22nd European Congress of Trauma & Emergency Surgery

Chairs

Damage control surgery and transcatheter arterial embolization in patient with penetrating hepatic and suprahepatic inferior vena cava injury

Abstract text (incl. references and figure legends) Case history A 30-year-old male presented to our emergency department after a stab wound with knife on right lower chest. Clinical findings The patient was in hypovolemic shock with the blood pressure of 90/60 mmHg, weak peripheral pulses at the rate of 110 per minute, An entry wound was observed on on right lateral axillary line. Investigation/Results Focused Assessment with Sonography for Trauma(FAST) was positive for free fluid in perihepatic area, Abdomianl CT findings showed penestrating wound in upper segment of right hepapatic lobe with arterial extravasation and the wound extended to suprahepatic IVC. Diagnosis Right hepatic and suprahepac IVC injury. Therapy and Progressions Transcatheter arterial embolization(TAE) was conducted to stop active bleeding from right hepatic artery. Then emergency operation was performed. Diaphragm, hepatic injury and the confluence of the IVC and the right atrium injury were repaired. Damage control surgery was performed with perihepatic packing and placed temporary abdominal closure dressing. The second-look laparotomy performed 36 h after the first surgery. The postoperative course was uneventful. Comments Injury to the supra-hepatic IVC is very rare and challenging to treat with high motality. Multiple factors have contributed to the patient"s favorable outcome, including rapid transfer and trauma response, relatively good health prior to injury and mutidisplinary therapeutic approach. Timely intervention and damage control surgery can stabilize and save these patients. References Predictors of Mortality in Patients with Penetrating Inferior Vena Cava Injuries Surviving to the Operating Room. Maciel JD, Plurad D, Gifford E, deVirgilio C, Koopmann M, Neville A, Putnam B, Kim DY. Am Surg. 2015 Oct;81(10):1000-4.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

Prof.

Outcomes of fifty-six surgical managed cases of blunt pancreatic injury

Abstract text (incl. references and figure legends) Introduction: As pancreatic injuries (PIs) are relatively rare among blunt abdominal traumas, their management protocols are not yet established. The absence of the protocol may be responsible for delay in diagnosis and treatment of main pancreatic duct (MPD) injury, and for related increase in mortality rate. The purpose of this study is to investigate the association between background, diagnosis, surgical treatment, and outcome in PI cases, and to clarify their optimal management. Material &amp; Methods: We reviewed the records of 56 patients with blunt PI who underwent surgery in Saitama Medical Center from 2007 to 2021. We examined backgrounds of the cases, grades and regions of the injury, hemodynamical status on admission, injury severity scores (ISS), operative procedures, and evaluated their associations with outcomes or post-operative complications. Results: The cases were 48 males and 10 females with the median age of 42 years (range: 4 to 81 years) and the median ISS of 26 (9 to 54). PIs involved 14 pancreas heads, 14 bodies, 28 tails and 22 main pancreatic ducts. Surgical procedures included 3 pancreatico-duo- denectomys, one middle segmental resection, 21 distal resections, 17 simple sutures, and 14 peritoneal drainages without pancreatic maneuver. We performed duodenotomy and MPD catheterization in 14 cases with no appreciable complications. Incidence of pancreatic fistula or pseudocyst were relatively high in cases with pancreatic head injury (50.0%), MPD injury (50.0%), and those underwent distal resection (52.4%). Conclusion: The intra-operative pancreatography and MPD decom- pression is safe and useful technique for the diagnosis and treatment of MPD injury, especially when severely injured pancreas head is preserved. Incidence of pancreatic fistula and pseudocyst should be taken into consideration, when deciding the indication and method of surgical management for PI.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

Modified Letton-Wilson procedure using easy way of pancreatico-gastrostomy: A case of pancreatic transection du to blunt abdominal trauma

Abstract text (incl. references and figure legends) Background: We have three surgical options for pancreatic transection: distal pancreatectomy (DP), Letton-Wilson procedure (LW) and pancreatico-duodenectomy (PD). DP is generally preferred. As LW and PD are need pancreatic reconstruction that surgeons tend to avoid. However, in our case, the pancreas head and uncinate process were also severely damaged, while the body and tail were almost intact. DP was not reasonable because there was a big concern about diabetes or malnutrition. Case report: 21-year male was injured by a motorcycle accident. As he was unstable upon arrival, after volume resuscitation he went to trauma pan scan and it showed severely injured pancreas and pneumoperitoneum. He had borough to operating room immediately. When the peritoneum was opened duodenal bulb and pancreas neck were completely transected. The sump of the proximal pancreas was sutured and distal was connected to the stomach with panceatico-gastrostomy (PG). Bowel reconstruction was made by Roux-Y. Post operative course was good, he could discharge without major complications. Discussion: Modified LW using PG might be a good option for pancreatic transection. Here in, we introduce our easy way of PG in which distal pancreas is invaginated into the stomach and the fixation is made by only one stich.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

Aiming for the "surgical soul"? – A penetrating pancreatic injury in a victim of multiple stab wounds

Abstract text (incl. references and figure legends) CASE HISTORY: A 43-year-old male was admitted to the emergency room with multiple stab wounds. CLINICAL FINDINGS: On admission, he was normotensive but tachycardic, with abdominal pain. The physical examination revealed fourteen stab wounds – to the chest, abdomen and other superficial body lacerations. INVESTIGATION/RESULTS: Chest X-ray: right pneumothorax – drained with a chest tube. FAST: free fluid in four quadrants - fluid resuscitation, transfusion and emergency surgery. DIAGNOSIS: Exploratory laparotomy: hemoperitoneum, full-thickness perforating stomach injury, transverse mesocolon lacerations and a zone 1 retroperitoneal hematoma resulting from a pancreatic laceration. THERAPY AND PROGRESSION: Gastric and mesocolic lacerations were repaired and haemostasis of the bleeding vessels was achieved with sutures and haemostatic agents. A drain was placed in the pancreatic bed. The patient was admitted to the ICU. On the third day, an abdominal CT was performed which confirmed a 22mm laceration in the pancreatic body, near the neck – Grade II on AAST classification. Complications: grade B pancreatic fistula and an intraabdominal fluid collection that required antibiotic therapy and percutaneous drainage. The patient progressed well and was discharged after 23 days. COMMENTS: Pancreatic injuries occur in less than 10% of all abdominal trauma. Grade I or II can generally be managed conservatively, while higher grades require resection or stenting. Ductal injuries restricted to side-branches have high success rates for conservative treatment. Penetrating injuries to the &quot;surgical soul&quot;, around the pancreatic head, are highly lethal and control of the bleeding is paramount. Stab wounds are associated with lower mortality than gunshot wounds (&lt;5%vs20%) but the morbidity is high, with a risk of pancreatic fistula over 10%. REFERENCES: Søreide K, Weiser TG, Parks RW. Clinical update on management of pancreatic trauma. HPB (Oxford). 2018 Dec;20(12):1099-1108Disclosure: 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.

Liver transplantation for sever hepatic trauma

Abstract text (incl. references and figure legends) Case history: A 64-year-old male was injured at workplace when heavy machinery compressed the right side of his body. Injury led to hemodynamic instability. Clinical findings: Patient was brought to regional hospital and was immediately operated due to hemodynamic instability, damage-control surgery was unsuccessfully attempted. Patient was transferred to the tertiary centre where embolisation and definitive hemostasis was achieved. Investigation/Results: After stabilization other injuries were addressed. ISS was calculated at 45 (AIS 5 liver trauma, AIS 4 flail chest and AIS 2 extremity fracture). Diagnosis: Patient developed acute liver failure, was transferred to a transplant centre and placed on high urgency Eurotransplant list. Therapy and Progression: Liver transplantation was successfully performed 14 days after initial injury. During the surgery extensive liver necrosis and an unexpected ischemic segment of the transverse colon was found. Second-look procedure was performed due to the wall changes of the segment of the transversal colon, colon gangrene was found and right hemicolectomy with primary anastomosis was performed. On the fourth post-transplant day patient deteriorated, was re-operated and completion colectomy with terminal ileostomy formation was performed due to the found perforations of the left colon. Patient condition continuously worsened leading to multiorgan failure and death ten days after transplantation. Comments: Liver transplantation can be offered to selected patients following sever liver trauma as a possible life-saving procedure after all other treatment modalities have been exhausted. There are no widely established guidelines for the selection of the patients after severe liver trauma for liver transplantation. When facing a critically injured patient with severe hepatic trauma, an early referral to a specialized centre, where liver transplantation could be offered, should be a priority. 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

Gunshot injury to the right hemithorax leading to liver trauma – Life saved by silicone breast implant?

Abstract text (incl. references and figure legends) Case history: A 61-year-old woman was brought to the emergency room 30 minutes after being shot in the right hemithorax. Upon arrival of the paramedics, the patient was unresponsive, without measurable blood pressure. Clinical findings: Physical examination revealed gunshot injury with the entry wound 1 cm medially from the right nipple at the superior border of the areola. Patient had signs of peritoneal irritation. Additional injuries to the right palm were noted. Investigation/Results: Imaging revealed hematoperitoneum. The projectile penetrated right breast, continued its path through the breast implant, hit the fifth rib and then advanced through the liver and stopped paravertebrally at the level of the L2. Diagnosis: As the patient was hemodynamically unstable with confirmed liver injury and hematoperitoneum emergency laparotomy was performed. Therapy and progression: Surgery revealed active bleeding from the fourth and fifth liver segments, hemostasis was successfully achieved. Small diaphragmatic injury was closed up, damaged breast implant from the right side was removed. In postoperative course patient developed biloma in the site of liver injury which was successfully managed by interventional and endoscopic interventions. Patient is still alive and under active surveillance. Comments: The liver is one of the most frequently injured organs in penetrating gunshot injuries. Emergency laparotomy should be performed in hemodynamically unstable patient. In presented case a breast implant changed the pathway of the projectile and was probably the important reason of non-fatal outcome.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

Fasciotomy techniques for chronic exertional compartment syndrome in the Netherlands

Abstract text (incl. references and figure legends) Introduction Recently, a new guideline for the treatment of exercise-related leg pain was introduced in the Netherlands. However, consensus on surgical treatment for the chronic exertional compartment syndrome (CECS) is lacking. This qualitative analysis aimed to explore fasciotomy techniques for CECS in the Netherlands. Material &amp; Methods: Surgeons in the Netherlands who performed at least 5 fasciotomies per year were invited to participate in this study. The Grounded Theory framework was used to iteratively collect and analyze data of semi-structured interviews and perioperative observations. Results: Interviews with 12 surgeons and 10 perioperative observations were analyzed (Table 1). Three major categories of CECS surgical management were identified (Figure 1). Which compartments a surgeon performed fasciotomies on depended on training and expertise. Most variation was found in fasciotomy technique for the posterior compartment, with minimally invasive versus open techniques reported, via an anterior or posterior approach. A fasciotomy knife was the preferred choice of instrument, but long scissors were also frequently used, especially for the posterior compartment. Standard choice of wound closure was subcuticular, although some surgeons preferred transcutaneous closure to limit wound tension. Fasciotomy techniques for the anterior compartment and post-operative rehabilitation instructions were similar. All surgeons considered suggestive patient history as an important indication for fasciotomy. Initial conservative treatment prior to surgical intervention was reported as essential by some, but not all participants. Moreover, not all surgeons viewed intracompartmental pressure measurement as a key indication for fasciotomy. Conclusions: Fasciotomy techniques in the Netherlands are primarily based on surgeons' personal opinion and experience. This study provides a basis for the development of national guidelines for fasciotomy approaches for CECS.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

Education

Skeletal trauma and sports medicine

Unstable pelvic fractures: Pelvic packing is still required in the era of angioembolization? A 3 year trauma center experience

Abstract text (incl. references and figure legends) Introduction: Unstable pelvic fractures are among the most difficult injuries to treat and require a strong multidisciplinary approach. In the era of angioembolization, the prognosis of these complex fractures has progressively improved. The aim of this study is to question the topicality of pelvic packing as a method of stabilization in the era of angioembolization and external fixators. Materials and Methods: From 01/09/2019 to 30/09/2022 were 401 patients admitted with a diagnosis of pelvic fracture. The following data were considered: degree of injury with Young and Burgees classification, need of angioembolization, need of external fixation, need of pelvic packing length of hospitalization, mortality. Results: All unstable patients required angioembolization and 90% of them required external fixators. Just in 2 cases we performed a pelvic packing due to a venous unstoppable bleeding and both died in the first 48 h. Conclusions: Pelvic packing remains an extreme rescue attempt for those patients who have a venous bleeding and those who angioembolization and external fixators do not give stability, but in our experience this kind of treatment is burdened with almost certain mortality. In our hospital a standardized and multidisciplinary protocol is in place whenever a pelvic fracture is diagnosed. Both stable and unstable pelvic fractures undergo immediate angiography followed by external fixation when the injury requires it. This type of protocol allows in our experience to be timely in blocking bleeding, improving prognosis, and reducing mortality. References: Lin SS, Zhou SG, He LS, Zhang ZX, Zhang XM. The effect of preperitoneal pelvic packing for hemodynamically unstable patients with pelvic fractures. Chin J Traumatol. 2021 Mar;24(2):100-103. doi: 10.1016/j.cjtee.2021.01.008. Lopez PP. Unstable pelvic fractures: the use of angiography in controlling arterial hemorrhage. J Trauma. 2007 Jun;62(6 Suppl):S30-1. doi: 10.1097/TA.0b013e3180654086. 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

Removal of a bent humeral intramedullary nail. A case study and review of removal techniques

Abstract text (incl. references and figure legends) Case history A 65-year-old male presented with deformed arm after falling 2m from a truck. Medical history included an intramedullary nail (IMN) after midshaft humeral fracture in 2018. Clinical findings Physical examination showed an upper arm in an angle of 60 degrees with no neurovascular deficits. Investigation/Results X-rays and CT-scan showed transverse humeral midshaft fracture and bent IMN with additional proximal neck fissure (Fig 1). Diagnosis Refractured humerus with bent IMN in-situ. Therapy and Progressions During surgery a lateral approach to IMN and fracture was performed. The IMN was cut, and the IMN-segments were extracted through the fracture site (FS) using extraction-screwdriver. Fracture fixation with VA-LCP-ankle-plate. Recovery was uneventful with no wound complications. Postop; 3-months no limitation, minimal pain, 6-months no limiting pain, 12-months X-rays show progressive consolidation, 15-months pain free, fully working. Comments Bent lower extremity (LE) IMNs are reported, but humeral are not. Bent IMNs are rare and challenging. Several techniques have been described in literature. We present an overview of described techniques in Table 1. In this case, open sectioning and two-piece extraction was used; other described techniques, using external forces are not indicated, due to vulnerable radial nerve. Anatomical differences between LE vs humerus require a uniquely tailored surgical approach. There is not one ideal standard technique for removing a bent IMN. This is the first reported bent humeral IMN. References Schmidt et al. Instr Course Lect. 2003;52:607–22 Bhandari et al. Acta Orthop. 2006;77(2):279–84 Kurup et al. Cochrane Database Syst Rev. 2011 Jun 15;(6):CD005959 Berkes et al. Springer London; 2015. p. 85–94 Gupta et al. Injury; 1985;16(4):276–80 SH et al. Malays Orthop J. 2021 Jul 1;15(2):163–5Disclosure: 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

A case report of a polytraumatized patient involved in a motor vehicle accident requiring multiple abdominal operations resulting in short bowel syndrome

Abstract text (incl. references and figure legends) We present a case report of a 59-year old woman who suffered severe abdominal trauma when injured in a motor vehicle collision. She suffered from subarachnoid haemorrhage, fracture of a rib and the sternum, bilateral pneumothorax, rupture of the abdominal wall and dissection of the right common iliac artery with a large retroperitoneal haematoma. After the initial resuscitation in the emergency department she underwent insertion of an aorto-bi-iliac endograft to stop the bleeding. Due to suspicion of small bowel injury on the CT scan she was operated, laparotomy revealed multiple small bowel perforations, ischemia of the sigmoid colon and destruction of the abdominal wall. The small bowel was resected and primary anastomoses were performed, the sigmoid colon was also resected and a colostomy was created. Negative pressure wound therapy was inserted to facilitate the reentry into the abdomen three days later, where an additional small bowel perforation was resected and an ischemic part of bowel was resected leaving in total 150cm of small bowel with an end ileostomy. At the time of the third reentry into the abdomen we inserted abdominal reapproximation anchor system to facilitate abdominal wall closure. She was treated for short bowel with parenteral nutrition and one year after the accident she was reoperated and the ileostomy along with the mucous fistula were closed to establish continuity of the bowel, enabling gradual weaning off from parenteral nutrition. This is a case of a complex patient that suffered from short bowel syndrome after undergoing multiple life-saving abdominal operations. However, after improving the nutritional and functional status, we managed to reconstruct the bowel and on this day she doesn't require parenteral nutrition anymore. References: Singh A, Prasad G, Mishra P, Vishkarma K, Shamim R. Lessons learned from blunt trauma abdomen: Surgical experience in level I trauma centre. Turk J Surg. 2021; 37(3): 277-85.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.

Duodenal and inferior vena cava injury secondary to penetrating trauma. About a case

Abstract text (incl. references and figure legends) INTRODUCTION The inferior vena cava (IVC) is the most frequently associated vascular lesions due to penetrating trauma, representing the 30-40% of all intra-abdominal vascular injuries. On the other hand, the incidence of duodenal injury rate is 3'7-5%. MATERAL &amp; METHODS The objective is to present a case of a 58-year-old male patient with duodenal and inferior vena cava (IVC) injury, and its surgical management. RESULTS We present a 58-year-old man with an attempted suicide with a cold weapon. The airway was patent. Blood pressure was 125/70mmHg, with normal heart rate. Glasgow 15/15. On examination, he presented a 4-cm-long incisional lesion with an adherent clot in the epigastrium, without abdominal pain. A CT scan is performed, revealing penetrating abdominal trauma with signs of duodenal perforation and hemoperitoneum (Image 1). Urgent surgical intervention was decided, objectifying a large retroperitoneal hematoma and perforation in the anterior and posterior face of both the duodenal knee and the inferior vena cava (Image 2). A Cattell Braasch maneuver was performed and the retroperitoneal hematoma was opened. After distal and proximal vascular control, the duodenal perforation and the IVC was sutured. Subsequently, he presented good clinical evolution, being discharged on the 6th postoperative day. CONCLUSIONS Traumatic retroperitoneal injuries usually occur in the context of a trauma patient with multiple associated injuries. The most frequent symptoms are pain and abdominal distension, although up to 8% of patients remain asymptomatic. In hemodynamically stable patients, the use of CT with oral and intravenous contrast stands out. The Cattle-Braasch maneuver facilitates the evaluation on the portal vein and IVC, in addition to the visualization of the 4 duodenal portions.  The most commonly adopted strategies to deal with penetrating IVC injuries are caval ligation and venorrhaphy. For duodenal injuries, a primary suture is accepted.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

Closed rupture of the rectus muscles due to seatbelt after motor vehicle collision – A case report

Abstract text (incl. references and figure legends) Case history: A 28 year old female with no past medical history was a front-seat passenger restrained with a seat belt in a car involved in a high velocity front end collision road traffic accident. Clinical findings: On arrival to Emergency department of regional hospital she was haemodynamically stable. Abdominal examination revealed pain in lower abdomen and bruises above iliac crist billaterally. Investigation/results: Laboratory tests revealed anemia and leukocytosis. X-ray of cervical spine, chest and pelvis excluded fractures. Computed tomography scan of thorax and abdomen showed moderate amount of free fluid in abdomen, intraperitoneal haematoma and contusion of abdominal wall, fracture of the first vertebra of the lumbar spine and fracture of the 11th left rib. Diagnosis: A diagnosis of polytrauma and intraabdominal injury was made. Therapy and Progression: Initial damage-limitation laparotomy revealed total rupture of both rectus muscles without laceration of the skin, haematomas of mesenterium and omentum, perforations of jejunum and sigmoid colon, multiple deserosations of the ileum and contusions of the bladder. Resection of sigmoid colon and jejunum both with latero-lateral anastomosis as well as the reconstruction of abdominal wall were performed. Postoperative course was complicated by dehiscence of sigmoid colon anastomosis and stercoral peritonitis which required re-laparotomy, resection of anastomosis, formation of terminal sigmostomy and Vacuum Assisted Closure therapy. 6 months later reconstruction of intestinal continuity was performed. Comments: Closed rupture of the rectus abdominis muscle secondary to seatbelt trauma is rare. Our case highlights the need for suspicion, investigation and subsequent surgical management of intra-abdominal injury following identification of this rare consequence of seatbelt trauma. References:Two cases of intestinal injuries due to seat belt without seat belt sign; Necdet Özçay et all; J Surg Case Rep. 2018 Nov; 2018(11):rjy298.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.

Pancreas trauma: Six cases analysis

Abstract text (incl. references and figure legends) Case history: Six male patients with a mean age of 30 years. Three were hospitalized for blunt trauma and three for penetrating trauma. Clinical findings: In addition to the trauma biomechanics and a complete physical examination, imaging tests were performed. Investigation/results: Three blunt trauma patients underwent FAST which showed free fluid, one patient with a gunshot wound underwent e-FAST which showed right hemopneumothorax and free fluid in the abdomen. A patient with a gunshot wound was previously submitted to a chest and abdomen CT scan. A patient with a penetrating foreign body injury was directly referred for exploratory laparotomy. Diagnosis: six patients with pancreatic trauma. Therapy and Progressions: Among patients with blunt trauma, one was submitted to a caudal pancreatectomy and splenectomy, one to a simple suture of the pancreas and one required left nephrectomy and caudal body pancreatectomy. Among patients with penetrating trauma, one was submitted to a caudal body pancretectomy, colonrhaphy, enterorrhaphy, gastrorraphy and right chest drainage, another was submitted to pancreas suture, duodenorrhaphy and colonrhaphy, and another patient with grade 2 pancreas injury was sutured and drainage. All patients received drains next to the pancreas. Three required blood transfusions. The mean hospital stay was 9 days. Three patients received only prophylactic antibiotics and three received antibiotic therapy for 7 days. Three patients received parenteral nutrition initially and then progressed to an oral diet. Two patients developed low output pancreatic fistula with satisfactory evolution. No deaths occurred. Comments: The management of pancreatic injuries is one of the most challenging situations for the surgeon. The correct identification of pancreatic lesions, associated with the appropriate therapeutic choice, are fundamental factors for the success of the treatment and better prognosis. References: Schmiegelow AF, Stockholm JH, Burgdorf SK. [Traumatic pancreatic lesions]. Ugeskr Laeger. 2019 Apr 15;181(16):V06180442. Danish. PMID: 31036150.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

Two-staged management of ankle fracture-dislocations with a posterior fragment: Computer-tomography-based treatment and its outcome

Abstract text (incl. references and figure legends) Introduction Trimalleolar fractures are difficult to treat and malreduction can lead to functional impairment. Involvement of the posterior malleolus has a poor predictive value. Current computer-tomography (CT)-based fracture classifications led to an increase in fixation of the posterior malleolus. The aim of this study was to describe the functional outcome after a two-stage stabilisation with direct fixation of the posterior fragment in trimalleolar dislocation fractures. Material Methods In a retrospective study, all patients presenting with a trimalleolar dislocation fracture (AO/OTA 44B3), an available CT scan and a two-stage operative stabilisation of the posterior malleolus by a posterior approach were included. All fractures were treated with initial external fixator and delayed definitive stabilisation including a posterior approach for fixation of the posterior malleolus. Next to clinical and radiological follow-up, outcome measures (Foot and Ankle Outcome Score (FAOS), Numeric Rating Scale (NRS), Activity of Daily Living (ADL), Hulsmans implant removal score) and complications were analysed. Results Between 2008 - 2019, a total of 1200 ankle fractures were treated. In a group of a total of 320 trimalleolar dislocation fractures, 39 patients fulfilled the inclusion criteria and were available for follow-up examinations. Mean follow-up was 49 months (standard deviation (SD) 29.7, range 16 - 148). The mean age was 60 years (SD 15.3, 17 - 84) with 69% female patients. The mean FAOS was 93/100 (SD 9.7, 57 - 100), NRS 2 (interquartile range (IQR) 0 - 3) and ADL 2 (IQR 1 - 2). 4 patients showed a postoperative infection, 6 re-operations had to be performed and implants were removed in 24 individuals. Conclusion A two-stage procedure of trimalleolar dislocation fractures with in direct reduction and fixation of the posterior tibial fragment through a posterior approach leads to good functional outcome scores with a low rate of complications.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 19
Skeletal trauma and sports medicine 4

Appointment

Chairs

Programme

Poster Session 19Skeletal trauma and sports medicine 4

Appointment

Chairs

Programme

Poster Session 19
Skeletal trauma and sports medicine 4