Retrospective analysis of treatment decisions and clinical outcome of Lisfranc injuries: operative vs. conservative treatment

Abstract Purpose Lisfranc injuries are rare and often pose a challenge for surgeons, particularly in initially missed or neglected cases. The evidence on which subtypes of Lisfranc injuries are suitable for conservative treatment or should undergo surgery is low. The aim of this study was to retrospectively analyze treatment decisions of Lisfranc injuries and the clinical outcome of these patients within the last ten years. Methods All patients treated due to a Lisfranc injury in a German level I trauma centre from January 2011 until December 2020 were included in this study. Radiologic images and medical data from the patient files were analyzed concerning the classification of injury, specific radiologic variables, such as the Buehren criteria, patient baseline characteristics, and patient outcome reported with the Foot Function Index (FFI). Results Ninety-nine patients were included in this study (conservative = 20, operative = 79). The overall clinical outcome assessed by the FFI was good (FFI sum 23.93, SD 24.93); patients that were identified as suitable for conservative treatment did not show inferior functional results. Qualitative radiological factors like the grade of displacement and the trauma mechanism were more strongly associated with the decision for surgical treatment than quantitative radiologic factors such as the distance from the first to the second metatarsal bone. Conclusion If the indication for conservative or operative treatment of Lisfranc injuries is determined correctly, the clinical outcome can be comparable. These decisions should be based on several factors including quantitative and qualitative radiologic criteria, as well as the trauma mechanism.

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Scoring systems for early prediction of tibial fracture non-union: an update

International Orthopaedics ◽

10.1007/s00264-021-05088-0 ◽

2021 ◽

Author(s):

George D. Chloros ◽

Nikolaos K. Kanakaris ◽

James S. H. Vun ◽

Anthony Howard ◽

Peter V. Giannoudis

Keyword(s):

Tibial Fracture ◽

Scoring Systems ◽

Trauma Centre ◽

Predictive Values ◽

Non Union ◽

Post Operative Period ◽

Male Patients ◽

Level I ◽

Healing Score ◽

Tibial Shaft Fractures

Abstract Purpose To evaluate the available tibial fracture non-union prediction scores and to analyse their strengths, weaknesses, and limitations. Methods The first part consisted of a systematic method of locating the currently available clinico-radiological non-union prediction scores. The second part of the investigation consisted of comparing the validity of the non-union prediction scores in 15 patients with tibial shaft fractures randomly selected from a Level I trauma centre prospectively collected database who were treated with intramedullary nailing. Results Four scoring systems identified: The Leeds-Genoa Non-Union Index (LEG-NUI), the Non-Union Determination Score (NURD), the FRACTING score, and the Tibial Fracture Healing Score (TFHS). Patients demographics: Non-union group: five male patients, mean age 36.4 years (18–50); Union group: ten patients (8 males) with mean age 39.8 years (20–66). The following score thresholds were used to calculate positive and negative predictive values for non-union: FRACTING score ≥ 7 at the immediate post-operative period, LEG-NUI score ≥ 5 within 12 weeks, NURD score ≥ 9 at the immediate post-operative period, and TFHS < 3 at 12 weeks. For the FRACTING, LEG-NUI and NURD scores, the positive predictive values for the development of non-union were 80, 100, 40% respectively, whereas the negative predictive values were 60, 90 and 90%. The TFHS could not be retrospectively calculated for robust accuracy. Conclusion The LEG-NUI had the best combination of positive and negative predictive values for early identification of non-union. Based on this study, all currently available scores have inherent strengths and limitations. Several recommendations to improve future score designs are outlined herein to better tackle this devastating, and yet, unsolved problem.

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The management of bite wounds in children—A retrospective analysis at a level I trauma centre

Injury ◽

10.1016/j.injury.2012.04.016 ◽

2012 ◽

Vol 43 (12) ◽

pp. 2117-2121 ◽

Cited By ~ 28

Author(s):

Manuela Jaindl ◽

Judith Grünauer ◽

Patrick Platzer ◽

Georg Endler ◽

Christiane Thallinger ◽

...

Keyword(s):

Retrospective Analysis ◽

Trauma Centre ◽

Level I ◽

Bite Wounds

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Acute Laryngeal Trauma in the Pediatric Patient

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949810700204 ◽

1998 ◽

Vol 107 (2) ◽

pp. 104-106 ◽

Cited By ~ 32

Author(s):

Robert M. Merritt ◽

John P. Bent ◽

Edward S. Porubsky

Keyword(s):

Adult Population ◽

Population Group ◽

Functional Results ◽

Senior Author ◽

Functional Evaluation ◽

Minor Trauma ◽

Multiple Fractures ◽

Laryngeal Trauma ◽

Level I ◽

Group 1

We reviewed the evaluation and management of pediatric laryngeal trauma, focusing on the unique characteristics of the immature airway as they affect functional results. The study was based on 91 cases of acute laryngeal trauma managed by the senior author (E.S.P.) from 1973 to 1996. Patients over 15 years old were considered physically mature and excluded. The remaining 10 cases (mean age 9.7) were reviewed in detail and compared to the adult series. Intervention ranged from level I (observation) to level III (open repair with stent placement). Outcome measure was by functional evaluation of swallowing, voice, and airway. Injuries were rated from group 1 (minor trauma) to group 4 (massive laryngeal injury with multiple fractures). Sixty percent fell into group 1 or 2. Conservative management in these patients produced excellent results as measured by decannulation (100%), functional speech (100%), and normal deglutition (100%). Conversely, 2 of the 4 patients with group 3 or 4 injuries had persistent airway and/or voice complications despite more aggressive intervention. As the pediatric larynx is protected by pliable cartilage and a more craniad location in the neck, traumatic laryngeal injuries in children tend to be less severe than those in the adult population. Group 1 or 2 injuries respond well to conservative treatment. However, children with extensive laryngeal injuries may have more long-term sequelae.

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Pseudoarthrosis of second metatarsal fracture

La Pediatria Medica e Chirurgica ◽

10.4081/pmc.2018.205 ◽

2018 ◽

Vol 40 (2) ◽

Author(s):

Jessica Zanovello ◽

Barbara Bertani ◽

Redento Mora ◽

Gabriella Tuvo ◽

Mario Mosconi ◽

...

Keyword(s):

Clinical Outcome ◽

Good Clinical Outcome ◽

Non Union ◽

Fractures In Children ◽

Second Metatarsal ◽

Traumatic Fracture ◽

Metatarsal Fracture ◽

Metatarsal Fractures ◽

Foot Fractures

Metatarsal fractures make up the greatest portion of foot fractures in children. Most of them are treated with closed reduction and non-weightbearing cast immobilization.Usually, these fractures heal uneventfully and delay union and pseudoarthrosis are rare. We report a case of a 10-year-old child with non-union of the second metatarsal following a traumatic fracture, caused by an accident 10 months before, and treated successfully by osteosynthesis with plate and screws. Good clinical outcome was achieved at 2 years follow-up.

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Novel coronavirus and trauma surgery: successful infection control from a level I trauma centre

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-020-01435-9 ◽

2020 ◽

Vol 46 (4) ◽

pp. 737-741

Author(s):

Péter Jávor ◽

Endre Varga ◽

Károly Fekete ◽

Ferenc Tóth ◽

Petra Hartmann

Keyword(s):

Infection Control ◽

Trauma Surgery ◽

Trauma Centre ◽

Successful Infection ◽

Level I ◽

Novel Coronavirus

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P.082 Traumatic inter hemispheric subdural hematomas – clinical presentation, management and outcome

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2016.186 ◽

2016 ◽

Vol 43 (S2) ◽

pp. S39-S40

Author(s):

R Bokari ◽

S Schur ◽

C Couturier ◽

A Al-Azri ◽

J Marcoux ◽

...

Keyword(s):

Clinical Outcome ◽

Conservative Management ◽

Subdural Hematoma ◽

Trauma Center ◽

Complete Resolution ◽

Clinical Presentation ◽

Acute Subdural Hematoma ◽

Detailed Review ◽

Subdural Hematomas ◽

Level I

Background: There is currently little data on the incidence, clinical outcome and management of traumatic interhemispheric subdural hematomas (IHSDHs). Methods: All patients admitted with an acute subdural hematoma (SDH) over a 5-year period at a Level I trauma center were included. A detailed review of all cases of large IHSDH (≥7 mm) was performed to document clinical presentation, management and outcomes. Results: Of 1182 patients with acute subdural hematomas (SDHs), 420 had IHSDHs (24%), and 50 were large IHSDHs. For patients with large IHSDH, the average age was 76 years (±11) and 44% were female. The average GCS was 12 on presentation (±4), and the average GOSE was 4 (±2). 66% of patients had associated cranial/ intracranial injuries (fracture, subarachnoid/epidural/SDH) and 26% required operations for acute convexity SDH. Three patients required operations for their IHSDH by inter hemispheric approach. By 10 weeks, 82% had a complete resolution of the IHSDHs. Conclusions: IHSDHs are often referred to as rare entities. Our results show they are common. Conservative management is often appropriate to manage even large IHSDHs, as most resolve spontaneously. This study will help document the occurrence of falx syndrome, as well as the management and outcomes of larger IHSDHs.

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Operative versus conservative treatment of apophyseal avulsion fractures of the pelvis in the adolescents: a systematical review with meta-analysis of clinical outcome and return to sports

BMC Musculoskeletal Disorders ◽

10.1186/s12891-017-1527-z ◽

2017 ◽

Vol 18 (1) ◽

Cited By ~ 29

Author(s):

H. Eberbach ◽

L. Hohloch ◽

M.J. Feucht ◽

L. Konstantinidis ◽

N.P. Südkamp ◽

...

Keyword(s):

Conservative Treatment ◽

Clinical Outcome ◽

Meta Analysis ◽

Return To Sports ◽

Avulsion Fractures ◽

Systematical Review

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Did Amendments to the Ontario Highway Traffic Act in 2009-2010 Affect the Proportion of Alcohol-Related Motor Vehicle Collisions Seen at a Level I Trauma Centre over a 10-year Period?

CJEM ◽

10.1017/cem.2016.343 ◽

2016 ◽

Vol 19 (2) ◽

pp. 106-111

Author(s):

Meghan Garnett ◽

Tanya Charyk Stewart ◽

Michael R Miller ◽

Rodrick Lim ◽

Kristine Van Aarsen ◽

...

Keyword(s):

Injury Severity ◽

Trauma Registry ◽

Motor Vehicle ◽

Trauma Centre ◽

Trauma Patients ◽

Highway Traffic ◽

Motor Vehicle Collisions ◽

Vehicle Collisions ◽

Level I ◽

Legislative Amendments

AbstractObjectivesTo determine if changes to the Ontario Highway Traffic Act (OHTA) in 2009 and 2010 had an effect on the proportion of alcohol-related motor vehicle collisions (MVCs) presenting to a trauma centre over a 10-year period.MethodsA retrospective review of the trauma registry at a Level I trauma centre in southwestern Ontario was undertaken. The trauma registry is a database of all trauma patients with an injury severity score (ISS) ≥12 and/or who had trauma team activation. Descriptive statistics were calculated. Interrupted time series analyses with ARIMA modeling were performed on quarterly data from 2004-2013.ResultsA total of 377 drivers with a detectable serum ethanol concentration (SEC) were treated at our trauma centre over the 10-year period, representing 21% of all MVCs. The majority (330; 88%) were male. The median age was 31 years, median SEC was 35.3 mmol/L, and median ISS was 21. A total of 29 (7.7%) drinking drivers died from their injuries after arriving to hospital. There was no change in the proportion of drinking drivers after the 2009 amendment, but there was a significant decline in the average SEC of drinking drivers after changes to the law. There was no difference in the proportion of drinking drivers ≤21 years after introduction of the 2010 amendment for young and novice drivers.ConclusionsThere was a significance decline in the average SEC of all drinking drivers after the 2009 OHTA amendment, suggesting that legislative amendments may have an impact on drinking before driving behaviour.

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