Lower Extremity Trauma in Vehicular Front-Seat Occupants: Patients Admitted to a Level 1 Trauma Center

Abstract Introduction Combat-related injuries have declined substantially in recent years as we have transitioned to a low-volume combat casualty flow era. Surgeons must remain actively committed to training for the next engagement to maintain life and limb-saving skills. Soft tissue coverage procedures were imperative to the management of complex lower extremity trauma that occurred during recent conflicts. The purpose of this study was to evaluate advanced soft tissue coverage procedures performed on the lower extremity over the previous decade on military and civilian trauma patients at a Department of Defense Level 1 trauma center to provide data that can be used to guide future training efforts. Materials and Methods The electronic surgical record system was searched for cases that utilized advanced soft tissue coverage (rotational and free flaps) to the lower extremity. The date of treatment, indication, procedure performed, and military/civilian patient designation were recorded. The data was categorized between military and civilian cases, rotational versus free flap, and indication and then charted over time. It was assessed as moving averages over a 12-month period. Statistically distinct periods were then identified. Results From January 2006 to March 2015, 132 advanced soft tissue coverage procedures were performed on the lower extremity (100 military, 32 civilian). Military soft tissue coverage data demonstrated peaks in 2007 and late 2011 to late 2012, averaging 6.5 (3.5–9.6) and 4.5 (3.2–5.8) per quarter, respectively. There were two low periods, from 2008 to mid-2010 and from mid-2012 to the end of the study, averaging 1.1 (0.6–1.6) and 1.8 (1.1–2.6) cases per quarter, respectively. Civilian procedures averaged 0.9 per quarter (0.5–1.2) throughout the study, but notably were equal to the number of military procedures by the last quarter of 2013 at 2.0 (1.2–2.8 civilian, 0.8–3.1 military). Conclusions This data supports prior identified trends in military cases correlating increased number of procedures with increased combat activity related to the conflicts in Iraq and Afghanistan in 2007 and 2011, respectively. The data showed relative stability in the numbers of civilian procedures with a slight uptrend beginning in mid-2012. A comparison after mid-2012 shows military procedures declining and civilian procedures increasing to eventually become equivalent at the end of the data collection. These trends follow previously reported data on tibia fracture fixation procedures and lower extremity amputations for the same time periods. These data demonstrate the importance of the civilian trauma mission for maintaining surgical skills relevant to limb salvage, such as rotational and free flaps, during a low-volume combat casualty flow era.

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Impact of Establishing A Level-1 Trauma Center For Lower Extremity Trauma: A 4-Year Experience

10.21203/rs.3.rs-710234/v1 ◽

2021 ◽

Author(s):

Min Ji Kim ◽

Kyung Min Yang ◽

Hyung Min Hahn ◽

Hyoseob Lim ◽

Il Jae Lee

Keyword(s):

Lower Extremity ◽

Limb Salvage ◽

External Fixator ◽

Trauma Center ◽

Emergency Operation ◽

Trauma Patients ◽

Soft Tissue Reconstruction ◽

Primary Amputation ◽

Level 1 ◽

Level 1 Trauma Center

Abstract Purpose: A multidisciplinary approach is essential for trauma patients’ treatment, particularly for cases with open lower extremity fractures, which are considered major traumas requiring a comprehensive approach. Recently, the social demand for severe-trauma centers has increased. This study analyzed the clinical impact of establishing a trauma center for the treatment of open lower extremity fractures.Methods: A retrospective chart review was conducted for trauma patients admitted to our hospital. Patients were classified into two groups: before (January 2014–December 2015, 178 patients) and after establishment of a Level-1 trauma center (January 2017–December 2018, 125 patients). We included patients with open fracture below the knee level and Gustilo type II/III, but excluded those with life-threatening trauma that affected the treatment choice.Results: Total 273 patient were included in this study, initial infection was significantly more common and external fixator application significantly less in post-center establishment group. The time to emergency operation decreased significantly from 13.89 ± 17.48 to 11.65 ± 19.33 hours post-center setup. By multivariate analysis, the decreased primary amputation and increased limb salvage was attributed to establishment of the trauma center. Conclusion: With the establishment of the Level-1 trauma center, limbs of patients with open lower extremity fractures could be salvaged, and the need for primary amputation was decreased. Early control of initial open wound infection and minimizing external fixator use allowed early soft tissue reconstruction. The existence of the center ensured a shorter interval to emergency operation and facilitated interdepartmental cooperation, which promoted active limb salvage and contributed to patients’ quality of life.

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PEDIATRIC ORTHOPAEDIC TRAUMA AND ASSOCIATED INJURIES AT AN INNER-CITY LEVEL 1 TRAUMA CENTER

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00114 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0011

Author(s):

Michael Levidy ◽

Rahul Rai ◽

Alice Chu ◽

Neil Kaushal ◽

O. Folorunsho Edobor-Osula

Keyword(s):

Lower Extremity ◽

Inner City ◽

Trauma Center ◽

Pediatric Patients ◽

Orthopaedic Trauma ◽

Associated Injuries ◽

Tibia Fractures ◽

Pediatric Orthopaedic ◽

Level 1 ◽

Level 1 Trauma Center

Background/Purpose: Pediatric orthopaedic trauma in inner city communities often present with unique and modifiable risk factors. The purpose of this study was to characterize and evaluate the pattern and nature of orthopaedic and associated injuries in pediatric patients involved in motor vehicle accidents (MVA), falls, sports related injuries and pedestrian struck either on foot or on bicycle at an inner-city level 1 trauma center. Methods: 260 pediatric patients who presented to the emergency department after a fall, a sports related injury, MVA, pedestrian struck on foot (PSoF), or pedestrians struck on bicycle (PSoB) with orthopaedic injuries at our institution between 2013 and 2020 were retrospectively reviewed. Results: The mean age of our cohort was 9.1 years (SD ±4.60). 36.5% (95/260) were girls, 63.5% (165/260) were boys. There were a total of 260 patients with a total of 331 fractures. 96.3% (319/331) of the fractures were appendicular while 3.6% (12/331) were axial. 43.8% (114/260) of patients had lower extremity fractures and 49.2% (128/260) had upper extremity fractures. Of all mechanisms, MVAs were most commonly associated with axial fractures (p<0.01). Falls were associated most commonly with upper extremity fractures (p<0.01), lower patient age (p<0.01) and negatively correlated with lower extremity fractures (p<0.01). Sports related injuries were most commonly correlated with tibia fractures (p<0.01). Sports etiologies were subdivided into Basketball (29%), Football (27%), Soccer (11%), and other physical activities like Rollerblading (11%) and Skateboarding (9%). PSoF was associated with tibia fractures (p<0.05) and open fractures (p<0.01). PSoB was the most likely mechanism to lead to lower extremity fractures (p=0.01) and head trauma (p<0.01). 75% (6/8) of PSoB were not wearing a helmet at the time of injury. Conclusion: Not surprisingly, falls represent the most common mechanism of pediatric orthopaedic injury. Other mechanism of injuries included MVAs, pedestrian struck on foot or bicycle were associated with more significant trauma including vertebral fractures, open fractures, head trauma and compartment syndrome. Preventative measures including education on car seat and seat belt use, helmet use and bicycle safety in children may reduce the incidence of these serious injuries. [Figure: see text]

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The Insensate Foot Following Severe Lower Extremity Trauma: An Indication for Amputation?

Yearbook of Orthopedics ◽

10.1016/s0276-1092(08)70396-1 ◽

2006 ◽

Vol 2006 ◽

pp. 95-97

Author(s):

M.F. Swiontkowski

Keyword(s):

Lower Extremity ◽

Lower Extremity Trauma ◽

Extremity Trauma

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Faculty Opinions recommendation of [CONFERENCE POSTER]: Outcomes of endoscopic realignment of blunt posterior urethral injuries at a Level 1 trauma center.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.11414968.12436067 ◽

2011 ◽

Author(s):

Sanjay Kulkarni

Keyword(s):

Trauma Center ◽

Level 1 ◽

Level 1 Trauma Center ◽

Urethral Injuries

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Identifying trauma patients with benefit from direct transportation to Level-1 trauma centers

BMC Emergency Medicine ◽

10.1186/s12873-021-00487-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Charlie A. Sewalt ◽

Benjamin Y. Gravesteijn ◽

Daan Nieboer ◽

Ewout W. Steyerberg ◽

Dennis Den Hartog ◽

...

Keyword(s):

Logistic Regression ◽

Trauma Center ◽

Trauma Patients ◽

Trauma Centers ◽

Absolute Benefit ◽

Predicted Probability ◽

Prehospital Triage ◽

Level 1 ◽

Level 1 Trauma Center ◽

Level 2

Abstract Background Prehospital triage protocols typically try to select patients with Injury Severity Score (ISS) above 15 for direct transportation to a Level-1 trauma center. However, ISS does not necessarily discriminate between patients who benefit from immediate care at Level-1 trauma centers. The aim of this study was to assess which patients benefit from direct transportation to Level-1 trauma centers. Methods We used the American National Trauma Data Bank (NTDB), a retrospective observational cohort. All adult patients (ISS > 3) between 2015 and 2016 were included. Patients who were self-presenting or had isolated limb injury were excluded. We used logistic regression to assess the association of direct transportation to Level-1 trauma centers with in-hospital mortality adjusted for clinically relevant confounders. We used this model to define benefit as predicted probability of mortality associated with transportation to a non-Level-1 trauma center minus predicted probability associated with transportation to a Level-1 trauma center. We used a threshold of 1% as absolute benefit. Potential interaction terms with transportation to Level-1 trauma centers were included in a penalized logistic regression model to study which patients benefit. Results We included 388,845 trauma patients from 232 Level-1 centers and 429 Level-2/3 centers. A small beneficial effect was found for direct transportation to Level-1 trauma centers (adjusted Odds Ratio: 0.96, 95% Confidence Interval: 0.92–0.99) which disappeared when comparing Level-1 and 2 versus Level-3 trauma centers. In the risk approach, predicted benefit ranged between 0 and 1%. When allowing for interactions, 7% of the patients (n = 27,753) had more than 1% absolute benefit from direct transportation to Level-1 trauma centers. These patients had higher AIS Head and Thorax scores, lower GCS and lower SBP. A quarter of the patients with ISS > 15 were predicted to benefit from transportation to Level-1 centers (n = 26,522, 22%). Conclusions Benefit of transportation to a Level-1 trauma centers is quite heterogeneous across patients and the difference between Level-1 and Level-2 trauma centers is small. In particular, patients with head injury and signs of shock may benefit from care in a Level-1 trauma center. Future prehospital triage models should incorporate more complete risk profiles.

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