Could temporary external fixation after reduction of displaced acetabular fractures prevent posttraumatic heterotopic ossification?

OBJECTIVES: To recommend appropriate immobilization after the initial reduction of acetabular displaced fractures in order to minimize the risk of heterotopic ossification formation. DESIGN: Retrospective study of patients treated in our surgical department during the years 2005-2018. MATERIALS AND METHODS: There were 94 patients included in statistical analysis. The factors of injury severity, course of surgery and hospitalization and incidence of complications were recorded. The functional and X-ray results were evaluated at least one year after surgery. RESULTS: The patients were divided into the two groups according to the type of fixation after closed reduction, the external fixation (EF) and the skeletal traction (ST) group. According to the type of fracture there were 33 patients with central displacement and 61 patients with posterior displacement. Ossification grade III. And IV. Occur in 20% of our sample. There was greater incidence of Brooker grade III. And IV. Ossification in the ST group, but statistically insignificant, p = 0.57. There was no statistically significant difference in the occurrence of ossifications regarding the severity of the head injury, p = 0.11, or to the severity of the injury p = 0.54. The combination of posterior displacement and ST results in higher risk for ossifications, specifically in our group at 11.48% compared to the combination of posterior displacement and EF where it is 8.2%. CONCLUSION: Skeletal traction for posterior displaced acetabular fracture appears to be a more risky procedure for the development of ossifications than external fixation.

Deceleration thoracic aortic ruptures in trauma center level I areas: a 6-year retrospective study.

OBJECTIVES: This retrospective study aimed to analyze the trend of mortality due to thoracic aortic ruptures caused by deceleration injuries that occurred within the catchment area of Hradec Kralove University Hospital. MATERIALS AND METHODS: The study sample comprised 175 patients who had sustained thoracic aortic ruptures caused by deceleration injuries and were transported to Hradec Kralove University Hospital in 2009-2014. The small proportion of patients enrolled in this retrospective study were diagnosed and treated at the emergency department (ED). However, the overwhelming majority of the sample comprised of patients who died at the accident scene and later underwent an autopsy at the Institute of Forensic Medicine in our hospital. RESULTS: Of 175 patients, 150 underwent an autopsy. Of these, 139 individuals (79%) died at the incident scene, and 11 (6%) were transported to the ED and later died of their injuries. A total of 36 patients were admitted to the hospital; 29 were admitted primary (11 later died), and 7 were transferred. No deaths occurred in the group of secondary admissions. Thus, 31% of all patients hospitalized died following transport to the hospital. Of 175 patients, 15% (or 69% of all hospitalized patients) survived their injuries. Among patients who died as a result of thoracic aortic injury, no unexpected deaths were recorded (i.e., no deaths among patients with survival probability more than 50% = PS > 0.5). CONCLUSION: Our results suggested that the lethality of thoracic aortic injuries might be minimized by transporting triage-positive patients directly to trauma centers. Accurate diagnoses and treatments were supported by admission chest X-rays, a massive transfusion protocol, and particularly, CT angiography, which is not routinely included in primary surveys. An additional prognostic parameter was clinical collaboration between an experienced trauma surgeon, an interventional radiologist, and a vascular or thoracic surgeon.

Initial chest X-ray in multiple trauma patients: Still works!

OBJECTIVE: Blunt thoracic aortic injury is life-threatening injury. High suspicion on this clinical condition can be made by initial chest X-ray on emergency department. The aim of study was to detect which other signs, except widened mediastinum, are specific for rupture of the thoracic aorta. METHODS: To the study were included all Triage positive patients primary headed from the scene of injury to the Trauma center Level I from January to December 2014 and which have performed chest X-ray on emergency department followed by CT of chest, abdomen and pelvis. On chest X-ray were evaluated diameter of superior mediastinum, deviation of trachea, deviation of left and right main bronchus, aortic arch, fracture of first or second rib on the left side and obliteration of aortopulmonary space. RESULTS: Totally n=208 patients were enrolled to the study. Seven patients had blunt thoracic aortic injury on CT angiography. All these patients had widened superior mediastinum more than 80 mm (p=0.021). Six patients with blunt thoracic aortic injury had obliteration of aortic arch (p=0.0001) and obliteration of aortopulmonary space (p=0.0001). CONCLUSION: All patients after high energy trauma with widened mediastinum together with obliteration of aortic arch and obliteration of aortopulmonary space on initial chest X-ray without initial CT, must be indicated to the CT after initial stop the bleeding procedures for the exclusion of traumatic rupture of thoracic aorta.