Ultraäänihoidon vaikutus liukenevalla luunkiinnittimellä kiinnitetyn hohkaluun murtuman paranemiseen

The purpose of the present study was to investigate the effects of low-intensity ultrasound on bioabsorbable self-reinforced poly-L-lactide (SR-PLLA) screws and on fracture healing after SR-PLLA device fixation in experimental and clinical cancellous bone fracture. In the first experimental study, the assessment of the mechanical strengths of the SR-PLLA screws was performed after 12 weeks of daily 20-minute ultrasound exposure in vitro. In the second experimental study, 32 male Wistar rats with an experimental distal femur osteotomy fixed with an SR-PLLA rod were exposed for daily low-intensity ultrasound treatment for 21 days. The effects on the healing bone were assessed. The clinical studies consist of three prospective, randomized, and placebo-controlled series of dislocated lateral malleolar fractures fixed with one SR-PLLA screw. The total number of the patients in these series was 52. Half of the patients were provided randomly with a sham ultrasound device. The patients underwent ultrasound therapy 20 minutes daily for six weeks. Radiological bone healing was assessed both by radiographs at two, six, nine, and 12 weeks and by multidetector computed tomography (MDCT) scans at two weeks, nine weeks, and 18 months. Bone mineral density was assessed by dual-energy X-ray absorptiometry (DXA). The clinical outcome was assessed by both Olerud-Molander scoring and clinical examination of the ankle. Low-intensity ultrasound had no effects on the mechanical properties and degradation behaviour of the SR-PLLA screws in vitro. There were no obvious signs of low-intensity ultrasound-induced enhancement in the bone healing in SR-PLLA-rod-fixed metaphyseal distal femur osteotomy in rats. The biocompatibility of low-intensity ultrasound treatment and SR-PLLA was found to be good. In the clinical series low-intensity ultrasound was observed to have no obvious effects on the bone mineral density of the fractured lateral malleolus. There were no obvious differences in the radiological bone healing times of the SR-PLLA-screw-fixed lateral malleolar fractures after low-intensity ultrasound treatment. Low-intensity ultrasound did not have any effects on radiological bone morphology, bone mineral density or clinical outcome 18 months after the injury. There were no obvious findings in the present study to support the hypothesis that low-intensity pulsed ultrasound enhances bone healing in SR-PLLA-rod-fixed experimental metaphyseal distal femur osteotomy in rats or in clinical SR-PLLA-screw-fixed lateral malleolar fractures. It is important to limit the conclusions of the present set of studies only to lateral malleolar fractures fixed with an SR-PLLA screw.Tutkimuksessa selvitettiin matala-intensiteettisen ultraäänihoidon vaikutusta liukenevalla luunkiinnittimellä kiinnitetyn hohkaluun murtuman paranemiseen. Tutkimus koostui viidestä osatyöstä, joista kaksi ensimmäistä oli kokeellisia ja seuraavat kolme kliinisiä. Liukenevista materiaaleista valmistettuja luunkiinnittimiä käytetään erilaisten murtumien kiinnittämiseen. Tässä tutkimuksessa käytetyt sauvat ja ruuvit olivat valmistettu elimistössä liukenevasta polylaktidista. 20 minuuttia kestävän päivittäisen matala-intensiteettisen ultraäänihoidon on eräissä tutkimuksissa esitetty nopeuttavan luunmurtuman paranemista. Tämän tutkimuksen tarkoituksena oli selvittää ultraäänihoidon yhteensopivuus liukenevien luunkiinnittimien kanssa sekä ultraäänihoidon vaikutukset hohkaluun murtuman paranemiseen. Ensimmäisessä kokeellisessa työssä polylaktidi-ruuveja altistettiin päivittäiselle ultraäänelle 12 viikon ajan. Ultraäänen ei todettu vaikuttavan heikentävästi polylaktidin mekaanisiin ominaisuuksiin. Toisessa kokeellisessa työssä kiinnitettiin 32 rotan katkaistu reisiluun alaosa polylaktidi-sauvalla ja tälle alueelle annettiin päivittäin ultraäänihoitoa kolmen viikon ajan. Ultraäänen ei todettu selvästi vaikuttavan paranevassa luussa tapahtuviin normaaleihin muutoksiin. Kliinisissä töissä paikaltaan siirtynyt nilkan ulkokehräksen murtuma kiinnitettiin operatiivisesti polylaktidi-ruuvilla ja murtumaa hoidettiin leikkauksen jälkeen kuuden viikon ajan päivittäin ultraäänellä. Ensimmäisessä kliinisessä työssä selvitettiin ultraäänihoidon vaikutusta ulkokehräksen luuntiheyteen 12 viikon kohdalla leikkauksesta 30 potilaalla. Ultraäänellä ei todettu olevan vaikutusta vamman ja leikkauksen jälkeiseen luuntiheyden muutokseen. Toisessa kliinisessä työssä selvitettiin ultraäänihoidon vaikutusta ulkokehräksen murtuman radiologiseen luutumiseen 22 potilaalla yhdeksän viikon kohdalla tehdyllä tietokonekuvauksella. Ultraäänihoidolla ei todettu olevan selvää radiologista luutumista nopeuttavaa vaikutusta. Viimeisessä kliinisessä työssä tutkittiin ultraäänihoidon mahdollisia pitkäaikaisvaikutuksia leikatussa nilkassa puolitoista vuotta vamman jälkeen 16 potilaan aineistossa. Kaikki murtumat olivat parantuneet hyvin, ultraäänihoidolla ei todettu olevan vaikutusta kliiniseen tulokseen tai luuntiheyden muutokseen leikatussa nilkassa. Tässä väitöskirjatutkimuksessa todettiin matala-intensiteettisen ultraäänihoidon soveltuvan käytettäväksi liukenevilla luunkiinnittimillä kiinnitetyissä murtumissa. Toisaalta, poiketen aikaisemmin julkaistuista tuloksista, ultraäänihoidolla ei tässä tutkimuksessa todettu olevan selviä hohkaluun murtuman paranemista edistäviä vaikutuksia

Pre-notification of arriving trauma patient at trauma centre: A retrospective analysis of the information in 700 consecutive cases

<p>Abstract</p> <p>Background</p> <p>Pre-notification of an arriving trauma patient, given by transporting emergency medical unit, is needed in terms of facilitating the admitting emergency department to get ready for the patient before the patient actually arrives. In the present study we retrospectively analyzed the pre-hospital information provided by 700 consecutive pre-notification mobile phone calls in terms to asses the response of trauma team activation regard to pre-notified information such as vital signs and level of consciousness, mechanism of injury (MOI), and estimated elapsed time (EET) from the time of pre-notification phone call to arrival.</p> <p>Results</p> <p>The median EET was 15 minutes (range 0 – 80 min, interquartile range 10 – 20 min). In 11% of the cases EET was 5 minutes or shorter. 17% of the patients were intubated and ventilated on scene at the time pre-notification phone call took place. The most commonly notified pre-hospitally diagnosed injuries were thoracic in 75 cases (11%), followed by unstable long bone (tibia, femur, humerus) fracture in 66 cases (9%), and abdominal injuries in 32 cases (5%). Trauma team was activated for 61% of 700 pre-notified patients. MOI without clinical symptoms was the reason for team activation in 75% of the cases. In 25% of the cases there were pre-hospitally observed clinical injuries or abnormalities in vital parameters.</p> <p>Conclusion</p> <p>Pre-notification phone call is of a crucial importance in organizing every day activities at a busy trauma centre, but it should not take place in too much advance. In any case, a pre-notification phone call, even on short notice, gives emergency department personnel some time to prepare for the incoming patient.</p

Traumapotilaan massiivisen verenvuodon tunnistaminen ja hoito

English summaryPeer reviewe

Recommendation of use of checklists in tibial intramedullary nail removal : Retrospective study of mechanical complications related to nail removal

Background: The removal of implants such as intramedullary nails is one of the most common operations in orthopedic surgery. The indications for orthopedic implants removal will always remain a subject of conversation and hardly supported by literature. The aim of this study to report injuries of treatment in tibial nail removal and to determine if there are fracture characteristics, patient demographics, or surgical details that may predict a complication. Methods: This is a retrospective seven-year (2010-2016) study including a total of 389 tibial intramedullary nail removals at the Helsinki University Hospital's orthopedic unit. Patients with tibial fracture and removal of intramedullary nail were identified from the hospital discharge register and analyzed. Results: A total of 21 (5,4%) nail removal related mechanical complications (iatrogenic fractures, nerve injuries, failures to remove the nail) were noted. The most common complication was iatrogenic fracture (n = 15, 3,8%). In 6/15 cases the fracture was caused by broken interlocking screws, In 5/15 cases the iatrogenic fracture was caused accidentally by extracting the nail without prior removal of all distal interlocking screws. In one case, new condensed bone had formed around the nail's distal end and case the forced nail extraction caused a re-fracture in both tibia and fibula. Conclusion: Nail removal can be a challenging operation which does not always receive the necessary preoperative planning or operative expertise. latrogenic fractures were most often caused by inadequate preoperative planning or assuming that a broken interlocking screw tilts during the extraction. We suggest the use of checklists in preoperative planning to avoid fractures caused by broken or undetected interlocking screws. (C) 2018 Elsevier Ltd. All rights reserved.Peer reviewe

Traumapotilaan verenkierron turvaamiseksi tehtävät kirurgiset hätätoimenpiteet

Vertaisarvioit

Ampumavammat

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The reliability of the ICD-AIS map in identifying serious road traffic injuries from the Helsinki Trauma Registry

Objective: The EU has recommended that its member countries compile statistics on the number of serious road traffic injuries. In Finland, the number of seriously injured road traffic patients is assessed using the International Classification of Diseases, 10th Revision (ICD-10) and the automatic conversion tool (ICD-AIS map) developed by The Association for the Advancement of Automotive Medicine (AAAM). The aim of this study was to assess how reliably the ICD-AIS map identifies both serious injuries and seriously injured patients due to road traffic accidents. Methods: Data was derived from the Helsinki Trauma Registry (HTR) and included 215 severe (New Injury Severity Score >15) trauma patients injured in road traffic accidents from the years 2016 and 2017. The severity ratings of injuries (Abbreviated Injury Scale, AIS 3+) and patients (Maximum Abbreviated Injury Scale, MAIS 3+) were determined by direct AIS coding of the HTR and were also generated by the ICD-AIS map based on ICD-10 injury codes. These two ratings were compared by injury mechanism and Injury Severity Score (155) body regions. The strength of agreement was described using Cohen's kappa. The most common injury codes with errors in severity rating by the ICD-AIS map were presented. Results: The number of seriously injured patients by the ICD-AIS map was 21% lower, and the number of serious injuries was 36% lower than the corresponding numbers by direct coding. The exact agreement of the injury ratings was 72% (kappa = 0.44, 95% CI 0.42-0.46). Most of the conversion errors were due to the simplicity of the ICD-10 codes used in Finland compared to those used in the ICD-AIS map (ICD-10-CM) and the missing codes from the ICD-AIS map. The most frequent misclassifications were due to multiple rib fractures, visceral organ injuries, some open fractures of extremities, and specific head injuries. Missing codes were most common in face, chest, and limb injuries. Conclusions: The ICD-10 injury codes presently used in Finland should be more specific to permit reliable conversion results by the ICD-AIS map. The problem with missing codes should be considered more closely. When implementing the ICD-11, all detailed injury codes should be introduced. (C) 2019 Elsevier Ltd. All rights reserved.Peer reviewe

Severe intimate partner violence affecting both young and elderly patients of both sexes

Background Intimate partner violence (IPV) affects 25-35 % of women and men in Western countries. Despite the high prevalence of IPV among trauma patients, very little is known about the associated injuries. Most previous studies excluded male victims and IPV is often limited to violence against women. Few reports on IPV among elderly patients exist. Methods We examined self-reports of IPV among patients at two major trauma centers of the Helsinki Central Hospital in Finland. Based on previous studies, we hypothesized that we would find the most severe injuries among young and middle-aged women. Results We identified 29 patients with a total of 105 injuries; patients typically presented with multiple injuries. Half of all patients required hospitalization or surgery. Contrary to previous studies, 17 % of our cohort were male, while 17 % of patients were 65 years or older. We found that 40 % of male victims presented with a New Injury Severity Score (NISS) over 15, indicating severe trauma. Two elderly patients presented with an NISS of 27, the highest in our study. Conclusions IPV leads to severe injury across all age groups among both male and female patients. The injury mechanism should be clearly defined for all trauma patients, keeping IPV in mind as a potential cause despite patient age or gender.Peer reviewe

Tylpät vatsavammat - alkuvaiheen hoidon strategia ja elinspesifisten vammojen hoitolinjat

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Alpine skiing injuries in Finland : a two-year retrospective study based on a questionnaire among Ski racers

Abstract Background Alpine skiing is one of the most popular winter sports in the world. Nevertheless, it has always been associated with a high risk of injury. There are however, only a few studies that have examined the risk of injury of competitive skiers, especially of the junior ski racers. Methods The inclusion criterion was an injury in alpine skiing resulting in a pause in training longer than one week. Athletes of all ages were included. The study period was from the start of the season of 2008&#8211;2009 to end of the season of 2009&#8211;2010 (two years). Results The average annual number of ski racers in Finland was 661. There were 61 injuries (36 males with a median age of 14&#160;years, 25 females with a median age of 14) fulfilling the inclusion criteria. Ligamentous knee injury was the most frequent (17) and lower leg fracture the second common (16) injury, respectively. There was a female dominance in the ACL injuries. Only one major abdominal injury and no major head injuries were observed. The overall training pause was 26&#160;weeks after the ACL injury and 17&#160;weeks after the lower leg fracture, respectively. Conclusion The most common and most disabling injuries affect the knee and the lower leg. The high number of lower leg and ACL injuries is alarming. A continuous and careful monitoring of injuries needs to be established to assess this trend. A systematic review of injuries is the appropriate way to monitor the effects of changes made in terms of safety. The present retrospective two-year pilot study forms a base for a continuous alpine ski injury survey in Finland