ectes-2024-eposter-hintergrund-660bca90303c0212783071.jpg

ectes-2024-eposter-logo-660bcc1ca0874706891033.svg

ectes-2024-eposter-start-660bc6df45fbd927741591.jpg

23rd European Congress of Trauma & Emergency Surgery

Prof. Dr.

Prof. Dr. med.

The value of the Alexander view for surgical indication assessment after acromioclavicular joint injury

Skeletal trauma and sports medicine

Research

Introduction: The indications for surgical treatment of a Rockwood Type III acromioclavicular joint injury have been a subject of controversial debate for many years. Assessing dynamic horizontal translation in the so-called Alexander views is helpful in identifying cases that would benefit from surgical intervention. The present study aimed to investigate how often, in the studied population, surgical indications were established based on the Alexander views when there was no clear surgical indication evident in the panoramic views taken for comparison. Material &amp; Methods: To this end, a retrospective analysis was conducted on 214 consecutive cases of acromioclavicular joint injuries treated at the investigating clinic. The study included patients with isolated acromioclavicular joint injuries who had both panoramic and Alexander views available. Results: The 214 cases consisted of 195 males and 19 females, with a mean age of 39 years. Using the panoramic views, the injuries were classified as follows: RW I (Rockwood Type I): 35 cases, RW II (Rockwood Type II): 23 cases, RW III (Rockwood Type III): 73 cases, and RW V (Rockwood Type V): 83 cases. After analyzing the Alexander views, a complete dynamic horizontal translation (Rockwood Type 3B) was observed in 52 of the 73 Rockwood Type III injuries and 7 of the Rockwood Type II injuries. The mean percentage deviation of the CC distance in Rockwood Type 3B cases was 57%, while it was 36% in Type 3A cases (no horizontal translation). Overall, the indication for surgical therapy was established in 59 cases based on the Alexander views. Conclusions: The results presented here suggest that the Alexander views serve as a valuable complement to panoramic views for assessing dynamic horizontal translation, enabling the determination of the surgical indication in cases of Rockwood Type III injuries.No!

Poster

Simultaneous bilateral shoulder dislocation: A review of two cases

Introduction: Although shoulder dislocation is common, bilateral presentation is a rare entity. Posterior bilateral dislocations are more frequent than anterior due to violent and involuntary muscle contractions. Anterior bilateral dislocation is more related to high energy trauma and is mainly seen combined with a fracture. Inferior dislocations, known as Luxation Erecta are extremely rare and comprise only 0.5% of all shoulder dislocations Case report: We present two cases of simultaneous bilateral shoulder dislocation A 80-year-old man with no previous trauma or medical history was admitted to the Emergency Department (ED) with pain in both shoulders after a forward fall hitting both upper limbs. There was no history of loss of consciousness or seizures. In the physical examination, both shoulders appeared symmetrical but without lateral convex contour. X-ray confirmed bilateral anterior shoulder dislocation. A 70-year-old man was admitted to the ED with severe pain after a fall from a 1.5 meters height. In physical examination, there was loss of the lateral convex contour on the right shoulder and he was unable to lower his left arm from a position above his head. X-ray confirmed anterior dislocation in the right shoulder and inferior dislocation in the left shoulder. Closed reduction and immobilization in an arm sling was performed in both cases. The post reduction evaluation demonstrated stable joints and normal neurovascular status. Discussion/Conclusion: Simultaneous bilateral shoulder dislocations are a rare entity, and asymmetric cases are even rarer. However, the symmetric bilateral anterior dislocation could be more challenging in the diagnosis. Due to the symmetric appearance of bilateral upper extremities on presentation, more than 15% of these injuries could be missed during the acute phase. Early reduction should be done to prevent complications. It is important to assess for neurovascular functions both before and after reduction.No

Multiple concomitant lesions in one upper extremity – Case report

Polytrauma

Case history: We present a rare case of a 46-year-old female who presented to our ER after a fall from standing height. Clinical findings: She complained of disabling pain in her left upper extremity. She had obvious deformity of her elbow and wrist. Diagnosis: Standard radiograph assessment showed Elbow dislocation (without associated fractures), humeral shaft fracture (AO 12-A2), distal radius fracture (AO 23-A3) and scaphoid (waist) fracture (figure 1,2,3 and 4)Therapy: The elbow dislocation was reduced in the ER and plaster splints were applied tothe fractures. The patient subsequently underwent ORIF with an anatomical volar plate of the radius fracture and percutaneous fixation with a Herbert type screw of the scaphoid fracture(figure 5 and 6); the humeral shaft fracture was treated conservatively with a U-shaped splint for three weeks followed by a Sarmiento-type orthosis for another 5 weeks. The antebrachial splint was removed 4 weeks after surgery. Physiotherapy was started 8 weeks after surgery, however recovery was slow and the patient developed functional limitations of the elbow and shoulder. At 5 years of follow up the patient presented with complete symmetrical ROM of all upper extremity articulations. Comments: Multiple upper extremity concomitant injuries are infrequent. This case highlights the importance of actively looking for associated injuries. There are some common associated injuries due to high energy trauma, however we report a very rare case of concomitant elbow dislocation, humeral shaft fracture, distal radius fracture and scaphoid fracture. Although the gold standard for the treatment of humeral shaft fractures is non-operatively, the patient's profile must be taken into account. Patients with multiple fractures should have a lower threshold for surgery in order to allow earlier rehabilitation. Abutalib RA, Khoshhal KI. Multiple Concomitant Injuries in One Upper Extremity: A Case Report. Am J Case Rep. 2016No

Ass. Prof.

Prof.

A simple technique to determine humeral stem height in reverse total shoulder arthroplasty for fracture

Education

Introduction Reverse total shoulder arthroplasty has shown favorable restoration of function and predictable long-term clinical outcomes for displaced proximal humerus fractures in the elderly population. However, surgical technique and intraoperative landmarks for correct placement of the humeral component have been transferred from the non-fracture settings where main anatomic structures and bone stock are mostly intact. In the fracture setting typical landmarks like humeral calcar, tuberosities, and pectoralis major tendon insertion can be compromised, and therefore humeral stem height is difficult to determine. We present a reliable simple technique to determine humeral stem height in reverse total shoulder arthroplasty for fracture. Objectives To compare short-term outcomes of reverse total shoulder arthroplasty patients where humeral stem height was determined using a novel technique with the data from current literature. Patients &amp; methods A retrospective review of a single-center surgical registry was performed. Patients who underwent a reverse total shoulder arthroplasty for fracture, in which the height of the uncemented humeral component (SMR Reverse, LimaCorporate, Udine, Italy) was determined using a novel technique, were identified. Post-operative complications (dislocation and loosening) were assessed. Results We identified 220 reverse shoulder arthroplasties with a mean follow-up of 32 months. The dislocation rate was 1,4% with no recorded loosening during the follow-up period. Conclusion This technique offers a reliable ability to determine appropriate humeral stem height placement and subsequent tensioning of the implant. References Fraser AN et al. Reverse Shoulder Arthroplasty Is Superior to Plate Fixation at 2 Years for Displaced Proximal Humeral Fractures in the Elderly: A Multicenter Randomized Controlled Trial. J Bone Joint Surg Am. 2020;102(12):e63. No

Lateral decubitus position technique via Neviaser portal for antegrade humeral intramedullary nailing

Trauma and Emergency surgery | Miscellaneous

Introduction Antegrade humeral intramedullary nailing technique via portal of Neviaser (PN) is a valid option to well established deltoid split approach. Standard position of the patient during the surgery is beach-chair. The objective of this study is to present lateral decubitus position in antegrade humeral intramedullary nailing via PN as a valid option. Patients and methods A retrospective review was conducted between june 2017 and june 2023 The study included 24 patients (15 female and 9 male) operated with antegrade humeral intramedullary nail via PN in lateral decubitus position. All patients presented with proximal (8 patients), proximal diaphyseal (4 patients) or mid-shaft (12 patients) humeral fracture. Short (10 nails) or long (14 nails) locked humeral nails were used for internal fixation. Implant related complications (e.g., cut-out, irritation, peri-implant fractures) and neurological complications were observed. All patients were operated in lateral decubitus position, with C-arm on the opposite site, during general anesthesia. The Targon® PH (B. Braun, Germany) and Medin® long humeral nail (Medin, Czech republic) were used. Distal locking of long humeral nails wes performed posterior-to-anterior. Results Two postoperative complications were observed (1 pseudoarthrosis, 1 cut-out). Two periprotetic fractures occured after fall, non releated to operation technique. We did not observe any neurological complications. Conclusion Lateral decubitus position is an alternative option in antegrade humeral nailing via portal of Neviaser. References Neviaser, TJ.: Arthroscopy of the shoulder. Orthop Clin North Am. 1987;18:361–372 Dilisio, MF., et al,: Intramedullary nailing of the proximal humerus: evolution, technique, and results. J Shoulder Elbow Surg. 2016;25(5):130-138. Dilisio, MF.,et al.: Extended Neviaser portal approach to antegrade humeral nailing. Orthpedics. 2013;36(2):244-248. no

Helical plating for peri-implant fractures after humeral intramedullary nailing: case report

Case history. A 62-year-old male sustained an accidental fall down the stairs. Physical examination revealed pain, arm deformity, and functional impairment, with normal distal neurovascular examination. Radiographic examination revealed a midshaft spiral fracture of the left humerus (AO 12B2, Arbeitsgemeinschaft Osteosynthesefragen classification). Therapy and Progressions. Closed reduction and anterograde intramedullary nailing were initially attempted but unfortunately, intraoperative fluoroscopy revealed a peri-implant fracture at the level of the distal locking. Consequently, we decided to conclude the surgery and request a postoperative control CT scan to assess the extent of the fracture before reoperation. It describes a complex fracture with both a sagittal line in the distal part and a long spiral line extending proximally. Subsequently, the intramedullary nail was removed and a rotator cuff repair was performed. Open reduction and internal fixation (ORIF) was performed through an extended posterior elbow approach. A two-plate construct was used for fixation using an extra-articular distal humeral locking compression plate (MBA®) and Ortholox® cerclage band system, followed by definitive osteosynthesis using another extra-articular humeral locking compression plate (Pantera®, MBA®). Results. At 2 weeks postoperatively, the patient complained of arm pain, had achieved flexion (100°) and extension (‒15°), and plain radiographs showed no secondary mobilization. At 5 months post-fixation, increased radiographic consolidation was observed with a full range of motion. Comments. Peri-implant fractures are rare but present technical challenges during surgery. Our case highlights the clinical concern of fractures occurring near or at the implant tip and emphasizes the importance of intraoperative fluoroscopy checks. We demonstrated successful management of these complex fractures using two contoured locking plates. References. Updegrove GF, Mourad W, Abboud JA. Humeral shaft fractures. J Shoulder Elbow Surg. 2018 Apr;27(4):e87-e97. doi: 10.1016/j.jse.2017.10.028. Epub 2017 Dec 29.No

Suture anchor repair as a treatment option for an acute Jersey finger injury

In this clinical case, a 19-year-old rugby player presented with pain, volar edema and an inability to actively flex the distal interphalangeal (DIP) joint of the fifth finger following a left-hand injury. Diagnostic imaging revealed a small bone fragment avulsion at the insertion site of the flexor digitorum profundus (FDP) tendon. Surgical intervention was carried out using a Brunner's Z-plasty approach to locate the bone fragment at the level of the DIP joint while ensuring the integrity of the flexor digitorum superficialis. A tenodesis of the FDP was performed, using a mini-anchor in the F3 footprint. The patient underwent a six-week immobilization period after surgery followed by a rehabilitation protocol. After 12 months, the patient regained full range of motion and returned to sports. Jersey finger is a common injury in rugby players and often results from a hyperextension of the DIP joint during active flexion, leading the affected digit to remain slightly extended compared to the others and an inability to actively flex the DIP joint. Surgical treatment is the preferred approach, and the specific surgical techniques depend on the injury's acuity, location, and the presence of associated fractures. Conservative treatment is generally not recommended for acute cases. Leddy and Packer classification system categorizes Jersey finger injuries into three types. In type I and II injuries the surgical options are dorsal buttons, direct ties around the bone, suture anchors or a combination of these techniques. In type III injuries various osseous fixation methods may be used, such as mini fragment screws, interosseous wires, kirschner wires or mini fragment plate fixation when dealing with sufficiently large fragments. In the presented case, despite the bone fragment avulsion representing a type III injury, the use of a suture anchor proved to be a less invasive and equally effective procedure with lower morbidity while maintaining excellent functional outcomes.No.

Isolated dorsal dislocation of the lunate – A clinical case

Case history:Male, 72y with personal history of diabetes and hypertension, presented in the ER with right wrist compression trauma with 10 days of evolution. Clinical findings: Complains of painful mobilization and limitation of movements. He demonstrated a global limitation of mobility: Flexion/Extension: 20º, complete pronation, supination with less 15 ° compared to the contralateral and Radial/Cubital deviation 15 °, but painfull. Results/ Diagnosis: Xray and CT showed a isolated dorsal dislocation of the lunate. Therapy and Progressions: The authors treated him with closed reduction and percutaneous K-wire fixation followed by a short period of immobilisation in a cast. The K-wires were removed at 5 weeks, after which he had a period of intense rehabilitation. At 6 months he has no limitation of function, near full mobility, compared to contralateral, occasional pain during exercise. Mayo Modified Wrist Score: 80/100 points. Xray showing: semilunar subluxation and radiocarpal osteoarthritis. The patient is highly satisfied. Comments: The position of the lunate is maintained by various ligaments and the bone structure surrounding it. Thus, this bone is very well anchored in the normal individual, and its dislocation requires, under normal conditions, a large amount of energy to cause an interruption of these structures. There is little data on dorsal lunate dislocation, or whether it occurs in the same pattern as palmar dislocations. If a dorsal lunate dislocation is diagnosed, percutaneous fixation with Kirschner wires should be considered, however, it appears that the immobilization period was insufficient, given the radiographic result.The fact that the surgical reduction was performed 10 days after the trauma may also have contributed to a worse radiographic result. References: Alonso-Tejero et.al 2022; Sidiki et.al 2012; Mountney et. al 2005; Elias et al. 2006 No

Outcome measures of the Matti Russe operation for treatment of scaphoid nonunion

Introduction: Scaphoid fractures are common with a non-union rate of 5-15%. Treatment options are widely debated. The most used treatment options involve plate or screw fixation. Due to a rising trend in patients needing secondary surgeries due to complaints related to hardware material, we set out to investigate an alternative approach that avoids these types of complications, namely the Matti Russe method. Our goal is to evaluate the rate of successful bone healing and the rate of subsequent interventions. Methods: In this retrospective study, 28 patients with scaphoid nonunion were studied in the Elkerliek Hospital in the Netherlands between 2006 and 2023. Union rate was evaluated based on radiological and clinical assessment. We also aimed to evaluate which factors possible play a role in nonunion of the scaphoid fractur after treatment. Results: This study consisted of 28 patients with a mean age of 27.44 years(17-62). 26 were male (96.3%) with a mean duration of nonunion of 11.3 months(1.08-43.83). 5 patients (18.5%) had surgery prior to the Matti Russe operation. Successful union was achieved in 24 (89.9%) patients. The 3 patients with persistent nonunion were all smokers(p= 0.056). Conclusions: Treating nonunion of the scaphoid remains a complex injury. Treatment with the Matti Russe methods shows to be an effective treatment without the need for osteosyntheses material, therefore avoiding complication with hardware that may possibly lead to a second surgery. References 1. Duckworth, Jenkins, Aitken, Clement, Court-Brown, McQueen. Scaphoid fracture epidemiology. J Trauma Acute Care Surg. 2012 doi:10.1097/ta.0b013e31822458e8 2. Rhemrev, Ootes, Beeres, Meylaerts, Schipper. Current methods of diagnosis and treatment of scaphoid fractures. Int J Emerg Med 2011 doi: 10.1186/1865-1380-4-4. 3. Schormans, Brink, Poeze, Hannemann. Angular Stable Miniplate Fixation of Chronic Unstable Scaphoid Nonunion. J Wrist Surg. 2018 doi:10.1055/s-0037-1603202.Epub 2017 May 10no

Deciding on thresholds for clinical relevance of PROMIS-upper extremity v2.0 in patients with upper extremity injury

Background. In this study we focussed on gaining a better interpretation of the PROMIS-UE T-score scale for measuring upper extremity function in patients with upper extremity injuries (UEIs). This is fundamental in order to clearly understand the clinical relevance of these outcomes. The aim of this study was to determine thresholds for mild, moderate and severe UE function for PROMIS-UE v2.0 T-scores, in patients with UEIs, by performing a vignettes study. Methods. A qualitative vignette study. Based on the PROMIS-UE v2.0 and the underlying item response theory model, vignettes were developed. These were tested in the pilot expert focus group and then, after modifications, used in a patient focus group. The vignettes were ranked by patients by functioning level and then threshold values were determined between no problems – mild problems, mild – moderate problems and moderate – severe problems. Results. This resulted in consensus on the following cut-offs: no problems – mild problems at T-score 45, mild problems – moderate problems at T-score 32.5 and moderate problems – severe problems at T-score 25 (Table 1 and 2). The thresholds provide additional information on interpretation of a larger range of the T-score scale, not only the evidently low or high T-scores. Conclusion. We advise to use these thresholds in clinical practice to objectify the outcome of treatment as perceived by patients. Future research with regards to influencing factors on ranking of the vignettes should follow.No

PD Dr.

Measuring bone healing: Comparison of parameters and scores

Introduction: Bone healing is a complex process that can not be replicated in its entirety in vitro. Research on bone healing still requires the animal model. The critical size femur defect (CSFD) in rats is a well-established model for fractures in humans that exceed the self-healing potential. New therapeutic approaches can be tested here in vivo. Histological, biomechanical, and radiological parameters are usually collected and interpreted. However, it is not yet clear to what extent they correlate with each other and how necessary it is to record all parameters. Methods: The basis for this study was data from three animal model studies evaluating bone healing. The µCT and histological (Movat pentachrome, osteocalcin) datasets/images were reevaluated and correlation analyses were then performed. Two image processing procedures were compared in the analysis of the image data. Results: There was a significant correlation between the histologically determined bone fraction (Movat pentachrome staining) and bending stiffness. Bone fraction determined by osteocalcin showed no prognostic value. Conclusions: The evaluation of the image datasets using ImageJ is sufficient and simpler than the combination of both programs. Determination of the bone fraction using Movat pentachrome staining allows conclusions to be drawn about the biomechanics of the bone. A standardized procedure with the ImageJ software is recommended for determining the bone proportion.no

Metal osteosynthesis with plates coated with hydroxyapatite and 1% silver in pathological bone fractures

Introduction Surgical intervention in the case of a pathological bone fracture with a metastatic lesion involves the implementation of metallo-osteosynthesis. For more effective integration of the metal plate with the bone, a material based on bioactive glass was sprayed onto their surface [1]. Material and Мethods Metal-osteosynthesis with plates coated with hydroxyapatite and 1% silver in pathological bone fractures was performed in 12 patients. The functional result of the operated limb was calculated according to the MSTS scale. Assessment of patients' quality of life, before and after surgical treatment, was carried out according to the EORTC QLQ - C30 system. The evaluation of the integration of the plate with the bone was carried out with the help of X-ray examination (formation of bone callus) and with the help of osteoscintigraphy. Results Postoperative complications were found in 1 (8.3%) patient, relapses of metastatic tumor were noted in 2 (16.7%) patients. The functional result of the operated limb after metallo-osteosynthesis was 76.8%. The quality of life of patients after metallo-osteosynthesis improved from 38 to 74 points. During the X-ray examination, the formation of a bone callus was noted in a shorter period of time, which was confirmed by a more intense accumulation of the radioisotope during osteoscintigraphy. Conclusions Metal-osteosynthesis with plates coated with hydroxyapatite and 1% silver in pathological bone fractures leads to a more stable fixation of bone fragments and accelerates bone formation at the fracture site. References Borsari V., Fini M., Giavaresi G. et al. Comparative in vivo evaluation of porous and dense duplex titanium and hydroxyapatite coating with high roughnesses in different implantation environments // J. Biomed. Mater. Res. - 2009. - 89A. - P. 550-560. No

The SCAFFOLD trial: Surgical use of 3D printed cages as addition for the filling of large bone defects – A protocol for randomised controlled trial

Introduction Traumatic critical size bone defects significantly lowers a patient&quot;s function and quality of life. When the defect size surpasses the natural capacity of the bone to bridge this gap, grafting materials are a necessity in the treatment strategy. Current treatment, such as the induced membrane technique (IMT) are often performed, though high failure rates are reported in defects larger than five centimetres. Addition of a custom, 3D-printed poly-ε-caprolactone with β-tri-calcium phosphate (PCL/TCP) scaffold to the IMT could improve outcomes in this clinically important problem. Objectives The primary objective is to research bone regeneration and the need for secondary surgeries in long bone defects of ≥ 5cm using a 3D-printed PCL-TCP scaffold. Secondary objectives are quality of life one year after surgery and cost effectiveness of the procedure. Study design 20 patients with a posttraumatic long bone defect of ≥5cm after debridement will be included. Patients will undergo a standard IMT procedure or standard IMT with the addition of a custom printed PCL-TCP scaffold (Osteopore) according to randomisation. The IMT consist of two procedures. The defect is debrided, stabilised and filled with a cement spacer during the first procedure. In the second procedure, this cement is removed and the defect is filled with the printed cage (if used according to randomisation), autograft (BMAC, RIA derived graft) and factor Peptide-15 (iFactor, Cerapedics). Follow-up is scheduled at regular intervals; 6 and 12 weeks, 6 months and 1 year after surgery. Outcome parameters The main outcome parameter is the volume of newly formed bone at the defect site on CT at the 6 months postoperatively. Secondary outcome parameters are cost effectiveness (MCQ, PCQ), quality of life, (EQ-5D5L, PROMIS), function (LEFS or DASH) and reinterventions.This study is performed by a consortium that consists of Maastricht Universitair Medisch Centrum (The Netherlands), Osteopore (Singapore), and Cerapedics (USA)

Poster session 3
Session 3: Upper extremity: Shoulder, humerus and hand

Appointment

Chairs

Topic

Programme

Poster session 3Session 3: Upper extremity: Shoulder, humerus and hand

Appointment

Chairs

Topic

Programme

Poster session 3
Session 3: Upper extremity: Shoulder, humerus and hand