22nd European Congress of Trauma & Emergency Surgery

Chairs

Reverse shoulder arthroplasty versus non operative treatment of 3-part and 4-part proximal humerus fractures in the elderly patient: A pooled analysis and systematic review

Abstract text (incl. references and figure legends) Background The treatment of complex proximal humerus fractures in elderly patients is not yet fully elucidated. Of all treatment options reverse shoulder arthroplasty (RSA) and non operative treatment (NOT) appear to provide the best results. Evidence to guide the choice between the two is sparse. Therefore, this review provides an overview of the available evidence on RSA versus non-operative treatment. Methods Studies comparing RSA and NOT were included for direct comparison by systematic review and pooled analysis for patient rated outcome and range of motion. Additionally, indirect comparison of case-series and non-comparative studies on either treatment modalities was performed separately. Results Three comparative studies were included with 77 patients that underwent RSA and 81 NOT. Both the Constant Murley score (mean difference 6 points) and DASH score (mean difference 8 points) were better in the RSA group. No differences were deteced in ASES, PENN score, pain scores and range of motion between treatment groups. The most common complications for RSA were infection (3%), nerve injury (2%) and dislocation (2%). Reoperation was required in 5%. In the NOT group common complications included malunion (42%), osteonecrosis (25%) and non-union (3%), however no reoperation was required. Patient satisfaction was equally high in both groups (RSA 100% RSA versus NOT 93%). Conclusion: Functional results appear to be slightly better for RSA. However, patient satisfaction seems comparable despite a high mal-union and osteonecrosis rate in the NOT group which, notably, do not require re-intervention. These results should however be viewed in light of distinct differences in patient characteristics between treatment groups.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) none

Polytrauma

Skeletal trauma and sports medicine

Quick shot presentation

The use of antibiotic-impregnated cancellous bone grafts in one-stage surgery for long bone fracture related infection : A case series

Abstract text (incl. references and figure legends) Objectives: The use of cancellous bone allografts is an established technique in bone reconstruction surgery , but its use is avoided in the presence of infection. Purified cancellous bone grafts impregnated with antibiotics ( AIBG) have shown their effectiveness as a local antibiotic delivery system. This study evaluates the clinical and radiographic outcomes of one-stage treatment of long bone fracture-related infections (FRI) with use of AIBG . Study Design &amp; Methods: 24 consecutive patients with long bone FRI treated in a single stage and with a minimum follow up of 9 months were retrieved from the bone infection database at a level 1 traumacentre. There were 17 men and 7 women with an average age of 55 years (30 to 75). 13 patients had an infected non-union and 11 patients an osteomyelitis. Deep tissue specimens revealed in 18 out of 24 cases a single germ : 12 Staphylococcus ( 6 epidermidis); one Streptococcus; 3 Cutibacterium and 2 gram-negative. Four patients had a polymicrobial infection ; two had negative culture. Vancomycin AIBG was used in all cases, tobramycin was used in 8 cases In 14 cases internal fixation was performed ( 8 x plates, 4 x nails, 2 x screws) Results: After a mean follow-up of 16 months there were 2 recurrences of infection: one persistent clavicle nonunion infected with cutibacterium and one persistent distal tibia nonunion infected with staf epidermidis. There were two persistent nonunions without infection ( one distal femur, one distal tibia) requiring secondary stabilisation surgery Conclusions: Elimination of infection following one stage surgical treatment of FRI with the use of AIBG was successful in 91% of cases comparing favorably with multi stage approachesDisclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) no

Prof.

The radial nerve protection plate technique : Avoiding radial nerve palsy in case of plate removal

Abstract text (incl. references and figure legends) Objectives Iatrogenic radial nerve palsy (RNP) is a well known complication when plating humeral shaft fractures with even an increased risk when plate removal is indicated. Bridging the nerve by a bended plate should allow plate removal in secondary surgery without RNP. Primary outcome is radial nerve palsy after removal of the radial nerve protection plate . Secondary outcome is the incidence of nonunion after primary surgery. Methods Retrospective , consecutive series. The Radial Nerve Protection Plate technique (RNPP) was introduced in may 2013 . Patients were included untill dec 2021, having at least 6 months follow up . In all patients the radial nerve was explored and subsequently bridged by the bended plate. Results In total 34 patients were included. 21 female, 13 male. Mean age was 62 y (range 17-91) . There were two preoperative RNP. 23 patients received a lateral plate through a direct lateral approach , 11 patients received a posterior plate through a posterior approach. 8 patients ( 23%) experienced a temporary RNP after primary surgery . There were 2 nonunions and 1 peri-implant fracture. In 7 patients the plate was removed after a mean of 14 months ( range 8-17) of which 6 lateral and 1 posterior. Reasons for removal were 4 times hindrance, 2 nonunions and 1 peri-implant fracture. There were no RNP after secondary surgery. One patient in whom we used cauterisation to clear the plate at the level of the radial nerve experienced a two day weakness in wrist dorsiflexion. Conclusions The RNPP technique avoids radial nerve palsy in case of removal of the plate without impeding primary fracture healing. When clearing the plate , avoid cauterization of the plate near the radial nerveDisclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) no

Postoperative load bearing in periprosthetic femoral fractures: A survey among orthopedic surgeons in the Netherlands

Abstract text (incl. references and figure legends) Introduction: Permissive weightbearing (PWB) has relatively recently been implemented to optimize rapid clinical recovery and restoration of function in patients suffering lower extremity fractures. PWB shows outcome advantages in this patient category. Currently there is no consensus on postoperative load bearing management after surgically treated periprosthetic femoral fractures (PPFF). The objective is to investigate the current postoperative practice of weightbearing instructions for patients with surgically treated PPFF, accounting for differences in types of periprosthetic fractures and treatment options among Dutch orthopedic surgeons. Material &amp; Methods: An online survey was distributed among the members of the hip and trauma working groups of the Dutch Orthopedic Association. Results: The response rate was 13% (n=75). The main finding was that postoperative load bearing regimes in case of Vancouver A, B and C PPFF differed greatly among Dutch orthopedic surgeons and no decisive guideline or consensus in postoperative load bearing regime after surgically treated PPFF was used in the Netherlands. Conclusion: In absence of decisive guidelines or consensus, more research is needed to explore the efficacy of PWB after surgically treated PPFF. References: 1. Meys, G. et al. (2019): A protocol for permissive weight-bearing during allied health therapy in surgically treated fractures of the pelvis and lower extremities. J Rehabil Med. 51(4): p. 290-297. Doi: 10.2340/16501977-2532. 2. Tian, et al. (2017): Partial versus early full weight bearing after uncemented total hip arthroplasty: a meta-analysis. J Orthop Surg Res. 12(1): p. 31. Doi: 10.1186/s13018-017-0527-x. 3. Duncan, et al. (1995): Fractures of the femur after hip replacement. Instr Course Lect. 44: p. 293-304. PMID: 7797866. Figure legends: 5 figures presenting the response of Dutch Orthopedic surgeons on postoperative load bearing regimen in PPFF Vancouver A, B1, B2, B3 and C.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) Statements and declarations: Ethical approval: this study is a survey-based study, no ethical approval was required. Informed consent to participate: this study is a survey-based study, no informed consent was needed. Informed consent to publish: this study is a survey-based study, no informed consent was needed. Authors Contributions: All authors contributed to the study conception and design. Material preparation and data collection was performed by M.A.M. Vesseur. Analysis were performed by M.A.M. Vesseur, J. Jelsma and J. Most. The first draft of the manuscript was written by M.A.M. Vesseur and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Funding: the authors did not receive support from any organization for the submitted work. Competing Interests: the authors have no relevant financial or non-financial interests to disclose. Availability of data and materials: not applicable. Acknowledgements: None.

Emergency surgery

Segmental resection and bone transport to primary upper ankle joint arthrodesis for fracture related infection of distal tibia

Abstract text (incl. references and figure legends) Introduction Fracture related infection (FRI) is a serious complication of surgical fracture treatment. Intra-articular fractures of distal tibia are often a result of high energy trauma, sufficient debridement produce bone and soft tissue defect, which requires the involvement of a plastic surgeon. Methods In our retrospective study we have treated ten consecutive patients, who have required segmental resection of distal tibia and the articular surface of the upper ankle joint. The average bone defect was nine centimetres. The soft tissue coverage is essential for the treatment of infection and bone healing, it had to be addressed first. The bone transport method with external fixator was used for the bone defect treatment. The goal was to achieve tibio-talar bone union. Fig1 Results We observed some pintrack infection, in one case with a progression to the bone, additional surgery was necessary. We have had the arthrodesis healing problems in three patients and distraction callus in two. Both the arthrodesis and the distraction callus can be bridged and fixed by a long retrograde nail. Fig2 Conclusion Bone transport is a surgical treatment for bone defect produced by segmental resection in order to heal infection. It is challenging for patients to maintain an external fixator for a longer period, therefore the possibility of early removal and additional surgery providing another type of fixation needs to be considered. Plastic surgeon involvement is crucial. It is essential that all possible treatments are put forward in the primary care of the injury to prevent infection, or to act quickly and correctly in the event of the early infection occurring regardless. References Metsemakers,W.J(2018).Infection after fracture fixation:Current surgical and microbiological concepts.Injury,49(3),511–522. McNally,M(2017). Ilizarov Treatment Protocols in the Management of Infected Nonunion of the Tibia.Journal of Orthopaedic Trauma,31,S47–S54.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Prof. Dr.

A recalibrated prediction model can identify level-1 trauma patients at risk of nosocomial pneumonia

Abstract text (incl. references and figure legends) Introduction: Nosocomial pneumonia has a poor prognosis in hospitalized trauma patients. Croce et al. published a model to predict post-traumatic VAP, which achieved high discriminatory capacity and reasonable sensitivity. We aimed to externally validate Croce&quot;s model to predict nosocomial pneumonia in patients admitted to a Dutch level-1 trauma center. Material &amp; Methods: This retrospective study included all trauma patients (≥16y) admitted for &gt;24h to our level-1 trauma center in 2017. Excluded were pneumonia or antibiotic treatment upon hospital admission, treatment elsewhere &gt;24h, or death &lt;48h. Croce&quot;s model used 8 clinical variables—on trauma severity and treatment, available in the ED—to predict nosocomial pneumonia risk. The predictive performance was assessed through discrimination and calibration before and after re-estimating the model&quot;s coefficients. In sensitivity analysis, models were updated with Ridge regression. Results: 809 Patients were included (median age 51y, 67% male), 86 (11%) developed pneumonia. Pneumonia patients were older, more severely injured, and underwent more emergent interventions. Croce&quot;s model showed good discrimination (AUC 0.83, 95%CI 0.79–0.87), yet predicted probabilities were too low (mean predicted risk 6.4%), and calibration was suboptimal. After full recalibration, discrimination (AUC 0.84, 95%CI 0.80–0.88) and calibration improved. Adding age to the model increased the AUC to 0.87 (95%CI 0.84–0.91). Prediction parameters were similar after Ridge regression. Conclusions: The externally validated and intercept-recalibrated models show good discrimination and have the potential to predict nosocomial pneumonia. Recalibration of Croce&quot;s model improved predictive performance. The recalibrated model provides further basis for pneumonia prediction in level-1 trauma patients. At this time, clinicians could apply the models to identify high-risk patients, increase monitoring, and initiate preventative measures.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Management of splenic injuries spanning two decades

Abstract text (incl. references and figure legends) Introduction: Splenic injuries are common in abdominal trauma patients. Several changes to the trauma system have contributed to current management strategies. Non-Operative Management (NOM) with radiological interventions is preferred when possible. This study investigates demographics, management, and mortality of patients with splenic injuries during our trauma registry's initial 15 years of registration. Material &amp; Methods: A retrospective observational cohort study of data recorded prospectively at Stavanger University Hospital's Trauma Registry between January 2004 and December 2018. Patients with Abbreviated Injury Scale (AIS) code for splenic injury were included. Results: A total of 135 patients (median age 23 years; males 74%) had a splenic injury, predominantly from blunt trauma (99%). A splenic injury occurred in 1.9% of all trauma patients, and in 30% of patients with abdominal injuries. Over half (55%) had polytrauma, with median ISS=25 and median NISS=29. Two-thirds had a severe splenic injury (AIS score ³3), distributed across OIS III at 34%, OIS IV at 22%, and OIS V at 8%, respectively. OIS I and II represented 36% of the injuries. Splenic injury as a single abdominal injury was seen in 54% of the patients. Associated injuries in other body regions were found in 87%, most frequently in the thoracic region (70%). NOM was chosen in 105 patients (78%) with a 4%(4/105) failure rate. Of the 30 surgically treated patients, 14 had a splenectomy, and 16 had spleen-preserving measures (with one delayed splenectomy). Angioembolization was done in 25%(34/135) of the patients. With an overall 30-day mortality of 6%, no further deaths occurred within 90 days after the incident. Conclusion: Splenic injuries are characterized by blunt injuries in young males resulting in a high-grade injury in two-thirds of the patients. NOM showed a low failure rate, and splenectomy-rate was 11%. Mortality was rare, with only three deaths attributed to uncontrollable bleeding.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Visceral trauma

Clinical features of acetabular fractures in the elderly: The comparison of the early and late elderly patients

Abstract text (incl. references and figure legends) Introduction： As aging society is progressing, the opportunity of treating acetabular fractures in the elderly is increasing. Besides, healthy life expectancy is getting longer. The purpose of this study is to compare the characteristics of fracture patterns and the complication rate of open reduction and internal fixation in early and late elderly patients Material and Methods： Out of 94 cases of operatively treated acetabular fractures from November 2011 to September 2022, 38 cases of the elderly older than 65 years were investigated. The early elderly group (E) was defined as ranging from 65 to 74, and the late elderly group (L) was defined as older than 75 years. The sex, the number of comorbidity, waiting durations for surgeries, fracture pattern (Judet Letournel classification), and the final physical status were investigated. The t-test and Mann-Whitney test were used to compare both groups statistically. Results: The number of cases was 22 cases in group E and sixteen cases in group L. The average age was 69 in E and 83.7 in L (p&lt;0.05), and the number of comorbidities was 0.72 in E and 1.3 in E (p&lt;0.05). The waiting period for surgery was 11.6 days in E and 10.6 in L (p&gt;0.05). In fracture morphology, anterior column with posterior hemi transverse fracture that is reportedly frequent in the elderly was 36.3% (8/22) in E and 50% (8/16) (p&gt;0.05). The fracture with impaction around the joint surface was observed in 45.4% (10/22) in E and 81.2% (13/16) in L(p&lt;0.05). The complication occurred in 6 cases in E (infection, abdominal hernia, and DVT with 2cases each) and one case in L (traumatic osteoarthritis). The patients with walking ability were 50% (11/22) in E and 19%(3/16) in L (p&lt;0.05). Conclusion: Compared with the early elderly, late elderly patients had more comorbidities and impaction around the joint. The physical status after surgeries in the late elderly was inferior to the early elderly.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Pattern and risk factors associated with trauma-related early mortality: A five-year experience from a national level I trauma center in Qatar

Abstract text (incl. references and figure legends) Introduction: The majority of trauma-related mortality occurs early following injury, and it is the leading cause of deaths and disability worldwide. However, the patient outcomes can be improved by identifying the risk factors for early mortality in trauma settings. Herein, we aim to identify factors predicting early mortality in trauma patients. Methods: A retrospective study was conducted to review all trauma-related mortality cases registered between 2013 and 2018 at HGH. Patients were divided and analyzed based on the time of mortality i.e. early (≤48 hours) and late (&gt;48 hours) deaths. Multivariate regression analysis was performed to identify the factors associated with early mortality. Results: During the study period, there were 8,624 trauma admissions; of them 354 (4.1%) patients died who were predominantly males, with a mean age of 35.8±17.2 years. The mortality pattern peaked immediately after injury (n = 323), followed by 70 mortalities within the first day, 43 mortalities in second day, 124 mortalities within the 3-7 day (second peak), and 127 mortalities after one week. Those who died early were more likely to have lower GCS, higher shock index, chest, and abdominal AIS and frequently required exploratory laparotomy and massive blood transfusion (p&lt;0.005). Whereas, higher injury severity score and frequent head injuries were observed in the late group. On multivariate analysis, shock index (OR 2.26; 95% CI 1.04-4.925; p=0.04) was an independent predictor for early deaths, whereas head injury was a predictor for late deaths (OR 0.22; 95% CI 0.09-0.52; p=0.001). Conclusion: One third of trauma-related mortalities occurred early following injury. Initial shock index seems to be a reliable hemodynamic indicator to predict early mortality in trauma patients. Therefore, timely hemostatic resuscitation and appropriate interventions for bleeding control may prevent early mortality post-trauma. Reference: Jin WY et al (2018) doi: 10.5505/tjtes.2018.29434Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Dr. med.

Prof. Dr. med.

Occult hypoperfusion in trauma patients : A systematic review on age-specific clinical outcome

Abstract text (incl. references and figure legends) Introduction Occult hypoperfusion (OH) is defined as inadequate tissue oxygenation in the presence of normal vital signs. This condition is associated with impaired outcome in trauma, however the impact of age is unclear. This study aimed to assess outcome of OH in both young and elderly trauma patients. Material &amp; Methods A systematic Medline literature search was conducted using MeSH terms. Studies reporting on occult hypoperfusion in adult trauma patients were accessed. All studies that clearly stated clinical outcome of OH vs. a control condition were included. Results 43 publications were identified by the MeSH-search, of whom 4 studies (n=3,334) reported on clinical outcome in OH. Average ISS varied between 7-28. Relative odds for mortality or major complications were higher in OH-situations than in normal conditions. If lactate levels are corrected within 24hrs, mortality is not increased in adult (age 43 ± 19) polytrauma patients with OH. In patients &gt; 65yrs, OH was associated with higher mortality and prolonged ICU-stay. In young patients, relative odds for mortality/ complications are lower in OH than in shock conditions (OR 0.52;95%CI:0.42-0.65). However, in patients aged ≥ 55 years, relative odds for mortality/complications is higher in OH than in shock-conditions (OR 1.21;95%CI:0.97-1.52). The need for lifesaving intervention did not differ between OH and shock conditions in burn patients. Conclusions Literature on age-specific outcome of occult hypoperfusion in trauma is sparse. However, findings indicate that OH is associated with impaired outcome in trauma patients of every age. Prompt correction of lactate seems to optimize outcome in younger patients with OH. Furthermore, the negative impact of OH on outcome is more profound in older than in younger trauma patients. Therefore, future studies should focus on prompt identification and treatment of OH, especially in higher-aged trauma patients. Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No.

Smartphone use during forward ambulation causes generalized alterations to sagittal axis and gait pattern – A 4D-motion lab analysis

Abstract text (incl. references and figure legends) Purpose: Excessive smartphone usage has been shown to cause substantial strain on the C-Spine, coining the term &quot;text-neck syndrome&quot;. Previous studies have shown that this effect extends to alter sagittal axis as a whole. The impact of smartphone usage during ambulation on posture and gait patterns remains relatively unexplored. Therefore, we aimed to evaluate the effect of smartphone usage on posture and gait in a dynamic experimental setting. Methods: Healthy volunteers were evaluated using the &quot;DIERS 4D-motion-lab&quot; during regular gait (control) and during &quot;texting while walking&quot; (TWW). Measurements included dynamic surface topography of the back, and foot pressure reaction force analysis. A within-subject design was used. Results were compared using paired student t-tests. An alpha of 0.05 was set as threshold for significance. Results: We included 20 participants (50 % female), with a mean age of 31,4 years. Mean cervical flexion during TWW was 29.6°. We observed a significant increase of thoracic kyphosis (p&lt;0.001), lumbar lordosis (p=0.05), cadence (0.001), and track width (p&lt;0.001) during TWW compared to control, while step length was significantly decreased (p = 0.02). Trunk inclination, as measure of the sagittal balance, remained unaltered. Conclusion: TWW causes multisegmental changes of the spinal axis, while sagittal balance is sustained. Besides postural changes, TWW also causes relevant alterations to the gait pattern by shortening step length and increasing track width.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) Nothing to disclose

Education

Approaching complications after femur fracture surgery

Abstract text (incl. references and figure legends) Introduction A presentation of complications after femoral fracture cases aims to give insight into the retrograde analysis of fixation failure. Each case emphasises a parameter important not only in this process, but also in preparation for upcoming surgery. Material Case 1 - Implant failure is imminent when not applying principles of stability. Only by guiding biology can one obtain bone healing. This gradually relieves the implant and prevents failure by cyclic loading. Case 2 - Due to the difference in the anatomical and mechanical axis of the femur, biomechanics plays an important role in fixation constructs. These should be load sharing if possible, especially in the subtrochanteric region, where forces are highest. Case 3 - Recognising biological problems creates demand for biological solutions. Checking primary x-rays and patient history is a must. In this case, an underlying unrecognised atypical bisphosphonate fracture was obscured by an hypertrophic non union. Case 4 - Assess the probability of infection and explant all potential foci. All operated metaphysiary femoral non unions should be treated as infected until proven otherwise. In high suspicion cases plan for staged treatment. Case 5 - Divide the femur into different segments. Remaining healthy bone stock is best used for new fixation points, fractured segments need stabilisation during healing, and bone defects need to be resolved. Case 6 - In cases with multiple implants stress distribution is crucial. Excluding stress risers from constructs and optimising screw distribution/fixation points increases success rates. Results Follow up x-rays from all of the cases will be shown and commented on. Conclusion Revision after femoral fracture surgery requires an individualised approach. The host is reviewed and optimised. Mechanical, biological and infectious causes of failure are assessed. Planned surgery should follow healing principles, aim towards load sharing and even stress distribution.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No.

The effect of delayed wound closure in severe open tibial shaft fracture complicated with the exposure of fracture

Abstract text (incl. references and figure legends) Introduction Deciding the time and method of wound closure in open tibial fractures is difficult, especially in the boundary case of Gustilo-Anderson type ⅢA or ⅢB. This retrospective cohort study aims to clarify the effect of delayed wound closure (DWC) in the "gray zone" cases compared to primary wound closure (PWC). Material and methods We retrospectively reviewed open tibial shaft fractures treated in one regional Japanese trauma center from 2013 to 2017. Among 47 type Ⅲ fractures, 22 fractures were either type ⅢC or ⅢB with extensive soft tissue loss and excluded from the cohort. Among the other 25 fractures, we included 14 fractures with exposure of fracture as boundary case of type ⅢA or ⅢB. At the initial treatment, we conducted debridement with fracture stabilization by an external fixator. PWC or Negative wound pressure therapy (NPWT) was applied to the open wound. Within a few days following the initial treatment, we conducted internal fixation. In DWC, the wound was closed a few days after the internal fixation. The primary outcome is the need for soft tissue reconstruction. The secondary outcome is the days before the final closure of the wound and complications related to the fracture. The result was compared between DWC and PWC. Results Ten patients (mean age 52.8) underwent DWC, and four patients (mean age 46) underwent PWC. Four patients (40%) in the DWC group and four (100%) in the PWC group required soft tissue reconstruction due to skin necrosis. For the final closure of the wound, 14.2±12.0 days were required in DWC group and 15.8±16.4 days were required in PWC group (p = 0.84). As a complication, one patient in DWC group and one patient in PWC group developed deep tissue infection. Conclusions DWC seems to be a safe option as a method of wound closure in open tibial fractures with the exposure of fracture. There is a need for further study to elucidate the effectiveness of DWC in reducing the need of soft tissue reconstruction.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Efficiency of a virtual fracture care review protocol for semi-elective surgical treatment in trauma patients

Abstract text (incl. references and figure legends) Introduction Virtual Fracture Clinics (VFC) have been widely accepted in management of trauma patients.1 This study aimed to determine the effect of VFC on efficiency of follow-up treatment in trauma patients who underwent semi-elective surgical treatment. Materials &amp; Methods In this retrospective cohort study, patients who received semi-elective surgery due to traumatic injury in 2019 and 2021 were included. All patients were treated at an urban level 2 trauma center, where VFC protocols were implemented during 2020. Of two study groups, one consisted of patients treated traditionally (pre-VFC group), one of patients treated through VFC review (VFC group). Outcomes included secondary healthcare utilization, time from emergency department (ED) presentation to surgery, and complications. Results In total, 1153 pre-VFC and 1102 VFC patients were included. The median number of outpatient clinic consultations was 5 (IQR:3) in pre-VFC patients and 4 (IQR:4) in VFC patients (p&lt;0.01). Pre-VFC patients had a median of 5 (IQR:4) face-to-face consultations and 0 (IQR:0) by phone. For VFC patients, this was 3 (IQR:3) and 1 (IQR:1), respectively (p&lt;0.01). A median of 2 (IQR:1) follow-up X-rays were acquired in pre-VFC patients vs. 1 (IQR:1) in VFC patients (p&lt;0.01). Less follow-up CT-scans were made in VFC patients, with a median of 0 (IQR:0) vs. 0 (IQR:0), respectively (p=0.01). Time from ED presentation to surgery was shorter in the VFC group, with a median of 8 (IQR:6) days vs. 8 (IQR:5) in the pre-VFC group (p=0.01). Complication rates were similar, with 3.9% pre-VFC and 3.1% in VFC patients (p=0.49). Conclusions VFC review reduced secondary healthcare utilization, increased remote delivery of care, and reduced time from ED presentation to surgery. Complication rates were low and similar between groups. References Davey MS et al. Virtual Fracture Clinics in Orthopaedic Surgery - A Systematic Review of Current Evidence. Injury. 2020;51(12):2757-2762 Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

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