concomitant injury
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Vestnik ◽  
2021 ◽  
pp. 102-106
Author(s):  
Е.К. Дюсембеков ◽  
А.Р. Халимов ◽  
Л.Н. Танашева ◽  
И.Т. Курмаев ◽  
А.С. Жайлаубаева ◽  
...  

Проведено клинико-неврологическое и инструментальное исследование смерти мозга у 23 пациентов с тяжелой черепно-мозговой травмой за 2020 год. Результаты исследования показали, что летальность в первые 72 часа была в 14 случаях - 60,9%. Досуточная летальность составила 9 случаев - 39,1 %. Пациенты трудоспособного возраста составили 83%. В большинстве случаев клиническая картина смерти мозга осложнялась наличием травм лица, спонтанными или индуцированными автоматизмами, ушибом легких при сочетанной травме. В данной статье описаны виды клинических исследований, используемых в диагностике смерти мозга, в сложных случаях дополнительных подтверждающих тестов. Research has been done of 23 patients with а severe traumatic brain injury (TBI) in 2020. Outcomes of our research have indicated mortality in the first 72 hours was in 14 cases - 60,9%.And the first day lethality was 9 cases - 39,1%. The significant quantity of working age patients amounts to 83%. Generally, brain death in any patient with catastrophic brain injury and a bedside exam consistent with brain death complicated by facial injuries, spontaneous or induced automatism, lungs contusion with concomitant injury. The article describes types of clinical examination, used in the definition of brain death. In complicated cases, supplementary confirm tests.


2021 ◽  
Vol 103-B (9) ◽  
pp. 1526-1533
Author(s):  
Carsten Schoeneberg ◽  
Bastian Pass ◽  
Ludwig Oberkircher ◽  
Katherine Rascher ◽  
Matthias Knobe ◽  
...  

Aims The impact of concomitant injuries in patients with proximal femoral fractures has rarely been studied. To date, the few studies published have been mostly single-centre research focusing on the influence of upper limb fractures. A retrospective cohort analysis was, therefore, conducted to identify the impact and distribution of concomitant injuries in patients with proximal femoral fractures. Methods A retrospective, multicentre registry-based study was undertaken. Between 1 January 2016 and 31 December 2019, data for 24,919 patients from 100 hospitals were collected in the Registry for Geriatric Trauma. This information was queried and patient groups with and without concomitant injury were compared using linear and logistic regression models. In addition, we analyzed the influence of the different types of additional injuries. Results A total of 22,602 patients met the inclusion criteria. The overall prevalence of a concomitant injury was 8.2% with a predominance of female patients (8.7% vs 6.9%; p < 0.001). Most common were fractures of the ipsilateral upper limb. Concomitant injuries resulted in prolonged time-to-surgery (by 3.4 hours (95 confidence interval (CI) 2.14 to 4.69)) and extended length of stay in hospital by 2.2 days (95% CI 1.74 to 2.61). Mortality during the admission was significantly higher in the concomitant injury group (7.4% vs 5.3%; p < 0.001). Additionally, walking ability and quality of life were reduced in these patients at discharge. More patients were discharged to a nursing home instead of their own home compared to patients without additional injuries (25.8% vs 30.3%; p < 0.001). Conclusion With a prevalence of 8.2%, the appearance of a concomitant injury is common in elderly patients with hip fracture. These patients are at a greater risk for death during the admission, longer hospital stays, and delayed surgery. This knowledge is clinically important for all who are involved in the treatment of proximal femur fractures. Cite this article: Bone Joint J 2021;103-B(9):1526–1533.


2021 ◽  
pp. 55-62
Author(s):  
O. A. Alekseechkina ◽  
L. T. Khamidova ◽  
A. K. Shabanov ◽  
G. P. Titova ◽  
V. Ya. Kiselevskaya-Babinina

Purpose. According to the assessment of liver hemodynamics, to determine the criteria for the probability of death in patients with severe concomitant injury and to establish the decisive time range in which these indicators are prognostic.Material and methods. The analysis of ultrasound (US) indicators in 57 patients with severe concomitant trauma was carried out in order to identify criteria for the probability of death and determine the time range in which these indicators have a prognostic character. All patients were divided into two groups: the first group of 40 surviving patients; the second of 17 dead. For comparison, three values were taken for each ultrasound indicator on the 1st, 3rd, 5th, 7th days from the moment of admission to the hospital. Comparison of the first and second groups of patients by these parameters revealed signs characterizing the violation of liver hemodynamics. The Mann-Whitney test, correlation analysis and stepwise logistic regression were used to study the relationships. Differences were considered statistically significant at a significance level of p < 0.05. Correlation was considered strong when R > 0.5. The best reliable regression model was chosen according to the highest value of the Akaike criterion.Results. In the first three days after trauma in patients of the first and second groups, the most significant were such ultrasound signs as a decrease in the diameter of the own hepatic artery (OHA), a decrease in the linear blood flow velocity (LBFV) along the SPA to 27–38 cm/s, and a decrease in volumetric blood flow in OHA, an increase in the index of resistance (IR) in OHA of more than 0.7, in combination, indicate liver dysfunction in patients in a state of traumatic shock. From the 5th day in the second group of patients, an increase in LBFV in the OHA (100–135 cm/s), an increase of 0.70–0.84, a decrease in volumetric blood flow less than 270 ml/min indicate violations of liver hemodynamics during the formation of organ dysfunction. On the 5–7th day, due to edema of the liver parenchyma against the background of an increase in the size of the liver and spleen and the formation of portal hypertension, arterialization of blood circulation occurs, which is characterized by a significant increase in LBFV in the OHA, a decrease in LBFV and volumetric blood flow in the portal vein. The third-fifth day after the injury can be considered a turning point – the correlation of most of the indicators with the fact of death and significant differences in the criterion in 9 out of 11 indicators indicate significant differences in all indicators in patients of the first and second groups. At the same time, not only dopplerographic indicators of hepatic blood flow, but also linear indicators of the size of the liver, spleen, signs of portal hypertension characterize the severity of the patient’s condition. Findings. 1). Carrying out an ultrasound of the liver with the use of Doppler ultrasound allows in the first 3 days from the moment of injury to conclude that there is liver dysfunction against the background of traumatic shock. 2). Statistical analysis of Doppler parameters of liver hemodynamics makes it possible to identify patients with a poor prognosis, severe liver dysfunction in the first 3–5 days from the moment of injury, as well as with developing multiple organ failure. 3). The obtained ultrasound results, indicating liver dysfunction in the early post-traumatic period, are confirmed by autopsy data.


2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Patrick Pflüger ◽  
Michael Zyskowski ◽  
Anne Weber ◽  
Katharina Gleisenberg ◽  
Chlodwig Kirchhoff ◽  
...  

Abstract Background Management of talar fractures remains to be one of the most challenging aspects in trauma surgery. Unfortunately, the evidence regarding the correct treatment of these fractures is mainly based on retrospective case series, while studies assessing the patient-reported outcome are rare. Therefore, the aim of this trial was to analyze the patient reported outcome in context of trauma mechanism and concomitant injuries following operative treatment of talar fractures. Methods A retrospective outcome study of patients with operatively treated talar fractures between 2003 and 2015 was conducted. The fractures were classified according to AO-/Hawkins classification system and to the Marti-Weber classification. Data was collected via patient registry, radiographs and a validated patient-reported outcome measure (PROM) for foot and ankle pathologies (Foot and Ankle Outcome Score = FOAS). An analysis regarding the functional outcome, concomitant injury and timing of surgery using the nonparametric Mann-Whitney U test and Spearman`s rank correlation was performed. Results In total the functional outcome of 32 patients suffering from fractures to the talus were analyzed. The median age of the study cohort was 35±12.2 years, including 9 female (28 %) and 23 male (72 %) patients. The median FAOS score was 72±22.7 (range 13–94). Patients with an isolated talar fracture had an FAOS of 87±20 and with concomitant injury a score of 60±23.4 (p = 0.016). Patients with a closed talar fracture without emergency operation due to dislocation or polytrauma, showed no correlation between timing of surgery and FAOS (r= -0.17, p = 0.43). 10 % of the patients developed an avascular necrosis and 25 % showed signs of a posttraumatic arthritis. The follow-up time was 41 months (range: 16–145). Conclusions Talar fractures were typically caused by high-energy trauma often associated with additional injuries of the lower extremity. The majority of the patients showed a fair to poor functional long-term outcome. Concomitant injuries of the lower extremity led to a lower FAOS. In closed talar fractures without the necessity of an emergency surgical intervention, time to surgery did not influence the patient reported outcome. Relating to the presented data, delayed surgery after soft tissue consolidation was not associated with a higher risk of developing an avascular necrosis.


2021 ◽  
Vol 100 (4) ◽  
pp. 133-140
Author(s):  
I.I. Babich ◽  
◽  
A.A. Pshenichniy ◽  
M.S. Avanesov ◽  
Yu.N. Melnikov ◽  
...  

Objective of the study: to improve the results of treatment of patients with depressed fractures of the cranial vault with concomitant trauma by developing a new technique of depressed fracture treatment. Materials and methods of research: from 2015 to 2020 at the Regional Children's Clinical Hospital, Rostov-on-Don, 80 children have undergone reconstructive surgical interventions for damage to the skull bones. Thirty patients with a depressed skull fracture, who underwent a one-stage reconstructive operation according to the method developed by the authors (patent № 2017143056 dated 08/12/17), and concomitant trauma made up the main group. Fifty patients, who underwent reconstructive correction of skull bone defects using the standard technique (cranioplasty with an allograft – titanium plate), made up a comparison group to analyze the effectiveness of the author's method of treating a depressed fracture. All children with concomitant injury underwent X-ray computed tomography (CT) of the brain, cervical spine, chest organs, abdominal cavity, pelvic bones, which made it possible to quickly diagnose and begin the required treatment. Results: no inflammatory changes were observed in the early/late postoperative period among 30 children in the main group. Patients in satisfactory condition were discharged 10–12 days after surgery. Conclusion: the presented author's method of one-stage reconstructive surgery allows to improve the results of treatment of patients with depressed fractures of the cranial vault with concomitant injury and their quality of life in general. This method of correcting a depressed fracture of bones of the cranial vault in children has a significant economic effect due to reduction of the length of hospital stay of the inpatients and saves budgetary resources on alloplastic materials used for bone defect hiding. In the presence of a concomitant injury and the severity of the patient’s condition, it is necessary to perform an X-ray examination of the damaged organs and systems in order to quickly establish a diagnosis and prescribe appropriate treatment. In case of damage to several organs and systems requiring surgical treatment, at the first stage, surgical intervention for brain damage is recommended, in the second stage, in the absence of a life-threatening condition, on the same day or at delay, depending on the patient's condition, further surgical correction of other damaged organs and systems should be carried out.


Author(s):  
Andreas Harbrecht ◽  
Michael Hackl ◽  
Tim Leschinger ◽  
Kilian Wegmann ◽  
Dominik Seybold ◽  
...  

Abstract Introduction Radial head fractures account for the majority of bony elbow injuries. The individual treatment options have been described in detail. In some cases, however, an unusual concomitant injury occurs, which can significantly impede primary osteosynthesis and healing. This concomitant injury can be an interposing cartilaginous capitellar fragment. Methods This retrospective study describes four cases of trapped cartilage fragments of the capitellum that compromised primary osteosynthesis or primary conservative healing of a radial head fracture. Radiological imaging, function and pain level are presented pre- and postoperatively (mean follow-up 9.25 months). Results None of the four cases showed preoperative evidence of an incarcerated cartilage fragment of the capitellum. They all showed limited elbow range of motion. CT examinations were performed in all cases. In each case, the cartilage fragment was first sighted upon surgery, subsequently removed and the fractures treated with ORIF. Mean follow-up was of 9.25 months. All fractures healed, with excellent function and low pain scores. Conclusions This study presents rare cases of a trapped humeral cartilage fragment in radial head fractures. Radiological imaging including CT scans cannot reliably detect this concomitant injury. Therefore, this problem becomes apparent and treatable only during surgery. A high degree of suspicion is necessary especially in patients with minimally displaced fractures associated with limited elbow motion and a gap at the fracture site as treating these injuries conservatively may lead to poor outcome.


2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S34-S35
Author(s):  
Spogmai Komak ◽  
Chuantao Jiang ◽  
Rebecca Crocker ◽  
Saleem Khan ◽  
Daniel J Freet ◽  
...  

Abstract Introduction Concomitant traumatic injury in the burn patient complicates care coordination and increases morbidity and mortality. The incidence of concomitant injury, however, is uncommon and reported to range from 5–7%. In May 2020, our level 1 trauma center began seeing 40% more patients per month that the 12 months prior. We sought to determine the incidence of concomitant injury in burn patients during this time of increased trauma volume and to examine the associated traumatic injuries in this group. Methods The burn registry at a single ABA-verified burn center was examined from 5/20–9/20. Patients with concomitant burn and traumatic injury were examined with respect to: %TBSA burn, mechanism of injury, operative interventions, associated traumatic injuries, and length of hospital stay. Continuous data was presented as mean (standard deviation). Results Eighty-nine burn patients were admitted during this period, of whom 24 (26.9%) had concomitant traumatic injuries. The cohort was young and mostly male; the mean TBSA was 16% () (Table 1). The most common mechanism of injury was motor vehicle collision (12 or 50%), followed by fall after high voltage electrical injury (6 or 25%) and motorcycle collisions (5 or 21%). The most common associated injuries were: pulmonary contusions 29.1% (7/24); long bone fractures 25% (6/24); pelvic/acetabular fractures 20.8% (5/24); femur fractures 16.6% (4/24); and solid organ injury: 16.6% (4/24). Twenty patients (83.3%) required burn or trauma operative intervention during hospital stay. Of the 20 patients who required operative intervention, 85% underwent burn surgery and 55% underwent trauma surgery (solid organ or orthopedic). Forty percent of these patients required operation for both burn and traumatic injury. In looking specifically at the electric injury group, all six patients required operative intervention for burn injuries, and four required extremity fasciotomy. Patients with electrical injury had a significantly longer hospital stay relative to their TBSA (p&lt; 0.04). Conclusions Concomitant trauma and burn injuries are infrequent yet present a major clinical challenge. Our recent increase in overall trauma volume was paralleled by an increase in patients with concomitant burn injuries. The associated traumatic injuries require a multi-disciplinary approach to minimize morbidity and restore function.


2021 ◽  
Vol 9 (4) ◽  
pp. 606-611
Author(s):  
D. A. Khubezov ◽  
L. D. Khubezov ◽  
S. N. Trushin ◽  
A. Yu. Ogoreltsev ◽  
D. K. Puchkov ◽  
...  

Introduction. In our country, severe concomitant injury is one of the main causes of death among people of working age. This poses an urgent task for the national health care and education system in the form of training qualified emergency surgeons.Purpose of the study. To improve the quality of practical training of specialists in the delivery of urgent surgical care for concomitant injury.Material and methods. The “Cadaver course of operative surgery for severe concomitant injury” was developed. The participants of the cadaver course were senior students of the Ryazan State Medical University. At the stages of the course, theoretical training was carried out, work in a cadaver operating room with mentors and independently was performed, as well as a comparative assessment of learning outcomes with the results of similar tests of clinical residents of the 2nd year of study.Results. Statistically significant differences were obtained in terms of indicators reflecting the level of practical training of students who completed the developed course. The level of theoretical training in the compared groups did not differ significantly.Conclusion. New opportunities have been opened for the widespread introduction of the developed training course into the educational process. It is necessary to further improve the proposed methodology and study the results of its use.


2021 ◽  
pp. 028418512098157
Author(s):  
Ye Na Son ◽  
Jung Im Kim ◽  
Han Na Lee ◽  
So Youn Shin

Background Isolated sternal fracture, a benign injury, has been increasing in the pan-scan era, although one-third of patients with sternal fracture still has trouble with concomitant injury. The differentiation of these two entities is important to optimize patient management. Purpose To evaluate correlation between retrosternal hematoma and concomitant injury in patients with sternal fracture and to identify predicting factors for concomitant injury in sternal fracture. Material and Methods A total of 139 patients (84 men; mean age = 54.9 ± 15.3 years) with traumatic sternal fracture were enrolled in this study. We reviewed medical charts and multiplanar computed tomography (CT) images to evaluate cause, location, and degree of sternal fracture, retrosternal hematoma, and concomitant injury. Univariate and multivariate analysis were used to identify variables that were associated with concomitant injury. Results Concomitant injury on chest CT was observed in 85 patients with sternal fracture. Of the patients, 98 (70.5%) were accompanied by retrosternal hematoma. Multivariate analysis revealed that retrosternal hematoma (odds ratio [OR] = 5.350; P < 0.001), manubrium fracture (OR = 6.848; P = 0.015), and motor vehicle accident (OR = 0.342; P = 0.015) were significantly associated with sternal fracture with concomitant injury. Conclusion Manubrium fracture and retrosternal hematoma portend a high risk of concomitant injury and indicate the need for further clinical and radiologic work-up.


2021 ◽  
Vol 342 (9) ◽  
pp. 69-77
Author(s):  
I.M. Samokhvalov ◽  
A.N. Petrov ◽  
V.A. Reva ◽  
N.I. Myasnikov

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