The American College of Surgeons Committee on Trauma's Advanced Trauma Life Support Course is currently taught in 50 countries. The 8th edition has been revised following broad input by the International ATLS subcommittee. Graded levels of evidence were used to evaluate and approve changes to the course content. New materials related to principles of disaster management have been added. ATLS is a common language teaching one safe way of initial trauma assessment and management.

PurposeThis review evaluates the application of bone morphogenetic proteins (BMPs) in delayed bone repair, aiming at a broad audience from clinicians to scientists. Next to an overview of the role of the different BMPs, their antagonists and their current applications, special attention is focused on new scientific developments improving the effects of BMP-based therapy for bone repair.MethodsPublication searches in PubMed and Embase revealed 850 relevant articles on the criteria ‘BMP’ AND ‘bone repair’ (as of May 2011). The abstracts were carefully reviewed and papers were selected according to the content.ResultsThe resulting publications showed that BMP-2 and BMP-7 are clearly the most extensively evaluated BMPs, in general with positive results on bone healing, comparable to the use of unspecific preparations such as autologous bone grafts or platelet-rich plasma.ConclusionsAlthough the efficacy of BMPs as stimulators of bone repair has been demonstrated in model systems and clinical studies, the use of BMPs to enhance fracture healing in the clinical setting is still controversial. Issues such as when, where and how much of which BMP is the most effective and profitable to use still have to be elucidated. But optimisation of the BMP products used in combination with cheaper production methods will inevitably stimulate the clinical use of BMPs for bone fracture healing in the near future.

BackgroundThe outcome after displaced intra-articular calcaneal fractures is influenced by the condition of the surrounding soft tissues. To avoid secondary soft tissue complications after surgical treatment, several less-invasive procedures for reduction and fixation have been introduced. The percutaneous technique according to Forgon and Zadravecz is suitable for all types of displaced intra-articular calcaneal fractures and was therefore introduced in our clinic. The aim of this study was to evaluate the long-term outcome of percutaneous treatment according to Forgon and Zadravecz in patients with displaced intra-articular calcaneal fractures.MethodsA cohort of patients with displaced intra-articular calcaneal fractures treated with percutaneous surgery was retrospectively defined. Clinical outcome was evaluated by standardized physical examination, radiographs, three published outcome scores, and a visual analogue scale of patient satisfaction.ResultsFifty patients with 61 calcaneal fractures were included. After a mean follow-up period of 35 months, the mean values of the Maryland foot score, the Creighton-Nebraska score, and the American Orthopaedic Foot and Ankle Society score were 79, 76, and 83 points out of 100, respectively. The average visual analogue scale was 7.2 points out of 10. The average range of motion of the ankle joint was 90% of normal and subtalar joint movements were almost 70% compared with the healthy side or normal values. Superficial wound complications occurred in seven cases (11%) and deep infections in two (3%). A secondary arthrodesis of the subtalar joint was performed in five patients and was scheduled in four patients (15%).ConclusionsCompared with the outcome of historic controls from randomized trials and meta-analyses, this study indicates favorable results for the percutaneous technique compared with the open technique. Despite similar rates of postoperative infection and secondary arthrodesis, the total outcome scores and preserved subtalar motion are overall good to excellent.

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Functional outcome and quality of life of survivors of severe injury have not returned to normal 1 year after trauma. The prevalence of specific limitations in this population is very high (40-70%). Female gender and comorbidity are predictors of long-term disability.

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Background and purpose Type-II distal clavicle fractures according to the Neer classification are generally operated because of the high non-union rate after non-operative treatment. Several surgical techniques have been developed in order to reduce the non-union rate and improve functional outcome. This meta-analysis overviews the available surgical techniques for type-II distal clavicular fractures.Methods We searched the literature systematically. No comparative studies were found. 21 studies (8 prospective and 13 retrospective cohort studies) were selected for the meta-analysis. Data were pooled for 5 surgical outcome measures: function, time to union, time to implant removal, major complications, and minor complications.Results The 21 studies selected included 350 patients with a distal clavicular fracture. Union was achieved in 98% of the patients. Functional outcome was similar between the treatment modalities. Hook-plate fixation was associated with an 11-fold increased risk of major complications compared to intramedullary fixation and a 24-fold increased risk compared to suture anchoring.Interpretation If surgical treatment of a distal clavicle fracture is considered, a fixation procedure with a low risk of complications and a high union rate such as plate fixation or intramedullary fixation should be used. The hook-plate fixation had an increased risk of implant-related complications.