BackgroundThere is scarce knowledge of physical function and pain due to multiple rib fractures following trauma. The purpose of this follow-up was to assess respiratory and physical function, pain, range of movement and kinesiophobia in patients with multiple rib fractures who had undergone stabilizing surgery and compare with conservatively managed patients.MethodsA consecutive series of 31 patients with multiple rib fractures who had undergone stabilizing surgery were assessed >1 year after the trauma concerning respiratory and physical function, pain, range of movement in the shoulders and thorax, shoulder function and kinesiophobia. For comparison, 30 patients who were treated conservatively were evaluated with the same outcome measures.ResultsThe results concerning pain, lung function, shoulder function and level of physical activity were similar in the two groups. The patients who had undergone surgery had a significantly larger range of motion in the thorax (p < 0.01) and less deterioration in two items in Disability Rating Index (sitting and standing bent over a sink) (p < 0.05).DiscussionIt is questionable whether the control group is representative since the majority of patients were invited but refused to participate in the follow-up. In addition, this study is too small to make a definitive conclusion if surgery is better than conservative treatment. But we see some indications, such as a tendency for decreased pain, better thoracic range of motion and physical function which would indicate that surgery is preferable. If operation technique could improve in the future with a less invasive approach, it would presumably decrease post-operative pain and the benefit of surgery would be greater than the morbidity of surgery.ConclusionsPatients undergoing surgery have a similar long-term recovery to those who are treated conservatively except for a better range of motion in the thorax and fewer limitations in physical function. Surgery seems to be beneficial for some patients, the question remains which patients.Trial registrationFoU i Sverige (R&D in Sweden), No 106121

Background: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) may improve Systolic Blood Pressure (SBP) in hypovolemic shock. It has, however, not been studied in patients with impending traumatic cardiac arrest (ITCA). We aimed to study the feasibility and clinical outcome of REBOA in patients with ITCA using data from the ABOTrauma Registry. Methods: Retrospective and prospective data on the use of REBOA from 16 centers globally were collected. SBP was measured both at pre- and post-REBOA inflation. Data collected included patients’ demography, vascular access technique, number of attempts, catheter size, operator, zone and duration of occlusion, and clinical outcome. Results: There were 74 patients in this high-risk patient group. REBOA was performed on all patients. A 7-10Fr catheter was used in 66.7% and 58.5% were placed on the first attempt, 52.1% through blind insertion and 93.2% inflated in Zone I, 64.8% for a period of 30 to 60 min, 82.1% by ER doctors, trauma surgeons, or vascular surgeons. SBP significantly improved to 90 mm Hg following the inflation of REBOA. 36.6% of the patients survived. Conclusions: Our study has shown that REBOA may be performed in patients with ITCA, SBP can be elevated, and 36.6% of the patients survived if REBOA placement is successful.

to the primary end point was analyzed. Results: Total of 300 bypasses were performed and 255 (85%) had DFUs. Mean follow up was 18.4 months. AFS was 91.4%, 62.9% and 57.4% in one month, 12 and 24 months respectively in diabetic patients and did not differ significantly from the non diabetics. There was a statistically significant increase in overall survival (p-0.045) in diabetics with a hazard ratio of 1.778 in non-diabetics after Cox regression analysis. Among the bypasses 119 (46%) were femoro-popliteal and 136 (54%) were pop-distal. AFS in pop distal bypasses was 67% and 62.2% in one and two years respectively while it was 58.3% in fem-pop bypasses in one year and 51.9% in two years. The values did not show any statistical significance and did not significantly differ from the non-diabetics. Median wound healing time was 3 months. Age, gender and smoking did not have a statistically significant effect on primary outcome. Conclusion: Lower limb arterial bypasses offer means of successful limb salvage and wound healing in diabetic patients with ischaemic foot ulcers. Further assessment, analysis and follow up are required on factors pertaining to wound care.

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