1,091 research outputs found

    Cerclage augmentation of S1-S2 trans-sacral screw fixation in osteoporotic posterior pelvis ring injuries - a biomechanical feasibility study

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    PURPOSE Injuries of the posterior pelvic ring are predominantly associated with osteoporosis. Percutaneously placed screws trans-fixing the sacroiliac joint have become the gold standard for their treatment. However, screw cut-out, backing-out and loosening are common complications. One promising option could be cerclage reinforcement of cannulated screw fixations. Therefore, the aim of this study was to evaluate the biomechanical feasibility of posterior pelvic ring injuries fixed with S1 and S2 trans-sacral screws augmented with cerclage. METHODS Twenty-four composite osteoporotic pelvises with posterior sacroiliac joint dislocation were stratified into four groups for S1-S2 trans-sacral fixation using either (1) fully threaded screws, (2) fully threaded screws with cable cerclage, (3) fully threaded screws with wire cerclage, or (4) partially threaded screws with wire cerclage. All specimens were biomechanically tested under progressively increasing cyclic loading until failure. Intersegmental movements were monitored by motion tracking. RESULTS The trans-sacral partially threaded screw fixation with wire cerclage augmentation resulted in significantly less combined angular intersegmental movement in the transverse and coronal plane versus its fully threaded counterpart (p = 0.032), as well as in significantly less flexion versus all other fixations (p ‚ȧ 0.029). CONCLUSION Additional cerclage augmentation could be performed intraoperatively to improve the stability of posterior pelvic ring injuries treated with S1-S2 trans-sacral screw fixation. Further investigations should follow in order to consolidate the current results on real bones and possibly consider execution of a clinical study. This article is protected by copyright. All rights reserved

    Surgical load in major fractures - results of a survey on the optimal quantification and timing of surgery in polytraumatized patients

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    PURPOSE It is known that the magnitude of surgery and timing of surgical procedures represents a crucial step of care in polytraumatized patients. In contrast, it is not clear which specific factors are most critical when evaluating the surgical load (physiologic burden to the patient incurred by surgical procedures). Additionally, there is a dearth of evidence for which body region and surgical procedures are associated with high surgical burden. The aim of this study was to identify key factors and quantify the surgical load for different types of fracture fixation in multiple anatomic regions. METHODS A standardized questionnaire was developed by experts from Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT)-Trauma committee. Questions included relevance and composition of the surgical load, operational staging criteria, and stratification of operation procedures in different anatomic regions. Quantitative values according to a five-point Likert scale were chosen by the correspondents to determine the surgical load value based on their expertise. The surgical load for different surgical procedures in different body regions could be chosen in a range between "1," defined as the surgical load equivalent to external (monolateral) fixator application, and "5," defined as the maximal surgical load possible in that specific anatomic region. RESULTS This questionnaire was completed online by 196 trauma surgeons from 61 countries in between Jun 26, 2022, and July 16, 2022 that are members of SICOT. The surgical load (SL) overall was considered very important by 77.0% of correspondents and important by 20.9% correspondents. Intraoperative blood loss (43.2%) and soft tissue damage (29.6%) were chosen as the most significant factors by participating surgeons. The decision for staged procedures was dictated by involved body region (56.1%), followed by bleeding risk (18.9%) and fracture complexity (9.2%). Percutaneous or intramedullary procedures as well as fractures in distal anatomic regions, such as hands, ankles, and feet, were consistently ranked lower in their surgical load. CONCLUSION This study demonstrates a consensus in the trauma community about the crucial relevance of the surgical load in polytrauma care. The surgical load is ranked higher with increased intraoperative bleeding and greater soft tissue damage/extent of surgical approach and depends relevantly on the anatomic region and kind of operative procedure. The experts especially consider anatomic regions and the risk of intraoperative bleeding as well as fracture complexity to guide staging protocols. Specialized guidance and teaching is required to assess both the patient's physiological status and the estimated surgical load reliably in the preoperative decision-making and operative staging

    Timing of Spinal Surgery in Polytrauma: The Relevance of Injury Severity, Injury Level and Associated Injuries

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    STUDY DESIGN Retrospective database analysis. OBJECTIVE Polytraumatized patients with spinal injuries require tailor-made treatment plans. Severity of both spinal and concomitant injuries determine timing of spinal surgery. Aim of this study was to evaluate the role of spinal injury localization, severity and concurrent injury patterns on timing of surgery and subsequent outcome. METHODS The TraumaRegister DGU¬ģ^{¬ģ} was utilized and patients, aged ‚Č•16¬†years, with an Injury Severity Score (ISS) ‚Č•16 and diagnosed with relevant spinal injuries (abbreviated injury scale, AIS ‚Č• 3) were selected. Concurrent spinal and non-spinal injuries were analysed and the relation between injury severity, concurrent injury patterns and timing of spinal surgery was determined. RESULTS 12.596 patients with a mean age of 50.8¬†years were included. 7.2% of patients had relevant multisegmental spinal injuries. Furthermore, 50% of patients with spine injuries AIS ‚Č•3 had a more severe non-spinal injury to another body part. ICU and hospital stay were superior in patients treated within 48¬†hrs for lumbar and thoracic spinal injuries. In cervical injuries early intervention (<48¬†hrs) was associated with increased mortality rates (9.7 vs 6.3%). CONCLUSIONS The current multicentre study demonstrates that polytrauma patients frequently sustain multiple spinal injuries, and those with an index spine injury may therefore benefit from standardized whole-spine imaging. Moreover, timing of surgical spinal surgery and outcome appear to depend on the severity of concomitant injuries and spinal injury localization. Future prospective studies are needed to identify trauma characteristics that are associated with improved outcome upon early or late spinal surgery

    Time for a paradigm shift in shared decision-making in trauma and emergency surgery? Results from an international survey

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    Background Shared decision-making (SDM) between clinicians and patients is one of the pillars of the modern patient-centric philosophy of care. This study aims to explore SDM in the discipline of trauma and emergency surgery, investigating its interpretation as well as the barriers and facilitators for its implementation among surgeons. Methods Grounding on the literature on the topics of the understanding, barriers, and facilitators of SDM in trauma and emergency surgery, a survey was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was sent to all 917 WSES members, advertised through the society’s website, and shared on the society’s Twitter profile. Results A total of 650 trauma and emergency surgeons from 71 countries in five continents participated in the initiative. Less than half of the surgeons understood SDM, and 30% still saw the value in exclusively engaging multidisciplinary provider teams without involving the patient. Several barriers to effectively partnering with the patient in the decision-making process were identified, such as the lack of time and the need to concentrate on making medical teams work smoothly. Discussion Our investigation underlines how only a minority of trauma and emergency surgeons understand SDM, and perhaps, the value of SDM is not fully accepted in trauma and emergency situations. The inclusion of SDM practices in clinical guidelines may represent the most feasible and advocated solutions

    ASTRONOMICAL DATA ANALYSIS SOFTWARE AND SYSTEMS XXX

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    Astronomical Society of the Pacific Conference Series, vol. 532 (2022)This volume contains the proceedings of the 30th annual conference on Astronomical Data Analysis Software and Systems (ADASS XXX). ADASS is the premier conference for the exchange of information about astronomical software, and it is organized each year by a different hosting astronomical institution at a different location. The conference provides a forum for astronomers, software engineers, and data specialists from around the world to discuss software and algorithms as used in all aspects of astronomy, from telescope operations, to data reduction, to outreach and education. In addition to presenting their work, delegates engaged in discussions on emerging technologies and debated future directions in areas such as common data formats, software reuse, and data dissemination. As such, ADASS is a vital mechanism to foster discussion for the advancement of the field. This was the first time that ADASS was held in a digital format as the health safety risks of the COVID-19 pandemic were too large to meet in person. Participants from around the world were able to join in via Zoom, YouTube, and other online platforms to discuss themes such as Science Platforms and Data Lakes, Citizen Science Projects in Astronomy, and Cloud Computing at Different Scales. These proceedings contain 146 papers representing the invited, contributed, and poster papers as well as the ‚ÄúBirds of a Feather‚ÄĚ sessions and demonstrations

    Standards in der Behandlung instabiler Beckenringverletzungen - Ergebnisse einer internationalen Umfrage

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    Pediatric trauma and emergency surgery: an international cross-sectional survey among WSES members

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    Background: In contrast to adults, the situation for pediatric trauma care from an international point of view and the global management of severely injured children remain rather unclear. The current study investigates structural management of pediatric trauma in centers of different trauma levels as well as experiences with pediatric trauma management around the world. Methods: A web-survey had been distributed to the global mailing list of the World Society of Emergency Surgery from 10/2021-03/2022, investigating characteristics of respondents and affiliated hospitals, case-load of pediatric trauma patients, capacities and infrastructure for critical care in children, trauma team composition, clinical work-up and individual experiences with pediatric trauma management in response to patients¬ī age. The collaboration group was subdivided regarding sizes of affiliated hospitals to allow comparisons concerning hospital volumes. Comparable results were conducted to statistical analysis. Results: A total of 133 participants from 34 countries, i.e. 5 continents responded to the survey. They were most commonly affiliated with larger hospitals (&gt;‚ÄČ500 beds in 72.9%) and with level I or II trauma centers (82.0%), respectively. 74.4% of hospitals offer unrestricted pediatric medical care, but only 63.2% and 42.9% of the participants had sufficient experiences with trauma care in children‚ÄȂȧ‚ÄČ10 and‚ÄȂȧ‚ÄČ5&nbsp;years of age (p‚ÄČ=‚ÄČ0.0014). This situation is aggravated in participants from smaller hospitals (p‚ÄČ&lt;‚ÄČ0.01). With regard to hospital size (‚ȧ‚ÄČ500 versus‚ÄČ&gt;‚ÄČ500 in-hospital beds), larger hospitals were more likely affiliated with advanced trauma centers, more elaborated pediatric intensive care infrastructure (p‚ÄČ&lt;‚ÄČ0.0001), treated children at all ages more frequently (p‚ÄČ=‚ÄČ0.0938) and have higher case-loads of severely injured children‚ÄČ&lt;‚ÄČ12&nbsp;years of age (p‚ÄČ=‚ÄČ0.0009). Therefore, the majority of larger hospitals reserve either pediatric surgery departments or board-certified pediatric surgeons (p‚ÄČ&lt;‚ÄČ0.0001) and in-hospital trauma management is conducted more multi-disciplinarily. However, the majority of respondents does not feel prepared for treatment of severe pediatric trauma and call for special educational and practical training courses (overall: 80.2% and 64.3%, respectively). Conclusions: Multi-professional management of pediatric trauma and individual experiences with severely injured children depend on volumes, level of trauma centers and infrastructure of the hospital. However, respondents from hospitals at all levels of trauma care complain about an alarming lack of knowledge on pediatric trauma management

    Standard practice in the treatment of unstable pelvic ring injuries: an international survey

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    PURPOSE Unstable pelvic ring injury can result in a life-threatening situation and lead to long-term disability. Established classification systems, recently emerged resuscitative and treatment options as well as techniques, have facilitated expansion in how these injuries can be studied and managed. This study aims to access practice variation in the management of unstable pelvic injuries around the globe. METHODS A standardized questionnaire including 15 questions was developed by experts from the SICOT trauma committee (Soci√©t√© Internationale de Chirurgie Orthop√©dique et de Traumatologie) and then distributed among members. The survey was conducted online for one¬†month in 2022 with 358 trauma surgeons, encompassing responses from 80 countries (experience‚ÄČ>‚ÄČ5¬†years‚ÄČ=‚ÄČ79%). Topics in the questionnaire included surgical and interventional treatment strategies, classification, staging/reconstruction procedures, and preoperative imaging. Answer options for treatment strategies were ranked on a 4-point rating scale with following options: (1) always (A), (2) often (O), (3) seldom (S), and (4) never (N). Stratification was performed according to geographic regions (continents). RESULTS The Young and Burgess (52%) and Tile/AO (47%) classification systems were commonly used. Preoperative three-dimensional (3D) computed tomography (CT) scans were utilized by 93% of respondents. Rescue screws (RS), C-clamps (CC), angioembolization (AE), and pelvic packing (PP) were observed to be rarely implemented in practice (A‚ÄČ+‚ÄČO: RS‚ÄČ=‚ÄČ24%, CC‚ÄČ=‚ÄČ25%, AE‚ÄČ=‚ÄČ21%, PP‚ÄČ=‚ÄČ25%). External fixation was the most common method temporized fixation (A‚ÄČ+‚ÄČO‚ÄČ=‚ÄČ71%). Percutaneous screw fixation was the most common definitive fixation technique (A‚ÄČ+‚ÄČO‚ÄČ=‚ÄČ57%). In contrast, 3D navigation techniques were rarely utilized (A‚ÄČ+‚ÄČO‚ÄČ=‚ÄČ15%). Most standards in treatment of unstable pelvic ring injuries are implemented equally across the globe. The greatest differences were observed in augmented techniques to bleeding control, such as angioembolization and REBOA, more commonly used in Europe (both), North America (both), and Oceania (only angioembolization). CONCLUSION The Young-Burgess and Tile/AO classifications are used approximately equally across the world. Initial non-invasive stabilization with binders and temporary external fixation are commonly utilized, while specific haemorrhage control techniques such as pelvic packing and angioembolization are rarely and REBOA almost never considered. The substantial regional differences' impact on outcomes needs to be further explored
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