22nd European Congress of Trauma & Emergency Surgery

Professor

Chairs

Prof.

Prof. Dr.

Blunt traumatic rupture of subcardiac diaphragm discovered accidentally during a laparotomy: Report of two cases

Abstract text (incl. references and figure legends) Blunt rupture of diaphragm is rare, and in most cases, it occurs on the left side1). In addition, it has a high morbidity and mortality. However, few cases have been reported in the subcardiac diaphragm and there is few description about the management2). Recently we operated two cases of blunt subcardiac diaphragmatic rupture after traffic accidents successfully. Two patients underwent emergency laparotomy first because of hemorrhagic shock and hemoperitoneum, and diaphragmatic ruptures were found accidentally below the heart after abdominal bleeding control. We approached through a laparotomy and a sternotomy respectively because one tore at the substernal part circumferentially and the other on the central tendon radially. The diagnosis of diaphragmatic rupture is difficulty on the arrival at the emergency room, and in addition if the rupture happens below heart, there is a slight chance to find because in my opinion liver supports a heart. For the rupture of subcardiac diaphragm, if we confirmed again during abdominal surgery and appropriate approaches are taken according to different locations, it can be diagnosed and treated quickly. References 1) KH Lim, MD; JY Park, MD, PhD.Blunt traumatic diaphragmatic rupture Single-center experience with 38 patients. Medicine (Baltimore) 2018;97(41):e12849 2) Jin-Mou Gao, Ding-Yuan Du, Hui Li, et al. Traumatic diaphragmatic rupture with combined thoracoabdominal injuries: Difference between penetrating and blunt injuries. Chinese Journal of Traumatology 2015;18:21-26 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

Polytrauma

Visceral trauma

Poster

Classification of polytrauma patients – A retrospective Finnish traumaregistry based study of 3359 patients

Abstract text (incl. references and figure legends) Introduction There are no published results of differences in short- and long-term mortality of severely injured patients when they are categorized as polytrauma patients by different criteria. In this study, we evaluated the differences in mortality between different groups of severely injured patients. Material and Methods Helsinki Trauma Registry (HTR) was used for patient identification from 1.1.2006 to 31.12.2015. Penetrating trunk injuries and children &lt;16 years are not included in the registry. The inclusion criteria for the HTR were ISS ≥16 in 2006 to 2011 and NISS ≥16 from 2012 onwards. Spinal injuries were excluded. Different groups were identified, and Kaplan-Meier survival curves were calculated to estimate the differences in mortality between different groups. A total of 3359 trauma patients were included for the analyses. In Kaplan-Meier analysis we see that Berlin polytrauma patients have significantly (Log Rank p&lt;0.001) higher mortality in short-term (30 d to 1 year) compared to other groups but the difference in cumulative mortality gradually levels out compared to isolated injury patient group and in the end of the follow-up the difference turns other way around. Conclusions Berlin definition polytrauma patients had the highest NISS-scores, while all polytrauma patients had the second highest NISS-scores. However, patients in these groups were the young. Therefore, one might think that young patients have a capability to recover better from a severe trauma. Polytrauma patients by Berlin definition have high short-term mortality compared to other severely injured patients. However, in long-term the mortality difference diminishes. Therefore, it is important to use all resources available in the early treatment of these patients. References Please see appendix.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

Emergency surgery

Long-term mortality of polytrauma patients by Berlin definition - A retrospective Finnish traumaregistry based study of 500 patients

Abstract text (incl. references and figure legends) Introduction Trauma surgeons around the world felt the need for a common and mutually shared definition of a polytrauma patient. A Berlin criteria for a polytrauma patient definition were proposed by an expert panel and mutually accepted. As stated previously, burden caused by a severe trauma is long lasting. The aim of this study was to evaluate the mortality of polytrauma patients by Berlin definition in long-term as well as factors associated in mortality of these patients. Material and Methods Helsinki Trauma Registry (HTR) was used for patient identification from 1.1.2006 to 31.12.2015. Penetrating trunk injuries and children &lt;16 years are not included in the registry. The inclusion criteria for the HTR were ISS ≥16 in 2006 to 2011 and NISS ≥16 from 2012 onwards. Spinal injuries were excluded. Different groups were identified, and Kaplan-Meier survival curves were calculated to estimate the differences in mortality between different groups. Results We identified 3557 patients from HTR. Of these patients 500 (14.1%) were defined as polytrauma patient by Berlin definition. A Kaplan-Meier Survival curve will be drawn, and cumulative mortality calculated. We will run a cox regression analysis of these patients to see what factors influence to the long-term mortality of these patients. Conclusion We try to conclude the long-term mortality of these patients and factors associated to it. References Please see appendix.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

Dr. med.

Prof. Dr. med.

Insufficient centralization during hemorrhagic shock precedes occult hypoperfusion after resuscitation in a porcine polytrauma model

Abstract text (incl. references and figure legends) Purpose: Occult hypoperfusion(OH) describes the absence of sufficient microcirculation despite normal vital signs. It can be quantified via persistent lactatemia and is associated with complications and a reduced outcome. Our study aims to identify potential causes for occult hypoperfusion after hemorrhagic shock (HS) in a porcine polytrauma model. Methods: 25 male Pigs (50 ± 5kg) underwent general anesthesia for 6 hours. They received a combined injury of blunt chest trauma with a lung contusion, a grade II (AAST) liver laceration, controlled HS (mean arterial pressure 30 ± 5 mm Hg for 60 minutes), and femoral shaft fracture. After 60 minutes, animals were resuscitated. Microcirculation was evaluated using near-infrared spectroscopy on the M. vastus lateralis of the fractured and uninjured site as well as on liver, stomach and colon. Lactate was measured via blood gas analysis. All measurements were taken at baseline, during HS at 15/30/45/60 min, and after resuscitation at 2h,4h and 6h. OH was defined as persistent lactatemia (&gt;2mmol/l) at 6h. Results: Lactate normalized in 18 animals (72%) after resuscitation (control). Four animals (16%) were diagnosed with OH. Three animals (12%) died during the observation period. Vital parameters (RR, SaO2, and Schock Index) didn"t differ between groups. Lactate was significantly higher in OH at 2h and 6h (p = 0.039 and p = 0.001). Significantly higher local bloodflow was noted during HS on the uninjured M. vastus lateralis at 30, 45, and 60 min (p = 0.012, p = 0.039 and p = 0.008) in OH compared to control. Oxygen delivery at that site was significantly higher at 45 and 60 min (p = 0.044, and p = 0.004), but lower at 4h (p = 0.039). Conclusion: Failure to centralize during hemorrhagic shock can lead to reduced local microcirculation and persistent lactatemia after resuscitation and OH. Our results support the validity of lactate clearance as a marker of sufficient resuscitation.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 declare

Impact of a femoral fracture on outcome after traumatic brain injury - A matched pair analysis of the TraumaRegister DGU®

Abstract text (incl. references and figure legends) Introduction: Traumatic brain injury (TBI) is the leading cause of death and disability in polytrauma and is often accompanied by concomitant injuries [1,2]. We analyzed the impact of a concomitant femoral fracture on outcome and mortality of TBI patients [3]. Material &amp; Methods: We conducted a retrospective matched-pair analysis of data from the multicenter trauma database TraumaRegister DGU®. Data from a 10-year period were analyzed regarding the influence of a concomitant femoral fracture on outcome and mortality of TBI patients. We included adult patients (≥ 16 years) with moderate to critical TBI (AIS 2-5). Patients with isolated TBI were compared to patients with combined TBI and femoral fracture. Matching criteria were TBI severity, ASA risk classification, initial GCS, age and gender. The chi-square test was used to evaluate categorical variables and statistical significance was defined as a p-value &lt; 0.05. Results: 4508 patients were included. Patients suffering combined TBI and femoral fracture showed a higher mortality rate overall, within &lt; 6h and &lt; 24h after injury (Figure 1). They presented with less favorable Glasgow Outcome Scale (GOS) at the time of discharge, a higher rate of multi-organ failure and of neurosurgical intervention than patients with isolated TBI. Interestingly, patients with moderate TBI (AISHead=2) showed an increased in-hospital mortality when presenting with a concomitant femoral fracture (p = 0.037, Figure 2). In addition, mortality was similar in patients receiving early total care of the femoral fracture and those treated with damage control orthopedics. Conclusions: Patients with combined TBI and femoral fracture have a higher mortality, more in-hospital complications, an increased need for neurosurgical intervention and inferior GOS at the time of discharge. References: [1] Maas et al. Lancet 2008 [2] van Leeuwen et al. Neurosurgery 2012 [3] Suto et al. J Trauma Acute Care Surg 2018 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

Skeletal trauma and sports medicine

Hypocalcemia in the polytraumatized patient: A systematic review

Abstract text (incl. references and figure legends) Introduction: Trauma-induced hypocalcemia is a severe complication, in view of the importance of calcium in the regulation of the body's physiological mechanisms. For this reason, the negative hemodynamic effects of hypocalcemia must be managed early in polytrauma patients, as they are linked to the lethal diamond: hypothermia, acidosis, coagulopathy and hypocalcemia. Thus, the objective of this article is to review about hypocalcemia in polytraumatized patients, with emphasis on the repercussion of this condition. Methods: A systematic review was performed by searching scientific articles – reviews, systematic reviews and meta-analysis -, published in the last five years in PubMed. The keywords used were &quot;hypocalcemia&quot; and &quot;trauma&quot; with the Boolean operator &quot;AND&quot;. In total, 44 articles were found, but only 3 were selected, considering the title and the abstract reading. Results: Polytrauma patients often present with hypocalcemia in the setting of severe hemorrhage secondary to trauma, which can be exacerbated by the need for transfusion and resuscitation. Thus, the time between trauma and treatment of the resulting massive bleeding should be as short as possible, using techniques for fast bleeding control and avoiding aggravating factors, such as hypocalcemia. Conclusions: Hypocalcemia is associated with increased morbimortality in trauma patients. Therefore, fast and effective management of these patients is fundamental. References: Wray JP, et al. The diamond of death: Hypocalcemia in trauma and resuscitation. Am J Emerg Med. 2021 Mar; 41:104-109. doi: 10.1016/j.ajem.2020.12.065. Epub 2020 Dec 28. PMID: 33421674.; DeBot M, et al. Trauma-induced hypocalcemia. Transfusion. 2022 Aug;62 Suppl 1:S274-S280. doi: 10.1111/trf.16959. Epub 2022 Jun 24. PMID: 35748689.; Vasudeva M, et al. Hypocalcemia in trauma patients: A systematic review. J Trauma Acute Care Surg. 2021 Feb 1;90(2):396-402. doi: 10.1097/TA.0000000000003027. PMID: 33196630; PMCID: PMCDisclosure: 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

Severe spinal injury after shoulder arthroplasty. A rare serious complication

Abstract text (incl. references and figure legends) Case history. We present a case of an 83-year-old-female with a four-part left proximal humeral fracture treated with reverse shoulder arthroplasty with tuberosity repair and interscalene block plus general anesthesia in a beach chair position. Clinical findings. In first postoperative day, the patient showed plegia and areflexia in the whole left upper limb, global hypoesthesia, in the C5 dermatomal region, gait disorder, right neck deviation and ptosis without myosis. Investigation/results. An MRI of the cervical spine showed ischemic tissue damage, with a hemorrhage component between C1 and C7 limited to left medulla. Diagnosis. Cervical spine cord ischemia with hemorrhagic component in left hemimedulla. Therapy and progressions. She received 4 mg of Dexamethasone every eight hours for a week, 100 mg of acetylsalicylic acid and prompt rehabilitation. One month postoperative, an EMG reported preganglionic motor neurons lesion, between C3-C4 and T1, especially at C5 and C6 levels. All sensory modalities were affected. Follow-up MRI at 2 months showed improvement compared to the previous. EMG at one year reported C5 and C6 proximal muscle reinnervation. Twenty months postoperatively, motor examination showed deltoid 2/5, triceps 4/5, wrist extensors 3/5, volar flexors 3/5, fingers flexors 3/5, extensor pollicis longus 3/5. She maintained global hypoesthesia in the whole left upper limb. Comments. It is necessary to consider all complications related to shoulder surgery like neurological injuries. They may occur as a consequence of acts related to surgery, a result of anesthetic techniques like interscalene block, but above all with patient positioning during surgery in beach chair position. This position has been associated with brain and spinal cord stroke, midcervical quadriplegia, and higher risk of venous and arterial air embolism. References. Ball CM. Neurologic complications of shoulder joint replacement. J Shoulder Elbow Surg. 2017;26(12):2125-2132. 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.

Poster Session 8
Polytrauma 2

Appointment

Chairs

Programme

Poster Session 8Polytrauma 2

Appointment

Chairs

Programme

Poster Session 8
Polytrauma 2