Open Posterior Reduction and Stabilization of AO Spine C3 Sacral Fractures.

AO Spine C3 sacral fractures are defined by separation of the spine including S1 from the pelvic ring and are usually result of a high-energy injury. Besides their high biomechanical instability and high rate of associated neurological impairment, these fractures are often extremely difficult to reduce due to severe bony impaction and dislocation. Additional difficulties in management of these fractures arise from only a thin-layer of soft-tissue coverage overlying the injured area

Transformation of perceptions on the role of sociality in human resource management and the concept of trust

Актуальность. В 1903 г. Ф. У. Тейлор писал, что причиной низкой производительности труда являются мысли и рассуждения, обусловленные общественными отношениями между предпринимателями и рабочими, и считал, что при условии их сотрудничества, взаимной помощи производительность последних может быть увеличена в среднем почти вдвое [1]. Проблема, сформулированная Ф.У. Тейлором, и поставленный им вопрос «Какие иные реформы… могут дать столько в направлении повышения благосостояния, уменьшения нищеты и облегчения страданий?» уже более ста лет оказывают мощное влияние на содержание исследовательских программ в области менеджмента. Однако многие из намеченных Ф. У. Тейлором задач все еще далеки от своего решения. Период социально-экономической нестабильности, вновь переживаемый страной в настоящее время, усиливает потребность в инструментах, активизирующих способность и готовность сотрудников выполнять возложенные на них задачи в условиях динамично изменяющейся внешней и внутренней среды. Цель исследования: проанализировать изменение представлений о роли социальности в системе знаний, требующее формирования новых подходов в управлении человеческими ресурсами. Методы: сравнение, обобщение и систематизация, в работе также используется аксиологический подход, предполагающий ценностное измерение исследуемых социокультурных явлений. Результаты: представлена система аргументов, свидетельствующих об усилении роли доверия как в организации общественной жизни в целом, так и в деятельности организации в частности. Показано, что «доверие» способствует упорядочению социальных взаимодействий в условиях трансформационных изменений (нарастания неопределенности и рисков в деятельности компании), когда снижаются возможности «уверенности» и «веры» как механизмов организации социальной жизни. Возрастанию роли фактора «доверие» также способствуют разделение труда, делегирование полномочий, сложность и «непрозрачность» организационных и технических систем. Вывод: более существенную роль начинает играть фактор «доверие» в функционировании системы управления организацией.The Relevance. In 1903 F. Taylor wrote that the reason for low labor productivity is thought and reasoning caused by the relations between entrepreneurs and workers. He believed that the intimate cooperation with the management and the help (which the workman should receive) from the management, would result on the average in nearly doubling the output of each man and each machine [1]. This problem formulated by F. Taylor and the posed question: «What other reforms … could do as much toward promoting prosperity, toward the diminution of poverty, and the alleviation of suffering?», - have been exerting a powerful influence on the content of research programs in the field of management for more than a hundred years. However, many of F. Taylor's problems are still far from being solved. The period of socio-economic instability that the country is experiencing again today increases the need for tools that activate the ability and willingness of employees to perform the tasks assigned to them in a dynamically changing external and internal environment. The purpose: to analyze trends in changes in ideas about the role of sociality in the system of knowledge about human resource management. The method: comparison, generalization and systematization; an axiological approach that assumes the value dimension of the studied sociocultural phenomena. Results. The author presents a system of arguments indicating the strengthening of the role of trust both in the organization of public life in general, and in the activities of the organization, in particular. It is shown that «trust» helps to streamline social interactions in the conditions of transformational changes (increasing uncertainty and risks in the company's activities), when the possibilities of «confidence» and «faith» as mechanisms for organizing social life decrease. The growing role of the factor «trust» is also facilitated by the growing division of labor, delegation of powers, the complexity and «opacity» of organizational and technical systems. Conclusion: the factor of trust begins to play an increasingly important role in the functioning of the organization's management system

Convergence of scaffold-guided bone regeneration and RIA bone grafting for the treatment of a critical-sized bone defect of the femoral shaft

Background: Critical-sized bone defects, mainly from trauma, infection or tumor resection are a challenging condition, often resulting in prolonged, complicated course of treatment. Autografts are considered as the gold standard to replace lost bone. However, limited amount of bone graft volume and donor-site morbidity have established the need for the development of alternative methods such as scaffold-based tissue engineering (TE). The emerging market of additive manufacturing (3D-printing) has markedly influenced the manufacturing of scaffolds out of a variety of biodegradable materials. Particularly medical-grade polycaprolactone and tricalcium phosphate (mPCL–TCP) scaffolds show appropriate biocompatibility and osteoconduction with good biomechanical strength in large preclinical animal models. This case report aims to show first evidence of the feasibility, safety, and efficacy of mPCL–TCP scaffolds applied in a patient with a long bone segmental defect. Case presentation: The presented case comprises a 29-year-old patient who has suffered a left-sided II° open femoral shaft fracture. After initial external fixation and subsequent conversion to reamed antegrade femoral nailing, the patient presented with an infection in the area of the formerly open fracture. Multiple revision surgeries followed to eradicate microbial colonization and attempt to achieve bone healing. However, 18 months after the index event, still insufficient diaphyseal bone formation was observed with circumferential bony defect measuring 6 cm at the medial and 11 cm at the lateral aspect of the femur. Therefore, the patient received a patient-specific mPCL–TCP scaffold, fitting the exact anatomical defect and the inserted nail, combined with autologous bone graft (ABG) harvested with the Reamer–Irrigator–Aspirator system (RIA—Synthes®) as well as bone morphogenetic protein-2 (BMP-2). Radiographic follow-up 12 months after implantation of the TE scaffold shows advanced bony fusion and bone formation inside and outside the fully interconnected scaffold architecture. Conclusion: This case report shows a promising translation of scaffold-based TE from bench to bedside. Preliminary evidence indicates that the use of medical-grade scaffolds is safe and has the potential to improve bone healing. Further, its synergistic effects when combined with ABG and BMP-2 show the potential of mPCL–TCP scaffolds to support new bone formation in segmental long bone defects.</p

The efficacy of open partial aponeurectomy for recurrent Dupuytren's contracture

To evaluate the efficacy of open partial aponeurectomy for recurrent Dupuytren's contracture. Eighteen patients with recurrent Dupuytren's contracture of 22 fingers were retrospectively assessed with a mean follow-up time of 94 months (range: 70-114 months). Examination parameters included the determination of range of motion (ROM), grip strength, pain and subjective outcome (disabilities of the arm, shoulder and hand (DASH) questionnaire). Dissection with special regard to former skin incision and expected wound defect. Modified incisions after Bruner (Mini-Bruner incisions) were facilitated. Dissection started at the palm. Fibrous tissue was resected proximally within the palm including vertical fibrotic septae. Direct preparation of the neurovascular bundles (NVB) was facilitated from proximal to distal. If the anatomy of the neurovascular structures became unclear around the natatory ligament preparation of the NVB at the distal end of the fibrous cord was performed. After complete preparation of a NVB, dissection was continued from medial to lateral until the other bundle was completely released. Transposition flaps and skin transplants were often used for sufficient wound closure. Recurrence rate was 36 % applying the definition of van Rijssen et al. Fifteen patients had a grip strength of 90 % or higher in comparison to the contralateral side. Ten patients had a pinch strength of 90 % or higher in comparison to the contralateral side. All patients except for one had pain reduction or none postoperatively. Fifteen patients had a DASH score of 15 or lower (range: 0-47). An unrelated ray amputation was suffered due to wound healing complications. Open partial aponeurectomy performed by a board certified hand surgeon proved to be safe. The postoperative functional outcome seemed to be related to the individual course of the disease

Epidemiology of open tibia fractures in a population-based database: update on current risk factors and clinical implications

BACKGROUND Open tibia fractures usually occur in high-energy mechanisms and are commonly associated with multiple traumas. The purposes of this study were to define the epidemiology of open tibia fractures in severely injured patients and to evaluate risk factors for major complications. METHODS A cohort from a nationwide population-based prospective database was analyzed (TraumaRegister DGU®). Inclusion criteria were: (1) open or closed tibia fracture, (2) Injury Severity Score (ISS) ≥ 16 points, (3) age ≥ 16 years, and (4) survival until primary admission. According to the soft tissue status, patients were divided either in the closed (CTF) or into the open fracture (OTF) group. The OTF group was subdivided according to the Gustilo/Anderson classification. Demographic data, injury mechanisms, injury severity, surgical fracture management, hospital and ICU length of stay and systemic complications (e.g., multiple organ failure (MOF), sepsis, mortality) were collected and analyzed by SPSS (Version 23, IBM Inc., NY, USA). RESULTS Out of 148.498 registered patients between 1/2002 and 12/2013; a total of 4.940 met the inclusion criteria (mean age 46.2 ± 19.4 years, ISS 30.4 ± 12.6 points). The CTF group included 2000 patients (40.5%), whereas 2940 patients (59.5%) sustained open tibia fractures (I°: 49.3%, II°: 27.5%, III°: 23.2%). High-energy trauma was the leading mechanism in case of open fractures. Despite comparable ISS and NISS values in patients with closed and open tibia fractures, open fractures were significantly associated with higher volume resuscitation (p < 0.001), more blood (p < 0.001), and mass transfusions (p = 0.006). While the rate of external fixation increased with the severity of soft tissue injury (37.6 to 76.5%), no major effect on mortality and other major complications was observed. CONCLUSION Open tibia fractures are common in multiple trauma patients and are therefore associated with increased resuscitation requirements, more surgical procedures and increased in-hospital length of stay. However, increased systemic complications are not observed if a soft tissue adapted surgical protocol is applied

Traumatic Hip Dislocations in Major Trauma Patients: Epidemiology, Injury Mechanisms, and Concomitant Injuries

Introduction: Traumatic hip dislocations (THDs) are severe injuries associated with considerable morbidity. Delayed recognition of fracture dislocations and neurovascular deficits have been proposed to cause deleterious long-term clinical outcomes. Therefore, in this study, we aimed to identify characteristics of epidemiology, injury mechanisms, and associated injuries to identify patients at risk. Methods: For this study based on the TraumaRegister DGU&reg; (January 2002&ndash;December 2017), the inclusion criterion was an Injury Severity Score (ISS) &ge;9 points. Exclusion criteria were an isolated head injury and early transfer to another hospital. The THD group was compared to a control group without hip dislocation. The ISS and New ISS were used for injury severity and the Abbreviated Injury Scale for associated injuries classification. Univariate and logistic regression analyses were performed. Results: The final study cohort comprised n = 170,934 major trauma patients. We identified 1359 individuals (0.8%) with THD; 12 patients had sustained bilateral hip dislocations. Patients with THD were predominantly male (79.5%, mean age 43 years, mean ISS 22.4 points). Aortic injuries (2.1% vs. 0.9%, p &le; 0.001) were observed more frequently in the THD group. Among the predictors for THDs were specific injury mechanisms, including motor vehicle accidents (odds ratio (OR) 2.98, 95% confidence interval (CI) 2.57&ndash;3.45, p &le; 0.001), motorcycle accidents (OR 1.99, 95% CI 1.66&ndash;2.39, p &le; 0.001), and suicide attempts (OR 1.36, 95% CI 1.06&ndash;1.75, p = 0.016). Despite a lower rate of head injuries and a comparable level of care measured by trauma center admission, both intensive care unit and total hospital stay were prolonged in patients with THD. Conclusions: Since early diagnosis, as well as timely and sufficient treatment, of THDs are of high relevance for long-term outcomes of severely injured individuals, knowledge of patients at risk for this injury pattern is of utmost importance. THDs are frequently related to high-energy mechanisms and associated with severe concomitant injuries in major trauma patients