Evaluation of a routine follow-up visit after an internal fixation of proximal femoral fracture

Background and purpose: Post-operative follow-up after internal fixation of fractures is a common practice. The goal of this study was to evaluate the necessity of a routine follow-up visit after internal fixation of a proximal femoral fracture. Our hypothesis is that these follow-up visits do not result in a change in the treatment plan, but add an extra cost to the health care system and lead to the purposeless utilisation of limited resources. Patients and methods: A retrospective study of 428 consecutive patients (431 fractures) with a scheduled outpatient clinic visit after internal fixation of proximal femoral fractures in a single hospital during years 2012-2013. We noted any changes in the patients' treatment plans based on the first follow-up visits, including scheduled visits up to ten weeks after internal fixation. Results: None of the patients showed signs of infection, implant failure or loss of reduction requiring reoperation at the scheduled follow-up visit. In only one (0.23%) visit a change in treatment plan was made as a result of the scheduled follow-up visit (decision to remove the distal screws from the long intramedullary nail to obtain dynamic compression). Scheduled visits did not occur for the following reasons, death (11.8%), visit to emergency department prior scheduled visit (3.2%), and not known (3.9%). Conclusions: The first scheduled visit within ten weeks after internal fixation of a proximal femoral fracture leads to no changes in treatment. We recommend considering the need of these follow-up visits. (c) 2017 Elsevier Ltd. All rights reserved.Peer reviewe

Missed Injuries in Polytrauma Patients after Trauma Tertiary Survey in Trauma Intensive Care Unit

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Vaaralliset eläimet

English summaryPeer reviewe

Kylkiluiden sarjamurtumat

Vertaisarvioitu. Näin hoidan.Kylkiluiden sarjamurtuman yhteydessä potilaan hallitseva oire on mobilisoitumiseen, hengittämiseen ja yskimiseen liittyvä kipu rintakehän alueella. Vammaan saattaa liittyä rintakehän segmentaalinen instabiilius (varsta- eli hetkurinta) (VIDEO). Muita mahdollisia liitännäisvammoja ovat keuhkoruhje sekä veri- ja ilmarinta. Suurienergiaisissa vammoissa vartalon varjoainetehosteinen tietokonetomografia (TT) on aina ensisijainen tutkimus. Pienienergiaisten vammojen osalta riittää usein keuhkokuva, joka otetaan potilaan seisoessa. Kivun aktiivinen hoito, varhainen mobilisaatio ja tarvittaessa hengityksen kajoamaton tukeminen ovat avainasemassa hengitysvajauksen estämisessä. Hengitysvajauksen riskin ennustamista vaikeuttaa se, että kipu on pahimmillaan vasta vammaa seuraavina päivinä. Useimmiten sarjamurtumapotilas kuuluu tehostettuun valvontaan, kunnes hengitysvajauksen vaara on ohi. Kirurginen hoito on tehokas pienelle potilasjoukolle. Esittelemme Töölön sairaalan hoitokäytännön

Does arrival time affect outcomes among severely injured blunt trauma patients at a tertiary trauma centre?

Background and aims: We aimed to determine whether the outcome of severely injured patients differs based on admission time (office hours vs. non-office hours) at a tertiary trauma centre without an in-house trauma surgeon consultant available at all times. We also studied subgroups of patients presenting with a New Injury Severity Score (NISS) >= 25 and patients experiencing major bleeding. Patients and methods: This trauma registry study consisted of severely injured patients (NISS > 15) with blunt trauma treated between 2006 and 2017 at a single institute. Causes of deaths were obtained from autopsy reports and classified as resulting from brain injury; exsanguination; multi-organ failure, adult respiratory distress syndrome, or sepsis; or other. Results: Among 1853 patients, 497 (27%) were admitted during office hours (OH) and 1356 (73%) during non-office hours (NOH). Further subgroup analysis consisted of 211 OH and 611 NOH patients with NISS >= 25, and 51 OH and 154 NOH patients experiencing major bleeding. The 30-day in-hospital mortality was 3.8%-7.4% lower in the NOH groups. We found no significant differences between the study groups in neither the standardised mortality ratio (SMR, defined as the ratio of observed to expected mortality) nor in the causes of death. In both groups, the primary cause of death resulted from brain injury. Conclusions: We found that arrival time did not affect mortality among patients with severe blunt trauma treated at a tertiary trauma centre without an in-house trauma surgeon consultant available at all times. Thus, this type of unit can maintain a standard of care during non-office hours by investing in precise treatment protocols and continuous education. However, our results do not apply to penetrating trauma injury patients. (C) 2019 Elsevier Ltd. All rights reserved.Peer reviewe

The role of outpatient visit after operative treatment of ankle fractures

It is a common practice that patients have a scheduled follow-up visit with radiographs following ankle fracture surgery. The aim of this study was to evaluate whether an early outpatient visit ( A change in treatment plan was observed in 9.8% of operatively treated ankle fracture patients. The mean age of the patients was 48 years and the mean follow-up time was 64 months. Of the changes in treatment plan, 91% were exclusively due to clinical findings such as infection. Only three of 878 patients required a change in their treatment plan based merely on the findings of the radiographs taken at the outpatient visit. Only 37% of the patients requiring a change in their postoperative management had solicited an unanticipated visit before the scheduled outpatient visit due to clinical problems such as infection or a cast-related issue. Our study showed that every tenth operatively treated ankle fracture patient requires a change in their treatment plan due to a clinical problem such as infection or a cast-related issue. Although at hospital discharge all patients are provided with written instructions on where to contact if problems related to the operated ankle emerge, only one third of the patients are aware of the clinically alarming symptoms and seek care when problems present. Our findings do not support obtaining routine radiographs at the early outpatient visit in an ankle fracture patient without clinical signs of a complication. (C) 2016 Published by Elsevier Ltd.Peer reviewe

Osteosynteesimateriaalin poisto aikuisilta

English summar

Major blunt trauma causes increased mortality up to 12 years : Long-term survival in 3 557 patients compared to 35 502 control persons

Background: Trauma registries usually report 30-day or in-hospital mortality as an outcome measure. However, some studies criticize this measure as inadequate; the impact of a major trauma could last longer than 1 month after the injury. We studied the long-term mortality of patients who sustained a major trauma. Methods: The Helsinki University Hospital's trauma registry was used for patient identification from 2006 to 2015 (New Injury Severity Score >= 16 and blunt mechanism of injury). For each trauma registry patient, 10 control persons matched by age, sex, and county of residency were obtained from the Population Register Center of Finland. Cause of death information was obtained from Statistics Finland. Results: We included 3 557 trauma registry patients and 35 502 control persons. Follow-up ranged from 1 year 7 months to 11 years 7 months. The 1-year mortality was 11 times higher in the trauma-patient group (22% vs. 2%). The long-term (approximately 12 years) mortality after the injury was 2.6 times higher in the trauma-patient group (46% vs. 18%). For patients surviving at least 1 year post-trauma, the mortality at 12 years was 2.2 times higher than in the control group (31% vs. 14 %). The cause of death was a disease in 73.3% of the trauma patients and 93.6% of the controls. Accidents were more often a cause of death in the patient population than in the control population (21.2% vs. 4.1%). Suicide was the cause of death in 3.0% of patients and 1.1% in controls. Several factors associated with increased mortality were identified. Conclusions: Major trauma patients had significantly higher long-term mortality compared to controls. To the best of our knowledge, this is the first study on this subject with a follow up of this duration with patients this severely injured and a cohort this large. (C) 2020 Elsevier Ltd. All rights reserved.Peer reviewe

Puolen vuosisadan vammakokemuksia

English abstrac