P. Mörsdorf

Quality of life after multiple trauma

ZusammenfassungHintergrundDas Polytrauma ist ein eigenständiges Verletzungsbild, das aufgrund seiner Komplexität etwa 25 % der Kosten bei der Versorgung aller Unfallverletzten bedingt. Durch den nicht selten langen Krankheitsverlauf und die häufig verbleibenden Dauerschäden ist davon auszugehen, dass ein stattgehabtes Polytrauma zu einer dauerhaften Beeinträchtigung der Lebensqualität des Patienten führt.FragestellungZiel der Studie war es, die aktuell wissenschaftlich gesicherten Daten zum Einfluss eines erlittenen Polytraumas auf die Lebensqualität des Patienten darzustellen und Prädiktoren für eine Verminderung der Lebensqualität nach einem Polytrauma zu identifizieren.Material und MethodenEs wurde eine Recherche mithilfe der wissenschaftlichen Datenbank MedLine durchgeführt. Aktuelle Arbeiten, welche sich mit der Lebensqualität nach erlittenem Polytrauma beschäftigen, wurden dabei ausgewertet.ErgebnisseNeben der physischen Erholung nach einem Polytrauma tritt der Begriff der Lebensqualität in den letzten Jahren immer mehr in den Vordergrund. Während die Letalität nach einem Polytrauma deutlich reduziert werden konnte, lässt sich ein vergleichbarer Effekt für die Lebensqualität nicht nachweisen. Als Prädiktoren für eine schlechtere Lebensqualität nach erlittenem Polytrauma konnten weibliches Geschlecht, hohes Alter, niedriger sozialer Status, begleitendes Schädel-Hirn-Trauma und eine Verletzung der unteren Extremität identifiziert werden.DiskussionDie Tatsache, dass zwar die Letalität nach einem Polytrauma reduziert, nicht aber die Einschränkung der Lebensqualität verringert werden konnte, macht deutlich, welche wichtige Rolle der physio- und psychotherapeutischen Nachbehandlung zukommt.AbstractBackgroundMultiple trauma is an independent injury pattern which, because of its complexity, is responsible for 25 % of the costs for the treatment of all injured patients. Because of the often long-lasting physical impairment and the high incidence of residual permanent handicaps, it is apparent that multiple trauma can lead to a reduction in patient quality of life.ObjectivesThe aim of this study was to give an overview of the known data concerning the change in quality of life for multiple trauma patients. Furthermore, predictors for the reduction of quality of life after multiple trauma will be identified.Materials and methodsA MedLine search was performed to identify studies dealing with the outcome after multiple trauma.ResultsIn addition to functional outcome parameters, the term quality of life has become more important in recent years when it comes to evaluating the outcome following injury. While the mortality after multiple trauma could be significantly reduced over the years, there is no comparable effect on the quality of life. Predictors for a worse quality of life after multiple trauma are female gender, high age, low social status, concomitant head injuries and injury to the lower extremities.ConclusionThe fact that mortality after multiple trauma has decreased but not impairment of the quality of life makes it clear that in addition to the acute medical treatment, a follow-up treatment including not only physiotherapy but also psychotherapy is crucial for multiple trauma patients.BACKGROUND Multiple trauma is an independent injury pattern which, because of its complexity, is responsible for 25 % of the costs for the treatment of all injured patients. Because of the often long-lasting physical impairment and the high incidence of residual permanent handicaps, it is apparent that multiple trauma can lead to a reduction in patient quality of life. OBJECTIVES The aim of this study was to give an overview of the known data concerning the change in quality of life for multiple trauma patients. Furthermore, predictors for the reduction of quality of life after multiple trauma will be identified. MATERIALS AND METHODS A MedLine search was performed to identify studies dealing with the outcome after multiple trauma. RESULTS In addition to functional outcome parameters, the term quality of life has become more important in recent years when it comes to evaluating the outcome following injury. While the mortality after multiple trauma could be significantly reduced over the years, there is no comparable effect on the quality of life. Predictors for a worse quality of life after multiple trauma are female gender, high age, low social status, concomitant head injuries and injury to the lower extremities. CONCLUSION The fact that mortality after multiple trauma has decreased but not impairment of the quality of life makes it clear that in addition to the acute medical treatment, a follow-up treatment including not only physiotherapy but also psychotherapy is crucial for multiple trauma patients.

Stimulation of angiogenesis by cilostazol accelerates fracture healing in mice

Cilostazol, a selective phosphodiesterase‐3 inhibitor, is known to control cyclic adenosine monophosphate (c‐AMP) and to stimulate angiogenesis through upregulation of pro‐angiogenic factors. There is no information, however, whether cilostazol affects fracture healing. We, therefore, studied the effect of cilostazol on callus formation and biomechanics during fracture repair. Bone healing was analyzed in a murine femur fracture stabilized with an intramedullary screw. Radiological, biomechanical, histomorphometric, histochemical, and protein biochemical analyses were performed at 2 and 5 weeks after fracture. Twenty‐five mice received 30 mg/kg body weight cilostazol p.o. daily. Controls (n = 24) received equivalent amounts of vehicle. In cilostazol‐treated animals radiological analysis at 2 weeks showed an improved healing with an accelerated osseous bridging compared to controls. This was associated with a significantly higher amount of bony tissue and a smaller amount of cartilage tissue within the callus. Western blot analysis showed a higher expression of cysteine‐rich protein 61 (CYR61), bone morphogenetic protein (BMP)‐4, and receptor activator of NF‐kappaB ligand (RANKL). At 5 weeks, improved fracture healing after cilostazol treatment was indicated by biomechanical analyses, demonstrating a significant higher bending stiffness compared to controls. Thus, cilostazol improves fracture healing by accelerating both bone formation and callus remodeling.

Lebensqualität nach Polytrauma

ZusammenfassungHintergrundDas Polytrauma ist ein eigenständiges Verletzungsbild, das aufgrund seiner Komplexität etwa 25 % der Kosten bei der Versorgung aller Unfallverletzten bedingt. Durch den nicht selten langen Krankheitsverlauf und die häufig verbleibenden Dauerschäden ist davon auszugehen, dass ein stattgehabtes Polytrauma zu einer dauerhaften Beeinträchtigung der Lebensqualität des Patienten führt.FragestellungZiel der Studie war es, die aktuell wissenschaftlich gesicherten Daten zum Einfluss eines erlittenen Polytraumas auf die Lebensqualität des Patienten darzustellen und Prädiktoren für eine Verminderung der Lebensqualität nach einem Polytrauma zu identifizieren.Material und MethodenEs wurde eine Recherche mithilfe der wissenschaftlichen Datenbank MedLine durchgeführt. Aktuelle Arbeiten, welche sich mit der Lebensqualität nach erlittenem Polytrauma beschäftigen, wurden dabei ausgewertet.ErgebnisseNeben der physischen Erholung nach einem Polytrauma tritt der Begriff der Lebensqualität in den letzten Jahren immer mehr in den Vordergrund. Während die Letalität nach einem Polytrauma deutlich reduziert werden konnte, lässt sich ein vergleichbarer Effekt für die Lebensqualität nicht nachweisen. Als Prädiktoren für eine schlechtere Lebensqualität nach erlittenem Polytrauma konnten weibliches Geschlecht, hohes Alter, niedriger sozialer Status, begleitendes Schädel-Hirn-Trauma und eine Verletzung der unteren Extremität identifiziert werden.DiskussionDie Tatsache, dass zwar die Letalität nach einem Polytrauma reduziert, nicht aber die Einschränkung der Lebensqualität verringert werden konnte, macht deutlich, welche wichtige Rolle der physio- und psychotherapeutischen Nachbehandlung zukommt.AbstractBackgroundMultiple trauma is an independent injury pattern which, because of its complexity, is responsible for 25 % of the costs for the treatment of all injured patients. Because of the often long-lasting physical impairment and the high incidence of residual permanent handicaps, it is apparent that multiple trauma can lead to a reduction in patient quality of life.ObjectivesThe aim of this study was to give an overview of the known data concerning the change in quality of life for multiple trauma patients. Furthermore, predictors for the reduction of quality of life after multiple trauma will be identified.Materials and methodsA MedLine search was performed to identify studies dealing with the outcome after multiple trauma.ResultsIn addition to functional outcome parameters, the term quality of life has become more important in recent years when it comes to evaluating the outcome following injury. While the mortality after multiple trauma could be significantly reduced over the years, there is no comparable effect on the quality of life. Predictors for a worse quality of life after multiple trauma are female gender, high age, low social status, concomitant head injuries and injury to the lower extremities.ConclusionThe fact that mortality after multiple trauma has decreased but not impairment of the quality of life makes it clear that in addition to the acute medical treatment, a follow-up treatment including not only physiotherapy but also psychotherapy is crucial for multiple trauma patients.BACKGROUND Multiple trauma is an independent injury pattern which, because of its complexity, is responsible for 25 % of the costs for the treatment of all injured patients. Because of the often long-lasting physical impairment and the high incidence of residual permanent handicaps, it is apparent that multiple trauma can lead to a reduction in patient quality of life. OBJECTIVES The aim of this study was to give an overview of the known data concerning the change in quality of life for multiple trauma patients. Furthermore, predictors for the reduction of quality of life after multiple trauma will be identified. MATERIALS AND METHODS A MedLine search was performed to identify studies dealing with the outcome after multiple trauma. RESULTS In addition to functional outcome parameters, the term quality of life has become more important in recent years when it comes to evaluating the outcome following injury. While the mortality after multiple trauma could be significantly reduced over the years, there is no comparable effect on the quality of life. Predictors for a worse quality of life after multiple trauma are female gender, high age, low social status, concomitant head injuries and injury to the lower extremities. CONCLUSION The fact that mortality after multiple trauma has decreased but not impairment of the quality of life makes it clear that in addition to the acute medical treatment, a follow-up treatment including not only physiotherapy but also psychotherapy is crucial for multiple trauma patients.

Selektive Blockade des Endothelin-B-Rezeptors verbessert durch gesteigerte arterioläre Perfusion das überleben von kritisch durchbluteten muskulokutanen Lappen

Background: The insufficient perfusion of distal flap areas, which may lead to partial necrosis, still represents a major challenge in plastic and reconstructive surgery. In the process of microvascular and endothelial dysfunction, endothelins (ET) and their receptors may play an important role. The aim of the study was therefore to investigate in a chronic in vivo model the effect of various ET-receptor antagonists in critically perfused flap tissue. Methods: A random pattern musculocutaneous flap was elevated in the back of 25 C57BL/6-mice and fixed into a dorsal skinfold chamber. Repetitive intravital fluorescence microscopy was performed over a 10-day observation period to assess arteriolar diameter and blood flow (aBF), functional capillary density (FCD), the area of tissue necrosis and the development of newly formed vessels. The following substances were administered intraperitoneally 30min before induction of ischemia, as well as daily for the following 4-day period: (i) BQ-123, a specific ET-A-receptor-antagonist (ET-A, 1 mg/kg, n = 6), (ii) BQ-788, a selective ET-B-receptor-antagonist (ET-B, 1 mg/kg, n = 6) and (iii), PD-142893, a non-selective ET-AB-receptor-antagonist (ET-AB, 0,5 mg/kg, n = 6). Animals receiving saline only served as controls (n = 7). Results: Despite a slight increase of aBF within the distal flap area of controls during the 10-day observation period (3978 ± 1765pL/s; d10), a distinct restriction of FCD was noted at day 10 (32 ± 18 cm/cm2). This perfusion failure resulted in a flap necrosis of 52 ± 3 %. Selective blockade of the ET-B-receptor resulted in a dramatic increase of aBF in the distal flap area (10399 ± 5759 pl/s; d10). Thus, adequate FCD could be maintained (132 ± 42 cm/cm2; d10), resulting in a significant reduction of flap necrosis (25 ± 4 %; d10; p < 0,05 vs. control). In contrast, neither selective ET-A-receptor-blockade nor non-selective ET-AB-receptor-blockade were able to significantly affect aBF when compared to controls (ET-A: 1107 ± 1107 pl/s; ET-AB: 2436 ± 1818 pl/s; n. s.). Accordingly, flap necrosis did not differ (ET-A: 46 ± 10 %; ET-AB: 51 ± 7 %; d10) when compared with controls. Although exposed to chronic ischemia, no morphologic signs for new blood vessel formation (vascular sprouting and bud formation) could be observed in any of the experimental animals. Conclusions: The data show that only the selective ET-B-receptorantagonist is able to maintain nutritive perfusion within critically perfused flap tissue, and hence to significantly reduce flap necrosis. Accordingly, administration of ET-B-receptorantagonists may be considered in the treatment jeopardized flaps.

Endogen produziertes, jedoch nicht exogen induziertes, Stickstoffmonoxid reduziert durch Verbesserung der nutritiven Durchblutung die Nekrose in kritisch perfundierten muskulokutanen Lappen

Unsere Ergebnisse zeigen, dass endogen gebildetes Stickstoffmonoxid wesentlich an der postoperativen Mikrozirkulationsstorung in kritisch durchbluteten Arealen randomisiert perfundierter myokutaner Lappen beteiligt ist. Die zusatzliche Applikation von NO-Donoren kann lediglich die kapillare Perfusion anhaltend verbessern. Die fehlende signifikante Reduktion der Nekrose nach Arginin- Behandlung ist wohl durch den gewebeschadigenden Effekt einer vermehrten Sauerstoffradikalbildung trotz Reduktion der chronisch-ischamischen Bedingungen verursacht.

Talusfrakturen – ein Update

Background: Talus fractures are rare and often result from axial trauma. As most of the talus surface is covered by cartilage, the blood supply is limited. Thus talus fractures are seen as one of the most severe fractures and often lead to significant long-term complications. Several studies suggest that the initial fracture classification can lead to correct treatment and that this can influence the long-term outcome. The aim of the current study was to investigate the importance of the initial fracture classification in respect to the radiological outcome in a large patient cohort. Patients and Methods: Over a span of 12 years, 61 patients with talus fractures were treated at our institution. Overall 45 patients were available for a retrospective analysis. Correlation analysis was performed between the initial fracture severity and the radiological outcome. Results: The average follow-up was 17.3 months (range 6-68). Significant correlations were found between the Marti-Weber Classification and Bargon Score (rs = 0.78; p < 0.0001), as well as between the Hawkins Classification and the Bargon Score (rs = 0.80; p < 0.0001). Conclusions: Precise prediction of the expected radiological outcome of talar neck and body fractures is possible through the initial fracture classification alone. Computed tomography is the accepted standard to determine the exact diagnosis and extent of injury.

Polytrauma in the elderly: a review

Although the field of geriatric trauma is – ironically – young, care for the elderly trauma patient is increasingly recognised as an important challenge, considering the worldwide trend towards increasing longevity. Increasing age is associated with physiological changes and resulting comorbidities that present multiple challenges to the treating physician. Even though polytrauma is less likely with increasing age, lower-energy trauma can also result in life-threatening injuries due to the reduced physiological reserve. Mechanisms of injury and resulting injury patterns are markedly changed in the elderly population and new management strategies are needed. From initial triage to long-term rehabilitation, these patients require care that differs from the everyday standard. In the current review, the special requirements of this increasing patient population are reviewed and management options discussed. With the increase in orthogeriatrics as a speciality, the current status quo will almost certainly shift towards a more tailored treatment approach for the elderly patient. Further research expanding our current knowledge is needed to reduce the high morbidity and mortality rate. Cite this article: Braun BJ, Holstein J, Fritz T, Veith NT, Herath S, Mörsdorf P, Pohlemann T. Polytrauma in the elderly: a review. EFORT Open Rev 2016;1:146-151. DOI: 10.1302/2058-5241.1.160002.

Sägeverletzungen der Hand – epidemiologische Aspekte

Background: No current studies regarding saw injuries have been published in German literature for quite some time. Despite awareness measures and safety instructions, saw accidents along with crush injuries are the most common causes of severe hand injuries. Approximately 12,000 circular saw injuries occur in Germany each year. Since professional providers have increased prices due to the rising energy costs and a wide range of different home appliance saws are available, increasing use has been made of portable circular saws in the do-it-yourself market sector. Patients and methods: At our hospital, we evaluated the data of 51 male patients with saw injuries. The present study investigated factors that may contribute to accidents involving saws. Results: 80 % of the accidents occurred at home, usually on weekends or after work. 51 % of the accidents happened while patients cut firewood. In 84 % of the cases, an electric table saw was used. The majority of severe hand injuries were sustained with lower priced saws. Injuries occurred most frequently between 11 a. m. and 2 p. m., primarily with injuries to bones, tendons, blood vessels and nerves. Replantable amputations or partial amputations occured rarely. In 37 % of the patients, anatomical reconstruction using osteosynthesis and/or microsurgical techniques was performed successfully. Conclusions: Saw injuries to the hand are sustained almost exclusively by men. Serious injuries from low-priced table saws and due to the lack of protective covering are predominant. Preventive measures and mandatory training could reduce the number of saw injuries in the years to come. The results obtained by us largely confirm the data from previous publications.

Penetrierende 2-Höhlen-Verletzung mit einer 20 cm langen dolchartigen Scherbe nach Sturz in eine Glastür@@@Penetrating injury of two body cavities with a 20 cm long dagger-like sliver after falling into a glass door

In Germany the numbers of penetrating thoracic injuries are rare compared to Anglo-American countries; however, the number of cases has increased in recent years due to an increase in violent incidents. This article reports the case of a patient who suffered such a penetrating thoracic injury after a domestic accident. Operative treatment was performed according to the well-established standard treatment algorithms. Contrary to the initial assessment of the emergency doctor, substantially more severe injuries were found.ZusammenfassungZwei-Höhlen-Verletzungen gehören in Deutschland im Vergleich zu angloamerikanischen Ländern zu den selteneren Entitäten. Jedoch steigt diese Zahl aufgrund zunehmender Gewaltbereitschaft stetig. Im hier folgenden Fall soll von einer Patientin berichtet werden, die sich akzidentiell nach häuslichem Sturz eine große thorakale Penetrationsverletzung mit erheblicher Begleitverletzung zuzog. Sie wurde entsprechend den gängigen Behandlungsalgorithmen operativ versorgt und zeigte entgegen der Ersteinschätzung des erstbehandelnden Notarztes eine erheblich größere Verletzungsschwere.AbstractIn Germany the numbers of penetrating thoracic injuries are rare compared to Anglo-American countries; however, the number of cases has increased in recent years due to an increase in violent incidents. This article reports the case of a patient who suffered such a penetrating thoracic injury after a domestic accident. Operative treatment was performed according to the well-established standard treatment algorithms. Contrary to the initial assessment of the emergency doctor, substantially more severe injuries were found.

Penetrierende 2-Höhlen-Verletzung mit einer 20 cm langen dolchartigen Scherbe nach Sturz in eine Glastür

In Germany the numbers of penetrating thoracic injuries are rare compared to Anglo-American countries; however, the number of cases has increased in recent years due to an increase in violent incidents. This article reports the case of a patient who suffered such a penetrating thoracic injury after a domestic accident. Operative treatment was performed according to the well-established standard treatment algorithms. Contrary to the initial assessment of the emergency doctor, substantially more severe injuries were found.ZusammenfassungZwei-Höhlen-Verletzungen gehören in Deutschland im Vergleich zu angloamerikanischen Ländern zu den selteneren Entitäten. Jedoch steigt diese Zahl aufgrund zunehmender Gewaltbereitschaft stetig. Im hier folgenden Fall soll von einer Patientin berichtet werden, die sich akzidentiell nach häuslichem Sturz eine große thorakale Penetrationsverletzung mit erheblicher Begleitverletzung zuzog. Sie wurde entsprechend den gängigen Behandlungsalgorithmen operativ versorgt und zeigte entgegen der Ersteinschätzung des erstbehandelnden Notarztes eine erheblich größere Verletzungsschwere.AbstractIn Germany the numbers of penetrating thoracic injuries are rare compared to Anglo-American countries; however, the number of cases has increased in recent years due to an increase in violent incidents. This article reports the case of a patient who suffered such a penetrating thoracic injury after a domestic accident. Operative treatment was performed according to the well-established standard treatment algorithms. Contrary to the initial assessment of the emergency doctor, substantially more severe injuries were found.