Advances and future directions for management of trauma patients with musculoskeletal injuries

Balogh, Zsolt J.; Reumann, Marie K.; Gruen, Russell L.; Mayer‐Kuckuk, Philipp; Schuetz, Michael; Harris, Ian; Gabbe, Belinda; Bhandari, Mohit

doi:10.1016/s0140-6736(12)60991-x

Cited by 124 publications

(84 citation statements)

References 87 publications

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“…Statistical underpinnings for this claim were not offered. In fact, intramedullary nails are routinely used today in many hospitals to treat fractures (Balogh et al 2012). Further refinement of the technique and the addition of multiple stabilizing devices like screws and plates mean that surgeons using Küntscher's technique have probably never used the original type of a Küntscher nail (Figure 2).…”

Section: Roentgenogram Of An Intramedullary Nail In a Femur In Time Mmentioning

confidence: 99%

Give Me a Break: Gerhard Küntscher and His Nail

Pierach¹

2014

pbm

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The treatment of broken bones has long adhered to principles of tight juxtaposition of fracture ends and of strict rest. Splinting and casting with plaster of Paris helped considerably. Attempts at internal splinting with pegs, bolts, or stabilizing contraptions usually failed. Foreign materials were either not biocompatible or broke easily, and the insertion of these prostheses directly into the fracture created additional risks from infections. All this changed when Gerhard Küntscher (1900-1972) stabilized broken long bones by intramedullary insertion of stainless steel nails through a small incision, distant from the fracture. Küntscher employed his method from the late 1930s on, initially as a surgeon at the Kiel University in Germany. His early and encouraging results were rejected when presented in 1940, and he remained ostracized thenceforth. During WWII he was stationed in Finland, where he treated wounded soldiers from both sides of the front. POWs returning home propagated the new method by revealing these rods in roentgenograms of their legs; had he not been so successful in treating POWs, he might have had to stand trial at the Nuremberg Doctors' Trial (1947). He documented his experiments and experiences in more than 200 articles and three monographs. Today, his method is employed universally.

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Section: Roentgenogram Of An Intramedullary Nail In a Femur In Time Mmentioning

confidence: 99%

Give Me a Break: Gerhard Küntscher and His Nail

Pierach¹

2014

pbm

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“…In addition, nonunions after long bone fractures have been identified as common problems in multiply injured patients. [2][3][4][5][6] These conditions are associated with a prolongation of total hospital stay, outpatient treatment, and rehabilitation period, as well as a reduction of quality of life. 2 Among the relevant factors for adverse bone healing, sex, older age, comorbidities, and infections were identified.…”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4][5][6] These conditions are associated with a prolongation of total hospital stay, outpatient treatment, and rehabilitation period, as well as a reduction of quality of life. 2 Among the relevant factors for adverse bone healing, sex, older age, comorbidities, and infections were identified. 3,4 The relevance of certain injury combinations or fixation techniques for fracture healing, however, is poorly described.…”

Section: Introductionmentioning

confidence: 99%

Is There an Impact of Concomitant Injuries and Timing of Fixation of Major Fractures on Fracture Healing? A Focused Review of Clinical and Experimental Evidence

Hildebrand

Griensven

Huber‐Lang

et al. 2016

Journal of Orthopaedic Trauma

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“…The severity and nature of the injuries directly influence the likelihood and volume of blood transfusions. Therefore, a central task in emergency medicine is to rapidly control haemorrhage to ensure the survival of injured patients [9,12,13,16,17,18,19]. Additionally, the time of transportation, the risks of hypothermia and trauma-induced coagulopathies as well as age and co-morbidities of each individual patient are further confounding determinants of the need for blood transfusion [9,16].…”

Section: Introductionmentioning

confidence: 99%

Utilisation of Blood Components in Trauma Surgery: A Single-Centre, Retrospective Analysis before and after the Implementation of an Educative PBM Initiative

Geissler

Kösters

Franz

et al. 2015

Transfus Med Hemother

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Background: The aim of our single-centre retrospective study presented here is to further analyse the utilisation of allogeneic blood components within a 5-year observation period (2009-2013) in trauma surgery (15,457 patients) under the measures of an educational patient blood management (PBM) initiative. Methods: After the implementation of the PBM initiative in January 2012, the Institute of Transfusion Medicine und Transplantation Immunology educates surgeons and nurses at the Department of Trauma Surgery to avoid unnecessary blood transfusions. A standardised reporting system was used to document the utilisation of blood components carefully for the most frequent diagnoses and surgical interventions in trauma surgery. These measures served as basis for the implementation of an interdisciplinary systematic exchange of information to foster decision-making processes in favour of patient blood management. Results: Since January 2012, the proportion of patients who received a transfusion as well as the number of transfused red blood cell (RBC) (7.3%/6.4%; p = 0.02), fresh frozen plasma (FFP) (1.7%/1.3%; p < 0.05) and platelet (PLT) (1.0%/0.5%; p < 0.001) units were reduced as a result of our PBM initiative. However, among the transfused patients, the number of administered RBC, FFP and PLT units did not decrease significantly. Overall, patients who did not receive transfusions were younger than transfused patients (p = 0.001). The subgroup with the highest probability of blood transfusion administered included patients with intensive care and long-term ventilation (before/after implementation of PBM: RBC 81.5%/75.9%; FFP 33.3%/20.4%; PLT 24.1%/13.0%). Only a total of 60 patients of 531 patients suffering multiple traumas were massively transfused (before/after implementation of PBM: RBC 55.6%/49.8%; FFP 28.4%/20.4%; PLT 17.6%/8.9%). Conclusion: According to our educational PBM initiative, at least the proportion of trauma patients who received allogeneic blood transfusions could be reduced significantly. However, in case of blood transfusions, the total consumption of RBC, FFP and PLT units remained stable in both time periods. This phenomenon might indicate that the actual need of blood transfusions rather depends on the severity of trauma-related blood loss, the coagulopathy rates or the complexity of the surgical intervention which mainly determines the intra-operative blood loss. Taken together, educational training sessions and systematic reporting systems are suitable measures to avoid unnecessary allogeneic blood transfusions and to continuously improve their restrictive application.

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Advances and future directions for management of trauma patients with musculoskeletal injuries

Cited by 124 publications

References 87 publications

Give Me a Break: Gerhard Küntscher and His Nail

Give Me a Break: Gerhard Küntscher and His Nail

Is There an Impact of Concomitant Injuries and Timing of Fixation of Major Fractures on Fracture Healing? A Focused Review of Clinical and Experimental Evidence

Utilisation of Blood Components in Trauma Surgery: A Single-Centre, Retrospective Analysis before and after the Implementation of an Educative PBM Initiative

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