Armpje drukken: aanval de beste verdediging?

Inleiding Humerusschachtfracturen kunnen veroorzaakt worden door een direct trauma, een val op de gebogen elleboog of hand met uitgestrekte arm of door een plotselinge rotatiebeweging. Een direct trauma resulteert meestal in een dwarse fractuur. Een plotselinge rotatiebeweging resulteert vaak in een spiraalfractuur in het bijzonder in het distale deel van de humerus. ‘Armpje drukken’ of ‘arm worstelen’ is een bezigheid die door jong volwassen mannen veelvuldig op recreatief, maar ook op competitief niveau wordt beoefend. Toch is deze activiteit minder onschuldig dan het in eerste instantie lijkt

Intensive care organisation

Abstract: In the last two decennia, the mixed population general intensive care unit (ICU) with a ‘closed format’ setting has gained in favour compared to the specialized critical care units with an ‘open format’ setting. However, there are still questions whether surgical patients benefit from a general mixed ICU. Trauma is a significant cause of morbidity and mortality throughout the world. Major or severe trauma requiring immediate surgical intervention and/or intensive care treatment. The role and type of the ICU has received very little attention in the literature when analyzing outcomes from critical injuries. Severely injured patients require the years of experience in complex trauma care that only a surgery/ trauma ICU can provide. Should a trauma center have the capability of a separate specialized ICU for trauma patients (‘closed format’) next to its standard general mixed ICU

De oudere patiënt met multipele ribfracturen

Abstract: Rib fractures resulting from blunt thoracic trauma occur frequently in elderly persons. Although usually due to a low impact trauma mechanism (e.g., fall from standing height), rib fractures are associated with significant morbidity and mortality in the elderly patient. This unfavorable clinical course is most often caused by respiratory insufficiency due to lung edema or pneumonia. This cases series presents three elderly patients who sustained multiple rib fractures and were subsequently admitted to a level I trauma center for treatment. Diagnostic challenges as well as different treatment approaches for this population are discussed. More specifically, age specific indications and contra-indications for intravenous or epidural analgesia and operative rib fixation are discussed. In addition, we show that a multidisciplinary approach, involving a trauma surgeon, anesthesiologist, intensive care physician and physical therapist is paramount for the prevention of potentially lethal complications. Samenvatting: Stomp thoracaal letsel met ribfracturen komt veel voor bij ouderen. Hoewel het traumamechanisme vaak van laag-energetische aard is, is het beloop dikwijls gecompliceerd. De morbiditeit en mortaliteit van deze letsels bij oudere patiënten zijn aanzienlijk. Enerzijds wordt dat verklaard door patiëntgerelateerde factoren, zoals een verminderde fysiologische reserve, comorbiditeit en verhoogde vatbaarheid van weefsels voor het ontstaan van letsel. Anderzijds kan de letselernst in deze populatie eenvoudig worden onderschat. Tijdige herkenning van deze factoren en de gevolgen hiervan, alsmede een multidisciplinaire behandeling zijn van essentieel belang om tot een goede diagnose te komen, een adequate behandeling in te stellen en complicaties te voorkomen. Wij illustreren dit aan de hand van 3 casussen

Elleboogluxaties: snel oefenen voor het beste resultaat!

Abstract: A dislocation with only ligament damage is called a simple elbow dislocation. A complex elbow dislocation is associated with fractures. Early mobilization exercises may prevent elbow stiffness. Case one is 27-year old woman with a simple elbow dislocation. Patient was started early mobilization exercises immediately. Case two is a 58-year old man with a complex elbow dislocation. Following open reduction and internal fixation, a hinged elbow fixator was applied, and patient immediately started with active mobilization exercises. Case three is a 49-year old women with elbow stiffness and joint ingruency following persistent joint instability after a simple elbow dislocation. After arthrolysis, a hinged elbow fixator was mounted. In conclusion, early mobilization exercises after an elbow dislocation is mandatory to full functional recovery. Plaster immobilization should not be used. In case of persistent instability, a hinged external fixator is indicated

De conventionele RCT voor trauma- en orthopedisch chirurgen: geen heilige graal

Abstract: Conventionele RCT’s voor trauma- en orthopaedisch chirurgisch onderzoek zijn moeilijk uitvoerbaar door chirurg- en patiënt gerelateerde redenen. Grote regionale cohortstudies en (quasi-) experimentele designs met vooraf gedefinieerde uitkomst parameters en een fulltime onderzoeker bieden een oplossing. De conventionele RCT kan dan worden ingezet voor specifiek gedefinieerde problemen die voortkomen uit de resultaten van deze studies

An infrapatellar nerve block reduces knee pain in patients with chronic anterior knee pain after tibial nailing: a randomized, placebo-controlled trial in 34 patients

Background and purpose — Anterior knee pain is common after tibial nailing. Its origin is poorly understood. Injury of the infrapatellar nerve is a possible cause. In this randomized controlled trial we compared changes in knee pain after an infrapatellar nerve block with lidocaine or placebo in patients with persistent knee pain after tibial nailing. Patients and methods — Patients with chronic knee pain after tibial nailing were randomized to an infrapatellar nerve block with 5 ml 2% lidocaine or placebo (sodium chloride 0.9%), after which they performed 8 daily activities. Before and after these activities, pain was recorded using a numeric rating scale (NRS; 0–10). Primary endpoint was the change in pain during kneeling after the infrapatellar nerve block. Secondary outcomes were changes in pain after the nerve block during the other activities. Results — 34 patients (age 18–62 years) were

Intensive care performance: how should we monitor performance in the future?

Abstract Intensive care faces economic challenges. Therefore evidence proving both effectiveness and efficiency, i.e. cost-effectiveness, of delivered care is needed. Today, the quality of care is an important issue in the health care debate. How do we measure quality of care, and how accurate and representative is this measurement? In the fol

Prevalence and mortality of abdominal compartment syndrome in severely injured patients: A systematic review

BACKGROUND Abdominal compartment syndrome (ACS) in severely injured patients is associated with high morbidity and mortality. Many efforts have been made to improve outcome of patients with ACS. A treatment algorithm for ACS patients was introduced on January 1, 2005 by the World Society of the Abdominal Compartment Syndrome. The aim of this study was to determine the prevalence and mortality rate of ACS among severely injured patients before and after January 1, 2005 using a systematic literature review. METHOD Databases of Embase, Medline (OvidSP), Web of Science, CINAHL, CENTRAL, PubMed publisher, and Google Scholar were searched for terms related to severely injured patients and ACS. Original studies reporting ACS in trauma patients were considered eligible. Data on study design, population, definitions

Noncompliance with guidelines on proton pump inhibitor prescription as gastroprotection in hospitalized surgical patients who are prescribed NSAIDs

Background and aims As NSAIDs can cause serious upper gastrointestinal harm, guidelines have been established for the prescribing of proton pump inhibitors (PPIs) in high-risk patients using NSAIDs. Studies examining guideline compliance in surgical patients are scarce. Therefore, a retrospective cross-sectional database study was carried out aimed at determining the proportion of noncompliance with the Dutch guideline and determining the association of several factors with this noncompliance. Materials and methods Hospital admissions of patients on surgical wards of Erasmus University Medical Center between 1 January 2013 and 1 August 2014 were included in which an NSAID was newly prescribed. Preadmission PPI use was excluded. The main outcome was the proportion of noncompliance with the guideline. As a secondary outcome, the association of several potential risk factors with noncompliance was assessed. The proportion of guideline noncompliance was calculated as the percentage of all included surgical ward admissions. For the secondary analysis, univariate and multivariable logistic regression analyses were carried out. R