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

A Study on Discrimination from the Perspective of Trauma, Body fluids, and Sacredness and Uncleanness

Abstract: Samenvatting Een patella bipartita komt regelmatig voor en is meestal een toevalsbevinding op een röntgenfoto. Een symptomatische patella bipartita is echter relatief zeldzaam. In dat geval kan gekozen worden voor een conservatieve, maar ook een chirurgische behandeling (bv. excisie van het losse patellafragment). De literatuur is daar niet eenduidig over. Wij presenteren een casus van een 26-jarige jongeman met pijnklachten van de knie gebaseerd op een patella bipartita. Excisie van het superolaterale fragment vond plaats waarna de m. vastus lateralis aan de resterende patella werd gehecht. 8 weken postoperatief waren de pijnklachten verdwenen en de kniefunctie volledig hersteld. Summary A symptomatic bipartite patella is a relatively common. However, a symptomatic bipartite patella is a rare condition. There can be chosen for a conservative or surgical treatment (for example excision of the patellar fragment). Current literature is not uniformly about the most successful treatment. We present a case report of a 26-year old patient with a painful knee, based on a bipartite patella. The superolateral patellar fragment was removed. After that, the vastus lateral muscle was sutured to the remaining patella. At follow-up in our out-door clinic after 8 weeks, the pain complaints disappeared and functional recovery was complete

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

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

Managing Successional Stage Heterogeneity to Maximize Landscape-Wide Biodiversity of Aquatic Vegetation in Ditch Networks

The presence of a high diversity of different successional stages in a landscape may help to conserve and promote landscape-wide biodiversity. A strategy to achieve this is using Cyclic Rejuvenation through Management (CRM), an approach employed in a variety of different ecosystems. CRM periodically resets the successional stages in a landscape. For aquatic systems this constitutes vegetation removal and dredging. For this approach to be useful (a) successional stages are required to be different in community composition and (b) these differences need to be caused by true replacement of species between stages. While potentially valid, these assumptions are not generally tested prior to application of CMR. In this study we test these assumptions to explore the usefulness of managing on successional stage heterogeneity for maximizing landscape-wide aquatic plant diversity. We carried out vegetation surveys in the ditch networks of 21 polder landscapes in Netherlands, each containing 24 ditch reaches. Using a clustering approach combined with insight from literature on vegetation succession in these systems we assigned our sampled communities to defined successional stages. After partitioning landscape diversity into its alpha and beta components, we quantified the relative importance of replacement among successional stages. Next, through scenario analyses based on simulations we studied the effects of reducing successional stage heterogeneity on landscape-wide biodiversity. Results showed that differences in community composition among successional stages were a potentially important factor contributing to landscape diversity. Early successional stages were characterized by higher replacement of species compared to late successional stages. In a scenario of gradual decrease of heterogeneity through the systematic loss of the earliest successional stages we found 20% of the species richness in a polder was lost, pointing toward the importance of maintaining early successional stages in a polder. This makes a compelling case for application of CRM within agricultural drainage ditch landscapes to maximize regional aquatic plant diversity. While applied to drainage ditch systems, our data-driven approach is broadly applicable to other systems and may help in providing first indications of the potential of the CRM approach. We argue that CRM may maintain and promote regional biodiversity without compromising the hydrological function of the systems