Trauma recidivism is reduced with engagement in psychosocial programming following orthopaedic trauma.

Introduction: Recidivism is common following injury. Interventions to enhance patient engagement may reduce trauma recidivism. Education, counseling, peer mentorship, and other resources are known as Trauma Recovery Services (TRS).

Recidivism after orthopaedic trauma has diminished over time.

Purpose: The purpose was to analyze our trauma population during two periods to assess for predictors of recidivism.

Methods: Prior (2007-2011, n = 879) and recent (2014-2019, n = 954) orthopaedic trauma patients were reviewed. Recidivists were those returning with an unrelated injury.

Trauma recidivism is pervasive and is associated with mental and social health opportunities.

Introduction: Recidivism after orthopedic trauma results in greater morbidity and costs. Prior studies explored the effects of social and medical factors affecting the frequency of return to the hospital with new, unrelated injury. Identification of mental, social and other risk factors for trauma recidivism may provide opportunities for mitigation.

Anterior Cervical Discectomy and Fusion With "Kissing" Allograft Interbodies.

Background: There is recent evidence to suggest that the use of polyetheretherketone (PEEK) interbodies are inherently associated with a higher rate of pseudarthrosis, in particular, at the C5-6 and C6-7 levels. Herein, we describe our technique utilizing two parallel structural allografts or "kissing" allografts, designed to mitigate the risk of pseudarthrosis and subsidence at these levels.

Materials And Methods: We retrospectively reviewed all anterior cervical discectomy and fusion (ACDF) procedures with "kissing" for degenerative spine pathology at a single institution between 2018 and 2019 for the C5-6 and C6-7 levels.

C1-C2 Arthrodesis With C1 Lateral Mass and C2 Parsicle Screws Combined With Interlaminar Arthrodesis and Wiring.

C1-C2 arthrodesis is a common procedure performed for the correction of atlantoaxial instability due to a host of pathologies, including degenerative, neoplastic, congenital, and trauma. While there is clinical equipoise, C1-C2 fusion is associated with a lower morbidity than occipital-cervical fusion. However, due to the unique morphometric characteristics of the C1 lateral mass, and the challenges that its fixation presents, some surgeons may elect to extend the construct to the occiput rather than attempt a C1-C2 fusion.

Enhancing Trauma Patient Experience Through Education and Engagement: Development of a Mobile Application.

Unlabelled: The purpose was to determine the utility of an open access mobile device application (App: http://bit.ly/traumaapp) to improve patient education and engagement.

Methods: A patient education app was developed with information regarding injury, treatment, and recovery for orthopaedic and other injuries.

Prevertebral Soft-Tissue Swelling at C7 Is Highly Sensitive for Cervical Spine Ligamentous Injury Study Type: Retrospective Cohort Study.

Unlabelled: To determine the diagnostic potential of prevertebral soft-tissue (PVST) swelling in cervical spine ligamentous injury (LI).

Background: PVST swelling in the cervical spine is a historical indicator of cervical spine injury; however, at present, there are no limited objective criteria to use PVST swelling to guide clinical decision-making regarding cervical spine LI. This study investigates PVST thickness as a screening measure for cervical spine LI with a potential to identify indications for advanced imaging.

Does prehospital spinal immobilization influence in hospital decision to obtain imaging after trauma?

Importance: This study highlights the unnecessarily high suspicion for cervical spine injury among study providers and shows that cervical CT scans were more likely in patients who arrived to the emergency department wearing a cervical collar, even when clinically cleared for suspicion of cervical spine injury by the emergency department provider.

Objective: To determine if patients with a cervical collar were more likely to undergo cervical spine imaging than those who arrived to the emergency department without a collar.

Design: Adult trauma patients at a level 1 trauma center over 4 months (n = 1,438) were stratified by acuity (1,2, or 3), mechanism, and known injury cephalad to clavicles, defined as pain, wounds, or hematomas.

Smoking Is Associated With Longer Intensive Care Unit Stays in Spine Trauma Patients.

Objective: To determine the impact of smoking on intensive care unit (ICU) outcomes in patients who underwent operative fixation for spine trauma.

Design: Retrospective cohort study.

Setting: Single academic level I trauma center.

Fracture fixation in the polytrauma patient: Markers that matter.

Timing and type of fracture fixation in the multiply-injured trauma patient have been important and controversial topics. Ideal care for these patients come from providers who communicate well with one another in a team fashion and view the whole person, rather than focusing on injury to individual systems. This group encompasses a wide range of musculoskeletal and other injuries, further complicated by the broad spectrum of patients, with variability in age, medical and social comorbidities, all of which may have profound impact upon outcomes.

A Rare Case of Cervical Charcot After Spinal Cord Injury: A Case Report.

Case: We present a rare case of cervical Charcot disease that was diagnosed in a paraplegic patient by loss of function caudal to the original level of spinal cord injury. Clinical imaging, diagnosis, differentials, and operative management are discussed.

Conclusions: Charcot disease of the cervical spine is rare and very difficult to diagnose in the paraplegic patient population.

Regionalization of Spine Trauma Care in an Urban Trauma System in the United States: Decreased Time to Surgery and Hospital Length of Stay.

Background: The effect of regionalized trauma care (RT) on hospital-based outcomes for traumatic spine injury (TSI) in the United States is unknown.

Objective: To test the hypothesis that RT would be associated with earlier time to surgery and decreased length of stay (LOS).

Methods: TSI patients >14 yr were identified using International Classification of Diseases Ninth Revision Clinical Modification diagnostic codes.

Early Tracheostomy in Patients With Traumatic Cervical Spinal Cord Injury Appears Safe and May Improve Outcomes.

Study Design: Retrospective case series.

Objective: To characterize outcomes associated with tracheostomy timing following traumatic cervical spinal cord injury (CSCI).

Summary Of Background Data: The morbidity associated with cervical spine trauma is substantially increased in the setting of concomitant CSCI.

Indications for CT-Angiography of the Vertebral Arteries After Trauma.

Study Design: Retrospective.

Objective: The purpose of this project is to identify factors that predict vertebral artery injury (VAI) in an effort to assess risks and benefits of computed tomography angiography (CT-A) of the neck in the trauma setting. We seek to develop guidelines for practitioners to stratify patients at medium/high risk of VAI from those who are at low risk.

Presentation Coagulopathy and Persistent Acidosis Predict Complications in Orthopaedic Trauma Patients.

Objectives: To evaluate the ability of measures of coagulopathy and acidosis to predict complications. We hypothesize that increased coagulopathy and acidosis over the first 60 hours of hospitalization will result in increased rates of infection and mortality.

Design: Prospective, observational.

Operative Versus Nonoperative Management of Civilian Gunshot Wounds to the Spinal Cord: Novel Use of the Functional Independence Measure for Validated Outcomes.

Background: Surgery for patients with gunshot wound spinal cord injury (GSCI) remains controversial. Few recent studies provide standardized follow-up and detailed functional outcomes. To our knowledge, the research we present in this study is unique in that we are the first to incorporate Functional Independence Measure (FIM) scores as an outcomes measure for neurologic recovery in patients with GSCI.

Risk factors for pulmonary complication following fixation of spine fractures.

Background Context: Previous studies have suggested pulmonary complications are common among patients undergoing fixation for traumatic spine fractures. This leads to prolonged hospital stay, worse functional outcomes, and increased economic burden. However, only limited prognostic information exists regarding which patients are at greatest risk for pulmonary complications.

Multiple Procedures in the Initial Surgical Setting: When Do the Benefits Outweigh the Risks in Patients With Multiple System Trauma?

Objectives: To compare single versus multiple procedures in the same surgical setting. We hypothesized that complication rates would not be different and length of stay would be shorter in patients undergoing multiple procedures.

Design: Prospective, cohort.

Floating Lateral Mass Fractures of the Cervical Spine.

Study Design: Level I trauma center case series.

Objective: The purpose of this study was (i) to characterize the floating lateral mass (FLM) fracture with the mechanism of injury, anatomical injury pattern, associated vascular injuries, neurological deficits, and key radiographic features; and (ii) to better understand the most effective method of treatment.

Summary Of Background Data: An uncommon and poorly described subset of unilateral lateral mass fractures is FLM with fractures of the adjacent pedicle and lamina.

Pedicolaminar Fracture-Dislocation.

A 28-year-old man presented to a level 1 trauma center with significant cervical spine pain after sliding into third base during a softball game. He struck his head on the thigh of the defensive player and had immediate pain in his neck and arm. He reported no loss of consciousness, no transient tetraplegia/paraplegia, and no loss of bowel and bladder control.

Early Appropriate Care: A Protocol to Standardize Resuscitation Assessment and to Expedite Fracture Care Reduces Hospital Stay and Enhances Revenue.

Objectives: We hypothesized that a standardized protocol for fracture care would enhance revenue by reducing complications and length of stay.

Design: Prospective consecutive series.

Setting: Level 1 trauma center.

Complications are reduced with a protocol to standardize timing of fixation based on response to resuscitation.

Background: Our group developed a protocol, entitled Early Appropriate Care (EAC), to determine timing of definitive fracture fixation based on presence and severity of metabolic acidosis. We hypothesized that utilization of EAC would result in fewer complications than a historical cohort and that EAC patients with definitive fixation within 36 h would have fewer complications than those treated at a later time.

Methods: Three hundred thirty-five patients with mean age 39.

The Reliability and Validity of the Thoracolumbar Injury Classification System in Pediatric Spine Trauma.

Study Design: The thoracolumbar injury classification system (TLICS) was evaluated in 20 consecutive pediatric spine trauma cases.

Objective: The purpose of this study was to determine the reliability and validity of the TLICS in pediatric spine trauma.

Summary Of Background Data: The TLICS was developed to improve the categorization and management of thoracolumbar trauma.