Survival trends and predictors of mortality in severe pelvic trauma: estimates from the German Pelvic Trauma Registry Initiative.

STUDY OBJECTIVE: To determine longitudinal trends in mortality, and the contribution of specific injury characteristics and treatment modalities to the risk of a fatal outcome after severe and complex pelvic trauma. METHODS: We studied 5048 patients with pelvic ring fractures enrolled in the German Pelvic Trauma Registry Initiative between 1991 and 1993, 1998 and 2000, and 2004 and 2006. Complete datasets were available for 5014 cases, including 508 complex injuries, defined as unstable fractures with severe peri-pelvic soft tissue and organ laceration. Multivariable mixed-effects logistic regression analysis was employed to evaluate the impact of demographic, injury- and treatment-associated variables on all-cause in-hospital mortality. RESULTS: All-cause in-hospital mortality declined from 8% (39/466) in 1991 to 5% (33/638) in 2006. Controlling for age, Injury Severity Score, pelvic vessel injury, the need for emergency laparotomy, and application of a pelvic clamp, the odds ratio (OR) per annum was 0.94 (95% confidence interval [CI] 0.91-0.96). However, the risk of death did not decrease significantly in patients with complex injuries (OR 0.98, 95% CI 0.93-1.03). Raw mortality associated with this type of injury was 18% (95% CI 9-32%) in 2006. CONCLUSION: In contrast to an overall decline in trauma mortality, complex pelvic ring injuries remain associated with a significant risk of death. Awareness of this potentially life-threatening condition should be increased amongst trauma care professionals, and early management protocols need to be implemented to improve the survival prognosis.

Bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and subcutaneous emphysema after thoracoscopic anterior fracture stabilization.

STUDY DESIGN: Case report and clinical discussion. OBJECTIVE: A rare case of air passage into multiple body compartments after thoracoscopic minimally invasive spine surgery is described. SUMMARY OF BACKGROUND DATA: In recent years, there is growing interest in thoracoscopic minimally invasive spine surgery for the treatment of thoracic and lumbar spine fractures. Severe complications due to the operative procedure are rare. METHODS: We present a case of a 73-year-old woman who developed bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and subcutaneous emphysema after thoracoscopic anterior stabilization of a Th12 fracture. RESULTS: The operative procedure was completed without any obvious intraoperative complications. Routine made postoperative radiograph of the chest revealed a pneumothorax on the right side, bilateral subphrenic free air, and bilateral supraclavicular air. Subsequently, a CT scan showed bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum and a supraclavicular subcutaneous emphysema. Bronchoscopy, esophagogastroduodenoscopy, and laryngoscopy showed no hollow organ injury or any other pathologic changes. Intraabdominal free air and pneumothoraces could not be detected on thoracic radiographs after 2 days. The patient remained cardiopulmonary stable throughout the hospital course. CONCLUSION: This report documents a rare case of air passage into multiple body compartments after thoracoscopic-assisted treatment of a spinal fracture, which has not yet been described previously. After exclusion of a tracheo-bronchial and hollow organ injury the process was self-limiting. To avoid this complication, special care should be taken to evacuate all intrathoracal air at the end of the endoscopic procedure.

Improved osseointegration of PTFEP-coated titanium implants.

BACKGROUND: Clinical success of bone implants is critically related to the interaction between the implant surface and the surrounding tissue. The polymer poly(bis(trifluoroethoxy)phosphazene) (PTFEP) is a promising, highly biocompatible surface coating which also inhibits the adsorption of granulocytes, macrophages, inflammatory cells, bacteria, and platelets. However, there is limited clinical experience of PTFEP as a coating for bone implants. Therefore PTFEP-coated titanium implants in an animal model were examined. MATERIAL/METHODS: PTFEP-coated titanium cylinders were implanted into the lateral femoral condyles of rabbits. Osseointegration was examined six weeks and six months after implantation using a non-destructive mechanical pull-out measurement and a histological analysis. RESULTS: The results indicate improved osseointegration of PTFEP-coated implants. Six weeks after implantation, the PTFEP-coated implants showed a higher stiffness (pull-out length [pol]=7.1+/-2.0 microm) compared with uncoated cylinders (pol=10.2+/-3.4 microm, p<0.05). Six months after implantation, the mechanical properties of both implants had adjusted, and histological analysis revealed an increased bone-implant interface of PTFEP-coated cylinders compared with the first 6 weeks (17.5% vs. 8.2% in controls, p<0.05). CONCLUSIONS: Taken together, the results of this preliminary study indicate promising applications of PTFEP as a coating material for bone implants.

The German Multicentre Pelvis Registry: a template for an European Expert Network?

The range of severity of pelvic injuries is wide and can include simple, undisplaced pelvic fractures, which may limit the activity of the individual patient for only a short period of time, and severe, complex or even open pelvic fractures, causing immediate life threatening situations. Even with continuous progress in development of techniques and treatment protocols, primary treatment and definitive reconstruction of pelvic ring injuries and acetabular fractures there is still an ongoing debate about specific problems in the evaluation of injuries and fractures. Because of the low incidence of pelvic fractures (37/100,000) the individual experience, which can be acquired by the surgical team, even in major Trauma Centres, is limited and can only be acquired over a longer period of time. The German Multicentre Pelvic Study Group started with reporting of pelvic fractures in 1991 and included 10 University- and Major Trauma Hospitals. The intense work on definitions and classification during the first years generated a universal "language" of understanding, which also helped in unifying indications and even procedures in pelvic and acetabular fractures. With several modifications and expansion of the number of participating hospitals the Group has been active until now and is just entering a "third phase" converting into the "German Multicentre Pelvic and Acetabular Registry" being technologically modified to an Internet based data registry. As this registry is already designed as an open platform, not limited in capacity and regions, it provides a platform, which may easily be expanded to the European level allowing for international multicentre studies and case sampling. Therefore this type of pelvic registry could act as a basis for further scientific evaluation of specific topics in the field of pelvic and acetabular surgery and could be a template for a European Expert Network. Driven by the differences of healthcare systems and organisation of trauma care within Europe and the challenge that pelvic fractures not only can lead to permanent disability, but also play an important role in posttraumatic fatalities, a clear need can be shown for detailed analysis of the present situation within the different European nations.

[Method of non-destructive mechanical testing of new surface coatings for prostheses]. / Methodik zur zerstörungsfreien Testung von Oberflächenbeschichtungen in der Endoprothetik.

Research into new surface coatings and surface processing methods for prostheses is subject to numerous studies. The aim of this study was to test an innovative biomechanical measuring method for the examination of the ingrowth of bone implants. Using a transcortical model, coated (n=14) or uncoated (n=14) titanic cylinders were implanted into the lateral condyle of 28 New Zealand White Rabbits. After 6 weeks or 6 months the animals were sacrificed and the osseointegration of the implants was evaluated biomechanically and histologically. Up to traction of 50 N the load dependent movement between bone and testing cylinder did not lead to a destruction of the bone-implant-interface. Therefore, biomechanical and histological investigations could be performed in the same specimen. The results of both evaluations showed a significant correlation (correlation coefficient -0.79; p < 0.01) and were absolutely reproducible. With the method of non-destructive mechanical testing, it is possible to halve the number of required animals. Additionally, the results of the biomechanical and histological analysis can be compared and thus serve as an internal control. In summary, the method of non-destructive mechanical testing represents an ideal tool to study new surface coatings and surface processing methods for prostheses.