Stephan Brand

Alcohol intoxication in road traffic accidents leads to higher impact speed difference, higher ISS and MAIS, and higher preclinical mortality

Alcohol is one of the most important personal risk factors for serious and fatal injuries, contributing to approximately one third of all deaths from accidents. It is also described that alcohol intoxication leads to a higher mortality in the clinical course. In this study, we hypothesized that alcohol intoxication leads to different accident kinematics, a higher ISS (Injury Severity Score), and higher preclinical mortality compared to sober patients. A technical and medical investigation of alcohol intoxicated road users was performed on the scene of the crash and at the primary admitting hospital. Alcohol testing was performed with either breath alcohol tests or measurement of blood alcohol concentration (BAC) in a standard laboratory test. Between 1999 and 2010, 37,635 road traffic accidents were evaluated by the Accident Research Unit. Overall 20,741 patients were injured, 2.3% of the patients were killed. Among the injured patients, 2.2% with negative BAC were killed, compared to 4.6% fatal injuries in patients with a positive BAC (p < 0.0001). Of the patients with a positive BAC, 8.0% were severely injured, compared to 3.6% in the BAC negative group (p < 0.0001). Regarding the relative speed at impact (Δv for motorized drivers, vehicle collision speed for pedestrians and bikers), there was a significant higher difference for BAC positive patients (30 ± 20) compared to the BAC negative patients (25 ± 19, p < 0.0001). Alcohol intoxication in trauma patients leads to higher preclinical mortality, higher impact speed difference, and higher injury severity. The subgroup analysis for different alcohol concentrations shows no difference in ISS, MAIS, and relative speed, but a correlation of increasing age of patients with higher alcohol concentrations.

Biomechanical Properties of Suture Anchor Repair Compared With Transosseous Sutures in Patellar Tendon Ruptures A Cadaveric Study

Background: Ruptures of the patellar tendon are debilitating injuries requiring surgical repair. Reliable data about the most appropriate suture technique and suture material are missing. The standard procedure consists of refixing the tendon with sutures in transpatellar tunnels, sometimes combined with augmentation. Hypothesis: Suture anchors provide at least equal results concerning gap formation during cyclic loading and ultimate failure load compared with transosseous suture repair. Study Design: Controlled laboratory study. Methods: A total of 30 human cadaveric patellar tendons underwent tenotomy followed by repair with 5.5-mm titanium suture anchors, 5.5-mm resorbable hydroxyapatite suture anchors, or transpatellar suture tunnels with No. 2 Ultrabraid and the Krackow whipstitch technique. Biomechanical analysis included pretensioning the constructs at 20 N for 30 seconds and then cyclic loading of 250 cycles between 20 and 100 N at 1 Hz in a servohydraulic testing machine with measurement of elongation. After this, ultimate failure load and failure mode analysis was performed. Results: Compared with transosseous sutures, tendon repairs with suture anchors yielded significantly less gap formation during cyclic loading (P < .05) and resisted significantly higher ultimate failure loads (P < .05). Common failure mode was pullout of the eyelet within the suture anchor in the hydroxyapatite anchor group and rupture of the suture in the titanium anchor group and—at lower load to failure—in the transosseous group. Conclusion: Patellar tendon repair with suture anchors yields significantly better biomechanical results than repair with the commonly applied transosseous sutures. Clinical Relevance: These findings may be of relevance for future clinical treatment of patellar tendon ruptures. Randomized controlled clinical trials comparing suture anchors to transosseous suture repair are desirable.

Current Concepts for Patellar Dislocation

Context: Patellar dislocation usually occurs to the lateral side, leading to ruptures of the Medial Patellofemoral Ligament (MPFL) in about 90% of the cases. Even though several prognostic factors are identified for patellofemoral instability after patellar dislocation so far, the appropriate therapy remains a controversial issue. Evidence Acquisition: Authors searched the Medline library for studies on both surgical and conservative treatment for patellar dislocation and patellofemoral instability. Additionally, the reference list of each article was searched for additional studies. Results: A thorough analysis of the anatomical risk factors with a particular focus on patella alta, increased Tibial Tuberosity-Trochlear Groove (TT-TG) distance, trochlear dysplasia as well as torsional abnormalities should be performed early after the first dislocation to allow adequate patient counseling. Summarizing the results of all published randomized clinical trials and comparing surgical and conservative treatment after the first-time patellar dislocation until today indicated no significant evident difference for children, adolescents, and adults. Therefore, nonoperative treatment was indicated after a first-time patellar dislocation in the vast majority of patients. Conclusions: Surgical treatment for patellar dislocation is indicated primarily in case of relevant concomitant injuries such as osteochondral fractures, and secondarily for recurrent dislocations.

Bicyclist–Bicyclist Crashes—A Medical and Technical Crash Analysis

Background: The purpose of this study was to analyze the actual injury situation of bicyclists focusing on accidents involving more than one bicyclist. A medical and technical analysis was performed as a basis for preventive measures. Methods: Technical and medical data were collected at the scene, shortly after the accident. Technical analysis included speed at crash, type of collision, impact angle, environment, lane used, and relative velocity. Medical analysis included injury patterns and severity (Abbreviated Injury Scale [AIS], Injury Severity Score [ISS]). Results: Five hundred seventy-eight injured bicyclists in 289 accidents from 1999 to 2008 were included into the study. Sixty-one percent were male (n = 350) and 39 percent were female (n = 228). Sixty-seven percent ranged between 18 and 64 years of age, 12 percent each between 13 and 17 years of age and older than 65 years, 8 percent between 6 and 12 years, and 1 percent between 2 and 5 years. Ninety-two percent of crashes took place in urban areas and 8 percent in rural areas. Ninety-seven percent of crashes occurred in dry conditions and 3 percent in wet conditions. Eighty-three percent of all accidents occurred during the daytime, 10 percent at night, and 7 percent at dawn. The helmet use rate was only 7.5 percent for all involved bicyclists. The mean Abbreviated Injury Scale (AIS) score was 1.31. Conclusion: The prevalence of bicycle-to-bicycle crashes is high. Most of these accidents occur in urban areas. Bicyclists should be considered as minimally or unprotected road users, with an unsatisfactorily low rate of helmet use. Though the average level and patterns of injuries is moderate, most of the severe injuries involved the head and extremities. However, there was no significant correlation between frequent helmet use and sustained injuries to the head of major AIS.

Vertebral fractures in motor vehicle accidents–a medical and technical analysis of 33,015 injured front-seat occupants

Spinal injuries pose a considerable risk to life and quality of life. In spite of improvements in active and passive safety of motor vehicles, car accidents are regarded as a major cause for vertebral fractures. The purpose of this study was to evaluate the current incidence of vertebral fractures among front-seat occupants in motor vehicle accidents, and to identify specific risk factors for sustaining vertebral fractures in motor vehicle accidents. Data from an accident research unit were accessed to collect collision details, preclinical data, and clinical data. We included all data on front-seat occupants. Hospital records were retrieved, and radiological images were evaluated. We analysed 33,015 front-seat occupants involved in motor vehicle accidents over a 24-year period. We identified 126 subjects (0.38%) with cervical spine fractures, 78 (0.24%) with thoracic fractures, and 99 (0.30%) with lumbar fractures. The mean relative collision speeds were 48, 39, and 40 kph in subjects with cervical, thoracic, and lumbar spine fractures, respectively, while it was 17.3 kph in the whole cohort. Contrary to the overall cohort, these patients typically sustained multiple hits rather than simple front collisions. Occupants with vertebral fractures frequently showed numerous concomitant injuries; for example, additional vertebral fractures. The incidence of vertebral fractures corresponded with collision speed. Safety belts were highly effective in the prevention of vertebral fractures. Apart from high speed, complex injury mechanisms as multiple collisions or rollovers were associated with vertebral fractures. Additional preventive measures should focus on these collision mechanisms.

Injury patterns of seniors in traffic accidents: A technical and medical analysis

AIM To investigate the actual injury situation of seniors in traffic accidents and to evaluate the different injury patterns. METHODS Injury data, environmental circumstances and crash circumstances of accidents were collected shortly after the accident event at the scene. With these data, a technical and medical analysis was performed, including Injury Severity Score, Abbreviated Injury Scale and Maximum Abbreviated Injury Scale. The method of data collection is named the German In-Depth Accident Study and can be seen as representative. RESULTS A total of 4430 injured seniors in traffic accidents were evaluated. The incidence of sustaining severe injuries to extremities, head and maxillofacial region was significantly higher in the group of elderly people compared to a younger age (P < 0.05). The number of accident-related injuries was higher in the group of seniors compared to other groups. CONCLUSION Seniors are more likely to be involved in traffic injuries and to sustain serious to severe injuries compared to other groups.

Simulator training: reducing risk in helicopter rescue.

In most countries, preclinical emergency medicine is exclusively run by paramedics. In Germany, Prof. Martin Kirschner, as one of the leading surgeons of his time, proposed as early as 1938 to bring the doctor to the patient and not the other way around. According to Kirschner, inappropriate treatment on scene and improper transport to the hospital have the potential to cause even more damage to the injured person than the injury itself. Based on this theory, Germany’s preclinical emergency medicine developed and is now, because of this history, performed by a physician-staffed system, for rescue missions by both land and air transport whenever indicated.1 During the late 1960s, the count of road deaths in Germany continuously rose, to a lamentable annual total of almost 20,000 in 1970. Because of the insight that immediate medical first aid on the scene and rapid transport to an appropriate hospital was crucial to the outcome of patients, the idea to integrate helicopters into the chain of survival arose. After a testing phase from 1968 to 1970, the first German rescue helicopter, Christoph 1, was inaugurated in Munich on November 1, 1970.2 On October 2, 1972, the rescue helicopter Christoph 4 was put into service in Hannover and is run by the Federal Police, helicopter emergency medical services (HEMS) of St. John’s, and trauma surgeons of the Trauma Department of the Hannover Medical School (Fig. 1). Today in Germany, 53 rescue helicopters provide approximately 80,000 primary and secondary missions per year.3

Intraprosthetic fixation techniques in the treatment of periprosthetic fractures-A biomechanical study

AIM To develop new fixation techniques for the treatment of periprosthetic fractures using intraprosthetic screw fixation with inserted threaded liners. METHODS A Vancouver B1 periprosthetic fracture was simulated in femur prosthesis constructs using sawbones and cemented regular straight hip stems. Fixation was then performed with either unicortical locked-screw plating using the less invasive stabilization system-plate or with intraprosthetic screw fixation using inserted liners. Two experimental groups were formed using either prostheses made of titanium alloy or prostheses made of cobalt chrome alloy. Fixation stability was compared in an axial load-to-failure model. Drilling was performed using a specially invented prosthesis drill with constantly applied internal cooling. RESULTS The intraprosthetic fixation model with titanium prostheses was superior to the unicortical locked-screw fixation in all tested devices. The intraprosthetic fixation model required 10 456 N ± 1892 N for failure and the unicortical locked-screw plating required 7649 N ± 653 N (P < 0.05). There was no significant difference between the second experimental group and the control group. CONCLUSION Intraprosthetic screw anchorage with special threaded liners enhances the primary stability in treating periprosthetic fractures by internal fixation.

Intraprosthetic screw fixation increases primary fixation stability in periprosthetic fractures of the femur—A biomechanical study

BACKGROUND The purpose of this study was to develop a new fixation technique for the treatment of periprosthetic fractures using intraprosthetic screw fixation. The goal was to biomechanically evaluate the increase in primary fixation stability compared to unicortical locked-screw plating. METHODS A Vancouver C periprosthetic fracture was simulated in femur prosthesis constructs. Fixation was then performed with either unicortical locked-screw plating using the LISS-plate or with intraprosthetic screw fixation. Fixation stability was compared in an axial load-to-failure model. RESULTS The intraprosthetic fixation model was superior to the unicortical locked-screw fixation in all tested devices. The intraprosthetic fixation model required 11,807N±1596N for failure and the unicortical locked-screw plating required 7649N±653N (p=0.002). CONCLUSION Intraprosthetic screw anchorage with a special prosthesis drill enhances the primary stability in treating periprosthetic fractures by internal fixation.

Hybrid and electric low-noise cars cause an increase in traffic accidents involving vulnerable road users in urban areas

Due to resource scarcity, the number of low-noise and electric cars is expected to increase rapidly. The frequent use of these cars will lead to a significant reduction of traffic related noise and pollution. On the other hand, due to the adaption and conditioning of vulnerable road users the number of traffic accidents involving pedestrians and bicyclists is postulated to increase as well. Children, older people with reduced eyesight and the blind are especially reliant on a combination of acoustic and visual warning signals with approaching or accelerating vehicles. This is even more evident in urban areas where the engine sound is the dominating sound up to 30 kph (kilometres per hour). Above this, tyre–road interaction is the main cause of traffic noise. With the missing typical engine sound a new sound design is necessary to prevent traffic accidents in urban areas. Drivers should not be able to switch the sound generator off.