Hans Christoph Pape

University of Zurich | UZH · Department of Trauma

Background: Pelvic fractures contribute to morbidity and mortality following injury. We sought to study the impact of pelvic fractures on the clinical course and outcomes of trauma patients with a pelvic fracture in comparison to patients with similar injury severity without pelvic fracture to identify potential parameters to track patients’ clinic...

Background: Life-threatening arterial bleeding from fragility fractures of the pelvis are very rare but associated with significant mortality, especially in anticoagulated patients. Case description: We report the successful interdisciplinary management of a 78-year-old woman under anticoagulation and antiplatelet therapy who had life-threatenin...

PurposeInterleukin-6 is a mainly proinflammatory interleukin and an indicator for the magnitude of surgery. The IL-6 serum concentration correlates with injury severity, the extent of tissue trauma and has negative impact on prognosis. To date it is unclear whether the immunologic changes assessed are age dependent. The aim of this study is to comp...

Background: A broad range of systemic complications has been described to occur in patients with open major fractures. Various causes have been claimed to play a role. We therefore surveyed a nationwide trauma registry to assess risk factors associated with closed and various types of open femur fractures. Methods: Cohort study in a nationwide p...

Purpose Treatment strategies for femoral fracture stabilisation are well known to have a significant impact on the patient’s outcome. Therefore, the optimal choices for both the type of initial fracture stabilisation (external fixation/EF, early total care/ETC, conservative treatment/TC) and the best time point for conversion from temporary to defi...

Purpose Intramedullary nailing (IMN) of fractures is associated with increased rates of inflammatory complications. The pathological mechanism underlying this phenomenon is unclear. However, polymorphonuclear granulocytes (PMNs) seem to play an important role. We hypothesized that a femur fracture and standardized IMN in pigs is associated with alt...

Introduction In light of current discussions about centralisation and teaching in medicine, we wanted to investigate the differences in in-hospital outcomes after surgical treatment of isolated ankle fractures, taking into account high-volume centres (HVCs) and low-volume centres (LVCs) and teaching procedures. Methods A retrospective analysis of...

Introduction Due to the Covid-19 pandemic, making more use of remote medical solutions has been advertised. The purpose of this study was to assess the willingness of orthopedic trauma patients to conduct an online video consultation (OVC) during the coronavirus pandemic compared to before. Methods A survey amongst orthopedic and trauma outpatient...

Introduction Occult hypoperfusion (OH) is defined as persistent lactic acidosis despite normalization of vital parameters following trauma. The aim of this study was to analyze the association of occult hypoperfusion with local circulation and inflammation of injured soft tissue in a porcine polytrauma model. Methods This experimental study was pe...

Introduction Local soft tissue status (STS) guides the timing for definitive surgical treatment strategies of fracture fixation around the ankle joint. The aim of this study was to assess different types of new technical devices in relation to the surgical treatment in closed ankle and pilon fractures. Methods This study was designed as a cohort s...

Introduction Extensive trauma surgery evokes an immediate cellular immune response including altered circulatory neutrophil numbers. The concurrent bone marrow (BM) response however is currently unclear. We hypothesize that these BM changes include (1) a relative reduction of the bone marrow neutrophil fraction and (2) increasing heterogeneity of t...

The pathophysiology after polytrauma represents a complex network of interactions. While it was thought for a long time that the direct and indirect effects of hypoperfusion are most relevant due to the endothelial permeability changes, it was discovered that the innate immune response to trauma is equally important in modifying the organ response....

Introduction: Unlike many other types of weapons, firearms are of special interest due to their high lethality and criminal value. There is lacking data on the epidemiology of gunshot wounds in Central Europe in a clinical context and especially the clinical (resuscitation) management as well as the outcome of victims with sustained firearm injurie...

Introduction: The injury severity score (ISS) continues to represent a key factor in assessing anatomic injury severity scoring and is based on the abbreviated injury scale (AIS). The advantages and disadvantages of the ISS and the AIS have been assessed in several studies. Thus, the aim of this work was to assess inter-observer variability of the...

This retrospective cohort study is concerned with similarities and differences in the Injury patterns in accidents involving electric bicycles, bicycles and motorbikes.

Pre-hospital and hospital trauma care during Covid-19-Lockdown – Experiences from a metropolitan European level 1 trauma center

PURPOSE Even though hip fracture care pathways have evolved, mortality rates have not improved during the last 20 years. This finding together with the increased frailty of hip fracture patients turned hip fractures into a major public health concern. The corresponding development of an indicator labyrinth for hip fractures and the ongoing practice...

Background: Contrast-induced nephropathy (CIN) has been well investigated in patients undergoing coronary angiography, but not in trauma patients. The main aim of this study was to determine the prevalence and to investigate independent risk factors for the development of CIN. Methods: Between 2008 and 2014, all pre-hospital intubated major trau...

Introduction There has been growing evidence in trauma literature that differences in insurance status lead to inequality in treatment and outcome. Most studies comparing uninsured to insured patients were done in the USA. We sought to gain further insights into differences in the outcomes of trauma patients in a healthcare system with mandatory pu...

Introduction The Revised Injury Severity Classification II (RISC II) score represents a data-derived score that aims to predict mortality in severely injured patients. The aim of this study was to assess the discrimination and calibration of RISC II in secondary transferred polytrauma patients. Methods This study was performed on the multicentre d...

Objectives:. Fat embolism and fat embolism syndrome (FES) remain common complications following long bone fractures. Incidence is highest after bilateral femur fractures. We performed a systematic review of FES after bilateral femur fractures and present two cases. Data sources:. Systematic literature search of the Cochrane, EMBASE, MEDLINE, Scopus...

Introduction:. Pelvic binders (PB) have become an established first–line treatment for on scene use in suspected pelvic ring injuries. A sustained incidence of incorrect placements was reported, usually above the trochanteric region. We examined if malplacement is associated with worse clinical parameters related to resuscitation. Methods:. Retrosp...

Objective:. To describe the surgical aspects potentially contributing to hardware failure of cephalomedullary nails. Data Sources:. A search of the Embase, PubMed (MEDLINE), Web of Science, and the Cochrane library for reports of hardware failures after intramedullary fixation of proximal femur fractures. Issues of cut out and cut through phenomena...

Zusammenfassung Das akute Kompartmentsyndrom der Extremitäten ist ein chirurgischer Notfall, dessen schnelle Diagnose und sofortige operative Therapie essenziell für das Outcome sind. Ursächlich ist ein Anstieg des Gewebedruckes innerhalb einer durch Faszien eingeschlossenen Muskelloge und eine daraus resultierende Mikroperfusionsstörung. Diese kan...

Background: As electric bicycles (e-bikes) become increasingly popular, reports of injuries associated with e-bike usage are also rising. Patterns, characteristics, and severity of injuries following e-bike crashes need further investigation, particularly in contrast to injuries from conventional bicycle crashes. Methods: This prospective observ...

The constant increase of life expectancy leads to a constant increase of elderly patients, especially of the western population [1]. In 2060, approximately one-third of the European population will be 65 years and older; the proportion of octogenarians is estimated to increase from 6% in 2015 to 11% in 2040 [2]. Similarly, in the US an estimated 1...

Introduction Traditionally, thoracolumbar split and burst-split fractures are treated with combined antero-posterior bi-segmental fusion procedures. Especially in the lower lumbar spine, such interventions are invasive and are associated with increased risk of neurological and vascular complications. This retrospective study aims to determine wheth...

Surgical decision making in the polytraumatized patient remains a challenging task and depends on numerous factors such as injury patterns, physiological stability and immunoinflammatory response. For patients approaching physiological instability (“borderline patients”) a staged surgical approach is recommended based on an initial assessment of in...

The local inflammatory impact of different reaming protocols in intramedullary nailing has been sparsely investigated. We examined the effect of different reaming protocols on fracture hematoma (FH) immunological characteristics in pigs. To do so, a standardized midshaft femur fracture was induced in adult male pigs. Fractures were treated with con...

Introduction Well-known risk factors (RF) for soft tissue complications following surgical treatment of fracture of the ankle region include diabetes, smoking, and the local soft tissue status. A weighted analysis might provide a risk profile that guides the surgical treatment strategy. The aim of this meta-analysis was to provide a risk profile fo...

This review paper on femoral neck fractures in the elderly provides updated information from the most recent literature and examines the advantages and disadvantages of different surgical treatment options. Femoral neck fractures are a common injury that many orthopaedic surgeons will encounter within their practice. These injuries are associated w...

PurposeWe sought to develop a simple, effective and accurate assessment tool using well-known prognostic parameters to predict mortality and morbidity in severely injured patients with major fractures at the stage of the trauma bay.Methods European Data from the TraumaRegister DGU® were queried for patients aged 16 or older and with an ISS of 9 and...

Purpose The management of severe soft tissue injuries to the extremities with full-thickness wounds poses a challenge to the patient and surgeon. Dermal substitutes are used increasingly in these defects. The aim of this study was to investigate the impact of the type of injury on the success rate of Matriderm® (MD)-augmented split-thickness skin g...

A mangled extremity is a combination of injuries to the bones, soft tissue, muscles, tendons, vessels, and/or nerves after high-energy trauma. It is an infrequent but severe injury. The difficult decision with mangled extremities is whether to amputate or to salvage the limb. There is no metric that can clearly predict the ideal patient for amputat...

Falls’ prevention is an integrated part in the management of geriatric patients with and without frailty. In most instances, it is performed by an exercise program and multiple tests. These tests (stand up and go, mobility tests) usually are performed by a person who has received some kind of medical training. This chapter presents a self-examinati...

The decision-making for patients treated in the ICU is different from the one required in the early stages after trauma, where resuscitation and hemorrhage control represent key factors. Early after injury, the surgical decision mainly serves to separate between surgical requirements and decide if damage control techniques, or a safe definitive sur...

The aim to minimize mortality rates in polytrauma led to numerous investigations, calculations, and scoring systems to describe the individual patient risk. Patients react differently to the same injury. This reaction depends on the physiologic state, comorbidities, age, and numerous other factors. Several scoring systems aim to quantify the injury...

PurposeUsing palmar plating to treat complex intraarticular distal radius fractures is standard of care. However, fracture fragments can also be managed using a dorsal approach with arthrotomy, which is useful when treating fractures involving the dorsal joint aspect. We compared radiological and clinical outcomes after dorsal plating with or witho...

Objectives The objectives of this study were to gather an expert opinion survey and to evaluate the suitability of summarized indications and interventions for DCO.Background The indications to perform temporary surgery in musculoskeletal injuries may vary during the hospitalization and have not been defined. We performed a literature review and an...

The University Hospital Zurich together with IBM® invented an outcome prediction tool based on the IBM Watson technology, the Watson Trauma Pathway Explorer®. This tool is an artificial intelligence to predict three outcome scenarios in polytrauma patients: the Systemic Inflammatory Response Syndrome (SIRS) and sepsis within 21 days as well as deat...

Traumatic adult humeral diaphyseal fractures can be difficult to deal with in geriatric patients. Three examples are summarized in using Titanium Elastic Nails® (TEN) in adult patients as an efficient alternative and an off-label strategy in treating diaphyseal as well as subcapital humeral fractures. A 75 years old adult female patient suffering f...

A mangled extremity is a combination of injuries to the bones, soft tissue, muscles, tendons, vessels, and/or nerves after high-energy trauma. It is an infrequent but severe injury. The difficult decision with mangled extremities is whether to amputate or to salvage the limb. There is no metric that can clearly predict the ideal patient for amputat...

Introduction: Cervical ligamentous injuries in patients with ankylosing spondylitis (AS) may be difficult to detect, even with the utilization of computed tomography (CT) scans. The purpose of this study was to investigate the influence AS has on various radiologic parameters used to detect traumatic and degenerative pathologies of the cervical spi...

Background: Osteoporotic vertebral fractures (OVFs) have become increasingly common, and previous nonrandomized and randomized controlled trials (RCTs) have compared the effects of cement augmentation versus nonoperative management on the clinical outcome. This meta-analysis focuses on RCTs and the calculated differences between cement augmentatio...

Background: Upper extremity injuries often lead to long-term problems in function and quality of life in patients. However, not much is known about this effect in polytrauma patients. This study aimed to describe the upper extremity injuries in polytrauma patients and to compare self-reported disability and quality of life in polytrauma patients w...

Background Reamer-Irrigator-Aspirator (RIA) of long bones is increasingly being used as an alternative to iliac crest harvesting for bone-grafts. This meta-analysis compares both harvesting techniques with regard to donor site morbidity, healing potency and implantation site morbidity. Methods PubMed/Medline/Embase/CENTRAL/CINAHL were searched for...

Background: Using Injury Severity Score (ISS) data, this study aimed to give an overview of trauma mechanisms, causes of death, injury patterns, and potential survivability in prehospital trauma victims. Methods: Age, gender, trauma mechanism, cause of death, and ISS data were recorded regarding forensic autopsies and whole-body postmortem CT. C...

There has been an ongoing discussion as to which interventions should be carried out by an “organ specialist” (for example, a thoracic or visceral surgeon) or by a trauma surgeon with appropriate general surgical training in polytrauma patients. However, there are only limited data about which exact emergency interventions are immediately carried o...

Salvage of a mangled limb can be a long and strenuous way, but it is feasible even with rather simple techniques such as augmented split‐skin grafting and maggot biodebridement. Salvage of a mangled limb can be a long and strenuous way, but it is feasible even with rather simple techniques such as augmented split‐skin grafting and maggot biodebride...

Introduction The aims of our study were (1) to determine the prevalence of hypokalemia, (2) to evaluate predictors for hypokalemia, and (3) to show the influence of hypokalemia on in-hospital outcome (mortality, adverse events, and length of stay) in a general trauma cohort. Methods We performed a four-year retrospective study and analyzed the inf...

Introduction Increasing sub-specialization has reduced the number of general surgeons involved in the care of trauma patients in German-speaking countries (Germany, Austria and Switzerland) over the past decades. Thus, the aim of this study was to assess, to what extent level 1 trauma centers are still prepared to provide immediate emergency surger...

PurposeSwiss and German (pre-)hospital systems, distribution and organization of trauma centres differ from each other. It is unclear if outcome in trauma patients differs as well. Therefore, this study aims to determine differences in characteristics, therapy and outcome of trauma patients between both German-speaking countries.Methods The TraumaR...

Background: Electric bicycles (E-bikes) are an increasingly popular means of transport, and have been designed for a higher speed comparable to that of small motorcycles. Accident statistics show that E-bikes are increasingly involved in traffic accidents. To test the hypothesis of whether accidents involving E-bikes bear more resemblance to motor...

Purpose The number of severely injured patients exceeding the age of 60 has shown a steep increase within the last decades. These patients present with numerous co-morbidities, polypharmacy, and increased frailty requiring an adjusted treatment approach. In this study, we establish an overview of changes we observed in demographics of older severe...

Background Carbon-reinforced PEEK (C-FRP) implants are non-magnetic and have increasingly been used for the fixation of spinal instabilities. Purpose To compare the effect of different metal artifact reduction (MAR) techniques in magnetic resonance imaging (MRI) on titanium and C-FRP spinal implants. Material and Methods Rod-pedicle screw constru...

Purpose Osteosynthetic treatment strategies of PHFs include MIPO or ORIF techniques. The aim of this study was to compare the 1 year outcome following either technique in type B PHFs. Methods This study was designed as a retrospective cohort study of patients treated at one academic Level 1 trauma center. Patients from 2009 to 2019 who required su...

Schwerverletzte Patientinnen und Patienten werden in der Schweiz im Rahmen der interkantonalen Vereinbarung der hochspezialisierten Medizin (IVHSM) behandelt. Das Swiss Trauma Board und die dort vereinten zwölf Schweizer Traumazentren arbeiten unter anderem mit dem deutschen Traumaregister zusammen, um eine bestmögliche Behandlung der Verletzten zu...