European journal of trauma and emergency surgery : official publication of the European Trauma Society
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Eur J Trauma Emerg Surg · Jan 2025
Letter Comparative StudyType B ankle fractures with additional medium-sized posterior fragment: mid-term functional and radiological outcome after fixation versus no fixation of the posterior fragment.
Guidelines for treatment of medium-sized posterior fragments in trimalleolar fractures are scarce and show varying advice. Recent trials comparing fixation and no fixation of posterior fragments, show no difference in outcomes one year postoperatively. This study compares functional outcome and development of osteoarthritis in patients with fixation of a posterior malleolar fracture to patients without fixation of the posterior malleolus fracture. ⋯ The value of fixation of medium-sized posterior fragments in type B ankle fractures seems limited after mid-term follow-up, although functional impairment caused by osteoarthritis might develop in the long-term. Because postoperative step-off > 1 mm increases the risk of osteoarthritis, restoration of the tibial plafond seems essential.
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Eur J Trauma Emerg Surg · Jan 2025
Surgical stabilisation of rib fractures in non-ventilated patients: a retrospective propensity-matched analysis using the data from the trauma registry of the German Trauma Society (TraumaRegister DGUⓇ).
Severe thorax trauma including multiple rib fractures and flail chest deformity are leading causes of death in trauma patients. Increasing evidence supports the use of surgical stabilisation of rib fractures (SSRF) in these patients. However, there is currently a paucity of evidence for its use in non-ventilator-dependent patients. ⋯ Here we report on the largest currently published dataset of non-intubated patients receiving SSRF, which showed reduced mortality in the SSRF cohort. The data indicates that SSRF is a viable treatment option for non-intubated patients. The observed late surgical time points, which may be due to cross over after failed conservative treatment, might be the cause for the observed increased rate of organ failure.
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Eur J Trauma Emerg Surg · Jan 2025
The effects of timing on fasciotomy outcomes in compartment syndrome - experience from crush-induced trauma following 2023 Turkey earthquakes.
This study was planned to evaluate limb survival and clinical outcomes of fasciotomies done before and after 24-48 h due to compartment syndrome in the extremities caused by crush injuries after the earthquakes in Turkey on February 6-7, 2023. ⋯ Fasciotomies earlier than 24 h prevented amputation and rate of muscle compartment excision was higher in fasciotomies done after 24 h especially for lower extremities. Upper extremity fasciotomy timing early or late did not change the outcomes.
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Eur J Trauma Emerg Surg · Jan 2025
Effects of early propranolol administration on mortality from severe, traumatic brain injury: a retrospective propensity score-matched registry study.
The role of beta-blockers in severe, traumatic brain injury (TBI) management is debated. Severe TBI may elicit a surge of catecholamines, which has been associated with increased morbidity and mortality. We hypothesize administering propranolol, a non-selective beta-blocker, within 48 h of TBI will reduce patient mortality within 30 days of injury. The TriNetX database was leveraged to determine if administering a propranolol within 48 h of severe TBI improves outcomes within 30 days of injury. ⋯ The results of this study demonstrate significantly reduced mortality within 30 days of injury and fewer neurosurgical interventions, seizures, and episodes of cardiac arrest in severe TBI patients who received propranolol within 48 h of injury.
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Eur J Trauma Emerg Surg · Jan 2025
Increasing prehospital tourniquet use attributed to non-indicated use: an 11-year retrospective study.
The use of prehospital tourniquets (PHTQ) for haemorrhage control in the civilian trauma population has increased over the past decade with some reports documenting the overuse of the device. The aim of this study was to identify the proportion of PHTQ use that is non-indicated and determine how this proportion is changing over time. ⋯ Over this 11-year period, we identified that the increase in PHTQ use in civilian trauma is from increasing non-indicated use. Given that complications are associated with unnecessary PHTQ use, the adherence to the guidelines needs to be urgently reinforced.