Standards for external fixation application: national survey under the auspices of the German Trauma Society

Tiziani, Simon; Dienstknecht, Thomas; Osterhoff, Georg; Hand, Thomas L.; Teuben, Michel; Werner, Clément M. L.; Pape, Hans-Christian

doi:10.1007/s00264-018-4127-0

Cited by 9 publications

(6 citation statements)

References 43 publications

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“…Our findings suggest that the pelvic ring is most commonly temporized with external fixation, with high accordance among surgeons who participated in this study. This is in line with recent literature reporting that surgeons tend to prefer supra-acetabular pin placement over iliac pins in a damage control setting [ 17 , 37 ].…”

Section: Study Limitationssupporting

confidence: 91%

“…Unstable pelvic ring injuries often require emergent restoration and mechanical stabilization of pelvic ring anatomy, in part to reduce bleeding and pain in patients [ 36 , 37 ]. Our findings suggest that the pelvic ring is most commonly temporized with external fixation, with high accordance among surgeons who participated in this study.…”

Section: Study Limitationsmentioning

confidence: 99%

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Standard practice in the treatment of unstable pelvic ring injuries: an international survey

Klingebiel

Hasegawa

Parry

et al. 2023

International Orthopaedics (SICOT)

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Purpose Unstable pelvic ring injury can result in a life-threatening situation and lead to long-term disability. Established classification systems, recently emerged resuscitative and treatment options as well as techniques, have facilitated expansion in how these injuries can be studied and managed. This study aims to access practice variation in the management of unstable pelvic injuries around the globe. Methods A standardized questionnaire including 15 questions was developed by experts from the SICOT trauma committee (Société Internationale de Chirurgie Orthopédique et de Traumatologie) and then distributed among members. The survey was conducted online for one month in 2022 with 358 trauma surgeons, encompassing responses from 80 countries (experience > 5 years = 79%). Topics in the questionnaire included surgical and interventional treatment strategies, classification, staging/reconstruction procedures, and preoperative imaging. Answer options for treatment strategies were ranked on a 4-point rating scale with following options: (1) always (A), (2) often (O), (3) seldom (S), and (4) never (N). Stratification was performed according to geographic regions (continents). Results The Young and Burgess (52%) and Tile/AO (47%) classification systems were commonly used. Preoperative three-dimensional (3D) computed tomography (CT) scans were utilized by 93% of respondents. Rescue screws (RS), C-clamps (CC), angioembolization (AE), and pelvic packing (PP) were observed to be rarely implemented in practice (A + O: RS = 24%, CC = 25%, AE = 21%, PP = 25%). External fixation was the most common method temporized fixation (A + O = 71%). Percutaneous screw fixation was the most common definitive fixation technique (A + O = 57%). In contrast, 3D navigation techniques were rarely utilized (A + O = 15%). Most standards in treatment of unstable pelvic ring injuries are implemented equally across the globe. The greatest differences were observed in augmented techniques to bleeding control, such as angioembolization and REBOA, more commonly used in Europe (both), North America (both), and Oceania (only angioembolization). Conclusion The Young-Burgess and Tile/AO classifications are used approximately equally across the world. Initial non-invasive stabilization with binders and temporary external fixation are commonly utilized, while specific haemorrhage control techniques such as pelvic packing and angioembolization are rarely and REBOA almost never considered. The substantial regional differences’ impact on outcomes needs to be further explored.

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Section: Study Limitationssupporting

confidence: 91%

Section: Study Limitationsmentioning

confidence: 99%

Standard practice in the treatment of unstable pelvic ring injuries: an international survey

Klingebiel

Hasegawa

Parry

et al. 2023

International Orthopaedics (SICOT)

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“…In polytrauma patients with brain injury, it is particularly important to consider blood loss because hypovolemia in these patients is associated with secondary brain injury and resultant hypotension and hypoxia [ 18 ]. Percutaneous procedures of the pelvis and spine have gained refinement and increased use over the past few decades [ 19 , 20 ]. Less invasive or percutaneous procedures may allow earlier, or emergent, stabilization of pelvis and spine fractures, due to the decreased physiologic burden [ 21 – 23 ].…”

Section: Discussionmentioning

confidence: 99%

Surgical load in major fractures — results of a survey on the optimal quantification and timing of surgery in polytraumatized patients

Klingebiel,

Hasegawa,

Strähle

et al. 2023

International Orthopaedics (SICOT)

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Purpose It is known that the magnitude of surgery and timing of surgical procedures represents a crucial step of care in polytraumatized patients. In contrast, it is not clear which specific factors are most critical when evaluating the surgical load (physiologic burden to the patient incurred by surgical procedures). Additionally, there is a dearth of evidence for which body region and surgical procedures are associated with high surgical burden. The aim of this study was to identify key factors and quantify the surgical load for different types of fracture fixation in multiple anatomic regions. Methods A standardized questionnaire was developed by experts from Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT)-Trauma committee. Questions included relevance and composition of the surgical load, operational staging criteria, and stratification of operation procedures in different anatomic regions. Quantitative values according to a five-point Likert scale were chosen by the correspondents to determine the surgical load value based on their expertise. The surgical load for different surgical procedures in different body regions could be chosen in a range between “1,” defined as the surgical load equivalent to external (monolateral) fixator application, and “5,” defined as the maximal surgical load possible in that specific anatomic region. Results This questionnaire was completed online by 196 trauma surgeons from 61 countries in between Jun 26, 2022, and July 16, 2022 that are members of SICOT. The surgical load (SL) overall was considered very important by 77.0% of correspondents and important by 20.9% correspondents. Intraoperative blood loss (43.2%) and soft tissue damage (29.6%) were chosen as the most significant factors by participating surgeons. The decision for staged procedures was dictated by involved body region (56.1%), followed by bleeding risk (18.9%) and fracture complexity (9.2%). Percutaneous or intramedullary procedures as well as fractures in distal anatomic regions, such as hands, ankles, and feet, were consistently ranked lower in their surgical load. Conclusion This study demonstrates a consensus in the trauma community about the crucial relevance of the surgical load in polytrauma care. The surgical load is ranked higher with increased intraoperative bleeding and greater soft tissue damage/extent of surgical approach and depends relevantly on the anatomic region and kind of operative procedure. The experts especially consider anatomic regions and the risk of intraoperative bleeding as well as fracture complexity to guide staging protocols. Specialized guidance and teaching is required to assess both the patient’s physiological status and the estimated surgical load reliably in the preoperative decision-making and operative staging.

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“…Останніми роками перевага належить різьбовим стрижням. Використання різьбового стрижня як фіксуючого елемента дозволяє надати максимально можливої жорсткості системі на межі «кістка -апарат», про що свідчать біомеханічні дослідження низки авторів [17,18].…”

Section: результати та їх обговоренняunclassified

Нестабільні Поєднані Пошкодження Таза: Сучасні Погляди На Лікування

Buryanov¹,

Domin²,

Kvasha³

2022

TRAUMA

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Актуальність. Серед травматологічних хворих пацієнти з пошкодженням кісток таза становлять від 5 до 10 % усіх випадків. Такі травми відносяться до найтяжчих пошкоджень апарату руху та опори. Летальність при ізольованих переломах таза становить від 6 до 19 %, при поєднаних — від 20 до 80 %, інвалідизація — від 40 до 56 %. Невирішені питання стосуються лікування пацієнтів при нестабільних пошкодженнях. Мета дослідження: визначити сучасні принципи лікування пацієнтів з нестабільними поєднаними пошкодженнями таза, проблемні питання та перспективні шляхи їх вирішення. Матеріали та методи: проведено аналіз літературних джерел баз даних Pubmed, Up-to-date, Scopus, Web of Science, MedLine, The Cochrane Library, EMBASE, Global Health, CyberLeninka, РІНЦ. Результати. Стабілізуючі оперативні втручання є частиною реанімаційного комплексу, метою якого є збереження життя шляхом зменшення больових реакцій та крововтрати. У цьому періоді застосовуються С-щипці або щипці Ганца та апарати зовнішньої фіксації різноманітних конструкцій. Однак при пошкодженні таза типу С фіксація тільки вентрального відділу не забезпечує достатню стабільність. Аналіз ефективності перкутанної фіксації двома ілеосакральними гвинтами для стабілізації крижово-клубового суглоба вважається найкращим способом фіксації заднього тазового напівкільця за умови їх проведення через три кортикальні шари. Висновки. 1. Лікування пацієнтів з нестабільними поєднаними пошкодженнями таза є важливим медичним та соціально-економічним питанням. 2. Приорітетним напрямком є лікування потерпілих з нестабільними поєднаними пошкодженнями таза типу С з використанням малоінвазивних технологій.

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Standards for external fixation application: national survey under the auspices of the German Trauma Society

Abstract: Despite the fact that external fixation usage is widespread and well established among trauma surgeons in Germany, there are substantial differences in the method of application.

Cited by 9 publications

References 43 publications

Standard practice in the treatment of unstable pelvic ring injuries: an international survey

Standard practice in the treatment of unstable pelvic ring injuries: an international survey

Surgical load in major fractures — results of a survey on the optimal quantification and timing of surgery in polytraumatized patients

Нестабільні Поєднані Пошкодження Таза: Сучасні Погляди На Лікування

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