European journal of trauma and emergency surgery : official publication of the European Trauma Society
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Eur J Trauma Emerg Surg · Feb 2019
Associated thoracic injury in patients with a clavicle fracture: a retrospective analysis of 1461 polytrauma patients.
During primary survey the main goal is to ascertain life-threatening injuries. A chest X-ray is recommended in all polytrauma patients as thoracic injury plays an important role in mortality. However, treatment-dictating injuries are often missed on the chest X-ray. In contrast, clavicle fractures should be relatively easy to diagnose on a chest X-ray. We previously showed that clavicle fractures occur in approximately 10 % of all polytrauma patients in our population. The aim was to compare polytrauma patients, with and without a clavicle fracture, to investigate if a clavicle fracture is associated with concomitant thoracic injury. ⋯ The clavicle can be seen as the gatekeeper of the thorax. In polytrauma patients, a clavicle fracture is easily diagnosed during primary survey and may indicate underlying thoracic injury, as the rate and extent of concomitant thoracic injury are high.
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Eur J Trauma Emerg Surg · Feb 2019
The Non-Union Scoring System: an interobserver reliability study.
The Non-Union Scoring System (NUSS) aims to classify non-unions according to their severity and relate them to four treatment categories. The main purpose of this study was to evaluate the reliability of the NUSS. In addition we assessed its clinical validity. ⋯ We conclude that the NUSS is both a reliable and valid system to classify non-unions.
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Eur J Trauma Emerg Surg · Feb 2019
Treating open lower limb fractures successfully; thoughts and current practice on therapy and centralization in The Netherlands.
The British Orthopedic Association (BOA) and British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) updated the evidence-based guidelines for the treatment and care of open lower limb fractures (BOAST 4). Following this, a Dutch version has been developed. The main points are multidisciplinary care, planning, and treatment of these injuries. Early osteosynthesis (within 7-14 days) combined with soft-tissue coverage results in more efficient care and less complications. ⋯ Surgeons agree on better and earlier multidisciplinary treatment of open lower limb fractures and the centralization of Gustilo 3 fractures.
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Eur J Trauma Emerg Surg · Feb 2019
Civilian cerebral gunshot wounds in rural South African patients are associated with significantly higher mortality rates than in urban patients.
This study focuses on a specific and often dramatic injury, namely gunshot wounds (GSW) of the head in order to determine whether there is a discrepancy in outcome between patients who sustain their injury in a rural setting and those who sustain it in an urban setting. ⋯ Cerebral GSWs are highly lethal injuries associated with significant mortality. Rural patients have a significantly longer transfer time, lower GCS on arrival and higher mortality than urban patients. Efforts should be directed at improving the pre-hospital EMS system in order to reduce delay to definitive care so that patient outcome can be optimised.
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Eur J Trauma Emerg Surg · Feb 2019
Serum thiol levels and thiol/disulphide homeostasis in gunshot injuries.
Gunshot injuries result in serious traumatic tissue damage due to high velocity of the bullet, deep penetration, and ballistic effect. Trauma is known to be related with oxidative stress. Serum thiol levels and disulphide/thiol homeostasis are novel oxidative stress biomarkers. In this study, we aimed to investigate serum thiol levels and disulphide/thiol homeostasis in injury patterns of patients admitted to the emergency department with a gunshot injury. ⋯ Our study results suggest that thiol-disulphide homeostasis is disrupted in patients sustaining gunshot injuries, and thiol levels decrease in correlation with the severity of trauma with a high sensitivity and specificity. As the level of native thiol is an independent predictor of the severity of trauma, reduced thiol levels may be of prognostic value in the early assessment of patients in the emergency room.