathologies (post-traumatic stress syndrome, depressive symptoms, anxiety disorders, sleep disorders), which in the long term can significantly impair quality of life and the risk of suicide. Providing regular psychological support helps the patient to adapt to the hospital environment and treatment, improves compliance, supports cooperation with physiotherapists and prepares the patient for rehabilitation. Basic psychotherapeutic care, using a variety of methods related to medical treatments and bodily processes, ranges from crisis intervention through supportive therapy to rehabilitation. It is essential that professional psychological support should be provided for the patient who has suffered a serious physical trauma as well as their relatives.

Successful treatment of a challenging periprosthetic femoral fracture on a premenopausal patient with a long history of immunosuppression

Takayuki Kurokawa, Endre Varga — sze, 15 máj 2024 15:32:28 +0000

While immunosuppression provides relief and care in patients with rheumatic arthritis, the prolonged usage of steroids has been known to cause various and serious complications. While in older patients it is common to find those with a long history of immunosuppression, younger patients also suffer from its prolonged complications. We present a 38 year old heavily immunocompromised female patient with excellent compliance on which we operated on multiple occasions and have treated from 2019 to 2022. The patient was originally diagnosed with rheumatoid arthritis at age 7, and has been receiving high dose immunosuppressive medication. The patient received bilateral total hip arthroplasty during 2009 and 2013, and a Total Knee Arthroplasty (TKE) in 2011. Over the course of her postoperative recovery, she suffered from multiple cases of periprosthetic fractures. In October 2019, the patient again presented with spontaneous pain in her right thigh. She was then diagnosed with a Vancouver C type periprosthetic fracture on the right femur, and was referred and admitted to our level one Trauma Center in Szeged, Hungary. After multiple trials, the patient received a Locking Compression Plate (LCP) type Proximal Femoral Hook Plate (PFHP) with cable fixation, attachments and a bone allograft to reinforce stability and neutralize stress on the fractured area. Multiple and repetitive challenges can be expected in treating bony fractures of weight bearing lower limbs for heavily immunocompromised patients. The patient, despite her young age, had the osteological biology of a elderly patient, requiring us to take into consideration not only surgical components but biological components as well. With a multidisciplinary approach from osteological, biological, and surgical fields, successful results may be acquired even in these challenging cases.

Arthroscopic treatment of femoral trochlear notch fracture caused by intra-articular dislocation of the patella

Norbert Wiegand, Gabor Bucs, Balazs Patczai — sze, 15 máj 2024 15:52:04 +0000

This case report presents a traumatic intra-articular patellar dislocation – associated intercondylar fracture of the distal femur – and the consequent arthroscope assisted reduction and percutaneous screw fixation. To the best of our knowledge, this is the first case in which the arthroscope assisted operative reduction and percutaneous screw fixation of the fracture fragment has been demonstrated. Our patient was a 55-year-old female who was treated by the aforementioned method which concluded with excellent results.