Sepsis and multiple-organ failure are common sequelae of multiple trauma. Although sepsis is considered to result from bacteria translocating through the gut mucosa, evidence for that is lacking. In order to define the chronic involvement of bacterial translocation, fracture was induced after crushing of the right femor on its mid in 11 rabbits. Blood was collected at regular time intervals for quantitative culture and for estimation of endotoxins (LPS) by the QCL LAL-assay, tumor necrosis factor-alpha (TNFalpha) by a bioassay in L929 fibrosarcoma cell line and malondialdehyde (MDA) by HPLC. After death, segments of liver, lung and spleen were cut for quantitative culture. Mean +/−SE of the log10 of viable cells in blood were 2.48 +/− 0.43, 3.16 +/− 0.46, 2.77 +/− 0.69 and 2.12 +/− 0.43 at 2, 4, 24 and 48 hours after fracture. Respective values for LPS were 1.50 +/−0.29, 1.54 +/− 0.44, 1.17 +/− 0.17 and < 1.00; for MDA 3.57 +/− 0.55, 7.50 +/− 3.00, 15.77 +/− 12.26 and 5.07 +/− 2.18 μM; and for TNFalpha 11.8 +/− 1.2, 36.7 +/− 25.9, 40.7 +/− 24.0 and 56.8 +/− 45.3 pg/ml. Positive tissue cultures for Serratia marscecens and Pseudomonas aeruginosa were found for six rabbits. Median survival for animals drawn positive tissue cultures was 1.00 days and 7.00 days for animals with negative tissue cultures (p: 0.0092). It is concluded that bacterial translocation is a process occurring early in a significant percentage in the field of multiple trauma. Its occurrence is accompanied by rapid progression to death. Further research is mandatory to clarify the reasons favoring that process in certain hosts compared to others

Confirmation of cervical stability in multiple trauma patients is often difficult. Prolonged collar immobilization of these patients is often required. Missed injuries can be catastrophic. Since January 2000, the senior author has regularly applied a modification of the classical White & Panjabi stretch test in the operating room as a method of assessing cervical stability in qualifying trauma patients. Review of the first thirty cases finds two cases of stable ligamentous injury identified which would have otherwise been missed, a mean of almost two weeks’ collar immobilization eliminated and no missed instabilities, with no complications or assessment failures to date. The purpose of this study was to present the protocol and preliminary results of a modified White & Panjabi cervical stretch test in the assessment of cervical instability in multiple trauma patients. Multiple trauma patients having no radiographic evidence of cervical instability on static imaging are routinely protected in hard collars until able to cooperate with clinical assessment and/or undergo flexion/extension radiographs for concern to possible discoligame-nous instability in the neck. Beginning in January 2000, such patients who were going to the operating room were routinely assessed with a stress test incorporating fluoroscopically-controlled axial distraction to tensile limit of the neck followed by maximum passive flexion and extension stressing. In the absence of intersegmental hypermobility, cervical precautions and immobilization were considered unnecessary and discarded. Chart documentation was reviewed for outcome and complications after discharge from the hospital. To date thirty-two tests have been performed and twenty-six cases had complete chart documentation available for review. No complications of the procedure and no missed instabilities have been identified. An average of thirteen days’ collar immobilization were eliminated by this protocol. Two cases of ligamentous hypermobility without instability were identified, one at O/C1 and the other at C5/6; both patients were treated observationally and have done well. One case of an undisplaced C2 pedicle fracture in a massively traumatized geriatric case was confirmed as stable on the day of injury, eliminating the need for collar support until the patient died of multiple organ failure twenty-one days later. Two patients went on to have neck pain complaints on regaining consciousness, but could be reassured that there was no instability. The operating-room cervical stress test is a practical and safe maneuver that can eliminate the requirement for collar immobilization in obtunded trauma patients, safely identify subtle ligamentous injuries without frank instability, and confirm stability in cases of undisplaced fracture. The operating-room cervical stress test is an effective tool in screening trauma patients for such injuries. It does not require access to MRI technology and can be used in any hospital with an operating room. Prolonged cervical collar immobilization and missed discoligamentous injuries of the neck in multiple trauma patients can be eliminated with the application of this test

Dislocation and carpal fracture-dislocation are a rare injury, interesting capsula and ligaments, with a variable damage of the vascularization. Classification is difficult for the complexity on this lesion.

The aim of our work is to underline how the best final clinical result is achieved after an immediate treatment of reduction and stabilization of bone injury.

We considered two groups:

A: 13 patients, who have been observed since 1991 until 1998:

B: Another group is at short term is since July 2002 until 2005 and is in 20 patients with 21 wrists 1 is bilateral.

Finally we think that is necessary, to avoid the instability and pseudoartrosis on the scaphoid, to treat all the transcapholunate dislocation with open reduction and stabilisation, as agreed with literature.

Dislocation and carpal fracture-dislocation are a rare injury, interesting capsula and ligaments, with a variable damage of the vascularization. Classification is difficult for the complexity on this lesion.

The aim of our work is to underline how the best final clinical result is achieved after an immediate treatment of reduction and stabilization of bone injury.

We considered two groups:

A: 8 patients, who have been observed since july ’93 until 1996 ; all the patients were men who had work or car accidents, with outstretched upper extremity. The ages of the patients ranged from 19 to 34 years.. All patients were followed for an average of 8 years

1 is bilateral

3 wrists reoperated for lacking initial reduction or for the general initial condition

Assesment of the patients includeds clinical rating and roentgenografich analysis. The clinical scoring included pain, functional status, range of motion and grip strength.

Among the various classifications, we took into account the one proposed by Allieu, based on the radio-lunate ligament, consequently this classification offers an important prognostic factor.

In one of our cases there was assocciated a fracture of the radial stiloid, and in other one a posterior dislocation of the elbow.

We treated all the patients with a volar approach, the stabilitation of the carpus and scaphoid was achieved utilizing K wires in four cases, microscrew in two patients for scaphoid’s fracture and in other one the Herbert screw in the A group

In the B recent group we used in all cases K wiring, and herbert screw in 8 wrists, microscrews in one , and internal capsulodesis in the 2 last for perilunate isolated dislocation

The initial failing of reduction is due to an unstable reduction in very injured patient ( we use only k wire for the navicular)

10 patients in the second B group have been treated by the same first Author

After surgery treatment, the wrist was immobilizated in a splint for 6 weeks, then a careful mobilitation was started.

Finally we think that is necessary, to avoid the instability and pseudoartrosis on the scaphoid, to treat all the transcapho-lunate dislocation with open reduction and stabilitation, as agreed with literature.

The decision to salvage or amputate a severely injured limb is one of the most difficult an orthopaedic surgeon may face. The inclination to undertake heroic measures to save the limb should be tempered by the realization that doing so may lead to repeated hospitalizations, extensive complications, and a poor functional outcome.

Such a decision is rarely clear-cut. Several factors require consideration: the degree of damage to the extremity and the severity of the overall injury, as well as the nature of the patient’s physical, psychologic, social, and economic status, including such aspects as age, previous state of health, attitude, wishes, reliability, support system, life-style, occupation, and financial resources.

In this study We present 36 cases of severe limb injury with arterial damage. In our cases we evaluate the efficacy of limb injury scoring system like MESS score, MESI score, NISSSA score, LSI and PSI system in predicting results of limb saving surgery.

Scoring systems should be used only as a guide for decision making. The relative importance of each of the associated trauma parameters (with the exception of prolonged, warm ischaemia time or risking the life of a patient with severe, multiple organ trauma) is still of questionable predictive value. A good understanding of the potential complications facilitates the decision-making process in limb salvage versus amputation.

The subjective factors include such aspects as lifestyle, occupation, age, wishes, attitude, reliability, social support system, and financial resources. These considerations are perhaps more subjective, but undoubtedly important, for man is more than his framework of tendons, veins, and bones.

Introduction and Objective. In multiple trauma patients, as well as in the healing of isolated fractures (Fx) with heavy bleeding (trauma haemorrhage, TH), complications occur very often. This is particularly evident in elderly patients over 65 years of age. Since these accompanying circumstances strongly influence the clinical course of treatment, the influence of age on bone regeneration after femoral fracture and severe blood loss was investigated in this study. Materials and Methods. 12 young (17–26 weeks) and 12 old (64–72 weeks) male C57BL / 6J mice per group were examined. The fracture group Fx underwent an osteotomy after applying an external fixator. The THFx group also received blood pressure-controlled trauma hemorrhage (35 mmHg for 90 minutes) and reperfusion with Ringer's solution for 30 minutes. The Sham group received only the catheter and one external fixator. μCT scans of the femora were performed in vivo after 2 weeks and ex vivo after 3 weeks. Histological and biomechanical examinations were also carried out. The statistical significance was set at p ≤ 0.05. The non-normally distributed data were analyzed using the Mann-Whitney-U or Kruskal-Wallis test. Results. The histology showed less mineralized bone in the fracture gap in old animals of the Fx (25.41% [1.68%]) and THFx groups (25.50% [4.07%]) compared with the young ones (34.20% [6.36%], p = 0.003; 34.31% [5.12%], p=0.009). Moreover, a severe blood loss lead to more cartilage in both young (6.91% [5.08%]) and old animals (4.17% [1.42%]) compared to animals with only a fracture (2, 45% [1.04%], p=0.004; 2.95% [1.12%], p=0.032). In old animals (11.37 / nm. 2. [17.17 / nm. 2. ]) in contrast the young mice with an isolated fracture (33.6/nm. 2. [8.83/nm. 2. ]) fewer osteoclasts were present (p=0.009). Therefore, the severe blood loss further reduced the number of osteoclasts only in young animals (16.83/nm. 2. [6.07/nm. 2. ]) (p=0.004). In the in vivo μCT, after 2 weeks, a lower volume of bone, cortex and callus was found in old THFx animals (3.14 mm. 3. [0.64 mm. 3. ]); 1.01 mm. 3. [0.04 mm. 3. ]; 2.07 mm. 3. [0.57 mm. 3. ]) compared with the Fx animals (4.29 mm. 3. [0.74 mm. 3. ], p=0.008; 1.18 mm. 3. [0, 25 mm. 3. ], p=0.004; 3.02 mm. 3. [0.77 mm. 3. ], p=0.008) After 3 weeks, the ex vivo μCT scans also showed a reduced callus percentage in old THFx animals (61.18% [13.9 9%]), as well as a low number of trabeculae (1.81 mm. -1. [0.23 mm. -1. ]) compared to animals without blood loss (68.72% [15.71%], p = 0.030; 2.06mm. -1. [0.37mm. -1. ], p=0.041). In the biomechanical test, a reduced elasticity limit of the old THFx mice (7.75 N [3.33 N]) in contrast to the old Fx (10.24 N [3.32 N]) animals was shown (p=0.022). Conclusions. A severe blood loss has a higher negative effect on the healing, morphometry, and biomechanical properties of previously fractured femora in old compared to young individuals

Unstable chest wall injuries have high rates of mortality and morbidity. These injuries can lead to respiratory dysfunction, and are associated with high rates of pneumonia, sepsis, prolonged ICU stays, and increased health care costs. Numerous studies have demonstrated improved outcomes with surgical fixation compared to non-operative treatment. However, an adequately powered multi-centre randomized controlled study using modern fixation techniques has been lacking. We present a multi-centred, prospective, randomized controlled trial comparing surgical fixation of acute, unstable chest wall injuries with the current standard of non-operative management. Patients aged 16–85 with a flail chest (3 or more consecutive, segmental, displaced rib fractures), or severe deformity of the chest wall, were recruited from multiple trauma centers across North America. Exclusion criteria included: severe pulmonary contusion, severe head trauma, randomization>72 hours from injury, inability to perform surgical fixation within 96 hours from injury (in those randomized to surgery), fractures of the floating ribs, or fractures adjacent to the spine not amendable to surgical fixation. Patients were seen in follow-up for one year. The primary outcome was days free from mechanical ventilation in the first 28 days following injury. Secondary outcomes were days in ICU, rates of pneumonia, sepsis, need for tracheostomy, mortality, general health outcomes, pulmonary function testing, and other complications of treatment. A sample size of 206 was required to detect a difference of 2 ventilator-free days between the two groups, using a 2-tailed alpha error of 0.05 and a power of 0.80. A total of 207 patients were recruited from 15 sites across Canada and USA, from 2011–2018. Ninety-nine patients were randomized to non-operative treatment, and 108 were randomized to surgical fixation. Overall, the mean age was 53 years, and 75% of patients were male, with 25% females. The commonest mechanisms of injury were: motor vehicle collisions (34%), falls (20%), motorcycle collisions (14%), and pedestrian injuries (11%). The mean injury severity score (ISS) at admission was 26, and patients had a mean of 10 rib fractures. Eighty-nine percent of patients had pneumothorax, 76% had haemothorax, and 54% had pulmonary contusion. There were no differences between the two groups in terms of demographics. The final results will be available and presented at the COA meeting in Halifax. This is the largest randomized controlled trial to date, comparing surgical fixation to non-operative treatment of unstable chest wall and flail chest injuries. The results of this study will shed light on the best treatment options for patients with such injuries, help understand outcomes, and guide treatment. The final results will be available and presented at the COA meeting in Halifax

The aim was to investigate the outcomes of patients admitted with orthopaedic injuries to adult Level 1 trauma centres. All patients admitted to the two Level 1 adult trauma centres in Victoria, Australia were registered by the Victorian Orthopaedic Trauma Outcome Registry (VOTOR). Baseline data collected included age, gender and injury cause, diagnosis and management. Patients were contacted 6 months after their trauma. Pain, disability, health related quality of life and work status were determined using visual analogues scales, global disability scales, SF12 and the work subscale of the Sickness Impact Profile. Patients were categorized into 3 groups: isolated orthopaedic injury alone, multiple orthopaedic injuries alone and orthopaedic injuries and other injuries. Non-parametric tests were used to compare outcomes across these groups. Six month outcomes were determined in 75.6% of 1181 eligible patients. The patients lost to follow-up were more likely to be male, younger and have isolated injuries than those who were available for follow-up. Patients reported ongoing pain (moderate-severe pain 37.2%), disability (79.5%) and inability to return to work (35.2%). Poorer outcomes were evident in those who had other injuries than those with isolated or multiple orthopaedic injuries alone. A large proportion of patients presenting to adult Level 1 trauma centres have ongoing pain and disability and a reduced capacity to work 6 months after orthopaedic injuries. Further research into the long-term outcomes of these patients is required to identify patient sub-groups and specific injuries and treatments that result in high morbidity

5207 patients treated for a calcaneous fracture in Ontario between 1993–1999 were identified from population datasets and were reviewed to evaluate regional practice variation and complication rates for operatively and non-operatively managed calcaneous fractures. There was considerable geographic variation in treatment. Individuals in some parts of Ontario were almost eight times more likely to receive operative treatment than others. The majority of calcaneous fractures in Ontario are treated non-operatively, however the large observed practice variation suggests that there is disagreement among treating clinicians. Primary subtalar fusion has a high risk of post-operative infection and should therefore be considered very cautiously. The purpose of this study was to evaluate regional practice variation and complication rates for operatively and non-operatively managed calcaneous fractures. The majority of calcaneous fractures in Ontario are treated non-operatively, however the large observed practice variation suggests that there is disagreement among treating clinicians. Primary subtalar fusion has a high risk of post-operative infection and should therefore be considered very cautiously. Given the observed regional variation in management of calcaneous fractures more work needs to be done to address this issue. 5207 fractures of the calcaneous in Ontario between 1993–1999were identified from population datasets. Regional variations in treatment and complication rates were computed. Multiple linear regression was used to identify factors associated with complications. There was considerable geographic variation in treatment. Individuals in some parts of Ontario were almost eight times more likely to receive operative treatment than others. General surgeons or general practitioners definitively treated 30% of patients (almost all closed). Overall rate of complications was low, however there was a 13.4 percent infection rate following immediate subtalar fusion. Infection was 5.3% following ORIF and 0.6% following closed treatment. Infection risk was increased in multiple trauma patients and those with open fractures. Subsequent subtalar fusion rates (within the study period) were higher in multiple trauma patients, but were not associated with treatment (open or closed). Amputation was 22.5 times more likely following open calcaneous fractures but the overall amputation rate was only 0.17%. No relationship between surgeon experience and the rate of complications following operative treatment was identified

Purpose of the study: Transversal or «U» fractures of the sacrum are rare. Reported for the first time by Bonin in 1945, such fractures concern less than 1% of spinal fractures. Initially, these injuries were often missed despite their association with neurological disorders such as caudia equina syndrome. This late diagnosis is related to the context of multiple trauma and also to insufficient knowledge of this type of injury. The purpose of this study was to draw clinicians’ attention to this type of injury in order to favor early diagnosis and appropriate treatment. Material and methods: This series included nine cases observed from 1999 to 2002. Mean age was 32 years, range 17–80. Female gender predominated (two-thirds of the patients). Six patients were fall victims, (suicide attempts or scaffold accidents). For eight patients, neurological signs involved a complete S1 or S2 caudia equina syndrome. L5 paralysis was noted in one patient due to a far-out syndrome. The diagnosis was established late in four patients, 2 to 45 days after trauma. Surgical treatment was instituted for six patients with neurological disorders diagnosed early. Treatment consisted in fracture reduction, posterior decompression and posterolateral stabilization. Intraoperative exploration revealed caudia equina contusion and compression in five of six patients with no loss of continuity. The sixth patient presented nearly complete root section. Results: Eight of the nine patients were followed and reviewed at 2 years 4 months on average. The patient with a root section committed suicide four months postoperatively. Neurological recovery was complete for the five other patients who underwent surgery. Motor, sensorial and sphincter function and the urodynamic study were normal at last follow-up. L5 paralysis recovered last. For the two non-operated patients, only one achieved partial recovery. Discussion: U fracture of the sacrum is a triple plane fracture which is difficult to explore with plain x-rays. In the context of a multiple trauma victim or attempted suicide, neurological complications are difficult to detect, further retarding the diagnosis of fracture. Roy Camille, Coutallier, Hessman report frequent misdiagnosis of the initial fracture and emphasize the contribution of computed tomography for correcting the diagnosis and establishing the surgical strategy. Surgery is the best option for improving prognosis, both in terms of neurological recovery and lumbopelvic stability. Conclusion: Emergency physicians, neurosurgeons and orthopedist should be aware of U fractures of the sacrum, particularly in high-energy fall victims. A better clinical approach, particularly systematic examination of the perineum, is the key to successful diagnosis and proper orientation of the x-ray work-up to establish a positive diagnosis and improve the therapeutic approach

We retrospectively reviewed 100 consecutive cases of foot trauma, sometimes accompanied by other injuries, in people who had instituted legal proceedings to recoup losses after motor vehicle accidents. To keep matters in their correct perspective, it must be noted that claims on a contingency basis were not acceptable at the time of this review. We excluded from the study patients with only minor foot injuries and significant other injuries. There was significant foot trauma in 14% of the reviewed motor vehicle accident cases, and 75% of patients had significant other injuries. Of patients who had suffered only foot trauma, 32% were male and 68% female. Their mean age was 36 years and the review was conducted a mean of 28 months after injury. Of those who suffered multiple injuries, 65% were male and 35% female. Their mean age was 34 years and the review conducted a mean of 21 months after injury. Combining the effects of patients’ other injuries but reviewing foot injuries separately, we assessed the long-term impact of the injuries as minimal, slight, moderate, severe or very severe. Nearly 50% of the foot injuries had a severe or very severe long-term impact, involving loss of amenities of life and the ability to earn a living. In 44% of the multiple trauma cases, the foot injury alone would cause significant loss of income. In about 30% of these cases the other injuries would have a similarly negative effect. We estimated that 60% of foot injures and 40% of other injuries would later come to need surgical treatment. When we assessed the quality of care the patients received, we found that 50% of those with only foot injuries and 40% of those with foot and other injuries had not been given optimal treatment for their foot injuries. In 15% of cases the other injuries could have received better treatment. Our review showed that foot injuries sustained in motor vehicle accidents can have serious long-term effects. However, because they are not life-threatening, at the time of the accident foot injuries receive suboptimal treatment. In multiple trauma patients, foot injuries should not be overlooked. Optimal treatment will improve the final outcome and enjoyment of life of motor vehicle accident victims

Purpose. In patients with multiple trauma delayed fracture healing is often diagnosed, but the pathomechanisms are not well known yet. The purpose of the study is to evaluate the effect of a severe hemorrhagic shock on fracture healing in a murine model. Methods. 10 male C57BL/6N mice per group (Fx, TH, THFx, Sham) and point in time were used. The Fx-group received an osteotomy after implantation of a fixateur extern. The TH-group got a pressure controlled hemorrhagic shock with a mean arterial blood pressure of 35 mmHg over 90 minutes. Resuscitation with 4 times the shed blood volume of Ringer solution was performed. The THFx group got both. Sham-animals received the implantation of a catheter and a fixateur extern but no blood loss or osteotomy. After 1, 2, 3, 4 or 6 weeks the animals were sacrificed. For the biomechanics the bones were analyzed via X-ray, µCT and underwent a 3-point bending test. The nondecalcified histology based on slices of Technovit 9100. The signaling pathway was analyzed via RT. 2. Profiler™ PCR Array Mouse Osteoporosis, Western Blot and Quantikine ELISA for RankL and OPG. Statistical significance was set at p < 0.05. Comparisons between groups were performed using the Mann–Whitney U (Fx vs. THFx) or Kruskal-Wallis Test (other groups). Results. The experiment showed that after 1 week the bones of the Fx- and THFx-mice were macroscopically instable. After 2 weeks the Fx-group showed macroscopically a stable bridging whereas the bones of the THFx-group were partly not stable bridged. 3 weeks after surgery the bones of both groups were stable bridged. Analysis via µCT showed that trauma hemorrhage leads to decreased density of the bone and callus and also to increased share of callus per bone volume after 2 weeks. The 3-point-bending test showed that the maximum bending moment is decreased in the group THFx compared to Fx after 2 weeks. The studies of the histology showed after 2 weeks a decrease in bone and cartilage after trauma-hemorrhage by optical analysis of photographs of the slices. The analyses of the signaling pathway pointed to an involvement of the RankL/Opg and IL6 pathway. Conclusion. A hemorrhagic shock has a negative effect on fracture healing in terms of reduced density of the bone and callus, increased share of callus per bone volume, decreased maximum bending moment, reduced mineralization of the callus and leads to changes in the RankL/Opg and IL6 pathways

Purpose: Injury of both cruciate ligaments raises difficult therapeutic problems in trauma victims. The severity of such lesions is related to the context of multiple trauma and to the general regional context associating vascular and neurological injury. Therapeutic management should be multidisciplinary to determine the appropriate strategy. Orthopaedic treatment should take into account the different diagnostic and therapeutic aspects. The purpose of this work was to detail ligament injuries observed and to assess results of treatments proposed. Material and methods: This retrospective series included 20 patients (14 men and 6 women), mean age 33 years (18–54). Five had multiple trauma with head injuries and multiple fractures. The initial diagnosis was traumatic knee dislocation in 14 patients. Seven patients underwent emergency vascular explorations with subsequent femoropopliteal bypass (n=3). Neurological lesions included three cases of complete section of the lateral popliteal sciatic. Orthopaedic treatment was used in three cases. We used external fixation for two months on the average in three patients. Six others underwent surgery (less than eight days after injury) after obtaining an MRI. The surgical strategy was based on several arguments: age, general status, level of the ligament injury. Three patients underwent secondary surgery on the anterior cruciate ligament. Outcome was assessed at a mean follow-up of 36 months (20–60). The clinical assessment of the objective result was based on frontal and sagittal laxity. The subjective result and the level of sports activities were also recorded. Radiographically, we studied the standard x-rays in single leg stance and also the stress images using telos with anterior then posterior drawer. Results: Excepting one case of amputation necessary due to the vascular and nervous injuries, orthopaedic treatment allowed an acceptable functional result in sedentary patients: good frontal stability and minimal anteroposterior residual laxity. Fourteen athletes underwent emergency surgery to repair the posterior cruciate ligament: posterior approaches in eight knees with injury of the floor with no posterior drawer at last follow-up; anterior approaches in six knees for suture of the posterior cruciate ligament and insertion of a synthetic ligament tutor with anterior cruciate ligament repair during the same operative time (two floor reinsertions, one patellar tendon plasty, and three Cho plasties). The stability of the posterior pivot was excellent but the tibial reinsertions of the anterior cruciate ligament failed. Seven knees required mobilisation under general anaesthesia 2.5 months later. Three knees underwent secondary anterior cruciate repair using the Kenneth Jones technique with negative Lachmann at last follow-up. Discussion: Excepting vascular and neurological emergencies dictating the initial therapeutic attitude, our orthopaedic management was based on a detailed identification of the lesion using emergency MRI: anterior or posterior approach, anterior cruciate repair technique dependng on association with peripheral ligament injury. Good results in terms of posterior laxity were achieved in this series, confirming the importance of emergency repair of the posterior cruciate. If the medial ligaments are intact, the anterior cruciate can be repaired in the emergency setting with a Cho plasy. In other situations, we prefer waiting before surgical repair of the anterior pivot

Background. pelvic fractures in elderly patients often result in poor prognosis due to immobilization associated complications. Thus, the target of the treatment in this patient group is early mobilization in order to reduce the risk of these complications. We report outcomes of 4 cases of pelvic fracture in elderly patients, who were treated with percutaneous screw fixation. Material and method. We examined medical records and images of 4 elderly patients between January 2012 and May 2012 in our center. Mean age of the patients was 88.8 years old (range 86–92 years). The causes of injury were motor vehicle accident in 3 patients, and a fall in 1 patient. Fracture types were ao type a in 1 patient, type b in 2 patients and type c in 1 patient. Mean injury severity score was 25 (10–57). We assessed functional status after the follow-up period using majeed. s. grading score for pelvic fractures. Result. No major complication including sever infection and deep vein thrombosis was observed during the follow-up period. Minor complication observed was screw loosening in 1 case, and screw prominence in another. Functional outcome by majeed. s. score were excellent in 1 case, and fair in 3 cases. The mean period between the operation and the first ride on the wheel chair was 3.5 (2–6) days. Conclusion. Early mobilization significantly affects the prognosis in multiple trauma patients. Percutaneous screw fixation may improve the prognosis in elderly patients with pelvic fracture

Painful foot and ankle joints are often pointed out as an impeding factor for lack of mobility and weight reduction. There is an assumption that weight loss will occur after their surgery due to increased mobility. The current study aimed to evaluate the effect of surgery on post-operative body mass index (BMI) in patients who underwent mid-foot or hind-foot arthrodesis. Our secondary aim was to look at the effect of sex, pre-operative obesity and good pain relief (AOFAS> 80) on post-operative BMI. All patients who underwent mid-foot and hind-foot arthrodesis between April 2005 and November 2006 were identified from the operating theatre records. Each patient’s BMI recorded pre-operatively was compared with that recorded at a minimum of 6 months postoperatively using the paired Student’s t-test. There were 35 eligible patients. 3 patients were excluded because of multiple trauma and 1 patient died during the period of study. We had 31 patients with 33 procedures with a mean age of 61 years (range 41–80). There were 18 females and 13 males. It was found that there was a mean increase of BMI by 0.25 (95%CI of −.95 to.44; p-value=0.47). It was noted that BMI of patients in obese group (BMI> 30) increased post-operatively by 0.07 (95%CI of −1.52 to 1.66; p-value=0.92). This study highlights the fact that there is no significant effect on BMI in obese patients after successful fusion surgery. The post-operative BMI is neither significantly affected by sex nor quality of pain relief

In Germany 427.500 persons per year were injured in traffic accidents. Because of faster cars the number of seriously injured persons increased. In a retrospective study we analysed the outcome and the posttraumatic quality of life (POLO Chart) of patients suffering from a severe trauma (ISS ≥ 50). Highlight of interest were:. pattern of injury. injured part of the body. days in ICU/days of external ventilation. outcome. actual state of health. mental health. changes in the social environment. Between 1/2000 and 12/2005 1435 patients with multiple trauma were hospitalized in our Trauma Center, 88 (6,5%) suffered from a severe trauma with ISS ≥ 50. A total of 29 patients answered the POLO Chart. The most important pattern of injury were caused by traffic accidents (62%),. Thoracic injury was the most common injury (94%) with an average AIS of 4,1. The patients with an ISS ≥ 50 spent significant more days in ICU and had significant more days of external ventilation than polytraumatized patients with an ISS < 50. 23% of the patients had a good outcome, 15% were severe physically handicapped and 36% died. Actually, more than half of the patients were more or less physically handicapped. 62% suffered from pain. 41% showed characteristics typically for a posttraumatic stress disorder. Only 15% were able to go back to work - on average two years after trauma. In conclusion the patients with severe trauma had a good survival rate, but they showed a poor posttraumatic quality of life, predominantly because of pain and mental ill like posttraumatic stress disorder. So in the time after trauma it is important to treat the whole patient and not only the physical lesions

Purpose of the study: Both conventional plates (CP) and volar locking plates (VP) are used for the ttreatment of distal fractures of the radius (Crognet 2006, Jupiter 2009). This was a retrospective analysis to compare the respective results of these two plating methods with a one year follow-up and to study the clinical outcomes and quality and duration of the reduction achieved. Material and methods: From 2005 to 2008, 48 CP and 33 VP were inserted for the same indications, simultaneously in the same unit. The four operators chose the material as needed. The time to treatment was less than 12 hours for 81% of patients. For CP, the fractures were comminutive in 60%, articular in 40% and associated with ligament injury for more than 10%. For VP, the fractures were comminutive in 80%, articular in 86% and in a context of multiple trauma in 20%. The clinical analysis included range of motion, index of reduction (IR), stability (IS) and efficacy (IF) defined at the SOFCOT symposium. Results: For the two series, the mean range of motion was flexion-extension 118, pronosupination 166; the recovered force was > 75% of the controlateral side. The QuickDash was excellent in more than 75%, good in 10%, fair in 10%, poor in 5%. More than 75% had an anatomic result. Complications were the same in percentage and in type for the two types of plates with no significant difference. For the VP, 95% of the clinical and radiographic outcomes were good or very good. For the CP, the results were the same. There was only one real loss of reduction with migration of an epiphyseal screw with no observable clinical impact. Discussion: This study was limited by the non randomization; there was a difference in the type of injury between the two series. Use of non-locked plates for fractures of the distal radius has proven efficacy as amply noted in the literature. This was analysed, and in particular with a few comparative CP/VP studies. Locking the volar plate does not guarantee stability in fragile cancellous bone. The problems encountered when removing the VP were not within the scope of this work. The cost of locking can limit systematic use. These two types of plates should not be considered in opposition but rather as complementary techniques

Introduction. The aim of this study was to investigate the differences between open vs closed femoral fractures with regard to the epidemiology, classification and outcome. Patients & methods. Data collected prospectively from MTOS and TARN-UK. Between 2001 and 2005, 67,665 trauma patients found and 8,591 were identified having sustained femoral shaft fractures. Demographics, pre and in-hospital data were recorded. The AIS and ISS were calculated. Outcomes and mortality rates were recorded. Four groups of patients were identified namely isolated/open (IO), polytrauma/open (PO), isolated /closed (IC), polytrauma/closed (PC). ANOVA analysis was contacted to determine the effect of fracture classification and severity of trauma to mortality using SPSS 11.0 software. Results. 7,978 patients having full data were included. There were 6,780 (85%) Isolated and 1,198 (15%) Polytrauma femoral fractures. When looking at Open vs Closed fractures we found 786 (9.8%) and 7,192 (90.2%) respectively. Combining the groups we recorded 502 IO, 6,278 IC, 284 PO, 914 PC. The median age was 53.9 years, the male/female ratio was 1.15 and the median ISS was 9. Males predominantly presented with open fractures with age distribution prevalence between 16-44 years. Elderly females >74 presented prevalence in IC fractures. Polytrauma related fractures had over six times higher mortality rates than isolated ones. A trimodal distribution of death was confirmed. The incidence of immediate deaths (<1h) was 23.3% for PO vs the 17% of PC fractures. Isolated closed fatalities were in 55.7% late deaths (>1st week), mostly attributed to hospitalisation and late post-injury complications. Conclusions. Young males predominate in this musculoskeletal entity. Elderly females present prevalence of closed fractures vs elderly males possibly due to osteoporosis. Open femoral fractures have a higher mortality rate as they represent high energy absorption. The combination of multiple trauma and femoral fractures shows higher mortality rates at all age groups

Background: The assessment of factors associated with return to work (RTW/NRTW) after multiple trauma is important in trauma research. Goals in rehabilitation should comprise RTW. The purpose of this study was to examine the RTW rate and which factors that predicted RTW for patients with severe multiple injuries using a prospective cohort design. Methods: 100 patients with a New Injury Severity Score (NISS) > 15, age 18–67 admitted to a Level I trauma center were included starting January 2002 through June 2003. Outcomes were assessed 6 weeks after discharge, 1 and 2 years post-injury. Instruments were the Brief Approach/Avoidance Coping Questionnaire, Multi-dimensional Health Locus of Control, SF-36, the WHODAS II and the COG for cognitive functioning. Results: Mean age was 34.5 years (SD 13.5), 83% were male. Mean NISS was 35.1 (SD 12.7). 66% were blue-collar workers. At 1 year 29% achieved complete RTW, 43% at 2 years. Mean time back to work was 12.8 months (SD 5.9). Differences between the RTW/ NRTW groups concerned personal and demographic variables, and physical and psychosocial functioning. Survival analysis showed that risk factors for NRTW were lower education, length of stay in hospital/rehabilitation > 20 weeks and low social functioning shortly after the return home. Conclusions: The majority of the patients had not completely returned to work 2 years post-injury. Demographic and injury related factors and social functioning were significant predictors of RTW status

Introduction Retrograde nailing of femoral shaft fractures, through the knee joint, have been increasing. The indications for retrograde nailing are presently still evolving. This paper aims to discuss the indications for retrograde nailing. Methods We had conducted a prospective trial of nailing of femoral shaft fractures, using the retrograde approach. Nails were placed and reamed, with both distal and proximal locking done. Attention was given to the appropriate entry point. A literature review is also presented. Results The set-up was easy. Operative time was a median of 70 minutes and average blood loss 200 mls. Time to union was 15 weeks with minimal complications, but dynamisation rates were high. No knee problems were found at a follow-up period of 47 months. Conclusions The indications for retrograde nailing are ipsilateral femoral and acetabular fractures, ipsilateral patellar and femoral shaft fractures, ipsilateral tibial amd femoral shaft fractures, multiple trauma, femoral fracture with previous ipsilateral hip fusion, bilateral femoral shaft fractures, the obese or pregnant patient with a unilateral/bilateral femoral shaft fractures and perhaps the elderly with a unilateral femoral shaft fracture. We feel that the retrograde nailing is a useful technique for the orthopaedic surgeon to have in his/her armamentarium. Due to the longer union time and possible knee damage, indications should be respected