A proposal of a new algorithm for decision-making approaches in open reduction and internal fixation of complex tibial plateau fractures - SOTA algorithm (Spanish Orthopaedic Trauma Association).

INTRODUCTION: The correct choice of surgical approaches in complex tibial plateau fractures is essential to achieve adequate reduction and fixation. Detailed fracture morphology and direction of columns displacement, that we have named the Main Deformity Direction (MDD), may aid in selecting the optimal surgical strategy. In this article we present a new algorithm based on MDD and column concepts. The aim of this study was to evaluate the outcomes of a group of tibial plateau fractures treated according to this algorithm. The secondary aim was to evaluate the incidence of the different MDD in our multicolumnar subgroup. PATIENTS AND METHODS: Excluding isolated lateral one-column fractures, open fractures and patients not treated following this algorithm, 72 patients with tibial plateau fractures surgically treated with open reduction and internal fixation were collected retrospectively, from three trauma centers, from January 2015 to April 2019. Radiological assessment was performed to establish the columns involved and the MDD. Quality and maintenance of reduction and alignment, complications and functional outcomes were assessed. RESULTS: Initial fracture analysis was performed in 72 patients (8 one-column, 35 two-column and 29 multicolumnar fractures). In the multicolumnar group, the posteromedial MDD was the most frequent pattern (17 of 29 patients). Four patients were excluded due to loss of follow-up, resulting 68 patients for final outcome analysis (7 one-column, 34 two-column and 27 multicolumnar). The average follow-up was 18 months (range: 6-52). Excellent/good outcomes were obtained in all one-column, 31 of 34 two-column and 25 of 27 multicolumnar fractures. Incomplete reduction was present in three patients. As complications, we had two loss of reduction, one conversion to knee arthroplasty, one nonunion and one deep infection. No patient presented neurological or vascular problems, knee instability or extension deficit. CONCLUSION: Satisfactory results have been obtained following the principles of our algorithm. In addition to the anatomical involvement of columns and segments, we believe that identifying the Main Deformity Direction (MDD) provides useful information for decision-making, especially in multicolumnar fractures. The most frequent MDD in our multicolumnar subgroup was the posteromedial MDD, but more than one-third presented a different MDD, requiring different surgical strategies.

Análisis del coste del tratamiento del paciente politraumatizado en un hospital de referencia en España / Cost-analysis of treating patients with multiple injuries in a reference hospital in Spain

Introducción: El objetivo del estudio es analizar el coste que supone el tratamiento de un conjunto de pacientes con traumatismo grave. Adicionalmente investigamos la distribución del gasto entre los diferentes servicios implicados en el manejo de estos pacientes. Material y método Utilizamos para el estudio los datos registrados en la base de datos Traumasur donde se recogen de modo prospectivo los datos de los pacientes que sufren traumatismos graves. Se analizan de modo retrospectivo los datos clínicos de los pacientes recogidos en el año 2008, un total de 131 pacientes. Utilizamos los datos obtenidos por el servicio de control financiero de nuestro centro, con datos del coste global y la división del gasto entre los departamentos implicados en el tratamiento. Resultados El valor medio de ISS y NISS fue respectivamente 31,8 y 39,4. La tasa de mortalidad fue del 17,5%. El coste global de los pacientes fue 3.791.879,3 €. El coste medio por paciente fue 28.945 €. El porcentaje medio del gasto global que supusieron el ingreso en UCI y planta fue respectivamente de 62 y 12,7%. El coste del ingreso en UCI ascendió hasta 68,4% en pacientes con ISS>40. A pesar de que los pacientes fallecidos presentaron lesiones más graves, presentaron menor coste en todos los capítulos. Conclusión Los pacientes con traumatismos graves suponen un importante gasto sanitario; el mayor porcentaje se debe a la estancia hospitalaria sobre todo a la estancia en UCI. Otros capítulos de gasto suponen un porcentaje menor del gasto (AU)

Introduction: The aim of this study is to analyse the costs of the treatment of a group of patients with severe injuries. The distribution of the costs between the different departments involved in the management of these patients is also investigated. Material and method: The data from patients who suffered severe injuries, and recorded in the Traumasur data base, were prospectively gathered to be used in the study. The data from a total of 131 patients treated in the year 2008 were collected. Data obtained from the hospital (..) (AU)

[Cost-analysis of treating patients with multiple injuries in a reference hospital in Spain]. / Análisis del coste del tratamiento del paciente politraumatizado en un hospital de referencia en España.

INTRODUCTION: The aim of this study is to analyse the costs of the treatment of a group of patients with severe injuries. The distribution of the costs between the different departments involved in the management of these patients is also investigated. MATERIAL AND METHOD: The data from patients who suffered severe injuries, and recorded in the Traumasur data base, were prospectively gathered to be used in the study. The data from a total of 131 patients treated in the year 2008 were collected. Data obtained from the hospital finance office were also used, providing the overall cost as well as the separate costs of each of the departments involved in the treatment. RESULTS: The injury severity score (ISS) and the new injury severity score (NISS) mean values were 31.8 and 39.4, respectively. The mortality rate was 17.5%. The overall costs of the patients was 3,791,879.3 €, with a mean cost per patient of 28,945 €. The mean percentage of the overall costs of the treatment incurred by the ICU and the ward was 62% and 12.7%, respectively. The cost of the ICU admission increased up to 68.4% in patients with an ISS>40. Although the patients who died had more serious injuries, they had a lower cost in all areas. CONCLUSION: Patients with multiple injuries represent a significant health cost, with the greater percentage being due to the hospital stay, particularly that in ICU. Other cost areas involve a lower percentage of the cost.