Implementation of a novel nursing assessment tool in geriatric trauma patients with proximal femur fractures.

Background: Geriatric trauma patients represent a special challenge in postoperative care and are prone to specific complications. The goal of this study was to analyse the predictive potential of a novel nursing assessment tool, the outcome-oriented nursing assessment for acute care (ePA-AC), in geriatric trauma patients with proximal femur fractures (PFF).

Methods: A retrospective cohort study of geriatric trauma patients aged ≥ 70 years with PFF was conducted at a level 1 trauma centre.

Which non-infection related risk factors are associated with impaired proximal femur fracture healing in patients under the age of 70 years?

Background/purpose: Impaired healing is a feared complication with devastating outcomes for each patient. Most studies focus on geriatric fracture fixation and assess well known risk factors such as infections. However, risk factors, others than infections, and impaired healing of proximal femur fractures in non-geriatric adults are marginally assessed.

Trochanteric fracture pattern is associated with increased risk for nonunion independent of open or closed reduction technique.

Purpose: Soft tissue injury and soft tissue injury as risk factors for nonunion following trochanteric femur fractures (TFF) are marginally investigated. The aim of this study was to identify risk factors for impaired fracture healing in geriatric trauma patients with TFF following surgical treatment with a femoral nail.

Methods: This retrospective cohort study included geriatric trauma patients (aged > 70 years) with TFF who were treated with femoral nailing.

Salvage of a mangled limb with Matriderm augmented split-skin grafting and maggot biodebridement.

Salvage of a mangled limb can be a long and strenuous way, but it is feasible even with rather simple techniques such as augmented split-skin grafting and maggot biodebridement.

Long-term experience with a collagen-elastin scaffold in combination with split-thickness skin grafts for the treatment of full-thickness soft tissue defects: improvements in outcome-a retrospective cohort study and case report.

Purpose: The management of severe soft tissue injuries to the extremities with full-thickness wounds poses a challenge to the patient and surgeon. Dermal substitutes are used increasingly in these defects. The aim of this study was to investigate the impact of the type of injury on the success rate of Matriderm® (MD)-augmented split-thickness skin grafting, as well as the role of negative pressure wound therapy (NPWT) in preconditioning of the wounds, with a special focus on the reduction of the bioburden.

Quantification of immobilization-induced changes in human calf muscle using speed-of-sound ultrasound: An observational pilot study.

Short-term immobilization leads to fatty muscular degeneration, which is associated with various negative health effects. Based on literature showing very high correlations between MRI Dixon fat fraction and Speed-of-Sound (SoS), we hypothesized that we can detect short-term-immobilization-induced differences in SoS.Both calves of 10 patients with a calf cast on one side for a mean duration of 41 ± 26 days were examined in relaxed position using a standard ultrasound machine.

Perforating foreign body causing incomplete facial paralysis.

Facial nerve trauma is a common cause of facial paralysis; both blunt and penetrating forces may compromise the facial nerve. A comprehensive primary and secondary survey is essential for diagnosis and treatment of the injury. Here we report on a young patient who sustained a quad bike accident, leading to an perforating injuries of the face from a bough, causing facial paralysis.

[Care Management for Polytrauma Patients in a Level-1 Trauma Centre].

Care Management for Polytrauma Patients in a Level-1 Trauma Centre In our level-1 trauma institution, polytrauma patients with an Injury Severity Score of 16 or higher are facing waiting times for transfer to a rehabilitation facility, causing a negative financial outcome for our institution. The purpose of this study is to stimulate rapid transfer to a rehabilitation facility. In a single-centre case study, care management for (poly)trauma patients was started to ensure time-directed treatment for trauma patients related to Diagnosis-Related Groups (DRG).

The coccygeal pressure ulcer-does coccygectomy prevent recurrence?

Study Design: This is a retrospective, non-randomized cohort study, with data collected during the regular annual visits between 2001 and 2019.

Objectives: The aim of this study was to evaluate the efficacy of coccygectomy for coccygeal pressure ulcers in individuals with paraplegia due to spinal cord injury or other neurological causes and to evaluate its role in the prophylaxis of ulcer recurrence.

Settings: This study included inpatients and outpatients with a coccygeal pressure ulcer who were treated surgically at our Institution REHAB Basel and were followed with regular annual check-ups.

[Fever after an Open Ankle Fracture - a Surprising Diagnosis].

Fever after an Open Ankle Fracture - a Surprising Diagnosis We present the case of a patient with a second-degree open dislocated ankle fracture and a complex wound situation as well as fever in the postoperative course. The man, originally from Nigeria, spent his annual holidays in a rural area of ​​the country, where he sustained a right-sided open dislocation fracture of his ankle in a car accident. After initial rudimentary care in Nigeria, the patient traveled back to Switzerland on his own, where he has been living for the past ten years.

[Posttraumatic Osteomyelitis: Improvement in Outcome by Negative Pressure Wound Therapy with Instillation Technique].

Posttraumatic Osteomyelitis: Improvement in Outcome by Negative Pressure Wound Therapy with Instillation Technique Abstract. Surgical treatment of post-traumatic (fistula) osteomyelitis can be difficult and is associated with an increased risk of later recurrence. Very often osteomyelitis is accompanied by a soft tissue (defective) wound.

Bacterial reduction and shift with NPWT after surgical debridements: a retrospective cohort study.

Background: Surgical debridement, negative-pressure wound therapy (NPWT) and antibiotics are used for the treatment of open wounds. However, it remains unclear whether this treatment regimen is successful in the reduction and shift of the bacterial load.

Methods: After debridement in the operating room, NPWT, and antibiotic treatment, primary and secondary consecutive microbiological samples of 115 patients with 120 open wounds with bacterial or yeast growth in ≥1 swab or tissue microbiological sample(s) were compared for bacterial growth, Gram staining and oxygen use at a level one trauma center in 2011.

High risk of adverse events in hospitalised hip fracture patients of 65 years and older: results of a retrospective record review study.

Objectives: Hip fracture patients of 65 years and older are a complex patient group who often suffer from complications and difficult rehabilitation with disappointing results. It is unknown to what extent suboptimal hospital care contributes to these poor outcomes. This study reports on the scale, preventability, causes and prevention strategies of adverse events in patients, aged 65 years and older, admitted to the hospital with a primary diagnosis of hip fracture.

Risk factors for prolonged treatment and hospital readmission in 280 cases of negative-pressure wound therapy.

Background: There is evidence of certain beneficial effects and increasing understanding of the mechanisms of action of negative-pressure wound therapy (NPWT). However, it is known that prolonged duration of NPWT is associated with increased bacterial growth and efforts should be made to decrease the duration of NPWT. It was the aim of this study to evaluate potential risk factors for the duration, from first application of NPWT to secondary wound closure and to identify factors that increase the rate of hospital readmission.

Therapy of acute and delayed spinal infections after spinal surgery treated with negative pressure wound therapy in adult patients.

We present the results of the treatment of infected primary or delayed spine wounds after spinal surgery using negative pressure wound therapy. In our institution (University Hospital Zurich, Switzerland) nine patients (three women and six men; mean age 68.6, range 43-87 years) were treated in the period between January to December 2011 for non-healing spinal wounds.

Complement activation and inhibition in wound healing.

Complement activation is needed to restore tissue injury; however, inappropriate activation of complement, as seen in chronic wounds can cause cell death and enhance inflammation, thus contributing to further injury and impaired wound healing. Therefore, attenuation of complement activation by specific inhibitors is considered as an innovative wound care strategy. Currently, the effects of several complement inhibitors, for example, the C3 inhibitor compstatin and several C1 and C5 inhibitors, are under investigation in patients with complement-mediated diseases.

Maggot excretions affect the human complement system.

The complement system plays an important role in the activation of the inflammatory response to injury, although inappropriate complement activation (CA) can lead to severe tissue damage. Maggot therapy is successfully used to treat infected wounds. In this study, we hypothesized that maggot excretions/secretions influence CA in order to modulate the host's inflammatory response.

First experiences with negative pressure wound therapy and instillation in the treatment of infected orthopaedic implants: a clinical observational study.

Purpose: Infections associated with orthopaedic implants remain a serious complication. The main objective in acute infection control is component retention, whereas this option is usually not considered for chronic infections.

Methods: This multi-centre prospective, non-randomised observational study investigated one possible treatment option for implant retention in combination with negative pressure wound therapy with instillation (NPWTi).

Synergism between maggot excretions and antibiotics.

Maggots are successfully used to treat severe, infected wounds. This study investigated whether maggot excretions/secretions influence the antibacterial activity of different antibiotics. Minimal inhibitory concentrations and minimal bactericidal concentrations (MBC) were determined of gentamicin and flucloxacillin for Staphylococcus aureus, of penicillin for Streptococcus pyogenes, of amoxicillin and vancomycin for Enterococcus faecalis, of gentamicin for Enterobacter cloacae, and of gentamicin, tobramycin, and ciprofloxacin for Pseudomonas aeruginosa by checkerboard titration.

Maggot excretions inhibit biofilm formation on biomaterials.

Background: Biofilm-associated infections in trauma surgery are difficult to treat with conventional therapies. Therefore, it is important to develop new treatment modalities. Maggots in captured bags, which are permeable for larval excretions/secretions, aid in healing severe, infected wounds, suspect for biofilm formation.

Cancellations of (helicopter-transported) mobile medical team dispatches in the Netherlands.

Background: The trauma centre of the Trauma Center Region North-West Netherlands (TRNWN) has consensus criteria for Mobile Medical Team (MMT) scene dispatch. The MMT can be dispatched by the EMS-dispatch centre or by the on-scene ambulance crew and is transported by helicopter or ground transport. Although much attention has been paid to improve the dispatch criteria, the MMT is often cancelled after being dispatched.

Negative pressure wound treatment with polyvinyl alcohol foam and polyhexanide antiseptic solution instillation in posttraumatic osteomyelitis.

In a retrospective, case-control cohort study an assessment was made of the clinical outcome of patients with osteomyelitis treated with a new modality of negative pressure wound therapy, so called negative pressure instillation therapy. In this approach, after surgical debridement, a site of osteomyelitis is treated with negative pressure of at least 300 mmHg applied through polyvinyl alcohol dressing. The polyvinyl alcohol foam is irrigated through the tubes three times a day with a polyhexanide antiseptic solution.

The influence of maggot excretions on PAO1 biofilm formation on different biomaterials.

Biofilm formation in wounds and on biomaterials is increasingly recognized as a problem. It therefore is important to focus on new strategies for eradicating severe biofilm-associated infections. The beneficial effects of maggots (Lucilia sericata) in wounds have been known for centuries.

Prehospital identification of major trauma patients.

Background And Aims: Prehospital triage is aimed at getting the right patient to the right hospital. Evaluations on the performance of prehospital triage tools are scarce. This study examines the ability of the American College of Surgeons' Committee on Trauma (ACSCOT) triage guidelines to identify major trauma patients in a European trauma system.