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

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

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

Injury Incidence Rates and Profiles in Elite Taekwondo during Competition and Training

This study aimed to investigate exposure adjusted injury incidence rates and profiles associated with training and competition in an elite taekwondo athlete population. 82 athletes were investigated for injuries over a period of 5 years. Individual fight time exposure for training and competition was recorded. The type and location of the injuries were classified and exposure-adjusted injury incidence rates (IIR) were calculated per 1000 h for training and competition. 66 athletes with a mean age of 19.3 +/- 4.2 years and 172 injuries were included in the final data assessment. The exposure adjusted IIR was significantly higher during competition (p<0.001) with a rate ratio of 6.33 (95% CI 4.58-8.69). Ankle and foot region as well as hand and wrist were most affected with significant higher IIR in competition (p<0.001). Joint injuries, fractures, and bruising occurred the most. Fractures occurred mainly to the hand and wrist region. Future investigations should focus on exposure adjusted injury data including analyses of the detailed mechanism leading to especially severe injuries to improve specific injury prevention in competition and promote evolution of protective gear

Influence of Malnutrition on Outcome after Hip Fractures in Older Patients

Background: Malnutrition might lead to a worse outcome in hip fractures of older patients. The purpose of this study is to analyze different indicators of malnutrition that lead to worse outcomes. Methods: 252 patients of a geriatric trauma unit were analyzed prospectively. Different demographic, as well as data on the trauma and whether osteoporosis prophylaxis or anticoagulation was present, were recorded. The nutritional status with respect to laboratory parameters as well as nutritional risk score was also analyzed. Results: The main finding of this study is that a poor nutritional status is statistically significantly associated with higher mortality as well as worse independence (p p < 0.05). Conclusions: Malnutrition of geriatric patients increases the risk for death, worse mobility, and independence after hip fractures. Osteoporosis prophylaxis prescribed during an inpatient stay enables patients to retain their independence. The nutritional status of geriatric patients with hip fractures should be obtained and provisions made

Risk and Influence Factors of Fall in Immobilization Period after Arthroscopic Interventions

Knee injuries are one of the most common injuries. Falls during the immobilization period can deteriorate the postoperative outcome. The risk factors causing falls after initial injury and the question of whether a rigid orthosis serves as a protective factor remain unclear. The primary aim of the study was to record the fall rate in the first six weeks after arthroscopic intervention. The secondary aim was to assess the influences of risk factors and protective factors on these fall ratios. Different scores were examined and compared in the groups &lsquo;fall event&rsquo; and &lsquo;no fall&rsquo;. Data from 51 patients (39 males, 12 females) with a mean age of 31.2 years (19&ndash;57 years) were collected. A total of 20 patients suffered at least one fall event within the observation period. A total of 18 of 23 fall events happened within the first three weeks postoperatively. The Extra Short Musculoskeletal Function Assessment Questionnaire (XSMFA) showed a significant difference between the groups (p = 0.02). People with multiple injuries to the knee joint were more likely to suffer fall events. Conclusively, patients with limited knee functions appeared to fall more frequently within the first three weeks postoperatively. Therefore, appropriate measures should be taken to protect the postoperative outcome. Physical therapy and patient behavioural training should be practiced perioperatively in patients at risk

Specific Radiologic Risk Factors for Implant Failure and Osteonecrosis of the Humeral Head after Interlocking Nailing with the Targon PH⁺ of Proximal Humeral Fractures in a Middle to Old Population

Background: Operative management of proximal humeral fractures is still challenging. While antegrade nailing has become a valid option in fracture fixation, risk factors for adverse events, and failure have not been sufficiently clarified. Methods: All patients of a single trauma center undergoing surgery for proximal humeral fractures with the Targon PH+ nail between 2014 and 2021 were evaluated retrospectively. This included complications, revisions, and failures. Pre- and postoperative radiographic imaging were assessed regarding fracture’s complexity, anatomic reduction, reconstruction of the medial hinge, metaphyseal head extension, and fixation of the implant in the calcar region. Follow-up was at a minimum of 12 months. Results: A total number of 130 patients with a mean age of 74.5 years (range 63–94, SD ± 8.2) are included in this study. Two- and three-part fractures were found in 58 patients, while 14 patients showed four-part fractures. Overall, a complication rate of 34.2% and an implant failure rate of 15.4% was found. Four-part fractures showed a significantly higher complication rate than two- and three-part fractures. Four-part fractures also showed significantly higher revisions (p = 0.005) and implant failures (p = 0.008). The nonsufficient anatomical reduction was found to be a risk factor for complications (p p p p = 0.002) and a metaphyseal head extension of under 8 mm (p = 0.005) were also demonstrated as risk factors for osteonecrosis of the humeral head. Conclusions: Four-part fractures in an elderly population show high complication, revision, and implant-failure rates. Therefore, demonstrated radiologic risk factors should be evaluated for improvements. Anatomical reduction and fixation near the calcar proved to be vital for successful antegrade nailing of complex fractures. To prevent osteonecrosis of the humeral head, reconstruction of the medial hinge and metaphyseal head extension should be evaluated

Short- and Mid-Term Survival of Geriatric Patients with Septic Arthritis of the Knee and the Impact of Risk Factors on Survival

Septic arthritis is common in older adults and can be related to joint surgery or hematogenous distribution. To date, the risk factors affecting survival are unknown. This study aimed to evaluate the effects of existing implants, positive synovial microbiological culture results, and the American Society of Anesthesiology Physical Status (ASA) classification on the short- and mid-term survival of older patients with primary septic gonarthritis. This retrospective study included 133 older adults >60 years who underwent surgery for primary septic gonarthritis. Data were collected from medical records and public obituaries. Kaplan–Meier survival curves were used to estimate the probability of survival, as well as log-rank tests to measure and compare survival rates over one- and five-year periods. The mean age was 74.9 years (SD ± 9.2), and the 5-year follow-up rate was 74.3% (the mean follow-up was 3000.5 days; SD ± 1771.6). Mean survival was significantly different in patients with implants and without implants (p = 0.015), and between ASA II, ASA III, and ASA IV (p p = 0.08). Older adults with septic monoarthritis and pre-existing medical implants showed impaired survival. The ASA classification prior to surgery for primary septic monoarthritis can be helpful in identifying patients with poorer mid-term outcomes