EP.TU.854Happy Patients and Updated Open Wound Management Protocols

Introduction Open injuries have a potential for serious bacterial wound infections and may lead to long term disabilities, chronic wound or bone infection, and even death. This QI study was undertaken to ring in changes to the current management protocol and align them as per WHO guidelines. Method Implementing changes through a Plan-Do-Study-Act (PDSA) cycle post an initial clinical audit among 38 patients of the organization. Re-audits were done to measure the outcome against the standard and establish a new protocol. Results Initial audit showed only a dismal 37% (n = 14) of patients being managed as per WHO protocol. Patient satisfaction percentage (as measured by a questionnaire) was also low with only 54% of patients satisfied with the treatment. Significant variations were noted post implementation of changes after the first PDSA cycle where >90% (n = 35) of patients reported that they noticed better wound healing, transition to optimal performance and were satisfied with treatment outcomes. Conclusions Timely wound dressings, appropriate antibiotic prophylaxis and increased patient’s awareness on wound hygiene through means of regular educational sessions and updated management protocols have led to healthier patients, lesser long term disabilities and happy patients.

Оrganizational aspects of primary health care for personal skeleton damage caused by road traffic accidents

The purpose of the study. Study the organizational aspects of providing primary health care for victims with the facial department of the skeleton as a result of traffic accidents. Materials and methods. To achieve this goal, a retrospective study was conducted. The work included victims of road accidents with damage to the facial part of the skull between the ages of 18 and 70 years. In total, 150 victims were included in the study between 2000 and 2019. Results of the study and their analysis. The study shows that injuries to the facial skeleton as a result of traffic accidents are relevant. As a result of the study, it was found that as a result of an accident, there is approximately the same number of closed and open injuries. At the same time, open injuries, which could be regarded as medium and severe, were identified in 45 (30%) cases. In addition, data analysis showed that in 30,7% of observations, first aid was provided by random witnesses and/ or relatives of victims who did not have the skills and necessary knowledge to provide such assistance. In addition, an additional 19,3 per cent of first aid was provided by staff of various services who have some knowledge and skills in first aid. This is due to the fact that in the first group, first aid was provided faster than in the second group. The lack of the necessary skills to provide first aid to victims with such an injury can be explained by the rather high percentage of errors, which in the first group amounted to 18,7%, while employees of various services showed good results in providing such assistance and errors were not noted. Key words: primary health care, damage to the facial skeleton, traffic accident.

1334 Improving Patient Flow Through the Hand Trauma Pathway

Aim A full-cycle audit was conducted at our plastic surgery unit, assessing adherence to hand trauma standards by the British Society for Surgery of the Hand. These stipulate that time from referral to clinic for open injuries and closed fractures should be within 24 hours and 72 hours respectively and time to theatre from date of injury (DOI) within 4 and 7 days, respectively. Method Data for the initial audit was collected from Nov 2019-Feb 2020 and for the re-audit from Aug-Dec 2020. Lists were generated of 50 patients with open injuries including flexor tendon, extensor tendon and nerve injuries and 50 hand fractures in both cycles. Data was collected on DOI, date of referral, clinic review and surgery. Results The initial audit results showed poor DOI documentation (open injuries 30%, fractures 54%). For open injuries, 44% met standards for clinical review within 24 hours and 94% for time to theatre. For fractures, 94% met the standard for time to clinic and 90% for time to theatre. The interventions included adding the standards to the clinic booking form and creating a mandatory DOI field on the referral system. The re-audit showed improvement of DOI documentation (open injuries 95%, fractures 100%) and the proportion of open injuries seen within 24 hours to 60%. Conclusions The interventions had a positive impact on our hand trauma pathway. Areas for improvement include reducing the number of patient visits to the service and encouraging early decision-making, particularly for patients reviewed in the emergency department.

A cross-sectional study on the impact of the prevention and control response of the COVID-19 pandemic on minor’s orthopedic trauma in Shanghai

Background The Chinese government has taken strong prevention and control measures against the COVID-19 pandemic. Although the pandemic is far from over, it has been effectively controlled in China. The outbreak of COVID-19 pandemic provides an opportunity to study the influence of governmental prevention and control response on orthopedic trauma in minors. Methods We collected and reviewed data and information on minor’s orthopedic trauma from 1 January to 30 June of the past three year (2018, 2019 and 2020). The data were divided according to the time of prevention and control response level in 2020 (the first level response is from January 24 to March 22, the second level response is from March 23 to May 7, and the third level response is May 8 to now). By comparing the relevant data from orthopedic emergency and operating rooms from the past three years, the influence of governmental pandemic prevention measures on orthopedic trauma in minors was analyzed. Results A total of 36,301 minors were included in the study cohort. Before the prevention and control response, the data of the orthopedic emergency department of National Children Medical Center (Shanghai) in 2020 was the same as the previous two years. The condition of children undergoing surgery at the time of injury is significantly different under different levels of prevention and control response. Under the first-level response, the number of fractures, open injuries, radial head subluxation, and surgery were significantly reduced, and the severity of patients with surgery was also significantly reduced. Under the second-level response, the number of operations began to increase, and the severity of the disease also began to rise. Under the third-level response control, the number of fractures, open injuries, and operations have returned to the levels of the previous two years. The severity of the operation has also returned to its previous level. The number of subluxations of the radial head is still different from before. Conclusion The prevention and control response for the pandemic of COVID-19 can reduce the incidence of orthopedic trauma in minors by strengthening the guardian’s care and restricting children’s outdoor activities. With the control of the pandemic, the amount of orthopedic trauma in minors will not be affected by low-level prevention and control.

Vector Appropriate Distraction and Reduction of a Neglected Trimalleolar Fracture-Dislocation Performed with a Temporary Intraoperative External Fixator

Traumatic fractures of the ankle can occur with concomitant tibiotalar dislocations, necessitating complex treatment. These injuries have higher rates of loose bodies, open injuries, postoperative complications, and worse patient reported outcomes compared to ankle fractures without dislocation. Patients with neglected or delayed presentations are associated with even higher rates of postoperative complications and worse outcomes compared to acute injuries. The chronicity of the injury leads to soft tissue contractures and malunited fractures, obligating a care plan which involves gradual reduction with a multiplanar external fixator with or without internal fixation at a later date. We discuss a 60-year-old homeless man who presented four weeks after an open trimalleolar fracture-dislocation and was definitely treated with an acute one-stage procedure. Anatomic reduction and stable fixation was achieved through a lateral malleolus osteotomy, soft tissue releases, TAL, and a temporary intraoperative external fixator. This technique was advantageous in this instance of anticipated patient noncompliance. We advocate for the judicious use of the described technique in similar challenging situations.

Current concepts in diagnosis and management of common upper limb nerve injuries in children

Peripheral nerve injuries (PNI) of the upper limb are a common event in the paediatric population, following both fractures and soft tissues injuries. Open injuries should in theory be easier to identify and the repair of injured structures performed as soon as possible in order to obtain a satisfying outcome. Conversely, due to the reduced compliance of younger children during clinical assessment, the diagnosis of a closed nerve injury may sometimes be delayed. As the compliance of patients is influenced by pain, anxiety and stress, the execution of the clinical manoeuvres intended to identify a loss of motor function or sensibility, can be impaired. Although the majority of PNI are neuroapraxias resulting in spontaneous recovery, there are open questions regarding certain aspects of closed PNI, e.g. when to ask for electrophysiological exams, when and how long to wait for a spontaneous recovery and when a surgical approach becomes mandatory. The aim of the article is therefore to analyse the main aspects of the different closed PNI of the upper limb in order to provide recommendations for timely and correct management, and to determine differences in the PNI treatment between children and adults.

A cross-sectional study on the impact of the prevention and control response of the COVID-19 pandemic on children's orthopedic trauma in Shanghai

Background: The Chinese government has taken strong prevention and control measures against the COVID-19 pandemic, and has achieved phased victory in the fight against it. The outbreak of COVID-19 pandemic provides an opportunity to study the influence of governmental prevention and control response on orthopedic trauma in children.Methods: We collected and reviewed data on orthopedic trauma from the first half of 2018, 2019, and 2020. The data were divided according to the time of prevention and control response level in 2020. By comparing the relevant data from orthopedic emergency and operating rooms from the past three years, the influence of governmental pandemic prevention measures on orthopedic trauma in children was analyzed. Results: A total of 36301 children were included in the study cohort. Before the prevention and control response, the data of the orthopedic emergency department in 2020 was the same as the previous two years. Under the first-level response, the number of fractures, open injuries, radial head subluxation, and surgery were significantly reduced, and the severity of patients with surgery was also significantly reduced. Under the second-level response, the number of operations began to increase, and the severity of the disease also began to rise. Under the third-level response control, the number of fractures, open injuries, and operations have returned to the levels of the previous two years. The severity of the operation has also returned to its previous level. The number of subluxations of the radial head is still different from before.Conclusion: The pandemic of COVID-19 has affected the social activities of Shanghai residents and reduced the incidence of orthopedic trauma in children. With the control of the pandemic, the living conditions of Shanghai residents have basically recovered.

Imaging foreign bodies in head and neck trauma: a pictorial review

Open injuries bear the risk of foreign body contamination. Commonly encountered materials include gravel debris, glass fragments, wooden splinters or metal particles. While foreign body incorporation is obvious in some injury patterns, other injuries may not display hints of being contaminated with foreign body materials. Foreign objects that have not been detected and removed bear the risk of leading to severe wound infections and chronic wound healing disorders. Besides these severe health issues, medicolegal consequences should be considered. While an accurate clinical examination is the first step for the detection of foreign body materials, choosing the appropriate radiological imaging is decisive for the detection or non-detection of the foreign material. Especially in cases of impaired wound healing over time, the existence of an undetected foreign object needs to be considered.Here, we would like to give a practical radiological guide for the assessment of foreign objects in head and neck injuries by a special selection of patients with different injury patterns and various foreign body materials with regard to the present literature.