FRAGILITY FRACTURES OF THE SACRUM: A SILENT EPIDEMIC

Fragility fractures of the sacrum (FFS) are caused by low-energy trauma in the elderly population. Due to the nuanced symptomatology, many FFS remains unrecognized and the prevalence is underestimated. The clinical presentation varies, typically presenting with weightbearing low back pain without even remembering of a previous trauma. Radiographs are usually insufficient for the diagnosis and second level imaging modalities are required. In particular, magnetic resonance demonstrated the highest diagnostic accuracy. Treatment should aim to guarantee early mobilization and weightbearing, efficient pain relief and early discharge from the hospital to a proper facility for rehabilitation. Conservative treatment is reserved to non-displaced fractures with an adequate pain relief within one week allowing early mobilization. Otherwise, surgical treatment must be preferred. Nowadays, minimally invasive techniques, such as ileo-sacral screws or trans-sacral bar osteosynthesis, are safe and effective procedures and have overcome open procedures. In more complex patterns, with complete dissociation between the pelvic ring and the ilio-lumbar spine, spino-pelvic fixation is the procedure of choice

Use of the iliac-outlet and iliac-inlet combined views in percutaneous posterior column retrograde screw fixation

Posterior column fractures are common acetabular injuries. Although displaced fractures require open reduction and fixation, undisplaced patterns may benefit from percutaneous screw fixation. The combination of iliac oblique with inlet and outlet views offers an intuitive and panoramic rendering of the bony corridor into the posterior column; lateral cross table view completes the sequence of fluoroscopic projections. Herein we describe the use of outlet/inlet iliac views and a detailed procedure for percutaneous retrograde posterior column screw fixation

A case report of femoral head fracture with osteochondral lesion treated by osteosynthesis and biomimetic scaffold: 2-year clinical and radiological follow-up

The aim of the present study was to present clinical and radiological outcome of a hip fracture-dislocation of the femoral head treated with biomimetic osteochondral scaffold. An 18-year-old male was admitted to the hospital after a motorcycle-accident. He presented with an obturator hip dislocation with a type IVA femoral head fracture according to Brumback classification system. The patient underwent surgery 5 days after accident. The largest osteochondral fragment was reduced and stabilized with 2 screws, and the small fragments were removed. The residual osteochondral area was replaced by a biomimetic nanostructured osteochondral scaffold. At 1-year follow-up the patient did not complain of hip pain and could walk without limp. At 2-year follow-up he was able to run with no pain and he returned to practice sports. Repeated radiographs and magnetic resonance imaging studies of the hip showed no signs of osteoarthritis or evidence of avascular necrosis. A hyaline-like signal on the surface of the scaffold was observed with restoration of the articular surface and progressive decrease of the subchondral edema. The results of the present study showed that the biomimetic nanostructured osteochondral scaffold could be a promising and safe option for the treatment of traumatic osteochondral lesions of the femoral head. Study Design: Case report

Endosteal plating for the treatment of malunions and nonunions of distal femur fractures

PurposeTo describe the surgical technique and the outcome of a case series of nonunion and malunion of distal femur fractures treated with an endosteal medial plate combined with a lateral locking plate and with autogenous bone grafting. MethodsWe retrospectively analyzed a series of patients with malunion or nonunion of the distal femur treated with a medial endosteal plate in combination with a lateral locking plate, in a period between January 2011 and December 2019, Database from chart review was obtained including all the clinical relevant available baseline data (demographics, type of fracture, mechanism of injury, time from injury to surgery, number of previous surgical procedures, type of bone graft, and type of lateral plate). Time to bone healing, limb alignment at follow-up and complications were documented. ResultsTen patients were included into the study: 7 male and 3 female with mean age of 48.3 years (range 21-67). The mechanism of trauma was in 8 cases a road traffic accident and in 2 cases a fall from height. According to AO/OTA classification 5 fractures were 33 A3, 3 were 33 C1, 1 was 33 C2 and 1 was 33 C3. The average follow up was 13.5 months. In all cases but one bony union was achieved. Bone healing was observed in average 3.3 months after surgery. No intraoperative or postoperative complications were reported. ConclusionA medial endosteal plate is a useful augmentation for lateral plate fixation in nonunion or malunion following distal femur fractures, particularly in cases of medial bone loss, severe comminution, or poor bone quality

Implant retention with serial debridement and use of antibiotic-loaded calcium sulfate beads in acute fracture-related infection (FRI) after pelvic ring or acetabular fractures: A retrospective case series of 7 cases

Background: The development of a pelvic wound infection in the presence of hardware after open reduction and internal fixation presents a clinical dilemma and there is little literature to aid in decision-making. The purpose of this study was to describe the possibility of debridement, antibiotic pearls and retention of the implant (DAPRI) procedure to eradicate the infection. Methods: Tumor-like debridement, antibiotic pearls and retention of the implant (DAPRI) aimed to remove the biofilm allowing a higher and prolonged local antibiotic concentration by using calcium sulfate antibiotic-added beads. Wound status, radiological signs of bone healing, gait and functional activity of the patient were evaluated. Results: Seven patients underwent this technique. The mean follow up time was nine months (range: 6 -16 months). Complete wound healing was achieved in all the patients with no major complications. Average time of bony union was 4.3 months (range: 3-6 months) with no need for implant removal. Conclusion: The DAPRI technique might represent a safe and more conservative treatment for management of early fracture-related infections (FRI) of the pelvis and acetabulum

ENTREPRENEURSHIP TEACHING: BUSINESS MODEL USING GENERATION

O presente estudo procurou descrever como utilizar o Business Model Generation em aulas de empreendedorismo, objetivando apresentar a metodologia utilizada para aplicar o modelo em sala de aula e a percepção dos alunos sobre o uso de um modelo prático durante o aprendizado. A fundamentação teórica realizada versou sobre o modelo em si e seus antecedentes, sendo na sequência descrita a aplicação do Business Model Generation na disciplina de empreendedorismo na Faculdade de Economia e Administração da Universidade de São Paulo. Foi realizada uma pesquisa qualitativa com os grupos de alunos, no total de quatorze, verificando-se que os mesmos aprovaram a iniciativa, sendo ressaltados pontos fortes e fracos da utilização do modelo em sala de aula. Além disso, apresentou-se a percepção dos docentes sobre a utilização do modelo. Trata-se de um estudo descritivo, qualitativo, considerado como um caso de ensino. Poderá contribuir com docentes de graduação na decisão de utilizar o modelo em sala de aula, além de promover o início de pesquisas de temas relacionados ao modelo, uma vez que ainda são poucos os esforços acadêmicos realizados nesse sentido.The present study sought to describe how to use the Business Model Generation in entrepreneurship classes, aiming to present the methodology used to apply the model in the classroom and students' perceptions about the use of a practical model for learning. A review of the literature was about the model itself and its background and then described in the application of the Business Model Generation in the discipline of entrepreneurship at the Faculdade de Economia e Administração, Universidade de São Paulo. Qualitative interviews were conducted with groups of students, in the total of fourteen, verifying that they approved the initiative and highlighted the strengths and weaknesses of the application of the model in the classroom. In addition, was presented the perception of teachers on the use of the model. This is a descriptive, qualitative study, considered as a teaching case. It may contribute to undergraduate teaching in the decision to use the model in a classroom, and promote the initiation of research on issues related to the model, since there are few academic efforts made in this direction

ENTREPRENEURSHIP TEACHING: BUSINESS MODEL USING GENERATION

O presente estudo procurou descrever como utilizar o Business Model Generation em aulas de empreendedorismo, objetivando apresentar a metodologia utilizada para aplicar o modelo em sala de aula e a percepção dos alunos sobre o uso de um modelo prático durante o aprendizado. A fundamentação teórica realizada versou sobre o modelo em si e seus antecedentes, sendo na sequência descrita a aplicação do Business Model Generation na disciplina de empreendedorismo na Faculdade de Economia e Administração da Universidade de São Paulo. Foi realizada uma pesquisa qualitativa com os grupos de alunos, no total de quatorze, verificando-se que os mesmos aprovaram a iniciativa, sendo ressaltados pontos fortes e fracos da utilização do modelo em sala de aula. Além disso, apresentou-se a percepção dos docentes sobre a utilização do modelo. Trata-se de um estudo descritivo, qualitativo, considerado como um caso de ensino. Poderá contribuir com docentes de graduação na decisão de utilizar o modelo em sala de aula, além de promover o início de pesquisas de temas relacionados ao modelo, uma vez que ainda são poucos os esforços acadêmicos realizados nesse sentido.The present study sought to describe how to use the Business Model Generation in entrepreneurship classes, aiming to present the methodology used to apply the model in the classroom and students' perceptions about the use of a practical model for learning. A review of the literature was about the model itself and its background and then described in the application of the Business Model Generation in the discipline of entrepreneurship at the Faculdade de Economia e Administração, Universidade de São Paulo. Qualitative interviews were conducted with groups of students, in the total of fourteen, verifying that they approved the initiative and highlighted the strengths and weaknesses of the application of the model in the classroom. In addition, was presented the perception of teachers on the use of the model. This is a descriptive, qualitative study, considered as a teaching case. It may contribute to undergraduate teaching in the decision to use the model in a classroom, and promote the initiation of research on issues related to the model, since there are few academic efforts made in this direction

WSES/GAIS/WSIS/SIS-E/AAST global clinical pathways for patients with skin and soft tissue infections

Skin and soft-tissue infections (SSTIs) encompass a variety of pathological conditions that involve the skin and underlying subcutaneous tissue, fascia, or muscle, ranging from simple superficial infections to severe necrotizing infections. Together, the World Society of Emergency Surgery, the Global Alliance for Infections in Surgery, the Surgical Infection Society-Europe, The World Surgical Infection Society, and the American Association for the Surgery of Trauma have jointly completed an international multi-society document to promote global standards of care in SSTIs guiding clinicians by describing reasonable approaches to the management of SSTIs. An extensive non-systematic review was conducted using the PubMed and MEDLINE databases, limited to the English language. The resulting evidence was shared by an international task force with different clinical backgrounds.Peer reviewe

WSES/GAIS/SIS-E/WSIS/AAST global clinical pathways for patients with intra-abdominal infections

Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in hospitals worldwide. The cornerstones of effective treatment of IAIs include early recognition, adequate source control, appropriate antimicrobial therapy, and prompt physiologic stabilization using a critical care environment, combined with an optimal surgical approach. Together, the World Society of Emergency Surgery (WSES), the Global Alliance for Infections in Surgery (GAIS), the Surgical Infection Society-Europe (SIS-E), the World Surgical Infection Society (WSIS), and the American Association for the Surgery of Trauma (AAST) have jointly completed an international multi-society document in order to facilitate clinical management of patients with IAIs worldwide building evidence-based clinical pathways for the most common IAIs. An extensive non-systematic review was conducted using the PubMed and MEDLINE databases, limited to the English language. The resulting information was shared by an international task force from 46 countries with different clinical backgrounds. The aim of the document is to promote global standards of care in IAIs providing guidance to clinicians by describing reasonable approaches to the management of IAIs.Peer reviewe

Correction to: Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members

Background: The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods: A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results: 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis. Conclusions: The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years