European Journal of Trauma (Eur J Trauma)

Publications in this journal

• Article: Trauma Research in Europe

  R. Jan A. Goris
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  ABSTRACT: Background: Publishing in journals with the highest possible Impact Factor and Citation Index is of paramount importance for a researcher and his research group. In this respect, European trauma researchers may be in a disadvantaged position, as the citation index of European trauma journals is relatively low, as compared to Anglo-American trauma journals. Material and Method: This article analyses relative differences observed in original studies published in a continental European and several Anglo-American trauma journals. Aspects analysed include the number, (source of) funding, country of origin, type and topic of study of the publications. Conclusion: It is concluded that the quality of original trauma publications from Europe is high, that the larger subsidized studies are published outside continental Europe, while relatively few European studies have received (substantial) funding. Obtaining substantial financial support for trauma research, i. e. to appoint and train dedicated trauma researcher, is of capital importance to promote the cause of trauma research in Europe.
  European Journal of Trauma 04/2012; 28(5):275-278.
• Article: Simultaneous Bilateral Tibial Tuberosity Avulsions—Over 6-Year Follow-up

  Ahmed Dhatta, Rangan Raghunathan, Hagen Jähnich
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  ABSTRACT: Simultaneous bilateral avulsions of the tibial tuberosity are rare injuries. The authors found only five reported cases in the orthopedic literature. We add a further case of bilateral avulsions of the tibial tuberosity with the longest reported follow-up.
  European Journal of Trauma 04/2012; 32(1):78-79.
• Article: Blunt Traumatic Rupture of the Left Atrial Appendage

  Pieter Joosse, Carel Goslings, Jan van der Meulen, Kees-Jan Ponsen
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  ABSTRACT: Background: The diagnostic evaluation and surgical management of blunt cardiac rupture is one of the challenges of trauma surgery. Case Study: We report the case of an 18-year-old male with blunt traumatic left atrial apendage rupture who was brought to the hospital after a fall from the sixth floor of a building. On arrival at the emergency department, he developed signs of cardiac congestion. Ultrasonography of the heart through the subxiphoid window, as part of the focused assessment for the sonographic examination of the trauma patient (FAST), revealed cardiac tamponade. The injury was successfully repaired after median sternotomy. Discussion: Clinical symptoms, diagnostic considerations, and treatment modalities are commented on. The focus is on the role of FAST as a diagnostic tool in this case.
  European Journal of Trauma 04/2012; 28(2):110-113.
• Article: Mortality Registration in Patients with a Proximal Femoral Fracture Admitted to a Surgical Ward

  Remy M. Tjeenk, Abbey Schepers, Pieter van de Linde, Paul J. Breslau, Mark-Paul F. M. Vrancken Peeters
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  ABSTRACT: Background: A mortality registration system for patients who died after admission to a surgical ward with a hip fracture was developed. The aim of this study was to verify whether performing autopsies is necessary to obtain an accurate picture of the clinical course of these patients. Methods: The mortality registration system was used to classify causes of death, to evaluate shortcomings in treatment, and to determine the extent of agreement between clinical and autopsy findings. Results: Between 1989 and 1998, 101 of the 1,240 patients (8%) admitted with a hip fracture died in hospital. Most of these patients (61%) died of postoperative complications, of which pneumonia was the most common. Shortcomings in medical treatment were observed in 16 of the 101 deaths (16%). Permission to perform an autopsy was given by the relatives of 46 patients (46%); in three patients (7%) there was a disparity between clinical and autopsy findings. Conclusions: The disparity between clinical and autopsy findings depends on the accuracy of the preoperative diagnosis and the complexity of the postoperative events. In this selected group of hip fracture patients, the causes of death and the shortcomings in medical care could be identified without the help of autopsy data.
  European Journal of Trauma 04/2012; 28(2):95-99.
• Article: Circulating Inflammatory and Metabolic Parameters to Predict Organ Failure after Muliple Trauma

  Johannes Frank, Marcus Maier, Jochen Koenig, Stefan Rose, Marten Bouma, Wim A. Buurman, Ingo Marzi
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  ABSTRACT: Background: Patients encountering severe trauma are at high risk of sequential organ complications. We studied the value of circulating inflammatory mediators and metabolic parameters to evaluate their predictive value with respect to the development of multiple organ failure (MOF). Patients and Methods: In 77 traumatized patients with a mean Injury Severity Score (ISS) of 28.8±1.1 points, C-reactive protein (CRP), polymorphonuclear (PMN) elastase, lactate, interleukin-6 (IL-6), IL-8, and soluble tumor necrosis factor receptors 1 and 2 (TNF-R1 and TNF-R2) were determined for a period of 11 days following multiple trauma. Results: Weak and moderate correlations were found between mean plasma concentrations of all parameters and mean MOF scores calculated from the whole observation period [range: lactate (r=0.31, p < 0.01) to TNF-R1 (r=0.53, p < 0.001)]. Daily TNF-R1 and lactate concentrations of the 1st week moderately correlated with mean MOF scores of the 2nd week (p < 0.01). ISS weakly correlated with all parameters exept lactate [range: IL-8 (r=0.27, p < 0.05) and PMN elastase (r=0.46, p < 0.001)]. Prediction of MOF could not be improved by inclusion of several or all investigated mediators into multiple regression models. Conclusion: Only early plasma TNF-R1 and blood lactate concentrations showed a moderate association with the development of late posttraumatic organ failure. Thus, the predictive role of inflammatory mediators with respect to the manifestation of organ dysfunction after severe trauma seems limited.
  European Journal of Trauma 04/2012; 28(6):333-339.
• Article: Comprehensive Biocompatibility Testing of a New Semirigid Titanium Spine Implant in Vitro

  Axel Wilke, Marcus Jäger, Stefan Endres, Maximilian Landgraff, Alexander Kiessling, Michael Pfeiffer, Peter Griss
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  ABSTRACT: Background: Titanium spine implants are well established materials in posterior spondylodesis. The biocompatibility of a semirigid tivanium cable suitable for pedicle screws in posterior spinal fusion (DDS-Plus®) was tested by a human bone marrow cell culture. In comparison to the tivanium cable implant (Ti6Al4V; DDS-Plus®), hydroxyapatite (HA), commercially pure titanium (cpTi), glass, chromium-cobalt alloy, (CrCoMo), polyaryletherketon (PAEK) and polyethylene (UHMW-PE) were tested. Materials and Methods: Scanning electron microscopy (SEM), SEM-energy dispersive X-ray analysis (SEM-EDX), fluorescent activated cell sorter (FACS), immunohistochemical techniques, light microscopy (LM) and immunochemical extracellular matrix analysis served to judge the in vitro biocompatibility of the different implants in a human bone marrow cell culture. Results: The datas of this investigation point out that the tivanium cable is equally biocompatible to commercially pure titanium and showed less signs of cytotoxicity than the other tested materials in vitro. Beside the titanium alloys, HA showed a high degree of biocompatibility compated to the polymers and CrCoMo too. Conclusions: In respect to their in vitro biocompatibility, the semirigid tivanium spine cable could be an alternative for other systems for posterior spondylodesis. Biomechanical and clinical studies are necessary to improve these datas.
  European Journal of Trauma 04/2012; 28(5):279-288.
• Article: Clinical Spectrum of Trauma at a University Hospital in Nigeria

  Babatunde A. Solagberu, Adedeji O. Adekanye, Chima P. K. Ofoegbu, Sulyman A. Kuranga, Ukpong S. Udoffa, Lukman O. Abdur-Rahman, Ezekiel O. O. Odelowo
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  ABSTRACT: Background and Objectives: Data on trauma in Nigeria requires updating just as trauma care needs coordination and organization. This study was done to examine the clinical spectrum of trauma and to propose measures for organization of trauma care. Patients and Methods: A 2-year prospective report of an ongoing trauma research is presented. Data obtained from September 1999 to December 2000) include name, age, sex, presenting diagnosis at the accident and emergency (A and E) unit, injury-arrival time, ode of transportation of patients to the hosptial, and the outcome of care. Results: Trauma patients comprised 2,913 of the 4,164 (70.0%) surgical patients seen in the A and E but 129 of 171 deaths (75.4%). Types of trauma were lacerations (585 patients, 20.1%), fractures (542, 18.7%), head injury (250, 8.6%), multiple injuries (249, 8.6%), burns (159, 5.5%), and others. Road traffic accidents (RTA) occurred in 1,816 patients (62.3%), falls in 308, assaults in 258, burns in 159, home accidents in 122, gunshot injuries in 107, industrial accidents in 73, and foreign body injuries in 70. There was no pre-hospital care. Transport to the A and E was done by relations, the police and a few Good Samaritans. Most of the patients reached the hospital in < 6 h. Common mortalities were from head injury (37 patients, 28.7%), multiple injuries (35, 27.1%), fractures (12, 9.3%), and burns (9, 7.0%). Of 106 deaths with timed records, 22 (20.7%), 56 (53.0%) and 28 (26.3%) occurred in 0–1 h, > 1–24 h and > 24 h, respectively. Conclusions: The spectrum of trauma is predominantly RTA-related, hence, trauma care organization would include prevention of RTA, organization of pre-hospital care aimed at transport time of < 2h, training volunteers from the populace and the police as emergency medical services technicians for resuscitation during transport and getting patients to hospital in optimal state, and an enhanced in-hospital care by designation and categorization of hospitals. These strategies, including continuous trauma research and funding, would go a long way in reducing mortalities from trauma, especially from RTA.
  European Journal of Trauma 04/2012; 28(6):365-369.
• Article: Predicting Survival after Trauma: a Comparison of TRISS and ASCOT in the Netherlands

  Sander P. G. Frankema, Michael J. R. Edwards, Ewout W. Steyerberg, Arie B. van Vugt
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  ABSTRACT: Background: Evaluating the performance of a trauma system may be attempted by comparing outcome in different trauma populations. Controlling for injury severity is a necessity for such evaluations. We compare two current models for doing so: the “Trauma and Injury Severity Score” (TRISS) and “A Severity Characterization Of Trauma” (ASCOT). Material and Methods: This study of high-energy trauma victims took place in Leiden, the Netherlands, between 1993 and 1998. Using the Hosmer-Lemeshow (HL) test and receiver operator characteristic (ROC) analysis, the TRISS and ASCOT models were compared for calibration and discrimination. Results: 1,024 patients, with an average Injury Severity Score (ISS) of 13.5, were eligible for inclusion. Blunt trauma was the predominant cause of injuries. Both models gave accurate, though pessimistic, results in predicting the actual number of fatalities (n = 71). The HL test indicated a sufficient fit for the ASCOT model (p = 0.28) and an insufficient fit (p = 0.02) for TRISS. The ROC curves were nearly identical (0.97). Including age as a linear variable, instead of using the current age groups, resulted in an improved discriminative power of the models. Conclusions: The ASCOT model proved superior over TRISS in its accuracy to estimate of survival chances. This difference was most evident for victims with an estimated survival chance of 60–90%. Future national trauma researchers should therefore collect ASCOT data. Improved ASCOT models could be developed, with age as a linear variable.
  European Journal of Trauma 04/2012; 28(6):355-364.
• Article: Malunion of a Complex Fracture of the Distal Radioulnar Joint (DRUJ)

  Ralf Metzger, Jonas Andermahr, Klaus Emil Rehm
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  ABSTRACT: Background: Generating an artificial spontaneous Sauvé-Kapandji situation after malunion of the distal radioulnar joint (DRJU) enables a patient to move forearm and wrist without pain. Case Study: A patient with an extensive combined fracture of the distal radius and ulna accompanied by a subluxation of the ulnar head and an avulsion fracture of the base of the ulnar styloid was treated with external fixator. During follow-up, an artificial fracture was observed at a former pin site. This led to nonunion approximately 3 cm proximal to the ulnar head. Comparable to a spontaneously generated Sauvé-Kapandji situation, the development of this nonunion resulted in a pain-ree situation allowing free movement of forearm and wrist. The extend of motion was 70°/0°80° pronation/supination.
  European Journal of Trauma 04/2012; 28(6):370-373.
• Article: Interleukin-6 (IL-6) – an Early Marker of Chest Trauma

  Wolf Strecker, Florian Gebhard, Juliusz Rager, Gerald Steinbach, Christina Ring, Mario Perl, Lothar Kinzl, Alexander Beck
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  ABSTRACT: Background and Objective: Although in recent years methods in emergency medicine have been remarkably improved, thoracic trauma remains associated with high mortality. To select adequate treatment in multitrauma patients, early diagnosis of lung contusion is of great importance. Upon hospital admission, however, even modern imaging techniques frequently fail to correctly estimate both severity and extent of chest trauma. Therefore, the aim of our study was to define laboratory markers indicating chest trauma almost immediately after accident. Patients and Methods: 107 trauma patients were enrolled in this prospective study. Blood samples were taken immediately at the site of accident, on hospital admission, after 30 and 60 min, and 2-hourly for an interval of 12 h, then daily. In addition to the biochemical analysis of 20 different substances, the following data were drawn and correlated to the laboratory results: Injury Severity Score (ISS), Polytrauma Score (PTS), Ulm score HTAPE (trauma pattern-specific: head, thorax, abdomen, pelvis, extremities; 0–3 degrees each), Multiple Organ Failure (MOF) score accordings to Goris et al, overall lethality, primary and secondary lethality. All trauma scores were subject to descriptive analysis. Our main analysis focuses on the thorax trauma score including variable selection by logistic regression as well as ROC analysis. Results: In nonsurvivors, overall trauma severity and head injury were remarkably higher (15.9%) than in survivors. Whereas there was a strong correlation between head injury and primary lethality (≤ 3 days), secondary lethality (> 3 days post trauma) was charged by thoracic trauma as well as by limb trauma. Of all mediators investigated, it was interleukin-6 (IL-6) that showed highest correlations (p < 0.0001) to the extent of chest trauma, especially during the first hour after hospital admission. Further correlations, yet clearly less pronounced, were found between IL-6 and PTS, between ISS, abdominal pelvic and limb trauma, but not to head injury. Our findings suggest that there is a correlation between endotoxin and 6-keto-prostaglandin F1α and the severity of thoracic injury, too, but it is of lower statistical impact compared to IL-6. The practical value of both mediators, however, is limited because of the sophisticated and time-consuming laboratory analysis they demand. Conclusion: The study results suggest IL-6 to be an early marker for the extent of chest trauma.
  European Journal of Trauma 04/2012; 28(2):75-84.
• Article: Impalement Injury by a Wooden Branch

  Christine Machens, Uwe Lehmann, Michael Müller, Hans-Josef Schmitt, Michael Uder, Tim Pohlemann
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  ABSTRACT: Case Study: We report the case of a 60-year-old male, who suffered an impalement injury by a wooden branch approximately 32 cm in length, when he fell from a tree. The pole penetrated the left proximal thigh dorsomedially, passed the inguinal ligament and went on through the preperitoneal space and the diaphragm into the thorax without injuring any organ. Directly after the accident, the patient went to the nearest emergency room. He had an approximately 6 cm long wound close to the ischiadic tubercle with no further signs of an incorporated foreign body and was in a stable general condition. Within the next hours, he developed pulmonary and circulatory insufficiency. Following enhanced diagnostics and secondary transfer to a trauma center, the foreign body, a wooden branch approximately 32 cm in length and 3 cm in diameter, could be surgically removed after 16 h. Discussion: The purpose of the presented paper is to discuss difficulties in the primary diagnosis of a major impalement injury which was misestimated by the patient's history, a stable general condition and only minor clinical signs at the entry portal and therefore mistaken for a “standard minor injury to the buttock”.
  European Journal of Trauma 04/2012; 28(5):314-317.
• Article: Posttraumatic Empyema

  J. Jason Hoth, Phillip T. Burch, J. David Richardson
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  ABSTRACT: Background: Posttraumatic empyema remains a significant clinical problem occurring in 2–10% of victims with thoracic trauma. Many of the factors responsible for the development of posttraumatic empyema are preventable and iatrogenic in nature. As such, it is a source of morbidity and mortality and an additional expense for the institutions who care for these patients. Pathogenesis: The primary feature associated with posttraumatic empyema is a retained hemothorax following chest trauma. Blood trapped within the pleural space impairs its own absorption and acts as an ideal culture medium for bacterial proliferation. Contamination of a retained hemothorax is derived from several sources, including tube thoracostomy, pneumonia, or from the mechanism of injury itself. The combination of tube thoracostomy and retained blood within the pleural space is implicated in most cases of posttraumatic empyema. Diagnosis: The diagnosis of posttraumatic empyema involves the use of clinical parameters and imaging studies. Chest computed tomography, the most useful imaging modality, has a high degree of sensitivity and specificity but must also be correlated with clinical findings of leukocytosis, fever, and often respiratory dysfunction. Treatment: Effective treatment of posttraumatic empyema centers on effective decortication and complete reexpansion of the involved lung. This can be achieved physically either at the time of thoracotomy or thoracoscopy or chemically through the use of fibrinolytic agents. Thoracotomy with decortication is the most successful form of therapy, and the rate of morbidity associated with this procedure is improving. Thoracoscopy with decortication is technically more difficult to perform and mor successful when performed early.
  European Journal of Trauma 04/2012; 28(6):323-332.
• Article: Abdominal Stab Wounds in Children: an 18-Year Experience

  Hayrettin Öztürk, Abdurrahman Onen, Selcuk Otçu, Ali İhsan Dokucu, Yusuf Yağmur, Senol Gedik
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  ABSTRACT: Objective: Evaluation of the diagnosis, management, and the role of selective treatment in children with abdominal stab wounds. Patients and Methods: 59 children (56 male and three female) were included in the study. The patients' median age was 11.8 years (range, 5–14 years). Time between injury and admission was about 3 h. Laparotomy was performed in 44 patients (74%). Solid organ injury was detected in 32 of these patients (73%) and could not be observed in twelve (27%). 15 patients (26%) were treated conservatively, and only one (6.6%) underwent laparotomy during the follow-up. The stomach was the most frequently injured organ (ten patients), followed by the intestines (nine patients). Types of surgical treatment were as follows: primary suture in 28 patients, resection-anastomosis in three, and osteotomy in two. Results: Some prognostic factors such as presence of abdominal organ evisceration and pneumoperitoneum were not significantly correlated with intraabdominal organ injury, whereas some other risk factors such as acute abdomen on admission (p < 0.002) or abdominal clinical and hemodynamic findings (p < 0.001) showed significant correlation with intraabdominal organ injury. The relative risk (odds ratio) of developing an intraabdominal organ injury was > 2 for patients with signs of an acute abdomen on admission. Postoperative complications were observed in five patients with organ injuries. None of our patients died. Conclusions: Conservative treatment can be safely performed in most children with abdominal stab injuries. Signs of major internal hemorrhage or generalized peritonitis are an absolute indication for emergency operation for abdominal stab wounds. Peritoneal penetrations, free air on the abdominal X-ray, and omental or intestinal evisceration are poor indicators of significant organ injuries, and patients presenting these signs shold be closely followed up for developing acute abdominal symptoms.
  European Journal of Trauma 04/2012; 28(2):85-89.
• Article: Unreamed Nailing of Diaphyseal and Metaphyseal Fractures of the Femur

  Karl Akke Alberts, André Stark
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  ABSTRACT: Background: Femoral intramedullary nails with antegrade or retrograde options for insertion and different locking possibilities have extended the indications to include both diaphyseal and metaphyseal fractures. Patients and Methods: A prospective series of 63 patients were treated with three different unreamed nailing and interlocking techniques selected according to the predominant fracture location. Median age of the 30 women and 33 men was 39 (17–97) years. High-energy injuries had occurred in 37 patients. Antegrade nailing and interlocking with standard technique was used in 29 diaphyseal fractures, antegrade nailing and placement of the proximal locking device to the femoral head was performed in eleven proximal fractures with involvement of the intertrochanteric region, and retrograde nailing and standard interlocking was done in 23 mainly distal fractures. Results: We encountered two types of major mechanical complications: angular malalignment and protrusion of the nail into the knee joint following compression in the fracture. Angular malalignment was found in four fractures. One midshaft fracture was fixed in a valgus reduction. Varus malalignment and loss of fixation occurred in two high subtrochanteric fractures after proximal locking with a spiral blade. In another midshaft fracture redisplacement in varus occurred. Compression in the fracture with protrusion of the nail by 2–10 mm into the knee joint following retrograde nailing was observed in six osteoporotic patients. Only two of these patients had significant knee problems. The median time to union – 4 months – did not differ significantly between the fixation groups. Conclusions: Thus, there are still problems after nailing very proximal and distal fractures. Most postoperative complications were seen after retrograde nailing of distal fractures, but the consequences of fixation failure in very proximal fractures were worse. Nevertheless, a protocol that takes advantage of the different options for nail introduction and locking depending on the fracture location seems promising.
  European Journal of Trauma 04/2012; 28(5):289-294.
• Article: Is Routine Angiography Necessary in Patients with a Gunshot Wound to the Neck? A Retrospective Analysis

  Derek F. P. Van Deurzen, A. Bas van As, Egbert J. M. M. Verleisdonk
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  ABSTRACT: Aim: The aim of this study was to investigate the implication of clinical findings of vascular injury and routinely employing angiography in patients who sustained a gunshot to the neck. Patients and Methods: We retrospectively studied the demographics, bullet tract, clinical findings, diagnostic investigations, methods of treatment, outcome, and time in hospital of 70 patients who sustained a gunshot to the neck and who all underwent angiography. Results: In nine cases angiography revealed lesions to the common carotid artery (four patients), internal carotid artery (three patients), vertebral artery (one patient), and lingual artery (one patient). Physical examination had already indicated vascular damage in seven of these patients with findings such as expanding hematoma (four patients), absent carotid pulsations (two patients), bruit (one patient), and hypovolemic shock (one patient). Subsequently, these seven patients were treated operatively by performing elective neck exploration. Of these seven patients who underwent surgical repair, vascular damage was already suspected based on physical examination. The two patients with injury on angiography without clinical evidence did not deteriorate on conservative management. Conclusions: Careful clinical assessment proves to be a useful instrument in determining the necissity of surgical exploration. In our experience in 70 patients, the results of angiography did not alter the management of the patients who sustained a gunshot to the neck. Our results on conservative management with selective angiography indicate that morbidity and mortality of unnecessary neck explorations are avoided without increased risk.
  European Journal of Trauma 04/2012; 28(2):90-94.
• Article: The Influence of Medical Care on the Death Rate from Trauma in England and South Moravia

  David W. Yates, Petr Svoboda, Ilona Kantorova
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  ABSTRACT: Background: Trauma is the leading course of death in humans from 5 to 45 years and one of the major causes of death and disability in all age groups. Medical care for trauma victims is burdensome and expensive. Aim of this study was to examine differences in trauma care and their effects on outcome in hospitals in England and South Moravia, Czech Republic. Patients and Methods: The data base of the Trauma Audit & Research Network was used to provide anonymous data of the process of trauma care in England and South Moravia. Admissions were analyzed over a 3-year period 1993–1995. In the study were included 1,853 patients directly admitted to Brno Traumatologic Hospital and 10,827 patients directly admitted to 15 hospitals in England. Patient characteristics were broadly similar (age 6–98, median 42 years, in Brno vs. 0–103, median 44 years, in England), and injury severity comparable in the two groups (Injury Severity Score [ISS] 1–75, median 9, in both Brno and England). Results: There were no differences in time to admission – in both groups was 62% of patients admitted to hospital within 60 min after injury. More senior doctors initially examined the patients in South Moravia than in England (92% vs. 32%). Transfer to the operating theater was more rapid in South Moravia (77% vs. 43% in < 2 h). The standardized W statistic (a measure of survival variation from the expected mean, per 100 patients) was +2.60 (95% confidence intervals [CI] +1.40 to +3.80) for the South Moravian patients and −0.61 (CI −1.04 to −0.18) for the English patients. Conclusion: These results suggest that the organization of medical care in the Brno Traumatologic Hospital in South Moravia is more effective in preventing death after trauma than that provided by a representative sample of 15 English hospitals.
  European Journal of Trauma 04/2012; 28(5):304-309.
• Article: Short-Term Effects of Different Arthroscopic Techniques in the Treatment of Chondral Defects (Shaving, Coblation, and Microfacturing)

  Gunter Spahn, Ralf Wittig
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  ABSTRACT: Background and Objective: Arthroscopic treatment of chondral defects includes different techniques. This study is intended to compare the short-term effects of mechanical shaving, electrosurgical coblation, and microfracturing. Patients and Methods: In 123 patients suffereing from medial arthrosis of the knee joint, an arthroscopy was performed. Evaluation included determination of the Lysholm score and measurement of pain by a visual analog scale (VAS). In 47 patients, the chondral defects were shaved mechanically (group A). 32 patients underwent electrosurgical coblation (group B). In 44 patients, the chondral defects were subjected to microfracturing according to Steadman et al (group C). Results: At follow-up after a period of 20.1 months, the Lysholm score had increased from 31.5±27.4 to 60.4±13.8 points (p < 0.05). Pain was reduced from 61.5±25.6 to 28.4±19.1 (p < 0.05). No differences were seen between the groups. Conclusion: The results suggest that the differences between the methods of chondral treatment are only marginal. Due to the mostly poor outcome, the indication for arthroscopic treatment of gonarthrosis should be viewed critically.
  European Journal of Trauma 04/2012; 28(6):349-354.
• Article: Self-Influcted Intracranial Injury Caused by a Crossbow Arrow

  Olaf Suess, Theodoros Kombos, Silke Suess, Rüdiger Stendel, Carlos Da Silva, Mario Brock
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  ABSTRACT: The availability of sophisticated hunting and sports weapons such as modern crossbows increases the incidence of uncommon types of accidental, suicidal, and homocidal head injuries. This report describes the case of a 47-year-old man with a nonfatal head injury due to a crossbow broadhead hunting arrow penetrating the left frontal lobe. The injury was accidentally self-inflicted by the intoxicated patient. A review of the literature has shown that self-inflicted head injuries caused by arrows are a very rare or, at least, a seldom reported entity. The mechanisms and pathophysiology of penetrating head injuries caused by different kinds of projectiles are discussed in order to clarify the management of these cases.
  European Journal of Trauma 04/2012; 28(5):310-313.
• Article: Defect Reconstruction in Articular Calcaneus Fractures with a Novel Calcium Phosphate Cement

  Michael R. Sarkar, Jens-Peter Stahl, Nikolaus Wachter, Matthias Schwamborn, Reinhard W. W. Schnettler, Lothar Kinzl
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  ABSTRACT: Background: Major osseous defects in trauma or tumor patients require surgical reconstruction. While transplantation of autogenous or allogenous bone is still regarded as the standard, a multitude of alternative substitute materials has been developed in the recent years. Currently, the majority of commercially available products is based on calcium phospate minerals which are known to be osteoconductive, but in which resorption occurs slowly, if at all. A new class of calcium phosphate cements has recently been introduced that may offer better resorbability due to their nanocrystalline structure. Patients and Methods: In a prospective study of eleven patients with twelve joint depression calcaneal fractures requiring open reduction and internal stabilization, the subchondral defects were filled with a novel nanocrystalline calcium phosphate cement (Biobon®). Nine patients with ten fractures underwent a 1-year clinical and radiologic follow-up. Results: The postoperative course was uneventful except for one postoperative infection. On follow-up X-rays, the contours of the cement material became blurred and its size decreased. Biopsies taken after 6–8 months during plate removal demonstrated residual cement with intense osseointegration. Signs of inflammatory tissue response were absent, and part of the material had been replaced by new bone. Conclusions: The substitute material investigated in this study has a high biocompatibility and may represent an interesting alternative to bone grafts. Compared to sintered calcium phosphates, the resorbability of the new cement appears superior due to its nanocrystalline structure. The low compressive strength, however, does not permit early weight bearing and requires additional stabilization with osteosynthetic implants.
  European Journal of Trauma 04/2012; 28(6):340-348.
• Article: Quantifying the Quality of Extra- and Intramural Trauma Care on an Individual Basis

  Sander P. G. Frankema, Michael J. R. Edwards, Arie B. van Vugt
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  ABSTRACT: Background: The objective of this study was to identify the variables needed for an alternative method by which the quality of care for trauma patients can be quantified. Patients and Methods: A prospective analysis of the clinical parameters and interventions was performed for the extramural as well as the intramural scene. Based on the information available after completion of the primary survey, the interventions needed were identified by a multidisciplinary forum made up of internal and external observers. These interventions were compared with the treatment, which was actuallc performed. We evaluated the reproducibility of the decisions made by the forum by means of a variability analysis. Results: During the review period, 275 patients were evaluated. An Injury Severity Score (ISS) ≥ 18 was recorded in 41 cases. 69 ABC stabilizing interventions were identified by the forum of the injury scene, 32 of which were not performed by the personnel of the emergency medical service (EMS). 91 in-hospital ABC stabilizing interventions were indicated, 22 of which were not performed by the emergency room (ER) personnel. Twelve patients succumbed within the 1st month. Conclusions: The pilot study confirms the feasibility of using a forum to identify the interventions prescribed by protocol for each individual patient. Forum-based case-to-case evaluation will be used as a surveillance tool to evaluate the adequacy of interventions and to quantify the quality of trauma care.
  European Journal of Trauma 04/2012; 28(5):295-303.