Does regional implementation of a clinical pathway for older adult patients with pelvic fragility fractures after low-energy trauma improve patient outcomes (PELVIC): a multicentre, stepped-wedge, randomised controlled trial.

Introduction: Patients with pelvic fragility fractures suffer from high morbidity and mortality rates. Despite the high incidence, there is currently no regional or nationwide treatment protocol which results in a wide variety of clinical practices. Recently, there have been new insights into treatment strategies, such as early diagnosis and minimally invasive operative treatment.

Overview of fracture liaison services in the UK and Europe: standards, model of care, funding, and challenges.

Fragility fractures represent a growing global problem, including in the United Kingdom and European countries. Reports demonstrate the benefits of national guidance and organized fragility fracture programs through fracture liaison services to deliver care to patients who sustain these injuries. The challenge of assembling multidisciplinary teams, providing routine screening of appropriate patients, and monitoring therapies where there is a known compliance problem, remains an obstacle to the success of fragility fracture treatment programs to all.

Additional clinical value of routine CT imaging in fragility fractures of the pelvis: a prospective cohort study (ARTIFACT).

Purpose: Additional CT imaging for fragility fractures of the pelvis (FFP) has a high detection rate for concomitant posterior ring fractures (cPRFs). However, the clinical value of routine additional CT imaging is unknown. This study aimed to determine the additional clinical value of routine CT imaging by changes in treatment policy and to establish the predictive value of pain localized around the sacroiliac joint (SIJ) for cPRFs.

Trauma care during the COVID-19 pandemic in the Netherlands: a level 1 trauma multicenter cohort study.

Purpose: The coronavirus (COVID-19) pandemic has caused major healthcare challenges worldwide resulting in an exponential increase in the need for hospital- and intensive care support for COVID-19 patients. As a result, surgical care was restricted to urgent cases of surgery. However, the care for trauma patients is not suitable for reduction or delayed treatment.

The effect of socioeconomic status on severe traumatic injury: a statistical analysis.

Purpose: The amount of studies performed regarding a link between socioeconomic status (SES) and fatal outcome after traumatic injury is limited. Most research is focused on work-related injuries without taking other important characteristics into account. The aim of this study is to examine the association between SES and outcome after traumatic injury.

Health-Related Quality of Life Is Decreased After Necrotizing Soft-Tissue Infections.

Background: A necrotizing soft-tissue infection (NSTI) is a rare but severe infection with a high mortality rate of 12%-20%. Diagnosing is challenging and often delayed. Treatment consists of surgical debridement of all necrotic tissue and administration of antibiotics.

[A man with a painful right shoulder].

Posterior sternoclavicular luxations are uncommon and potentially life threatening. When clinically suspected, a computed tomography angiography is the gold standard to investigate whether important structures located in the mediastinum are at risk. A fast reduction should be performed to reduce pain and prevent acute and late complications.

[Metal implants and airport security checks].

Orthopaedic surgeons and trauma surgeons in the Netherlands are implanting 65,000 joint replacements and treating nearly 300,000 fractures per year. For many travellers with a metal implant - but also for the physicians who are treating them - it is unclear what the consequences will be when they have to go through airport security checks. These checks follow a fixed procedure in accordance with European rules which involves travellers passing through a number of visible and invisible barriers.

[Falling from a height: Psychiatric comorbidity and complications].

Objective: To investigate whether a mental disorder increases the occurrence of complications in patients after 'a fall from a height'.

Design: Retrospective descriptive study.

Methods: Data on all patients admitted following a 'fall from a height' in the period 2004-2012 was retrieved from the trauma registry of the Academic Medical Center (AMC) in Amsterdam, the Netherlands.

Failure rate and complications of angiography and embolization for abdominal and pelvic trauma.

Background: Angiography and embolization have become the treatment of choice after abdominal trauma or pelvic injury in hemodynamically stable patients with a suspicion of internal hemorrhage (contrast extravasation, pseudo-aneurysm, or a vessel cutoff diagnosed on computed tomographic scanning). Some studies, however, report a high incidence of rebleeding (failure) or complications. The aim of this study was to evaluate the failure rate and the complications in trauma patients undergoing such procedures.

Changing patterns in diagnostic strategies and the treatment of blunt injury to solid abdominal organs.

Background: In recent years there has been increasing interest shown in the nonoperative management (NOM) of blunt traumatic injury. The growing use of NOM for blunt abdominal organ injury has been made possible because of the progress made in the quality and availability of the multidetector computed tomography (MDCT) scan and the development of minimally invasive intervention options such as angioembolization.

Aim: The purpose of this review is to describe the changes that have been made over the past decades in the management of blunt trauma to the liver, spleen and kidney.

Improved outcomes in the non-operative management of liver injuries.

Objectives: Non-operative management has become the treatment of choice in the majority of liver injuries. The aim of this study was to assess the changes in primary treatment and outcomes in a single Dutch Level 1 trauma centre with wide experience in angio-embolisation (AE).

Methods: The prospective trauma registry was retrospectively analysed for 7-year periods before (Period 1) and after (Period 2) the introduction of AE.

Functional treatment versus plaster for simple elbow dislocations (FuncSiE): a randomized trial.

Background: Elbow dislocations can be classified as simple or complex. Simple dislocations are characterized by the absence of fractures, while complex dislocations are associated with fractures. After reduction of a simple dislocation, treatment options include immobilization in a static plaster for different periods of time or so-called functional treatment.

The association of mobile medical team involvement on on-scene times and mortality in trauma patients.

Objectives: Mobile medical teams (MMTs) provide specialized care on-scene with the purpose to improve outcome. However, this additional care could prolong the on-scene time (OST), which is related to mortality. The purpose of this study was to assess the effects of MMT involvement on the mortality rate and on the OST, in a Dutch consecutive cohort of Level I trauma patients.

Literature review of the role of ultrasound, computed tomography, and transcatheter arterial embolization for the treatment of traumatic splenic injuries.

Introduction: The spleen is the second most frequently injured organ following blunt abdominal trauma. Trends in management have changed over the years. Traditionally, laparotomy and splenectomy was the standard management.

Complications in multitrauma patients in a Dutch level 1 trauma center.

Background: Complication registration is an important part of monitoring the quality of health care. The aim of this article was to describe the incidence, type, and impact of complications occurring within 6 months after the initial trauma in multitrauma patients.

Methods: During a 2-year period, all trauma patients with an Injury Severity Score (ISS) ≥ 16 who were not directly transferred to other hospitals were included.

An evaluation of a Shockroom located CT scanner: a randomized study of early assessment by CT scanning in trauma patients in the bi-located trauma center North-West Netherlands (REACT trial).

Background: Trauma is a major source of morbidity and mortality, especially in people below the age of 50 years. For the evaluation of trauma patients CT scanning has gained wide acceptance in and provides detailed information on location and severity of injuries. However, CT scanning is frequently time consuming due to logistical (location of CT scanner elsewhere in the hospital) and technical issues.

The effect of the introduction of the Amsterdam Trauma Workflow Concept on mortality and functional outcome of patients with severe traumatic brain injury.

The purpose of this study was to analyze the effect of the introduction of an all-in workflow concept that included direct computed tomography (CT) scanning in the trauma room on mortality and functional outcome of trauma patients with severe traumatic brain injury (TBI) admitted to a level-1 trauma center. To this end, a retrospective comparison was made of a 1-year cohort prior to the implementation of the all-in workflow concept (Pre-CT in trauma room cohort [Pre-TRCT]) and a 1-year cohort after the implementation (Post-TRCT). All severely injured TBI patients aged 16 years or older that were presented in our level-1 trauma center and that underwent a CT of the head were initially included.

Assessment of a new trauma workflow concept implementing a sliding CT scanner in the trauma room: the effect on workup times.

Introduction: We developed a new shockroom resuscitation setting that includes a moveable, multislice computed tomography (CT) scanner capable of scanning patients during the initial trauma resuscitation phase without (multiple) patient transfers that previously were necessary. This enables us to perform a complete diagnostic trauma workup, without leaving the shockroom. In this study, we assess the effect of the new Trauma Workflow Concept on the initial diagnostic workup times in the trauma room.

Significant forefoot varus deformity resulting in progressive stress fractures of all lesser metatarsal bones.

Stress fractures may occur in any bone, but appear most frequently in the metatarsal bones. Consecutive stress fractures of all lesser metatarsals in a short period are rare, and only a few cases have been described in the literature. We report an unusual case of a young man with consecutive stress fractures of four adjacent lesser metatarsal bones.

A Retrospective Study of Five Clinical Criteria and One Age Criterion for Selective Prehospital Spinal Immobilization.

Unlabelled: Full spinal immobilization of blunt trauma victims is a widely accepted prehospital measure, applied in order to prevent (further) damage to the spinal cord. However, looking at the marginal evidence that exists for the effectiveness of spinal immobilization, and the growing evidence for the negative effects following immobilization, a more selective protocol might be able to reduce possible morbidity and mortality as good as the present prehospital immobilization protocol. In a retrospective study, the sensitivity of a selective prehospital immobilization protocol that adds an age criterion to five clinical spine clearance criteria is examined.