Sacroiliac Screw Placement with Ease: CT-Guided Pelvic Fracture Osteosynthesis in the Elderly

Background and Objectives: The number of geriatric patients presenting with fragility fractures of the pelvis is increasing due to ageing Western societies. There are nonoperative and several operative treatment approaches. Many of which cause prolonged hospitalisation, so patients become bedridden and lose mobility and independence. This retrospective study evaluates the postoperative outcome of a computed tomography-guided (CT-guided) minimally invasive approach of sacroiliac screw osteosynthesis. The particular focus is to demonstrate its ease of use, feasibility with the equipment of virtually every hospital and beneficial outcomes to the patients. Materials and Methods: 28 patients (3 men, 25 women, age 80.5 ± 6.54 years) with fragility fractures of the pelvis types II-IV presenting between August 2015 and September 2021 were retrospectively reviewed. The operation was performed using the CT of the radiology department for intraoperative visualization of screw placement. Patients only received screw osteosynthesis of the posterior pelvic ring and cannulated screws underwent cement augmentation. Outcomes measured included demographic data, fracture type, postoperative parameters and complications encountered. The quality of life (QoL) was assessed using the German version of the EQ-5D-3L. Results: The average operation time was 32.4 ± 9.6 min for the unilateral and 50.7 ± 17.4 for the bilateral procedure. There was no significant difference between surgeons operating (p = 0.12). The postoperative CT scans were used to evaluate the outcome and showed only one case of penetration (by 1 mm) of the ventral cortex, which did not require operative revision. No case of major complication was reported. Following surgery, patients were discharged after a median of 4 days (Interquartile range 3–7.5). 53.4% of the patients were discharged home or to rehabilitation. The average score on the visual analogue scale of the EQ-5D-3L evaluating the overall wellbeing was 55.6 (Interquartile range (IQR) 0–60). Conclusions: This study shows that the operative method is safe to use in daily practice, is readily available and causes few complications. It permits immediate postoperative mobilization and adequate pain control. Independence and good quality of life are preserved

Sacroiliac Screw Placement with Ease: CT-Guided Pelvic Fracture Osteosynthesis in the Elderly

Background and Objectives: The number of geriatric patients presenting with fragility fractures of the pelvis is increasing due to ageing Western societies. There are nonoperative and several operative treatment approaches. Many of which cause prolonged hospitalisation, so patients become bedridden and lose mobility and independence. This retrospective study evaluates the postoperative outcome of a computed tomography-guided (CT-guided) minimally invasive approach of sacroiliac screw osteosynthesis. The particular focus is to demonstrate its ease of use, feasibility with the equipment of virtually every hospital and beneficial outcomes to the patients. Materials and Methods: 28 patients (3 men, 25 women, age 80.5 ± 6.54 years) with fragility fractures of the pelvis types II-IV presenting between August 2015 and September 2021 were retrospectively reviewed. The operation was performed using the CT of the radiology department for intraoperative visualization of screw placement. Patients only received screw osteosynthesis of the posterior pelvic ring and cannulated screws underwent cement augmentation. Outcomes measured included demographic data, fracture type, postoperative parameters and complications encountered. The quality of life (QoL) was assessed using the German version of the EQ-5D-3L. Results: The average operation time was 32.4 ± 9.6 min for the unilateral and 50.7 ± 17.4 for the bilateral procedure. There was no significant difference between surgeons operating (p = 0.12). The postoperative CT scans were used to evaluate the outcome and showed only one case of penetration (by 1 mm) of the ventral cortex, which did not require operative revision. No case of major complication was reported. Following surgery, patients were discharged after a median of 4 days (Interquartile range 3–7.5). 53.4% of the patients were discharged home or to rehabilitation. The average score on the visual analogue scale of the EQ-5D-3L evaluating the overall wellbeing was 55.6 (Interquartile range (IQR) 0–60). Conclusions: This study shows that the operative method is safe to use in daily practice, is readily available and causes few complications. It permits immediate postoperative mobilization and adequate pain control. Independence and good quality of life are preserved

Einflussfaktoren auf die Mortalität bei Patienten mit hüftgelenknahen Frakturen an einem regionalen Traumazentrum

Background!#!Primary care hospitals and regional trauma centers play an essential role in the treatment of hip fractures.!##!Objective!#!This study investigated the relationship between patient-related parameters and in-hospital mortality as well as complications of hip fractures at a regional trauma center.!##!Methods!#!In a retrospective study, data were collected from all patients > 60 years admitted over 2 years to a regional trauma center with a hip fracture. Patient-related parameters included age, sex, fracture location, method of surgical treatment, time of surgery, duration of surgery, length of inpatient stay, blood transfusion, complications, comorbidities, use of anticoagulant medication and need for postoperative intensive care treatment. The relationship between these parameters and hospital mortality as well as complications was investigated.!##!Results!#!Data were collected from 360 patients undergoing 335 surgeries (f:m 225:110) with a mean age of 83 ± 8 years. The total in-hospital mortality rate was 7.76% (n = 26). Factors increasing in-hospital mortality included: age > 85 years (odds ratio [OR] 5.126; 95% confidence interval [CI] 0.665-39.498; p = 0.1167); male sex (OR 1.85 95%-CI [0.82-4.14]; p = 0.0555); time of surgery > 24 h (OR 1.896 95%-CI [0.661-5.441]; p = 0.2341); ≥ 3 comorbidities (OR 10.61 95%-CI [3.681-27.501]; p < 0.0001); intake of anticoagulants (OR 6.19 95%-CI [2.69-14.24]; p < 0.0001) and postoperative intensive care (OR 5.9 95%-CI [2.56-13.76]; p < 0.0001).!##!Conclusion!#!In the present study a statistically significant influence of the number of comorbidities or Charlson comorbidity index, the intake of anticoagulant drugs and need for postoperative intensive care treatment on the in-hospital mortality of patients with proximal femoral fractures in a regional trauma center was found

Pay for performance – motivation to succeed in Advanced Trauma Life Support courses – a question of background or funding?

Objective: To correlate students’ performance with their professional background and motivation to take part in Advanced Trauma Life Support (ATLS) courses. We base our analysis on the self-determination theory that differentiates intrinsic (ambition to perform by individual itself) from extrinsic motivation (incentive by external stimuli).Design: We present a non-blinded, monocentric, non-randomized descriptive study of 376 students taking part in an ATLS course at one course site in Germany. Part of a two-day ATLS course are two written tests; we correlate test scores with background information provided by the students in a questionnaire of 13 items (age, sex, adress, board certification, specialty, subspecialty, position, hospital level of care, hospital operator and hospital participation in trauma network, motivation, funding source, condition of funding).Setting: The students were recuited at the BG Trauma Center Ludwigshafen (Germany), a large 528-bed trauma center and one of 13 ATLS course sites in Germany.Participants: 449 ATLS course students taking part in ATLS courses at the above-mentioned course site from February 2009 to May 2010 were sent a questionnaire asking for their background. All 449 course students were eligible to participate. 376 (83.7%) questionnaires were returned, pre- and post-test results of all students aquired and included into our calculations. 312 (83%) were male and 64 (17%) female. The majority (59.3%) of recruited students came from trauma surgery, 21.8% from anesthesiology, 8% from general surgery, 4% from abdominal surgery, 0.5% from vascular or thoracic surgery each and 5.9% from other specialties.Results: Neither age, sex, subspecialty, hospital level of care, hospital operator, or hospital participation in trauma network played a role with respect to motivation or test results. The high degree of intrinsic motivation of consultants (92.3%) had no impact on their test results. Anesthesiologists were higher motivated (75.6% intrinsically motivated) in contrast to all surgical colleagues (63.6%), which showed significant differences in the pre- (89.8% vs. 85.3%, p=0.03) but not the post-test. Of all 13.6% students who were self-payers, 94.1% were intrinsically motivated; the 86.2% whose course fee was accounted for were less likely to be intrinsically motivated (63.9%). Sponsoring however did not have a negative impact on test results. Conditional funding (sponsored only on passing both tests) was detrimental to motivation: 0% of these individuals were intrinsically motivated and they scored significantly lower (82.5%) than all other students in the post-test (86.9%, p=0.002). Overall, intrinsically motivated students overtopped extrinsically motivated students in the post-test (88.0% vs. 83.4%, p<0.001).Conclusions: ATLS course participation is not compulsory for medical doctors in Germany. Intrinsic motivation to take part in these courses is a key prerequisite to increase performance, irrespective of the background of the students. Intrinsically motivated students are ready to invest into their education and vice versa. Conditional funding (course fee only sponsored on passing the course) evokes no intrinsic motivation at all and causes worse results

Influence of extracorporeal shock wave therapy (ESWT) on bone turnover markers in organisms with normal and low bone mineral density during fracture healing: a randomized clinical trial

Background: Low bone mineral density (BMD) leads to metaphyseal fractures, which are considered of delayed, qualitatively reduced healing resulting in prolonged care phases and increased socioeconomic costs. Extracorporeal shockwave therapy (ESWT) is already approved to support bone healing of pseudarthrosis and delayed unions. With this study, we examined its influence on bone turnover markers (BTM) during fracture healing in patients with low and normal BMD. Methods: Within a period of 2 years, patients with a metaphyseal fracture of the distal radius or the proximal humerus, requiring surgical osteosynthesis were included into the study. Patients were randomized within their fracture groups whether they received ESWT after surgery or not. ESWT was applied once after surgery with an energy flux density (EFD) of 0.55 mJ/mm² à 3000 shockwaves. In addition, serum levels of vitamin D3, parathyroid hormone (iPTH), bone alkaline phosphatase (BAP), c-telopeptide of type-I-collagen (β-CTX) and serum band 5 tartrate-resistant acid phosphate (TRAP5b) were determined before surgery and post-operatively in week 1, 4, 8, 52. T-score levels as an indicator of the BMD were measured with dual-energy X-ray absorptiometry (DXA). Results: 49 patients (40 females, 9 males; mean age 62 years) with fractures of the metaphyseal distal radius (n=25) or the proximal humerus (n=24) were included in the study. The follow-up time was one year. 24 of them were diagnosed of having low BMD, whereas 25 had a normal BMD. During follow-up time serum levels of bone turnover markers, as well as vitamin D3 and iPTH, showed no significant changes; however, ESWT approaches the decreased serum levels of patients with low BMD to the level of healthy organisms.Conclusions: ESWT as treatment option of fractures in patients with low BMD can lead to an equilibration of levels of bone turnover markers to the levels of patients with normal BMD

The representative COVID-19 cohort Munich (KoCo19): from the beginning of the pandemic to the Delta virus variant

Le Gleut R, Plank M, Pütz P, et al. The representative COVID-19 cohort Munich (KoCo19): from the beginning of the pandemic to the Delta virus variant. BMC Infectious Diseases. 2023;23(1): 466.**Background** Population-based serological studies allow to estimate prevalence of SARS-CoV-2 infections despite a substantial number of mild or asymptomatic disease courses. This became even more relevant for decision making after vaccination started. The KoCo19 cohort tracks the pandemic progress in the Munich general population for over two years, setting it apart in Europe. **Methods** Recruitment occurred during the initial pandemic wave, including 5313 participants above 13 years from private households in Munich. Four follow-ups were held at crucial times of the pandemic, with response rates of at least 70%. Participants filled questionnaires on socio-demographics and potential risk factors of infection. From Follow-up 2, information on SARS-CoV-2 vaccination was added. SARS-CoV-2 antibody status was measured using the Roche Elecsys® Anti-SARS-CoV-2 anti-N assay (indicating previous infection) and the Roche Elecsys® Anti-SARS-CoV-2 anti-S assay (indicating previous infection and/or vaccination). This allowed us to distinguish between sources of acquired antibodies. **Results** The SARS-CoV-2 estimated cumulative sero-prevalence increased from 1.6% (1.1-2.1%) in May 2020 to 14.5% (12.7-16.2%) in November 2021. Underreporting with respect to official numbers fluctuated with testing policies and capacities, becoming a factor of more than two during the second half of 2021. Simultaneously, the vaccination campaign against the SARS-CoV-2 virus increased the percentage of the Munich population having antibodies, with 86.8% (85.5-87.9%) having developed anti-S and/or anti-N in November 2021. Incidence rates for infections after (BTI) and without previous vaccination (INS) differed (ratio INS/BTI of 2.1, 0.7-3.6). However, the prevalence of infections was higher in the non-vaccinated population than in the vaccinated one. Considering the whole follow-up time, being born outside Germany, working in a high-risk job and living area per inhabitant were identified as risk factors for infection, while other socio-demographic and health-related variables were not. Although we obtained significant within-household clustering of SARS-CoV-2 cases, no further geospatial clustering was found. **Conclusions** Vaccination increased the coverage of the Munich population presenting SARS-CoV-2 antibodies, but breakthrough infections contribute to community spread. As underreporting stays relevant over time, infections can go undetected, so non-pharmaceutical measures are crucial, particularly for highly contagious strains like Omicron