22nd European Congress of Trauma & Emergency Surgery

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Prof.

The mortality burden of frailty in hip fracture patients

Skeletal trauma and sports medicine

Emergency surgery

Abstract text (incl. references and figure legends) Introduction Frailty is a condition characterized by a reduced ability to adapt to external stressors because of a reduced physiologic reserve, which contributes to the high risk of postoperative mortality following hip fracture surgery. This study aims to investigate how frailty is associated with the specific causes of mortality in hip fracture patients. Material &amp; Methods All adult patients in Sweden who suffered a traumatic hip fracture and underwent surgery between 2008 and 2017 were eligible for inclusion. The Orthopedic Hip Frailty Score (OFS) was used to classify patients as non-frail (OFS 0), pre-frail (OFS 1), and frail (OFS ≥2). The association between the degree of frailty and both all-cause and cause-specific mortality was determined using Poisson regression models with robust standard errors while adjusting for potential confounders. Results After applying the inclusion and exclusion criteria, 127,305 patients remained for further analysis. 24% of patients were non-frail, 28% were pre-frail, and 48% were frail. Frail patients exhibited an almost 4-fold higher risk of all-cause mortality 30 days postoperatively [adjusted incidence rate ratio (adj. IRR) and 95% confidence interval (CI): 3.8 (3.4-4.3), p&lt;0.001] and 90 days postoperatively [adj. IRR (95% CI): 3.9 (3.6-4.2), p &lt;0.001], compared to non-frail patients. Of the primary cause of 30-day mortality, frailty was associated with a 3.2 times higher risk of cardiovascular mortality [adj. IRR (95% CI): 3.2 (2.6- 4.0), p&lt;0.001], a 2.6 times higher risk of respiratory mortality [adj. IRR (95% CI): 2.6 (2.0- 3.5), p&lt;0.001], and a 5.0 times higher risk of multiorgan failure [adj. IRR (95% CI): 5.0 (4.0- 6.3), p&lt;0.001]. Conclusion Frailty is associated with a significantly increased risk of all-cause and cause-specific mortality at 30 and 90 days postoperatively. Across both timepoints, cardiovascular and respiratory events along with multiorgan failure were the most prevalent causes of mortality.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

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Recovery and functional outcome after radial nerve palsy in adults with a humeral shaft fracture: A multicenter prospective case series

Abstract text (incl. references and figure legends) Introduction: The consequences of radial nerve palsy associated with a humeral shaft fracture are unclear. The aim of this study was to examine the functional recovery of radial nerve palsy in patients with a humeral shaft fracture. Methods: All patients followed in the HUMMER study, a multicenter prospective cohort study including 390 adult patients with a closed humeral shaft fracture type AO type 12A or 12B, who had either radial nerve palsy at presentation or postoperative radial nerve palsy, were extracted from the HUMMER database. Data consisted of treatment and recovery of radial nerve palsy, functional outcome (Disabilities of the Arm, Shoulder, and Hand (DASH) and the Constant-Murley score), pain level, health-related quality of life (Short Form-36 (SF-36) and EuroQoL-5D-3L (EQ-5D)), activity resumption, and range of motion (ROM) of the shoulder and elbow joint) at 12 months after trauma. Results: Three of the 145 nonoperatively treated patients had radial nerve palsy at presentation. One recovered spontaneously and one after osteosynthesis. Despite multiple surgical interventions, the third patient did not recover radial nerve function after entrapment between fracture fragments. Thirteen of the 245 operatively treated patients had radial nerve palsy at presentation; all recovered. Nine other patients had postoperative radial nerve palsy of which eight healed uneventfully. One had ongoing recovery at the last follow-up, after nerve release and suture repair due to entrapment under the plate were performed. One year after trauma, the functional outcome scores of all patients suggested full recovery regarding functional outcome (DASH and Constant-Murley score), pain, quality of life, activity resumption, and ROM. Conclusion: Radial nerve palsy in patients with a humeral shaft fracture at presentation or postoperatively functionally recovers in 94% and 89%, respectively.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.) All authors declare: DDH and EMMVL had financial support from the OTC Foundation for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

4 times troubles during distraction osteogenesis of femur by mono-tube type external fixator – A case report

Polytrauma

Abstract text (incl. references and figure legends) Case report:24 years old male This case had many accidents during the treatment of open femoral shaft fracture. He was injured by traffic accident (severe head injury: JCS III-100, open fracture of femur and tibia). He recovered from severe head injury (sequelae: epilepsy), then he was transferred to our hospital 2 months after injury. External fixation had been attached in femur and tibia. MRSA infection was occurred in femur. After debridement, ORIF by plate with shortening was performed. Fracture was united 9 months after ORIF. Then we started distraction osteogenesis with mono tube external fixator. 5 weeks after distraction, proximal fragment was displaced. At this time, displacement was corrected with adding one more external fixator. 2 weeks after this event, epilepsy attack occurred and proximal fragment was displaced again. At this time, pins were bended. 5mm pins were changed to 6mm pins and one more pin was added in proximal and distal. We corrected this deformity under another external fixation systems. 2 months after this surgery, we removed one mono tube external fixator. Fracture occurred at distraction part and one more external fixator was attached again. One month later after this event, he complained severe hip pain. X rays showed femoral neck fracture. ORIF for femoral neck and distraction part were performed. Femoral neck fracture was healed and ossification of distraction part was completed. We introduce some technique used in this case.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

Comparison of osteosynthesis with and without additional plate for Vancouver type B1 and type C periprosthetic fractures of femur

Abstract text (incl. references and figure legends) Introduction: This study aimed to compare the clinical outcomes of well-fixed periprosthetic femoral fractures after hip arthroplasty according to augmentation with attachment plate. Patients and methods: The medical records of patients who underwent reduction and internal fixation of Vancouver type B1 and C periprosthetic femoral fractures after hip arthroplasty were retrospectively obtained from a single center. Data on demographic data, injury mechanism, fracture pattern including open fractures and Vancouver classification, cause of hip arthroplasty, time interval between fracture and arthroplasty, and surgical method were recorded. Functional outcomes including Koval and HHS Score at postoperative 1 year were reviewed. The need for reoperation was also reviewed. Radiologic findings included union time and anatomical alignment of femur at the last radiologic follow-up. We compared surgical outcomes according to augmentation of attachment plate use. Results: Twenty nine patients were included. Their mean age was 79.5 years, and the mean follow-up period was 18.4 months. There were 19 cases of Vancouver type B1 fractures and 10 cases of type C fractures. There were 13 patients of use of attachment plate (group 1); 16 patients of non-use (group 2). One patient in group 1 (7.7%) and 7 (43.8%) in group 2 had a nonunion or delayed union (p = 0.07). One (6.25%) patient in group 2 underwent revision surgery. Koval scores at postoperative 1 year were 3.7 ± 2.2 in group 1 and 3.2 ± 2.5 in group 2, respectively (p = 0.589). HHS scores at postoperative 1 year were 71.1 ± 13.8 in group 1 and 65.0 ± 26.7 in group 2, respectively (p = 0.505). Beals-Towers criteria revealed excellent or good outcomes (group 1, 100% vs. group 2, 87.5%, p = 0.051). Group 1 has less unsatisfactory outcomes (7.7% vs 43.8%, p = 0.044). Conclusion: Internal ﬁxation with augmentation with attachment plate in the well-fixed periprosthetic fractures following showed good clinical outcomes.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

Results of anterior cruciate ligament reconstruction in older athletes

Education

Abstract text (incl. references and figure legends) BACKGROUND: Older adults remain active for longer and continue to participate in sports and activities that require rotation on 1 leg later in life. The rate of anterior cruciate ligament (ACL) tears is therefore increasing in the over-40s, with an associated increase in the rate of surgical reconstruction, but there is little literature on its effectiveness. The aim of this study is to compare the outcomes of elderly patients who have undergone ACLR with those of a younger group of patients. Materials and Methods: patients who underwent patella grafting (bone-patella tendon-bone, BPTB) at the Department of Traumatology, University of Szeged, Hungary, were included in the study with a 5-year follow-up. Patients were divided into groups based on demographic and clinical data, respectively young athletes 40 years, with an additional 3 subgroups of 10-10 years older athletes. Primary outcome measures were graft function and the difference between sites. Secondary outcome measures were patient complaints, pain and functionality in daily life (Lysholm scale, 0-100). Results were analysed by one-way ANOVA and Dunn's post hoc test. Results: 131 patients were included in the study between 2011 and 2015. Graft failure (rupture/expansion ≥ 6 mm) occurred in 7 cases. Patients' complaints were reduced with good outcome in both young and senior groups, with Lysholm scale scores of 96.89±4.45 vs 96.77±2.843 (p=0.103). No significant side difference was found between the groups 2.49±1.2 mm vs 3.05±1.8 mm (p=0.111). Conclusions: The results of ACL reconstruction in senior athletes are similar to those of younger (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

Hybrid solution to treat acetabular fracture in the elderly: Combining fixation and prosthesis. Is it only a chance or a definitive method?

Abstract text (incl. references and figure legends) Introduction: as we know, an acetabular fracture in the elderly raises both lifestyle and bone fusion problems. In accordance with our previous research, in order to avoid expected complications, we have developed a new hybrid (bone-uniting and prosthetics) system for treating old, unstable, displaced acetabular fractures. Material and method: in our institute, we have developed a new procedure that combines the principles of bone fusion and prosthetics for the care of patients over 65 years of age who are expected to be porotic. We solve cup instability with osteosynthesis, and we bridge the porosity with angle-stable implants. Given that the procedure combines the principles of osteosynthetic, i.e., fracture fixation, and does not require gluing, we can achieve sufficient theoretical stability. Arthrosis cannot occur as a result of the joint replacement, and good stability is expected due to the surrounding stabilization elements and shell plasma surface. Results: in the last four years, we operated on 14 elderly patients with the mentioned system. The intraoperative results are encouraging: the operative time was reduced from 180 minutes to an average of 95 minutes, the intraoperative blood loss was controllable throughout (&lt;2000 ml), and the patients could start partial exercise the next day. The long-term functional tests resulted in an HHS value above 80 for all patients, which is a good-excellent result according to international literature. In the initial 14 cases, we were not forced to undergo shell revision or any other changes, and the EQ-5D results of our patients are also encouraging. Conclusion: the hybrid solution that we have introduced, that is, combining osteosynthetic and prosthetic principles, is a safe, stable procedure to be considered in the surgical procedure for acetabular fractures in the 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

Retrospective analysis of management of pelvic fractures in elderly patients

Abstract text (incl. references and figure legends) Introduction:Pelvic fractures in elderly patients (PFE) represents a challenge for orthopedic trauma surgeon. More than 50% of all pelvic fractures occur in patients older than 65 years. Incidence of PFE is increasing, with osteoporosis being the most important risk factor. At our department approximately 200 of PFE per year are treated. Treatment protocol was initiated with early in hospital pain-controlled mobilization.Material and methods:We performed retrospective analysis of PFE over a one-year period. Inclusion criteria were 1.) age over 65 years 2.) radiologically confirmed pelvic fracture 3.) patient treated at level 1 trauma center and follow up at our outpatient clinic. Demographic information, mechanism of injury, length of hospital stays where indicated, mobility, type of treatment and place of discharge was documented.Results:In the year 2018 we treated 190 elderly patients with pelvic fractures. Average age was 83 years, females representing 82% of patients. The majority of PEF (80%) were low energy fractures. Eight were treated operatively, half of operated patients sustained low energy fracture. Average length of stay was 6 days and majority of patients returned to their original place of domicile. Before injury 30% of patients were dependent on mobility aid and at the last follow up after injury 75% patients were depended respectively. 4 (2%) patients remained immobile after the injury that weren"t immobile before the injury. 6% mortality was noted at hospital records.Conclusion:Although majority of patients were treated nonoperatively, majority remained mobile. After the end of follow up the need for walking aid increased significantly, but patient were ambulatory at the end of follow up. Further analysis is necessary. Reference: Rommens PM, Boudissa M, Krämer S, et al. Operative treatment of fragility fractures of the pelvis is connected with lower mortality. A single institution experience. PLoS One. 2021 Jul 9;16(7):e0253408.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

Say goodbye to routine X-rays; de-implementation strategy in X-ray follow-up for wrist and ankle fractures

Abstract text (incl. references and figure legends) Introduction Omitting routine radiographs after the initial 2 weeks of follow-up (FU) in patients with ankle and wrist fractures has proven not to affect patient-reported outcome.1,2 We developed a focused de-implementation strategy based on the known facilitators/barriers.3 This study aims to assess the classical de-implementation (DI) of routine radiographs for wrist and ankle fractures and the added value of a focused strategy in clinical practice. Material &amp; Methods This descriptive retrospective multicenter cohort study included patients with either a non-weber A type ankle fracture (AF) or distal radius fracture (DRF). Patients with open fractures, pathological fractures, or an ISS≥16 were excluded. The primary outcome was the number of routine radiographs, two weeks after trauma, during 3 different research phases: at baseline (before DI), after classical DI, and after the focused DI strategy. Radiographs were indicated as routine if no clinical indication was reported. Descriptive statistics and Chi2-test analysis were performed. Results Results of the first 2 research phases are now available. Baseline data included patients with 155 DRFs and 135 AFs of which 364 radiographs were made during FU. For AF 86.3% of FU radiographs were routine, and for DRF 97% were. After classical DI, 30 AFs and 9 DRFs were included of which 39 radiographs were made (so far, updated results in May). For AF 56.7% were routine radiographs during FU and 44.4% for DRF. Chi2-testing showed a p-value of &lt;0.0001. After classical DI, no routine radiograph led to a change in treatment strategy. Conclusions Preliminary results show a significant reduction in routine radiographs following classical de-implementation methods, without clinical consequences. Further results will be available at the ECTES congress in May. References 1 van Gerven et al J Bone and Joint Surgery 2019 2 van Gerven et al J Bone and Joint Surgery 2020 3 van Gerven et al J Eval Clin Practice 2019 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.) This study was funded by ZonMw, The Netherlands Organization for Health Research and Development (project number 84300095007)

Do sarcopenia and myosteatosis predict adverse outcomes after emergency laparotomy? A single center retrospective analysis on 242 patients

Abstract text (incl. references and figure legends) I Emergency laparotomy (EL) is related to a high risk of morbidity and mortality. Low skeletal muscle mass (sarcopenia) and poor muscle quality (myosteatosis) have been reported as a prognostic predictor in various conditions. The impact of sarcopenia and myosteatosis on postoperative outcomes in patients who underwent emergency laparotomy were investigated. M&amp;M A total of 242 consecutive patients who underwent emergency laparotomy from January 2015 to December 2021 were retrospectively evaluated. Skeletal muscle index (SMI) and Muscle Radiation Attenuation (MRA) was measured as the cross‐sectional area (cm2) of skeletal muscle in the L3 region on computed tomography (CT). SMI was normalized for height (cm2/m2). Sarcopenia was defined as an SMI of ≤41.6 and ≤ 32 cm2/m2 in men and women, respectively. Myosteatosis was defined as an MRA of ≤29.3 and ≤ 22 HU in men and women, respectively. Postoperative morbidity, mortality at 30 days, and length of hospital (LOS) stay were evaluated. R One hundred and eighteen were women, while 124 were men. Median age was 70 (range 21-96). One hundred and three patients were sarcopenics and 189 were myosteatosics, while 75 presented both characteristics. No differences were shown between sarcopenia and postoperative complications (Clavien Dindo&gt;2), mortality at 30 days, and LOS. Myosteatosis, instead, was found to be associated with higher LOS (17 days versus 8 days, P 0.002) and higher severe complications rate (84,4% versus 14,6% P=0.0049) but not to 30 days mortality. C Myosteatosis, but not sarcopenia, seems to be related with increased adverse outcomes following emergency laparotomies. It would be useful to consider the myosteatosis, in addition to other clinical factors, to estimate the perioperative risk of patients candidate to emergency laparotomies. R Park B Short-and long-term impact of sarcopenia on outcomes after emergency laparotomy:A systematic review and meta-analysis.Surgery.2022 Jul;172(1):436-445. 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

Prevalence of chronic pain after severe lower limb injury (SLLI): A systematic review and meta-analysis

Abstract text (incl. references and figure legends) Background Severe lower limb injuries (SLLIs) threaten limb viability and patients&quot; lives. In many cases, either emergency salvage or amputation is required. Chronic pain is a major cause of morbidity following SLLI, but the prevalence of this is not clearly understood. The aims are to 1) determine overall prevalence of chronic pain following SLLI, 2) report the prevalence of chronic pain in patients who have undergone salvage and amputation, 3) report the prevalence of residual and phantom limb pain in amputated patients, and 4) report the prevalence of chronic pain in civilian and military patients. Methods This was a systematic literature review using the PRISMA checklist and protocol. Search results from the Medline, Embase, Ovid and Web of Science databases were imported, and data was extracted into Microsoft excel. Meta-analyses of proportions and binomial prevalence were completed. Results Forty-three studies that reported outcomes of 5601 patients were included in this review. Estimated overall prevalence of pain was 63% (0.63 [0.55, 0.70], I2= 95%). The prevalence of chronic pain in amputees was similar to those who underwent limb reconstruction on proportional (OR 1.22 [0.70, 2.11], p= 0.48, I2 = 60%) and binomial ((Amputation 0.64 [0.55, 0.73], I2 = 93%) versus (Salvage 0.56 [0.44, 0.67], I2 = 94%)) analyses. There was a higher prevalence of chronic pain in civilian (0.70 [0.63, 0.77], I2 = 87%) versus military (0.51 [0.35, 0.66], I2 = 97%) populations. There was no difference between residual and phantom limb pain prevalence in amputees (OR 1.06 [0.64, 1.78], p= 0.81, I2= 92%). Conclusions There is a high prevalence of chronic pain following SLLI. There is no difference in prevalence of pain after amputation compared with salvage, and no difference in residual versus phantom pain prevalence in amputees. There is a higher prevalence of pain in civilian versus military populations. This review has identified targets for intervention and further research.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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