BackgroundExternal fixation is commonly used as a means of definitive fixation of pelvic fractures. Pin site infection is common, with some cases of osteomyelitis and inpatient nursing can be challenging. The aim of this study is to report the outcomes and complications of an alternative minimally invasive technique, known as INFIX, utilising spinal pedicle screws inserted into the supra-acetabular bone and connected by a subcutaneous rod.MethodsA single-centre prospective case series was performed. The primary outcome measures were fracture stability and displacement at time of implant removal and intra- and post-operative complications.ResultsTwenty-one patients were recruited, with 85.7 % of fractures being lateral compression type. Mean follow-up was 342 days. Mean application time was 51 min (range 44–65). Nineteen were removed electively, with mean time to removal 109 days. All cases were stable with no displacement. Two cases were removed emergently, one due to wound infection and the other due to lateral femoral cutaneous nerve neuropathic pain. Twelve patients sustained a lateral femoral cutaneous nerve palsy, with 20/42 nerves being affected. Improvement in all lateral femoral cutaneous nerve symptoms were reported with removal. Nine patients developed asymptomatic heterotopic ossification, and there were three deep infections and one symptomatic due to the bar.ConclusionsMinimally invasive internal fixation with the INFIX for anterior pelvic ring fractures is an alternative to anterior external fixation. However, a higher rate of lateral femoral cutaneous nerve palsy is noted, and the implant is not well tolerated by all patients. Further studies are required to define fracture types and patients best suited to the technique and how LFCN complications may be minimised.Trial registration ACTRN12616001421426. Registered 12 October 2016. Retrospectively registered.

Therapeutic study, level V.

Incidental pulmonary nodules are common in the general population. This has implications for possible lung cancer screening recommendations in the Australian population. Referral and/or review systems are essential to ensure adequate follow up of incidental findings, as it is likely some patients are not receiving adequate follow up at present.

Background The COVID‐19 pandemic has had a profound effect on the presentation and management of trauma at the Royal Melbourne Hospital, a level 1 Adult Major Trauma Service, and a designated COVID‐19 hospital. This study compares the changes in epidemiology and trauma patient access to emergency imaging and surgery during the pandemic response. Methods The population of interest was all trauma patients captured in the hospital's Trauma Registry from March 16 th ‐September 10 th , 2016‐2020. Regression modelling assessed changes in mechanism and severity of the injury, and mortality during two lockdowns compared with the proceeding four years. Cases were matched with Hospital Administrative databases, to assess median time from admission to emergency CT scan, operating theatre, length of stay, and immediate surgery (OPSTAT). Results Throughout 2020, the hospital treated 525 COVID‐19 patients. Compared with previous years, there was up to a 34% reduction in major trauma and a 28% reduction in minor trauma admissions during the pandemic (p<0.05). ICU admissions were almost half of predicted. Some of the largest reductions were seen in motor vehicle crashes (49%) and falls (28%) (p<0.05). Time to CT, surgery and immediate surgery (OPSTAT) showed no change and having a suspected COVID‐19 diagnosis did not prolong any of these times except for the length of stay. Mortality was similar to previous years. Conclusion The COVID‐19 pandemic has had widespread societal changes, resulting in a substantial decrease in trauma presentations. Despite COVID's immense impact on the hospital's trauma service, the quality of care was not impaired.

Background Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), is a major cause of potentially preventable morbidity and mortality amongst trauma patients. Venous thromboembolism prevalence varies from 1 to 58%, and traditionally, compliance with prophylaxis protocols is low in major trauma cohorts. This study aimed to describe VTE prevalence, prophylaxis practices and outcomes amongst VTE cases at an Australian level-one trauma centre. Methods A retrospective review of all VTE cases occurring in acute, major trauma admissions between 1 January 2010 and 30 June 2019 was conducted using prospectively collected registry data. Data regarding demographics, time to diagnosis, VTE prophylaxis, VTE risk assessment tool (RAT) usage and all-cause mortality were collected. Chemoprophylaxis was considered adequate if administered for 48 h prior to diagnosis. VTE cases diagnosed within 48 h of admission were excluded from prophylaxis compliance analysis. A subgroup analysis of patients with intracranial haemorrhage (ICH) was also completed. Results During the study period, 238 VTE events occurred in 237 patients from 7482 major trauma admissions, giving a VTE prevalence of 3.18%. The all-cause mortality rate was 8.0%. VTE chemoprophylaxis was administered for 109 of 211 eligible patients (51.7%). Of the remaining 102 VTE cases, 75 (73.5%) did not receive prophylaxis due to a documented contraindication, while 27 (26.5%) did not receive prophylaxis with no contraindication recorded. The VTE RAT was completed in 49.0% of cases. Conclusion Venous thromboembolism prevalence at our institution was consistent with published figures for comparable institutions. A review of compliance with prophylaxis protocols showed several potential areas for improvement.

median diameter of the main pancreatic duct was 7 (4-10) mm and 8 (4-10) mm (p 0.16), respectively. Results: All operations in I group were performed laparoscopic. The operating time was 375 (320-501) minutes in I group and 240 (179-280) minutes in II group (p 0,08). Blood loss was 70 (30-200) and 100 (50-450) ml (p 0.5), respectively. The postoperative stay period was 4 (4-8) days in I group and 7 (5-14) days in II group (p 0.45). There was 1 (11.15%) complications in II group. The follow-up was 4 (3-8) months in I group and 4 (3-7) months in II group. Pain relief was complete in all groups. Conclusions: A prospective randomized trial demonstrates advantages of laparoscopic Frey procedure.

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Introduction:The presentation of pelvic trauma patients can be time critical. This study will aim to identify the impact of delayed presentation in pelvic trauma patients on morbidity and mortality and identify the effect of time to pelvic surgery on patient outcomes. Methods:Patients presenting to a Level 1 Trauma Centre between July 2001 and June 2014 with major pelvic trauma were retrospectively identified using two prospective databases. Time from injury to arrival and surgery and referral from another hospital were identified. Outcomes included intensive care (ICU) admission, length of stay and mortality.Results: 1300 patients were identified. 133 (10.2%) patients were transferred from a rural hospital. The risk of death was higher in patients presenting directly (11.6% vs. 6.1%, p=0.028), although their Injury Severity Score was higher (28.1 vs. 24.0, p<0.001). There was no difference in ICU days (3.95 vs. 3.58, p=0.50) or length of stay (14.97 vs. 15.81, p=0.50). Transfer was more timely if ICU was required (17.9 vs. 46.8 hours, p=0.028). Pelvic surgery occurred in 79 (43.9%) in the transferred group and 370 (33.0%) patients presenting directly. Conclusions:Mortality is not increased with initial presentation at rural hospitals, although these patients had less severe injury. There is a higher mortality with earlier surgery, although this likely reflects the seriousness of the patient's condition rather than the surgery itself.This study aims to identify the impact delayed presentation has on morbidity and mortality in pelvic trauma patients. It will examine the effect of initial presentation at a rural or other metropolitan non-Level 1 Trauma Centre prior to definitive management at a Level 1 Trauma Centre. Finally this study will identify the effect of time to pelvic surgery on patient outcomes. MethodsA retrospective review of patients with major pelvic trauma