Correlation between Age, Emergency Department Length of Stay and Hospital Admission Rate in Emergency Department Patients Aged ≥70 Years

Background: Interdisciplinary emergency departments (EDs) are confronted with trauma and nontrauma patients of any age group. Length of stay (LOS) and admission rates reflect both disease complexity and severity. Objective: To evaluate LOS and admission rates in different age groups according to traumatic and nontraumatic etiologies. Patients and Methods: During May 2011 a total of 4,653 adult patients (defined as ≥18 years old) seen in the ED of our municipal hospital were evaluated for their primary problem, Emergency Severity Index, LOS and admission rate. 1,841 trauma patients (mean age: 51.9 years; SD 22.5 years) and 2,812 nontrauma patients (mean age: 60.0 years; SD 20.4 years) were included. Results: Median LOS in the ED was 1:41 h (trauma) and 1:52 h (nontrauma). Trauma patients aged ≥70 years spent more time in the ED than nontrauma patients of this age group (patients aged ≥70 years median: 2:08 vs. 1:56 h; p < 0.0001). However, no significant difference was found in patients aged <70 years (1:33 vs. 1:48 h; p = 0.64). Comparing older with younger patients, median LOS within the ED was about 8 min longer in nontrauma patients aged ≥70 years (p = 0.22) and about 35 min longer in trauma patients aged ≥70 years (p < 0.00001). Conclusions: The correlation between age and LOS is stronger for trauma patients, which might indicate a special need for geriatric expertise in elderly trauma ED patients. Thus an interdisciplinary approach including surgical and geriatric expertise may be advantageous

Die Anwendung von rekombinantem homologen Wachstumshormon bei der Distraktionsosteogenese

An Yucatan Micropig(R) wurde überprüft, ob die systemische Applikation von Wachstumshormon (GH) in der Lage ist, die Regeneratkonsolidierung bei der Distraktionsosteogenese signifikant zu beschleunigen. Es erfolgte die Entwicklung eines speziellen externen Fixateurs (Halbringf.) mit welchem biomechanische in-vivo Messungen durchgeführte werden konnten. Ebenso wurden serologische, sonographische, röntgenologische, computertomographische, histomorphometrische und post mortem biomechanische Untersuchungen entwickelt und durchgeführt. Die Applikation von rekombinantem spezies-spezifischen Wachstumshormon bei der Distraktionsosteogenese zeigte bei dem von uns gewählten Tiermodell eine signifikante Beschleunigung der Regeneratkonsolidierung. Die biomechanischen Messungen ergaben eine mehr als verdoppelte Steifigkeit und Festigkeit der distrahierten Tibiae nach nur 10 Tagen Konsolidierungszeit im Vergleich zur Kontrollgruppe. Die CT erbrachte für die mit GH behandelten Tiere einen signifikant erhöhten Mineralisierungsgrad im Regenerat, zum gleichen Ergebnis kam die digitale Lumineszenzradiographie und die sonographische Vermessung des Regeneratdurchbaus. Somit zeigten alle Meßmethoden eine deutliche Beschleunigung der Regeneratkonsolidierung durch systemisch appliziertes GH. In den serologischen Untersuchungen fand sich eine signifikante Korrelation zwischen dem Serumspiegel der b-ALP und dem des IGF-I. Dies ist ein Hinweis darauf, dass die Wirkung des Wachstumshormons auf das Regenerat durch seinen Mediator IGF-I bedingt ist.To investigate the effect of systemic growth hormone (GH) application experiments were performed in a micropig animal model. Systemic daily s.c. injection of species-specific recombinant GH was investigated in Yucatan micropigs to evaluate the effect on intramembranous bone formation in distraction osteogenesis. Quantitative computed tomography (qCT), quantitative ultrasound, digital luminescence radiography, biomechanical in-vivo and post mortem testing, serological investigations as well as histomorphometric analyses were performed to investigate differences in regenerate formation. Systemic GH administration significantly increased in the present animal model the torsional stability of the regenerate in-vivo as well as post mortem in comparison to the contralateral side. Also all additional methods showed an accelerated regenerate consolidation in case of GH application. Systemic Insulin-like growth factor -I levels correlated well with the bone specific alkaline phosphatase levels. This may indicate, that the effect of GH on the distraction osteogenesis is IGF-I mediated

Instability prolongs the chondral phase during bone healing in sheep

In this sheep study, we investigated the influence of fixation stability on the temporal and spatial distribution of tissues in the fracture callus. As the initial mechanical conditions have been cited as being especially important for the healing outcome, it was hypothesized that differences in the path of healing would be seen as early as the initial phase of healing. ----- ----- Sixty-four sheep underwent a mid-shaft tibial osteotomy that was treated with either a rigid or a semi-rigid external fixator. Animals were sacrificed at 2, 3, 6 and 9 weeks postoperatively and the fracture calluses were analyzed using radiological, biomechanical and histological techniques. Statistical comparison between the groups was performed using the Mann–Whitney U test for unpaired non-parametric data. ----- ----- In the callus of the tibia treated with semi-rigid fixation, remnants of the fracture haematoma remained present for longer, although new periosteal bone formation during early healing was similar in both groups. The mechanical competence of the healing callus at 6 weeks was inferior compared to tibiae treated with rigid fixation. Semi-rigid fixation resulted in a larger cartilage component of the callus, which persisted longer. Remodeling processes were initiated earlier in the rigid group, while new bone formation continued throughout the entire investigated period in the semi-rigid group. ----- ----- In this study, evidence is provided that less rigid fixation increased the time required for healing. The process of intramembranous ossification appeared during the initial stages of healing to be independent of mechanical stability. However, the delay in healing was related to a prolonged chondral phase

Bioabsorbable metal screws in traumatology: A promising innovation

MAGNEZIX® CS (Syntellix AG, Hanover, Germany) is a bioabsorbable compression screw made of a magnesium alloy (MgYREZr). Currently there are only two clinical studies reporting on a limited number of elective patients who received this screw in a hallux valgus operation. We applied MAGNEZIX® CS for fixation of distal fibular fracture in a trauma patient who had sustained a bimalleolar fracture type AO 44-B2.3. Clinical course was uneventful, fracture healing occurred within three months. Follow-up X-rays showed a radiolucent area around the implant for some months, yet this radiolucent area had disappeared in the 17-months follow-up X-ray. Keywords: Magnesium, Bioabsorbable, Compression screw, Osteosynthesis, Ankle fractur

Magnesium-Based Absorbable Metal Screws for Intra-Articular Fracture Fixation

MAGNEZIX® (Syntellix AG, Hanover, Germany) is a biodegradable magnesium-based alloy (MgYREZr) which is currently used to manufacture bioabsorbable compression screws. To date, there are very few studies reporting on a limited number of elective foot surgeries using this innovative implant. This case report describes the application of this screw for osteochondral fracture fixation at the humeral capitulum next to a loose radial head prosthesis, which was revised at the same time. The clinical course was uneventful. Degradation of the magnesium alloy did not interfere with fracture healing. Showing an excellent clinical result and free range-of-motion, the contour of the implant was still visible in a one-year follow-up

Aid to Recognition and Evaluation of the Conservation Status of a European-Interest Habitat of Lowland, Species-Poor Hay Meadows (Natura 2000 Code 6510) in the Pays-de-la-Loire Region

On the basis of a bibliographic analysis and a field phytosociological survey, the authors show that most mesophilic hay meadows in the Pays-de-la-Loire region, often under mixed farming schemes and sometimes only moderately grazed, belong to the European-interest habitat “lowland species-poor hay meadows (Alopecurus pratensis, Sanguisorba officinalis)” (Natura 2000 code 6510). This interpretation concerns not only three plant associations indeed referred to in the Cahiers d’habitats agropastoraux (Galio veri-Trifolietum repentis Sougnez 1957, Luzulo campestris-Brometum mollis Foucault 1989 and Heracleo sphondylii-Brometum mollis Foucault 1989), but also some other mesophilic meadow communities that have yet to be described. This analysis supplements the Cahiers d’habitats by proposing to explicitly add to the “species-poor hay meadows” European-interest habitat all the vegetations, whether or not already described, that belong to the two phytosociological alliances, Brachypodio-Centaureion and Arrhenatherion. Eutrophised (fertilised) meadows are included in the definition of the habitat as a state of deterioration. The authors also provide criteria for establishing a key for habitat characterisation in order to help recognise and assess the habitat’s conservation status. They propose to base such assessments on the trophic level as exhibited by the respective proportions of oligotrophic species (relicts of the initial grassland from which they derive) and the eutrophic species.À partir d’une analyse bibliographique et d’une étude phytosociologique de terrain, les auteurs montrent qu’une majorité des prairies mésophiles de fauche de la région des Pays-de-la-Loire, souvent à exploitation mixte, voire faiblement pâturées, relèvent de l’habitat d’intérêt communautaire des « prairies maigres de fauche de basse altitude (Alopecurus pratensis, Sanguisorba officinalis) » (code Natura 2000 : 6510). Cette interprétation porte non seulement sur trois associations végétales effectivement citées par les Cahiers d’habitats agropastoraux (le Galio veri-Trifolietum repentis Sougnez 1957, le Luzulo campestris-Brometum mollis Foucault 1989 et l’Heracleo sphondylii-Brometum mollis Foucault 1989), mais aussi sur d’autres communautés prairiales mésophiles non encore décrites. L’analyse complète les Cahiers d’habitats en proposant d’intégrer explicitement à l’habitat d’intérêt communautaire des « prairies maigres de fauche » l’ensemble des végétations, qu’elles soient décrites ou non, appartenant aux deux alliances phytosociologiques du Brachypodio- Centaureion et de l’Arrhenatherion. Les prairies eutrophisées (fertilisées) rentrent dans la définition de l’habitat dont elles constituent un état de dégradation. Les auteurs fournissent, en outre, des critères pour la constitution d’une clé de caractérisation de l’habitat dans le but d’aider à le reconnaître et à en évaluer l’état de conservation. Ils proposent de fonder cette évaluation sur le niveau trophique, révélé par les proportions respectives d’espèces oligotrophiles (relictuelles des pelouses initiales dont elles dérivent) et d’espèces eutrophiles

Dorsal versus transgluteal approach for hip hemiarthroplasty: an analysis of early complications in seven hundred and four consecutive cases

Purpose Hemiarthroplasty (HA) is an established treatment for femoral neck fractures of the elderly. Several surgical approaches are currently used including dorsal and transgluteal. It is still unclear whether one approach may be advantageous. We compared early complication rates after dorsal and transgluteal approaches. Methods We retrospectively analysed a cohort including 704 consecutive patients who received HA for femoral neck fracture; 212 male and 492 female patients were included, and the mean age was 80.4 years (SD 9.8 years). In 487 patients a dorsal and in 217 a transgluteal approach was chosen. In all patients an Excia® stem with self-centring bipolar head manufactured by Aesculap (Tuttlingen, Germany) was used. We evaluated early postoperative complications including dislocation, infection, haematoma, seroma and perioperative fracture. Complication rates after dorsal and transgluteal approaches were calculated and compared by the chi-square test. Results After a dorsal approach 10.5 % [confidence interval (CI) 7.7–13.2 %] of the patients suffered one or more early complications. Following a transgluteal approach this proportion was 9.7 % (CI 5.7–13.6 %), which was not significantly different (p = 0.75). The predominant complication after a dorsal approach was dislocation (3.9 %; CI 2.2–5.6 %). The dislocation rate after a transgluteal approach was significantly lower (0.5 %; CI 0–1.4 %). Postoperative haematoma however was seen after a transgluteal approach in 5.5 % (CI 2.5–8.6 %), which was significantly more frequent than after a dorsal approach (1.2 %; CI 0.2–2.2 %). The frequency of the other types of complications did not significantly differ. Conclusions The rate of early surgical complications after dorsal and transgluteal approaches is not significantly different. However, the dorsal approach predisposed to dislocation, whereas the transgluteal approach predisposed to haematoma