Triage tools for detecting cervical spine injury in pediatric trauma patients.

Background: Pediatric cervical spine injury (CSI) after blunt trauma is rare. Nonetheless, missing these injuries can have severe consequences. To prevent the overuse of radiographic imaging, two clinical decision tools have been developed: The National Emergency X-Radiography Utilization Study (NEXUS) criteria and the Canadian C-spine Rule (CCR).

External validation of clinical decision rules for children with wrist trauma.

Background: Clinical decision rules help to avoid potentially unnecessary radiographs of the wrist, reduce waiting times and save costs.

Objective: The primary aim of this study was to provide an overview of all existing non-validated clinical decision rules for wrist trauma in children and to externally validate these rules in a different cohort of patients. Secondarily, we aimed to compare the performance of these rules with the validated Amsterdam Pediatric Wrist Rules.

Plate Fixation Compared with Nonoperative Treatment for Displaced Midshaft Clavicular Fractures: A Multicenter Randomized Controlled Trial.

Background: The use of operative treatment for clavicular fractures is increasing, despite varying results in previous studies. The aim of this study was to compare plate fixation and nonoperative treatment for displaced midshaft clavicular fractures with respect to nonunion, adverse events, and shoulder function.

Methods: In this multicenter, prospective, randomized controlled trial, patients between 18 and 60 years old with a displaced midshaft clavicular fracture were randomized between nonoperative treatment and open reduction with internal plate fixation.

Trauma surgery by general surgeons: Still an option for proximal femoral fractures?

Introduction: Surgery for proximal femoral fractures in the Netherlands is performed by trauma surgeons, general surgeons and orthopaedic surgeons. The aim of this study was to assess whether there is a difference in outcome for patients with proximal femoral fractures operated by trauma surgeons versus general surgeons. Secondly, the relation between hospital and surgeon volume and postoperative complications was explored.

Emergency Department Pain Management in Adult Patients With Traumatic Injuries Before and After Implementation of a Nurse-Initiated Pain Treatment Protocol Utilizing Fentanyl for Severe Pain.

Background: Pain management in the emergency department (ED) remains suboptimal. Nursing staff protocols could improve this, but studies show divergent results.

Objective: Our aim was to evaluate a nurse-initiated pain-management protocol in adult patients with traumatic injuries in the short and in the long term, utilizing fentanyl for severe pain.

The reliability and reproducibility of the Hertel classification for comminuted proximal humeral fractures compared with the Neer classification.

Introduction: The Neer classification is the most commonly used fracture classification system for proximal humeral fractures. Inter- and intra-observer agreement is limited, especially for comminuted fractures. A possibly more straightforward and reliable classification system is the Hertel classification.

[The Amsterdam wrist rules: the multicenter prospective derivation and external validation of a clinical decision rule for the use of radiography in acute wrist trauma].

Background: Although only 39% of patients with wrist trauma have sustained a fracture, the majority of patients is routinely referred for radiography. The purpose of this study was to derive and externally validate a clinical decision rule that selects patients with acute wrist trauma in the Emergency Department (ED) for radiography.

Method: This multicenter prospective study consisted of three components: (1) derivation of a clinical prediction model for detecting wrist fractures in patients following wrist trauma; (2) external validation of this model; and (3) design of a clinical decision rule.

Anesthesia with topical lidocaine hydrochloride gauzes in acute traumatic wounds in triage, a pilot study.

Background: Topical application of lidocaine in wounds has been studied in combination with vasoconstrictive additives, but the effect without these additives is unknown. The objective was to examine use of lidocaine-soaked gauzes without vasoconstrictive agents, in traumatic wounds in adult patients, applied in triage.

Methods: A prospective pilot study was performed during 6 weeks in the Emergency Department of a level 1 trauma center.

Physiological uptake values of 18F-FDG in long bones of the lower extremity on PET/CT imaging.

Introduction: Fluorine-18 fluorodeoxyglucose (F-FDG) PET/computed tomography (CT) has proven to be a valuable imaging modality with high diagnostic accuracy for the detection of bone infections. However, the physiological uptake values for F-FDG in the long bones of the lower extremity have not been established yet. This hampers correct interpretation of a F-FDG-PET/CT scan.

The Amsterdam wrist rules: the multicenter prospective derivation and external validation of a clinical decision rule for the use of radiography in acute wrist trauma.

Background: Although only 39 % of patients with wrist trauma have sustained a fracture, the majority of patients is routinely referred for radiography. The purpose of this study was to derive and externally validate a clinical decision rule that selects patients with acute wrist trauma in the Emergency Department (ED) for radiography.

Methods: This multicenter prospective study consisted of three components: (1) derivation of a clinical prediction model for detecting wrist fractures in patients following wrist trauma; (2) external validation of this model; and (3) design of a clinical decision rule.

Mason Type I Fractures of the Radial Head.

Mason type I fractures are the most common fractures of the radial head. The fractures have a benign character and often result in good, pain-free function. Nevertheless, up to 20% of patients with a Mason type I fracture report loss of extension and residual pain.

The Unstable Distal Radius Fracture-How Do We Define It? A Systematic Review.

Background Unstable distal radius fractures are a popular research subject. However, to appreciate the findings of studies that enrolled patients with unstable distal radius fractures, it should be clear how the authors defined an unstable distal radius fracture. Questions In what percentage of studies involving patients with unstable distal radius fractures did the authors define unstable distal radius fracture? What are the most common descriptions of an unstable distal radius fracture? And is there one preferred evidence-based definition for future authors? Methods A systematic search of literature was performed to identify any type of study with the term unstable distal radius fracture.

Factors Associated with Patient Delay in Scaphoid Nonunions.

Delay in seeking medical attention by patients, ─so-called patient delay, contributes to the relative high rate of delayed diagnosis and treatment in scaphoid nonunion cases. In this retrospective study we investigated the incidence of patients with a patient delay exceeding 6 months, thus by definition having an established nonunion. In addition to this, we investigated demographic, injury and patient related factors associated with this patient delay in scaphoid nonunion patients.

A clinical decision rule for the use of plain radiography in children after acute wrist injury: development and external validation of the Amsterdam Pediatric Wrist Rules.

Background: In most hospitals, children with acute wrist trauma are routinely referred for radiography.

Objective: To develop and validate a clinical decision rule to decide whether radiography in children with wrist trauma is required.

Materials And Methods: We prospectively developed and validated a clinical decision rule in two study populations.

Plain radiography in children with spoke wheel injury: A retrospective cohort study.

Background And Purpose: Bicycle spoke injury (BSI) mostly occurs in children as a result of entrapment of the leg in the bicycle spokes. No guideline or protocol exists that defines what type of radiography is indicated to diagnose or rule out a fracture commonly associated with these injuries. The aim of this study was (1) to evaluate the type of radiographs that are obtained in children with BSI, (2) to assess in which anatomical regions fractures occur and (3) to evaluate on which radiographs a fracture can be detected in children with BSI.

Early mobilisation versus plaster immobilisation of simple elbow dislocations: results of the FuncSiE multicentre randomised clinical trial.

Background/aim: To compare outcome of early mobilisation and plaster immobilisation in patients with a simple elbow dislocation. We hypothesised that early mobilisation would result in earlier functional recovery.

Methods: From August 2009 to September 2012, 100 adult patients with a simple elbow dislocation were enrolled in this multicentre randomised controlled trial.

Erratum to: The effect of postoperative wound infections on functional outcome following intra-articular calcaneal fractures.

Erratum to: Arch Orthop Trauma Surg DOI 10.1007/s00402-015-2219-5. The original version of this article unfortunately contained a mistake and has been corrected.

The Minimum Clinically Important Difference of the Patient-rated Wrist Evaluation Score for Patients With Distal Radius Fractures.

Background: The Patient-rated Wrist Evaluation (PRWE) is a commonly used instrument in upper extremity surgery and in research. However, to recognize a treatment effect expressed as a change in PRWE, it is important to be aware of the minimum clinically important difference (MCID) and the minimum detectable change (MDC). The MCID of an outcome tool like the PRWE is defined as the smallest change in a score that is likely to be appreciated by a patient as an important change, while the MDC is defined as the smallest amount of change that can be detected by an outcome measure.

Wound Infections Following Implant removal below the knee: the effect of antibiotic prophylaxis; the WIFI-trial, a multi-centre randomized controlled trial.

Background: In the Netherlands about 18,000 procedures with implant removal are performed annually following open or closed reduction and fixation of fractures, of which 30-80% concern the foot, ankle and lower leg region. For clean surgical procedures, the rate of postoperative wound infections (POWI) should be less than ~2%. However, rates of 10-12% following implant removal have been reported, specifically after foot, ankle and lower leg fractures.

Bioabsorbable Versus Metallic Screw Fixation for Tibiofibular Syndesmotic Ruptures: A Meta-Analysis.

Ankle fractures with syndesmotic rupture require operative treatment. In most cases, this consists of fixation of the tibiofibular joint with 1 or more screws. Bioabsorbable screws are used for the same purpose but have the advantage that screw removal is unnecessary.

The effect of postoperative wound infections on functional outcome following intra-articular calcaneal fractures.

Introduction: High rates of postoperative wound infections (POWI) are reported following the operative treatment of calcaneal fractures. This leads to additional therapy, prolonged hospital stay, burden for patients and increased costs. The primary aim of this study is to evaluate the effect of POWI following the extended lateral approach of displaced intra-articular calcaneal fractures on functional outcome.

Does repeat Hb measurement within 2 hours after a normal initial Hb in stable trauma patients add value to trauma evaluation?

Background: In our level I trauma center, it is considered common practice to repeat blood haemoglobin measurements in patients within 2 h after admission. However, the rationale behind this procedure is elusive and can be considered labour-intensive, especially in patients in whom haemorrhaging is not to be expected. The aim of this study was to assess the value of the repeated Hb measurement (r-Hb) within 2 h in adult trauma patients without evidence of haemodynamic instability.

Good functional recovery of complex elbow dislocations treated with hinged external fixation: a multicenter prospective study.

Background: After a complex dislocation, some elbows remain unstable after closed reduction or fracture treatment. Function after treatment with a hinged external fixator theoretically allows collateral ligaments to heal without surgical reconstruction. However, there is a lack of prospective studies that assess functional outcome, pain, and ROM.

Routinely recorded versus dedicated time registrations during trauma work-up.

Introduction: Since time intervals are used to determine quality of trauma care, it is relevant to know how reliable those intervals can be measured. The aim of our study was to assess the reliability of time intervals as recorded in our hospital databases.

Patients And Methods: We conducted a prospective study on time intervals in our level-1 trauma centre and compared those with the routinely recorded data from February 2012 to June 2012.