Background Previous studies have associated mu-opioid receptor (OPRM1) genotype with pain and analgesia responses in postoperative and patient populations. This study investigates the role of catechol-o-methyltransferase (COMT) and OPRM1 genotypes in acute postoperative pain scores, opioid use, and opioid-induced sedation after surgical procedures for orthopedic trauma in an otherwise healthy patient population. Methods Verbal pain / sedation scores, opioid use, and physiologic responses in the immediate postoperative period were examined for association with genetic variants in Caucasians genotyped for OPRM1 single nucleotide polymorphisms (SNPs) A118G and C17T, and COMT SNPs. Results OPRM1 A118G genotype was associated with patients’ postoperative numerical pain scale (NPS) ratings at 15 min in the postanesthesia care unit (PACU) (P = 0.01) and patients’ sedation scores at 15 min in the PACU (P = 0.02). COMT genotype (rs4818) was associated with opioid consumption in the first 45 min in the PACU (P = 0.04). NPS ratings at 45 min were also higher in the group of patients with A/A genotype of rs4680 than in patients with the other two genotypes at this SNP (P = 0.03). Our haplotype trend analysis identified a COMT haplotype ‘GCGG’ significantly associated with NPS at 15 min (P = 0.0013), amount of opioids consumed in the first 45 min (P = 0.0024), and heart rate at 45 min in PACU (P = 0.017). Conclusions The results indicate that genetic variations in COMT contribute to the acute postoperative pain and analgesia responses and physiologic responses in this group of otherwise healthy postoperative orthopedic trauma patients.

In severely injured patients, DCO should be considered. On the other hand, there is still a lack of randomized studies for a more precise characterization of the patients who benefit from DCO treatment.

In patients with severe trauma requiring secondary operations of > 3 h duration, performance of this operation should be avoided on post trauma days 2-4.

Introduction: The role of trauma documentation systems for trauma research has continuously increased since the first trauma registries were developed in the late 1980s. Data acquisition and processing improved highly, partly because modern computer and network technologies offer new approaches. International comparison is important for the learning process and the investigation of differences in the mechanisms of injury, rescue systems and treatment protocols. We demonstrate keypoints of the learning curve thus supporting a further spreading of trauma registries. Methods: Seven exemplary trauma registries from the United States,

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Purpose of Review This review focuses on the evolution of minimally invasive techniques in orthopedic surgery and provides an overview of the evidence-based knowledge of the last decade. Recent Findings Implants and surgical techniques for minimally invasive osteosynthesis in periarticular, spinal and pelvic fractures underwent rapid improvement. They show adequate healing along with low complication rates and satisfactory outcome. Computer-assisted insertion of implants and navigation offer new possibilities and are particularly advantageous in difficult anatomical regions, such as the pelvis or spine. Summary The treatment purpose in minimally invasive orthopedic surgery consists of anatomic reconstruction and stabilization of the articular surface, length, axis and rotation with minimal soft-tissue trauma. This review article highlights the surgical evolution and discusses recent advances in techniques and technology implementing minimally invasive approaches as the gold standard of treatment in the near future.

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Posterior fracture-dislocation of the hip is a rare injury in sports and is most frequently seen after road traffic accidents. A posterior fracture-dislocation of the hip that occurred in an adult sportsman during rugby is reported. This case illustrates the great forces that can be sustained by the hip joint of rugby players. Operative stabilization led to a stable hip joint allowing early mobilization. Following rehabilitation, the patient returned to light sporting activities after 9 months.