Operational experience of the Dutch helicopter emergency medical services (HEMS) during the initial phase of the COVID-19 pandemic: jeopardy on the prehospital care system?

Abstract Purpose The SARS-CoV-2 virus has disrupted global and local medical supply chains. To combat the spread of the virus and prevent an uncontrolled outbreak with limited resources, national lockdown protocols have taken effect in the Netherlands since March 13th, 2020. The aim of this study was to describe the incidence, type and characteristics of HEMS and HEMS-ambulance ‘Lifeliner 1’ dispatches during the initial phase of the COVID-19 pandemic compared to the same period one year prior. Methods A retrospective review of all HEMS and HEMS-ambulance ‘Lifeliner 1’ dispatches was performed from the start of Dutch nationwide lockdown orders from March 13th until May 13th, 2020 and the corresponding period one year prior. Dispatch-, operational-, patient-, injury-, and on-site treatment characteristics were extracted for analysis. In addition, the rate of COVID-19 positively tested HEMS personnel and the time physicians were unable to take call was described. Results During the initial phase of the COVID-19 pandemic, the HEMS and HEMS-ambulance was requested in 528 cases. One year prior, a total of 620 requests were received. The HEMS (helicopter and ambulance) was cancelled after deployment in 56.4% of the COVID-19 cohort and 50.7% of the historical cohort (P = 0.05). Incident location type did not differ between the two cohorts, specifically, there was no significant difference in the number of injuries that occurred at home in pandemic versus non-pandemic circumstances. Besides a decrease in the number of falls, the distribution of mechanisms of injury remained similar during the COVID-19 study period. There was no difference in self-inflicted injuries observed. Prehospital interventions remained similar during the COVID-19 pandemic compared to one year prior. Specifically, prehospital intubation did not differ between the two cohorts. The rate of COVID-19 positively tested HEMS personnel was 23.1%. Physicians who tested positive were unable to take call for a mean of 25 days (range 8–53). Conclusion A decrease in the number of deployments and increase in the number of cancelled missions was observed during the COVID-19 study period. No major differences in operational- and injury characteristics were found for HEMS and HEMS-ambulance dispatches between the initial phase of the COVID-19 pandemic in the Netherlands and the same period one year prior. These findings highlight the importance of continued operability of the HEMS, even during pandemic circumstances. Level of evidence III, retrospective comparative study.

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ALLOGENEIC PLATELET-RICH PLASMA FOR ROTATOR CUFF REPAIR

Acta Ortopédica Brasileira ◽

10.1590/1413-785220172501163417 ◽

2017 ◽

Vol 25 (1) ◽

pp. 38-43 ◽

Cited By ~ 4

Author(s):

CHRIS HYUNCHUL JO ◽

JI SUN SHIN ◽

SEUNG YEON LEE ◽

SUE SHIN

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Platelet Rich Plasma ◽

Level Of Evidence ◽

Cross Sectional ◽

Significant Difference ◽

One Year ◽

Arthroscopic Rotator Cuff ◽

Retrospective Comparative Study ◽

Cuff Repair

ABSTRACT Objective: To investigate the safety and efficacy of allogeneic platelet-rich plasma (PRP) in rotator cuff repair . Methods: Seventeen patients with a full-thickness rotator cuff tear were included. Ten patients underwent arthroscopic rotator cuff repair with allogeneic, and seven patients with autologous PRP. Three PRP gels in a volume 3 ml each were applied between the torn end and the greater tuberosity. Clinical outcomes were assessed preoperatively and at a minimum of 2 years after surgery. Structural outcomes were evaluated with the presence of retear and the change of the cross-sectional area (ACT) of the supraspinatus . Results: Allogeneic PRP did not cause any adverse events during the follow-up period. There was no significant difference in the clinical outcome measures between the two groups (all p > 0.05). The retear rate was 33.3% and 25.0% in the allogeneic group and autologous group, respectively (p = 0.764). The change between the one-year postoperative and immediately postoperative ACT was not also significantly different between the two groups (p = 0.373) . Conclusion: Allogeneic PRP in arthroscopic rotator cuff did not cause any local or general complications and that has the efficacy comparable to autologous PRP with respect to the clinical and structural outcomes. Level of Evidence III, Retrospective Comparative Study.

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SURVIVAL OF NONAGENARIAN PATIENTS WITH HIP FRACTURES: A COHORT STUDY

Acta Ortopédica Brasileira ◽

10.1590/1413-785220172504167561 ◽

2017 ◽

Vol 25 (4) ◽

pp. 132-136 ◽

Cited By ~ 4

Author(s):

Alexa Ovidiu ◽

Gheorghevici Teodor Stefan ◽

Popescu Dragos ◽

Veliceasa Bogdan ◽

Alexa Ioana Dana

Keyword(s):

Internal Fixation ◽

Hip Fractures ◽

Survival Data ◽

Demographic Data ◽

Level Of Evidence ◽

Asa Score ◽

Kaplan Meier ◽

Trochanteric Region ◽

One Year ◽

Retrospective Comparative Study

ABSTRACT Objective: The objective of this study was to assess survival and factors that may influence survival in nonagenarians with hip fracture. Methods: We retrospectively analyzed 134 nonagenarian patients admitted for hip fractures over a period of 9 years, and reviewed medical records and survival data from the National Population Register. The analysis included demographic data, ASA score, surgical delay, type of treatment, and mortality. Results: Mean patient age was 92.53 years (range 90-103 years). Of the total, 35.8% of the fractures involved the femoral neck and 64.2% were in the trochanteric region. Overall mortality was 18.7% at 30 days, and 9% at one year. Mean survival for the entire sample was 683±78.1 days, with a median of 339 days; survival in men and women was 595±136.8 days and 734±94.6 days, respectively. We found that type of fracture (p=0.026) and ASA score (p=0.004) were the main factors influencing survival. Kaplan-Meier survival analysis indicated that patients with extracapsular fractures treated by internal fixation had a better survival rate (p=0.047). There was no significant differences between sexes (p = 0.102) or diagnosis (p = 0.537) Conclusion: Although nonagenarian patients have numerous comorbidities, surgical treatment using internal fixation seems superior to a conservative approach. Level of Evidence III, Retrospective Comparative Study.

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Treatment of Severe Ulnar Instability of the MCP Joint Improves Function in LRTI Arthroplasty for Osteoarthritis of the Thumb CMC Joint

Journal of Wrist Surgery ◽

10.1055/s-0039-1697650 ◽

2019 ◽

Vol 09 (02) ◽

pp. 105-115

Author(s):

Johanna Wirth ◽

Eva-Maria Baur

Keyword(s):

Patient Satisfaction ◽

Strength Function ◽

Ulnar Collateral Ligament ◽

Metacarpophalangeal Joint ◽

Metacarpal Bone ◽

Control Group ◽

Level Of Evidence ◽

Pinch Grip ◽

Significant Difference ◽

Retrospective Comparative Study

Abstract Background Comorbidity in the metacarpophalangeal joint (MCPj) of the thumb, i.e., hyperextension or ulnar collateral instability, could affect the outcome of arthroplasty in the thumb carpometacarpal joint (CMCj). Objective In a retrospective study, we evaluated the effect of arthrodesis of the MCPj for thumbs with unstable MCPj and simultaneous ligament reconstruction tendon interposition (LRTI) arthroplasty for the CMCj in terms of strength, function, and patient satisfaction. Patients and Methods A total of 69 thumbs treated with a LRTI arthroplasty of the CMCj were included. In 14 of those cases, an arthrodesis of the MCPj was performed as well. In 12 thumbs, both procedures were done simultaneously; in one case MCPj arthrodesis followed LRTI arthroplasty, whereas one patient already had MCPj arthrodesis at time of LRTI arthroplasty. Those 14 thumbs were compared with the control group of 55 thumbs who had only undergone LRTI. At a mean follow-up of 4 to 5 years (mean 54 [10–124] months) postoperative assessments included range of motion (ROM) of the CMC, MCP, and interphalangeal (IP) joint of the thumb, as well as any instability of the MCPj. Pinch and grip strength were examined, also the visual analogue scale (VAS), patient satisfaction, QuickDASH, PRWE-Thumb, and the Kapandji's Opposition Score. Radiologically, proximalization of the first metacarpal bone was measured. Student's t-test was used to determine significance, p < 0.05 was considered significant. Results Additional arthrodesis of the MCPj provided no significant difference of function in thumbs that only had a hyperextension-instability. However, in thumbs with marked ulnar instability, stronger pinch-grip was obtained with arthrodesis, compared with only LRTI. Conclusion In patients with advanced painful thumb CMCj osteoarthritis, we recommend (simultaneous) arthrodesis of the MCPj, to allow a stable thumb grip if there is additional marked ulnar collateral ligament instability. Level of Evidence This is a Level III, retrospective comparative study.

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Comparison of Chitosan-Based Liquid Scaffold and Hyaluronic Acid–Based Soft Scaffold for Treatment of Talus Osteochondral Lesions

Foot & Ankle International ◽

10.1177/1071100720937662 ◽

2020 ◽

Vol 41 (10) ◽

pp. 1240-1248

Author(s):

Ramazan Akmeşe ◽

Mehmet Batu Ertan ◽

Hakan Kocaoğlu

Keyword(s):

Magnetic Resonance ◽

Osteochondral Lesions ◽

Resonance Imaging ◽

Analog Scale ◽

Level Of Evidence ◽

Time Period ◽

Significant Difference ◽

Vas Scores ◽

American Orthopaedic ◽

Retrospective Comparative Study

Background: The aim of this study was to evaluate the clinical and radiologic results of 2 different scaffolds with hyaluronan or chitosan-based structure used in the treatment of talus osteochondral lesions. Methods: Eighty-one patients who underwent chondral lesion repair with hyaluronan (n = 42) or chitosan-based (n = 39) scaffold were included. American Orthopaedic Foot & Ankle Society (AOFAS) and visual analog scale (VAS) scores were evaluated within and between groups preoperatively and at the 3rd, 12th, and 24th month postoperatively. In all patients, magnetic resonance imaging was performed between the 12 and 18th month postoperatively and compared with magnetic resonance observation of cartilage repair tissue (MOCART) scoring. Results: Within-group evaluations revealed significant improvements in AOFAS and VAS scores at postoperative 3 and 12 months. The postoperative 24th-month results of AOFAS scores in any group did not differ significantly from the 12th-month results. There was no significant difference between the groups in comparison of AOFAS, VAS, and MOCART scores at any time period. Conclusion: Both scaffolds were found to be effective in cartilage healing but had no clinical or radiologic superiority to each other. This is the first study to compare the use of different cell-free scaffold types in osteochondral defects of the talus. Level of Evidence: Level III, retrospective comparative study.

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Distal Metatarsal Segmental Shortening for the Treatment of Chronic Metatarsophalangeal Dislocation of Lesser Toes

Foot & Ankle International ◽

10.1177/1071100720961086 ◽

2020 ◽

pp. 107110072096108

Author(s):

Tzu-Cheng Yang ◽

Yun-Hsuan Tzeng ◽

Chien-Shun Wang ◽

Ming-Chau Chang ◽

Chao-Ching Chiang

Keyword(s):

Demographic Data ◽

Level Of Evidence ◽

Radiographic Measurements ◽

Group I ◽

Significant Difference ◽

Scale Scores ◽

Group Ii ◽

American Orthopaedic ◽

Retrospective Comparative Study ◽

Mtp Joints

Background: This retrospective study aimed to describe the techniques and results of distal metatarsal segmental shortening (DMSS) for the treatment of chronic irreducible metatarsophalangeal (MTP) dislocation of lesser toes. Methods: We retrospectively reviewed patients who underwent DMSS for chronic dislocation of MTP joints of lesser toes between January 2010 and December 2017 with follow-up of at least 24 months. Demographic data, radiographic measurements, functional outcomes, and complications were analyzed. Furthermore, the results of patients with short segment of shortening (group I, <10 mm) were compared to those with long segment of shortening (group II, ≥10 mm). A total of 43 MTP joints of 30 patients with an average age of 70.4 years were included. Results: Union was observed in 42 metatarsals (97.7%). Mean American Orthopaedic Foot & Ankle Society scale scores improved significantly from 42.2 (range, 15-65) preoperatively to 79.1 (range, 52-90) ( P < .001). Mean visual analog scale pain score improved significantly from 5.0 (range, 1-9) preoperatively to 1.8 (range, 0-6) ( P < .001). Complications included 1 nonunion, 1 osteonecrosis, 3 metatarsal angulation, 4 recurrent instability, 4 symptomatic osteoarthritis, 3 transfer metatarsalgia, and 1 floating toe. Group I included 23 MTP joints and group II included 20 MTP joints. There was no significant difference in clinical outcomes and complications between the 2 groups. Conclusion: DMSS was a reliable procedure for the treatment of chronic irreducible dislocated MTP joint of lesser toes. It provided satisfactory surgical outcomes and a low rate of postoperative complications, regardless of length of metatarsal shortening. Level of Evidence: Level III, retrospective comparative study.

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ANTEGRADE X RETROGRADE NAILING IN FEMORAL FRACTURES: A STUDY ON CONSOLIDATION AND INFECTION

Acta Ortopédica Brasileira ◽

10.1590/1413-785220192706218655 ◽

2019 ◽

Vol 27 (6) ◽

pp. 313-316

Author(s):

Jorge Rafael Durigan ◽

Ana Carolina da Silva ◽

Pedro Takata ◽

Caio Zamboni ◽

Claudio Santili ◽

...

Keyword(s):

Intramedullary Nailing ◽

Bone Healing ◽

Femoral Fractures ◽

Healing Time ◽

Retrograde Nailing ◽

University Hospitals ◽

Level Of Evidence ◽

Femur Fractures ◽

Significant Difference ◽

Retrospective Comparative Study

ABSTRACT Objective: Osteosynthesis with intramedullary nailing is considered the method of choice to treat diaphyseal femur fractures in adults. The objective of this retrospective study was to evaluate the bone healing time and incidence of infection in patients with diaphyseal femur fractures treated surgically with retrograde and antegrade intramedullary nailing. Methods: The medical records of 123 patients from two university hospitals dated 2011-2013 were evaluated, with 126 diaphyseal femur fractures having been found. The most frequent treatment was antegrade intramedullary nailing (51%), of which 38% involved reaming (n=25). Results: We found evidence of 92% healed fractures at 12 months postoperatively. Complications included chronic osteomyelitis in one patient and femoral neck fracture in another patient, both after reamed antegrade nailing. Pyoarthritis of the knee associated with osteomyelitis affected two patients after reamed retrograde nailing and one patient after unreamed retrograde nailing. Conclusion: We did not observe a significant difference in bone healing rates with the use of reamed or unreamed antegrade or retrograde nailing. Complications included the presence of infection with an incidence similar to that reported in the literature, and of particular significance, unrelated to the type of approach. Level of evidence III, Retrospective comparative study.

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Comparison of Intravitreal Aflibercept and Ranibizumab for Treatment of Myopic Choroidal Neovascularization: One-Year Results—A Retrospective, Comparative Study

Journal of Ophthalmology ◽

10.1155/2019/8639243 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Burak Erden ◽

Selim Bölükbaşı ◽

Emine Baş ◽

Akın Çakır

Keyword(s):

Choroidal Neovascularization ◽

Treatment Modalities ◽

Intravitreal Ranibizumab ◽

Myopic Choroidal Neovascularization ◽

Significant Difference ◽

Intravitreal Aflibercept ◽

Before And After ◽

The Mean ◽

One Year ◽

Retrospective Comparative Study

Purpose. To compare one-year treatment outcomes of intravitreal aflibercept (IVA) and intravitreal ranibizumab (IVR) for treatment of myopic choroidal neovascularization (mCNV). Methods. The medical records of a total of 30 eyes diagnosed with mCNV and underwent IVA or IVR treatment for a minimum one-year follow-up were studied retrospectively. All the subjects had an axial length >26 mm and received a 1 + PRN (pro re nata) regimen IVA or IVR. Best-corrected visual acuity (BCVA) and central macular thicknesses (CMT) on optical coherence tomography were evaluated before and after treatment. Results. There were 12 eyes in IVA group, with a mean age of 60.0 ± 10.2 years. The mean BCVA significantly improved from baseline 1.54 ± 0.76 to 0.85 ± 0.61 and the mean CMT significantly decreased from baseline 384.3 ± 119.1 μm to 305.9 ± 75.4 μm at Month 12 (p:0.024 and p:0.011, respectively). There were 18 eyes in IVR group, with a mean age of 57.4 ± 13.1 years. The mean BCVA improved from baseline 1.14 ± 0.90 to 1.04 ± 0.93 and the mean CMT significantly decreased from baseline 366.5 ± 102.3 μm to 323.6 ± 103.6 μm at Month 12 after IVR (p:0.345 and p:0.011, respectively). There was no significant difference between the groups in CMT changes in the study period (p:0.178), but IVA resulted in significantly better final visual gain (0.69 versus 0.09; p:0.006). Conclusions. Both IVA and IVR treatment modalities resulted in similar anatomical outcomes but IVA had better visual outcomes in treatment of mCNV.

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A characteristic MRI finding to diagnose a partial tear of the medial meniscus posterior root: an ocarina sign

Knee Surgery and Related Research ◽

10.1186/s43019-021-00120-4 ◽

2021 ◽

Vol 33 (1) ◽

Author(s):

Takayuki Furumatsu ◽

Takaaki Hiranaka ◽

Keisuke Kintaka ◽

Yuki Okazaki ◽

Naohiro Higashihara ◽

...

Keyword(s):

Bone Marrow ◽

Medial Meniscus ◽

Posterior Root ◽

Level Of Evidence ◽

Partial Tear ◽

Positive Ratio ◽

Mri Features ◽

Significant Difference ◽

Diagnostic Values ◽

Retrospective Comparative Study

Abstract Background Diagnosing partial tears of the medial meniscus (MM) posterior root is difficult. The aim of this study was to evaluate diagnostic values involved in conventional magnetic resonance imaging (MRI) features of MM posterior root tears (MMPRTs) and find other MRI-based findings in patients with partial MMPRTs. Methods Eighteen patients who had arthroscopically confirmed partial MMPRTs were included. As a control, 18 patients who underwent partial meniscectomy for other types of MM tears were evaluated. Isolated partial MMPRTs were classified into the following three types: type A, accurate partial stable tear (cleavage < 1/2 of root width); type B, bridged unstable root tear (cleavage ≥ 1/2 of root width); type C, complex horn tear expanded to the root. Conventional MRI-based findings of MMPRTs were evaluated between two groups (n = 23). Posterior root irregularity, bone marrow spot, and ocarina-like appearance showing several condensed circles in triangular meniscal horn (ocarina sign) were also evaluated. Results Posterior root irregularity and bone marrow spot were frequently observed in the partial MMPRTs (47.8%), compared with the other MM tears (P = 0.007 and 0.023, respectively). The ocarina sign was detected in 69.6% of patients with partial MMPRTs. A significant difference between two groups was observed in a positive ratio of ocarina sign (P < 0.001). Types A, B, and C of the partial tear/damage were observed in three, eight, and seven patients, respectively. The ocarina sign was the most common MRI finding in each type of partial MMPRT. Conclusions This study demonstrated that a characteristic MRI finding, “ocarina sign,” was frequently observed in patients with partial tear/damage of the MM posterior root. The ocarina sign was the most common MRI finding in several types of partial MMPRTs. Our results suggest that the ocarina sign may be useful to diagnose unnoticed partial MMPRTs. Level of evidence: IV, retrospective comparative study.

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The role of suction drainage in the management of peri-operative bleeding in Total and Unicomcompartmental knee arthroplasty: a retrospective comparative study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04868-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Nicola Manta ◽

Laura Mangiavini ◽

Cristiana Balbino ◽

Andrea Colombo ◽

Elisa Giacomina Pandini ◽

...

Keyword(s):

Knee Arthroplasty ◽

Postoperative Bleeding ◽

Postoperative Blood Loss ◽

Transfusion Rate ◽

Surgical Wound ◽

Suction Drainage ◽

Level Of Evidence ◽

Significant Difference ◽

Retrospective Comparative Study ◽

Clinical Records

Abstract Background Suction drainage is commonly applied after total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) to reduce hematoma, swelling and to favor surgical wound healing. However, its efficacy remains controversial; thus, the purpose of this study is to evaluate drainage efficiency in the management of postoperative bleeding in TKA and UKA. Methods The cohort comprised 134 clinical records of patients affected by knee osteoarthritis (OA) who underwent either TKA or UKA. All the patients were subdivided into 2 groups: the first one with drainage and the second one without drainage (respectively 61 and 73 patients). For each group, hemoglobin levels in the preoperative, first, second and third postoperative day were collected. Postoperative complications such as swelling, bleeding from the surgical wound or the need for blood transfusion, were also recorded. Results Our results did not show any significant difference of hemoglobin levels in the first (p = 0.715), second (p = 0.203) and third post-operative day (p = 0.467) between the two groups. Moreover, no significant correlation between knee swelling or transfusion rate and the drainage was observed (p = 0.703 and p = 0.662 respectively). Besides, a significant correlation was found between bleeding from the surgical wound and the absence of drainage (p = 0.006). Conclusions The study demonstrates how the routine use of suction drainage does not provide substantial benefits in the postoperative blood loss management after TKA or UKA. Trial registration ClinicalTrials.gov NCT04508101, 09/08/2020, Retrospectively registered Level of evidence III

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Morphologic Analysis of Nonosseous Talocalcaneal Coalitions Using 3D Reconstruction

Foot & Ankle Orthopaedics ◽

10.1177/24730114211039487 ◽

2021 ◽

Vol 6 (4) ◽

pp. 247301142110394

Author(s):

Azusa Yoneda ◽

Yasuhito Tanaka ◽

Hiromasa Fujii ◽

Shinji Isomoto ◽

Kazuya Sugimoto

Keyword(s):

Articular Surface ◽

Relative Size ◽

Three Dimensional ◽

Control Group ◽

Level Of Evidence ◽

Surface Areas ◽

Talocalcaneal Joint ◽

Talocalcaneal Coalition ◽

Significant Difference ◽

Retrospective Comparative Study

Background: Resection of talocalcaneal coalitions has generally involved osseous coalitions. We attempted to evaluate the morphology of nonosseous talocalcaneal coalitions. This study aimed to investigate if the calcaneal articular surface area of feet with talocalcaneal coalitions is different than that of normal feet. Methods: Twenty nonosseous talocalcaneal coalition cases with analyzable computed tomography (CT) scans were compared to 20 control cases. Three-dimensional models of the talus and calcaneus were constructed, and the surface areas of the posterior facet (SPF), whole talocalcaneal joint of the calcaneus (SWJ), and coalition site (SCS) of each 3D-CT model were measured. “Calibrated” values of the 2 groups were created to adjust for relative size of the tali and then compared. The preoperative and postoperative AOFAS Ankle-Hindfoot scale was calculated for 9 cases that had undergone single coalition resection. Results: The calibrated SPF and SWJ were significantly greater in the coalition group than in the control group (40% and 12%, respectively). No significant difference was detected between the calibrated (SWJ – SCS) value of the coalition group and the calibrated SWJ value of the control group. The AOFAS scale was improved postoperatively in all 9 cases analyzed. Conclusion: The calcaneal articular surface of nonosseous talocalcaneal coalition feet in our series was larger than that of the normal feet. This study indicates that the total calcaneal articular surface after coalition resection may be comparable to the calcaneal articular surface of normal feet. We suggest that the indication for coalition resection be reconsidered for nonosseous coalition. Level of Evidence: Level III, retrospective comparative study.

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