Diagnostics

Research

16 pages, 865 KiB

Open AccessArticle

Whole-Body Magnetic Resonance Tomography and Whole-Body Computed Tomography in Pediatric Polytrauma Diagnostics—A Retrospective Long-Term Two-Center Study

by Marnie Raimann, Johanna Ludwig, Peter Heumann, Ulrike Rechenberg, Leonie Goelz, Sven Mutze, Vera Schellerer, Axel Ekkernkamp and Mustafa Sinan Bakir

Diagnostics 2023, 13(7), 1218; https://doi.org/10.3390/diagnostics13071218 - 23 Mar 2023

Cited by 3 | Viewed by 1852

Abstract

Although serious accidents remain the leading cause of pediatric mortality, protocols to orient diagnostic procedures towards a certain type of initial imaging are widely needed. Since 2007, we have performed whole-body magnetic resonance imaging (WBMR) and whole-body computed tomography (WBCT) for diagnoses of [...] Read more.

Although serious accidents remain the leading cause of pediatric mortality, protocols to orient diagnostic procedures towards a certain type of initial imaging are widely needed. Since 2007, we have performed whole-body magnetic resonance imaging (WBMR) and whole-body computed tomography (WBCT) for diagnoses of severely injured children. We retrospectively reviewed 134 WBMR and 158 WBCT in patients younger than 16 years that were performed at two trauma centers between 2007 and 2018. A higher Injury Severity Score (ISS) was found in WBCT vs. WBMR (10.6 vs. 5.8; p = 0.001), but without any significant difference in mortality. The WBMR was significantly preferred at younger ages (9.6 vs. 12.8 years; p < 0.001). The time between patient’s arrival until diagnosis was 2.5 times longer for WBCT (92.1 vs. 37.1 min; p < 0.001). More patients in the CT group received analgesic sedation and/or intubation at 37.3% vs. 21.6% in the MRI group. Of these patients, 86.4% (CT) and 27.6% (MRI) were already preclinically sedated (p < 0.001). Correspondingly, 72.4% of the patients were first sedated in-hospital for MRIs. In conclusion, WBMR is an alternative and radiation-free imaging method for high-energy-traumatized children. Although the selected diagnostics seemed appropriate, limitations regarding longer duration or additional analgesic sedation are present, and further studies are needed. Full article

(This article belongs to the Special Issue Diagnosis and Management in Trauma Surgery)

► Show Figures

Figure 1

12 pages, 417 KiB

Open AccessArticle

Initial Serum Levels of Magnesium and Calcium as Predictors of Mortality in Traumatic Brain Injury Patients: A Retrospective Study

by Ahammed Mekkodathil, Ayman El-Menyar, Suhail Hakim, Hisham Al Jogol, Ashok Parchani, Ruben Peralta, Sandro Rizoli and Hassan Al-Thani

Diagnostics 2023, 13(6), 1172; https://doi.org/10.3390/diagnostics13061172 - 19 Mar 2023

Cited by 2 | Viewed by 4571

Abstract

Background: We sought to evaluate the predictor role of the initial serum level of calcium and magnesium in hospitalized traumatic brain injury (TBI) patients. Materials and methods: A retrospective analysis of all TBI patients admitted to the Hamad Trauma Center (HTC), between June [...] Read more.

Background: We sought to evaluate the predictor role of the initial serum level of calcium and magnesium in hospitalized traumatic brain injury (TBI) patients. Materials and methods: A retrospective analysis of all TBI patients admitted to the Hamad Trauma Center (HTC), between June 2016 and May 2021 was conducted. Initial serum electrolyte levels of TBI patients were obtained. A comparative analysis of clinical variables between patients with abnormal and normal serum electrolyte level was performed. Logistic regression analysis with the variables that showed a significant difference (p < 0.05) in the bivariate analysis was performed to calculate the odds ratios (OR) for mortality. Results: There was a total of 922 patients with clinical records of serum electrolyte levels at admission. Of these, 757 (82.1%) had hypocalcemia, 158 (17.1%) had normal calcium level, and 7 (0.8%) had hypercalcemia. On the other hand, 616 (66.8%) patients had normal magnesium level, 285 (30.9%) had hypomagnesemia, and 12 (1.3%) had hypermagnesemia. The mortality rate in hypocalcemia group was 24% while in patients with normal calcium level it was 12%, p = 0.001. Proportionate mortality rates in hypomagnesemia and normal magnesium groups were 15% and 23% (p = 0.006), respectively. On the other hand, 7 out of 12 (58%) hypermagnesemia patients died during the index hospitalization. The regression model including GCS, ISS, PT, aPTT, INR, Hemoglobin, Bicarbonate, Lactate, Sodium, Potassium, Calcium, Magnesium, and Phosphate showed that hypocalcemia was not a significant predictor [OR 0.59 (CI 95%: 0.20–1.35)] of mortality after TBI. However, hypermagnesemia was a significant predictor [OR 16 (CI 95%: 2.1–111)] in addition to the GCS, ISS, aPTT, Bicarbonate, and Lactate values on admission. Conclusion: Although hypocalcemia and hypomagnesemia are common in hospitalized TBI patients, hypocalcemia was not a significant predictor of mortality, while hypermagnesemia was an independent predictor. Further studies with larger sample size and with prospective design are required to support these findings and their importance. Full article

(This article belongs to the Special Issue Diagnosis and Management in Trauma Surgery)

► Show Figures

Figure 1

15 pages, 923 KiB

Open AccessArticle

Management of Traumatic Femur Fractures: A Focus on the Time to Intramedullary Nailing and Clinical Outcomes

by Syed Imran Ghouri, Fuad Mustafa, Ahad Kanbar, Hisham Al Jogol, Adam Shunni, Ammar Almadani, Nuri Abdurraheim, Atirek Pratap Goel, Husham Abdelrahman, Elhadi Babikir, Ahmed F. Ramzee, Khalid Ahmed, Mutaz Alhardallo, Mohammad Asim, Hassan Al-Thani and Ayman El-Menyar

Diagnostics 2023, 13(6), 1147; https://doi.org/10.3390/diagnostics13061147 - 17 Mar 2023

Cited by 1 | Viewed by 5503

Abstract

Background: Femur shaft factures (FSF) are common injuries following high-energy mechanisms mainly involving motor vehicle crashes (MVC). We evaluated the timings of nailing management and analyzed the pattern of fracture union and outcome in a level 1 trauma center. Methods: This was a [...] Read more.

Background: Femur shaft factures (FSF) are common injuries following high-energy mechanisms mainly involving motor vehicle crashes (MVC). We evaluated the timings of nailing management and analyzed the pattern of fracture union and outcome in a level 1 trauma center. Methods: This was a retrospective observational study of all the admitted trauma patients who sustained femoral fractures between January 2016 and September 2020. Data were analyzed and compared based on time to Intramedullary Nailing (IMN) (<12 h, 12–24 h and >24 h) and outcomes of FSF (union, delayed union and nonunion). Results: A total of 668 eligible patients were included in the study, of which the majority were males (90.9%) with a mean age of 34.5 ± 15.8, and 54% of the injuries were due to MVCs. The chest (35.8%) was the most commonly associated injured body region, followed by the pelvis (25.9%) and spine (25.4%). Most of femur fractures (93.3%) were unilateral, and 84.4% were closed fractures. The complete union of fractures was observed in 76.8% of cases, whereas only 4.2% and 3.3% cases had delayed union and nonunion, respectively, on the clinical follow-up. Patients in the delayed IMN (>24 h) were severely injured, had bilateral femur fracture (p = 0.001) and had higher rate of external fixation, blood transfusion, pulmonary complications and prolonged hospitalization. Non-union proportion was greater in those who had IMN <24 h, whereas a delayed union was greater in IMN done after 24 h (p = 0.5). Those with a nonunion femur fracture were more likely to have bilateral fracture (p = 0.003), frequently had retrograde nailing (p = 0.01), and high-grade femur fracture (AO type C; p = 0.04). Conclusion: This study showed that femur fracture is not uncommon (8.9%), which is manifested with the variety of clinical characteristics, depending on the mechanism, management and outcome in our center. Bilateral fracture, retrograde nailing and AO classification type C were the significant risk factors of non-union in patients with diaphyseal fractures. The timing of IMN has an impact on the fracture union; however, it is not a statistically significant difference. Therefore, the treating physicians should consider the potential risk factors for a better outcome by careful selection of treatment in sub-groups of patients. Full article

(This article belongs to the Special Issue Diagnosis and Management in Trauma Surgery)

► Show Figures

Figure 1

12 pages, 1147 KiB

Open AccessArticle

Blood Count-Derived Inflammatory Markers Correlate with Lengthier Hospital Stay and Are Predictors of Pneumothorax Risk in Thoracic Trauma Patients

by Vlad Vunvulea, Răzvan Marian Melinte, Klara Brinzaniuc, Bogdan Andrei Suciu, Adrian Dumitru Ivănescu, Ioana Hălmaciu, Zsuzsanna Incze-Bartha, Ylenia Pastorello, Cristian Trâmbițaș, Lucian Mărginean, Réka Kaller, Ahmad Kassas and Timur Hogea

Diagnostics 2023, 13(5), 954; https://doi.org/10.3390/diagnostics13050954 - 2 Mar 2023

Cited by 4 | Viewed by 2073

Abstract

(1) Background: Trauma is one of the leading causes of death worldwide, with the chest being the third most frequent body part injured after abdominal and head trauma. Identifying and predicting injuries related to the trauma mechanism is the initial step in managing [...] Read more.

(1) Background: Trauma is one of the leading causes of death worldwide, with the chest being the third most frequent body part injured after abdominal and head trauma. Identifying and predicting injuries related to the trauma mechanism is the initial step in managing significant thoracic trauma. The purpose of this study is to assess the predictive capabilities of blood count-derived inflammatory markers at admission. (2) Materials and Methods: The current study was designed as an observational, analytical, retrospective cohort study. It included all patients over the age of 18 diagnosed with thoracic trauma, confirmed with a CT scan, and admitted to the Clinical Emergency Hospital of Targu Mureş, Romania. (3) Results: The occurrence of posttraumatic pneumothorax is highly linked to age (p = 0.002), tobacco use (p = 0.01), and obesity (p = 0.01). Furthermore, high values of all hematological ratios, such as the NLR, MLR, PLR, SII, SIRI, and AISI, are directly associated with the occurrence of pneumothorax (p < 0.001). Furthermore, increased values of the NLR, SII, SIRI, and AISI at admission predict a lengthier hospitalization (p = 0.003). (4) Conclusions: Increased neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic inflammatory index (SII), aggregate inflammatory systemic index (AISI), and systemic inflammatory response index (SIRI) levels at admission highly predict the occurrence of pneumothorax, according to our data. Full article

(This article belongs to the Special Issue Diagnosis and Management in Trauma Surgery)

► Show Figures

Figure 1

10 pages, 7441 KiB

Open AccessArticle

Anti-Toothbreaker: A Novel Low-Budget Device Enabling Contactless Dental Protection and a Forbidden Technique during Direct Laryngoscopy for Endotracheal Intubation

by Sam Razaeian and Helena Kristin Liebich

Diagnostics 2023, 13(4), 594; https://doi.org/10.3390/diagnostics13040594 - 6 Feb 2023

Cited by 2 | Viewed by 1803

Abstract

Background: Iatrogenic dental injury is the most common complication of conventional laryngoscopy during orotracheal intubation. The main cause is unintended pressure and leverage forces from the hard metal blade of the laryngoscope. The aim of this pilot study was to introduce and test [...] Read more.

Background: Iatrogenic dental injury is the most common complication of conventional laryngoscopy during orotracheal intubation. The main cause is unintended pressure and leverage forces from the hard metal blade of the laryngoscope. The aim of this pilot study was to introduce and test a novel, reusable low-budget device not only providing contactless dental protection during direct laryngoscopy for endotracheal intubation, but also enabling, in contrast to established tooth protectors, active levering with conventional laryngoscopes for easier visualization of the glottis. Methods: A constructed prototype for intrahospital usage was evaluated by seven participants on a simulation manikin for airway management. Endotracheal intubation was performed with and without the device using a conventional Macintosh laryngoscope (blade size 4) and a 7.5 mm endotracheal tube (Teleflex Medical GmbH, Fellbach, Germany). Necessary time and success of first pass were determined. Degree of visualization of the glottis with and without the device was stated by the participants according to the Cormack and Lehane (CL) classification system and the Percentage of Glottic Opening (POGO) scoring system. In addition, subjective physical effort, feeling of safety regarding successful intubation, and risk for dental injury were queried on a numeric scale between 1 and 10. Results: All participants except one stated that the intubation procedure was easier with usage of the device than without it. On average, this was subjectively perceived as being approximately 42% (range, 15–65%) easier. In addition, time to first pass success, as well as degree of glottis visualization, subjective physical effort, and feeling of safety regarding risk for dental injury, were clearly better with usage of the device. Concerning feeling of safety regarding successful intubation, there was only a minor advantage. No difference in first pass success rate and number of total attempts could be observed. Conclusion: The Anti-Toothbreaker is a novel, reusable low-budget device which might not only provide contactless dental protection during direct laryngoscopy for endotracheal intubation, but also enables, in contrast to established tooth protectors, active levering with conventional laryngoscopes for easier visualization of the glottis. Future human cadaveric studies are needed to investigate whether these advantages also prove themselves there. Full article

(This article belongs to the Special Issue Diagnosis and Management in Trauma Surgery)

► Show Figures

Figure 1

10 pages, 1914 KiB

Open AccessArticle

Assessment of Acute Lesions of the Biceps Pulley in Patients with Traumatic Shoulder Dislocation Using MR Imaging

by Georg C. Feuerriegel, Nicolas S. Lenhart, Yannik Leonhardt, Florian T. Gassert, Peter Biberthaler, Sebastian Siebenlist, Chlodwig Kirchhoff, Marcus R. Makowski, Klaus Woertler, Alexandra S. Gersing, Jan Neumann and Markus Wurm

Diagnostics 2022, 12(10), 2345; https://doi.org/10.3390/diagnostics12102345 - 28 Sep 2022

Cited by 5 | Viewed by 3804

Abstract

Background: Shoulder dislocations represent common injuries and are often combined with rotator cuff tears and potentially damage to the biceps pulley. Purpose: To assess the occurrence and type of biceps pulley lesions in patients after traumatic anterior shoulder dislocation using 3T MRI. Methods: [...] Read more.

Background: Shoulder dislocations represent common injuries and are often combined with rotator cuff tears and potentially damage to the biceps pulley. Purpose: To assess the occurrence and type of biceps pulley lesions in patients after traumatic anterior shoulder dislocation using 3T MRI. Methods: Thirty-three consecutive patients were enrolled between June 2021 and March 2022 (14 women, mean age 48.0 ± 19 years). All patients underwent MR imaging at 3 T within one week. Images were analyzed for the presence and type of pulley tears, subluxation/dislocation of the LHBT, rotator cuff lesions, joint effusion, labral lesions, and osseous defects. Results: Seventeen patients (52%) with traumatic anterior shoulder dislocation demonstrated biceps pulley lesions. Of those, eleven patients (33%) showed a combined tear of the sGHL and CHL. All seventeen patients with lesions of the biceps pulley showed associated partial tearing of the rotator cuff, whereas three patients showed an additional subluxation of the LHBT. Patients with pulley lesions after dislocations were significantly older than those without (mean age 52 ± 12 years vs. 44 ± 14 years, p = 0.023). Conclusion: Our results suggest an increased awareness for lesions of the biceps pulley in acute traumatic shoulder dislocation, particularly in patients over 45 years. Full article

(This article belongs to the Special Issue Diagnosis and Management in Trauma Surgery)

► Show Figures

Figure 1

13 pages, 1130 KiB

Open AccessArticle

Association of In-Hospital Mortality and Trauma Team Activation: A 10-Year Study

by Da-Sen Chien, Giou-Teng Yiang, Chi-Yuan Liu, I-Shiang Tzeng, Chun-Yu Chang, Yueh-Tseng Hou, Yu-Long Chen, Po-Chen Lin and Meng-Yu Wu

Diagnostics 2022, 12(10), 2334; https://doi.org/10.3390/diagnostics12102334 - 27 Sep 2022

Cited by 5 | Viewed by 2153

Abstract

Background: Early trauma team activation (TTA) may improve clinical outcomes through early diagnosis and timely intervention by a dedicated multidisciplinary team. Controversy seems to exist about the effect of establishing trauma team systems in traumatic injury populations. Our aim was to identify factors [...] Read more.

Background: Early trauma team activation (TTA) may improve clinical outcomes through early diagnosis and timely intervention by a dedicated multidisciplinary team. Controversy seems to exist about the effect of establishing trauma team systems in traumatic injury populations. Our aim was to identify factors that may be associated with clinical outcomes in trauma injury and to investigate the effect of trauma team activation. Method: This retrospective descriptive study included all traumatic patients from the Taipei Tzu Chi Hospital Trauma Database. All prehospital vital signs, management, injury type, injury mechanisms, hospitalization history, and clinical outcomes were analyzed, and multivariable logistic regression was used to investigate the association between trauma team activation and clinical outcomes. Subgroups of TTA in minor injury and non-TTA in major injury were also analyzed. Result: In this study, a total of 11,946 patients were included, of which 10,831 (90.7%) patients were minor injury (ISS < 16), and 1115 (9.3%) patients were major injury (ISS ≥ 16). In the minor injury population, TTA had a higher intensive care unit (ICU) admission rate, operation rate, re-operation rate, and prolonged total length of stay (LOS). In the major injury population, TTA had a higher mortality rate, prolonged total LOS, and prolonged ICU LOS. After adjusting for mechanism of injury and injury severity, there was no association between in-hospital mortality and TTA, compared with the non-TTA group. However, the TTA group had a higher risk of ICU admission, prolonged ICU LOS, and prolonged total LOS. The subgroup analysis showed trauma team activation had a higher risk of mortality in the 60- to 80-year-old population, major injury (ISS ≥ 16), consciousness clear population, and non-head injury group. Conclusions: We found there was no significant association between in-hospital mortality and TTA. However, in the TTA group, there was a higher risk of ICU admission, prolonged total, LOS, and prolonged ICU LOS. In the subgroup analysis, TTA had a higher risk of mortality in the 60- to 80-year-old population, major injury (ISS ≥ 16), consciousness clear population, and non-head injury group. Our results reflect TTA-criteria-selected patients with greater ISS and a high risk of mortality. Full article

(This article belongs to the Special Issue Diagnosis and Management in Trauma Surgery)

► Show Figures

Figure 1

10 pages, 497 KiB

Open AccessArticle

Evaluation of Post-Hospital Care of Traumatic Brain Injury in Children, Adolescents and Young Adults—A Survey among General Practitioners and Pediatricians in Germany

by Wiebke Käckenmester, Claas Güthoff, Dana Mroß, Gertrud Wietholt, Kristina Zappel and Ingo Schmehl

Diagnostics 2022, 12(9), 2265; https://doi.org/10.3390/diagnostics12092265 - 19 Sep 2022

Viewed by 1526

Abstract

Background: The long-term effects of mild Traumatic Brain Injury (TBI) in children and adolescents are increasingly discussed due to their potential impact on psycho-social development and education. This study aims to evaluate post-hospital care of children and adolescents after mild TBI using a [...] Read more.

Background: The long-term effects of mild Traumatic Brain Injury (TBI) in children and adolescents are increasingly discussed due to their potential impact on psycho-social development and education. This study aims to evaluate post-hospital care of children and adolescents after mild TBI using a physician survey. Methods: A self-developed, pre-tested questionnaire on diagnostics and treatment of TBI in outpatient care was sent to a representative sample of general practitioners and pediatricians in Germany. Results: Datasets from 699 general practitioners, 334 pediatricians and 24 neuropediatricians were available and included in the analysis. Nearly half of the general practitioners and most pediatricians say they treat at least one acute pediatric TBI per year. However, a substantive proportion of general practitioners are not familiar with scales assessing TBI severity and have difficulties assessing the symptoms correctly. Pediatricians seem to have better knowledge than general practitioners when it comes to treatment and outpatient care of TBI. Conclusions: To increase knowledge about TBI in outpatient physicians, targeted training courses should be offered, especially for general practitioners. Moreover, handing out written information about long-term effects and reintegration after TBI should be encouraged in outpatient practice. Full article

(This article belongs to the Special Issue Diagnosis and Management in Trauma Surgery)

9 pages, 1687 KiB

Open AccessArticle

Self-Reduction in Proximal Humerus Fractures through Upright Patient Positioning: Is It up to Gravity?

by Sam Razaeian, Christian Krettek and Nael Hawi

Diagnostics 2022, 12(9), 2096; https://doi.org/10.3390/diagnostics12092096 - 29 Aug 2022

Cited by 1 | Viewed by 2870

Abstract

Background: The self-reduction in proximal humerus fractures (PHFs) remains a poorly explored myth, and it was rarely investigated in the past. One of the oldest hypotheses suggests that gravity and the weight of the affected arm alone are driving forces, which facilitate a [...] Read more.

Background: The self-reduction in proximal humerus fractures (PHFs) remains a poorly explored myth, and it was rarely investigated in the past. One of the oldest hypotheses suggests that gravity and the weight of the affected arm alone are driving forces, which facilitate a self-reducing potential in PHFs. However, thus far, clear radiographic evidence for this theory is missing in the literature. This study aimed to investigate the immediate effect of upright patient positioning on self-reducing of PHFs. Methods: Between November 2019 and November 2020, seven consecutively bedridden but mentally competent patients were admitted to our emergency department with an acute proximal humerus fracture. Within routinely attempts of closed reductions under the control of an image converter (C-arm), immobile patients were mobilized into an upright sitting position on a stretcher while the affected arm was immobilized in a sling. Fluoroscopic controls were performed before and after upright positioning. Changes in the head-shaft angle (HSA), as well as the medial hinge index (MHI), were determined on plain true anteroposterior (AP) fluoroscopic images. Results: In all cases, upright patient positioning had an immediate self-reducing effect. This effect could be seen in five out of seven cases for both HSA and MHI. Changes in HSA and MHI averaged 21.2° and 0.25, respectively. Mean deviation from an ideal, anatomic HSA of 135° decreased through upright positioning from 25.5° to 13.8°. Mean deviation from an ideal, anatomic MHI of 1 decreased through upright positioning from 0.28 to 0.19. Conclusions: Upright patient positioning might contribute immediately to the self-reduction in PHF through the force of gravity. This underlines the importance of being aware of patients’ position when interpreting X-ray images within treatment decision-making processes. Full article

(This article belongs to the Special Issue Diagnosis and Management in Trauma Surgery)

► Show Figures

Figure 1

11 pages, 1001 KiB

Open AccessArticle

Telemedicine in Neurosurgical Trauma during the COVID-19 Pandemic: A Single-Center Experience

by Nenad Koruga, Anamarija Soldo Koruga, Robert Rončević, Tajana Turk, Vjekoslav Kopačin, Domagoj Kretić, Tatjana Rotim and Alen Rončević

Diagnostics 2022, 12(9), 2061; https://doi.org/10.3390/diagnostics12092061 - 25 Aug 2022

Cited by 4 | Viewed by 1887

Abstract

Telemedicine is a rapid tool that reduces the time until treatment for patients, which is especially useful for neurosurgical trauma. The aim of our study was to evaluate the use of telemedicine in neurosurgery during the COVID-19 pandemic compared with the pre-pandemic era. [...] Read more.

Telemedicine is a rapid tool that reduces the time until treatment for patients, which is especially useful for neurosurgical trauma. The aim of our study was to evaluate the use of telemedicine in neurosurgery during the COVID-19 pandemic compared with the pre-pandemic era. We assessed the utilization of telemedicine at the Department of Neurosurgery at University Hospital Center Osijek in Croatia over a timespan of one year prior to the COVID-19 pandemic and the first year of the pandemic, starting with the date of first lockdown in Croatia. For each time period, the total number of consults and specific clinical inquiries were recorded and adequately grouped as well as comprehensive patient characteristics. There were 336 consults in the pre-pandemic period and 504 in the pandemic period. The number of trauma-related consults during COVID-19 measures was significantly higher than the pre-pandemic era (288 and 138, respectively, p < 0.0001). Neurosurgical trauma patients requiring consults in the pandemic period were significantly older than before the pandemic (64.9 ± 18.5 and 60.6 ± 19.1, respectively, p = 0.03). Significantly, the number of admissions to our center and urgent surgeries did not significantly differ between these periods. Telemedicine is a cost-effective tool in the neurosurgical evaluation of patients, especially for trauma. The COVID-19 pandemic accelerated telemedicine implementation and improved neurosurgical trauma treatments. Full article

(This article belongs to the Special Issue Diagnosis and Management in Trauma Surgery)

► Show Figures

Figure 1

15 pages, 1039 KiB

Open AccessArticle

by Victor Lu, James Zhang, Ravi Patel, Andrew Kailin Zhou, Azeem Thahir and Matija Krkovic

Diagnostics 2022, 12(5), 1289; https://doi.org/10.3390/diagnostics12051289 - 22 May 2022

Cited by 16 | Viewed by 4017

Abstract

Fracture related infections (FRI) are debilitating and costly complications of musculoskeletal trauma surgery that can result in permanent functional loss or amputation. Surgical treatment can be unsuccessful, and it is necessary to determine the predictive variables associated with FRI treatment failure, allowing one [...] Read more.

Fracture related infections (FRI) are debilitating and costly complications of musculoskeletal trauma surgery that can result in permanent functional loss or amputation. Surgical treatment can be unsuccessful, and it is necessary to determine the predictive variables associated with FRI treatment failure, allowing one to optimise them prior to treatment and identify patients at higher risk. The clinical database at a major trauma centre was retrospectively reviewed between January 2015 and January 2021. FRI treatment failure was defined by infection recurrence or amputation. A univariable logistic regression analysis was performed, followed by a multivariable regression analysis for significant outcomes between groups on univariable analysis, to determine risk factors for treatment failure. In total, 102 patients were identified with a FRI (35 open, 67 closed fractures). FRI treatment failure occurred in 24 patients (23.5%). Risk factors determined by our multivariate logistic regression model were obesity (OR 2.522; 95% CI, 0.259–4.816; p = 0.006), Gustilo Anderson type 3c (OR 4.683; 95% CI, 2.037–9.784; p = 0.004), and implant retention (OR 2.818; 95% CI, 1.588–7.928; p = 0.041). Given that FRI treatment in 24 patients (23.5%) ended up in failure, future management need to take into account the predictive variables analysed in this study, redirect efforts to improve management and incorporate adjuvant technologies for patients at higher risk of failure, and implement a multidisciplinary team approach to optimise risk factors such as diabetes and obesity. Full article

(This article belongs to the Special Issue Diagnosis and Management in Trauma Surgery)

► Show Figures

Figure 1

Review

Jump to: Research, Other

20 pages, 339 KiB

Open AccessReview

AI-Based Decision Support System for Traumatic Brain Injury: A Survey

by Flora Rajaei, Shuyang Cheng, Craig A. Williamson, Emily Wittrup and Kayvan Najarian

Diagnostics 2023, 13(9), 1640; https://doi.org/10.3390/diagnostics13091640 - 5 May 2023

Cited by 9 | Viewed by 2754

Abstract

Traumatic brain injury (TBI) is one of the major causes of disability and mortality worldwide. Rapid and precise clinical assessment and decision-making are essential to improve the outcome and the resulting complications. Due to the size and complexity of the data analyzed in [...] Read more.

Traumatic brain injury (TBI) is one of the major causes of disability and mortality worldwide. Rapid and precise clinical assessment and decision-making are essential to improve the outcome and the resulting complications. Due to the size and complexity of the data analyzed in TBI cases, computer-aided data processing, analysis, and decision support systems could play an important role. However, developing such systems is challenging due to the heterogeneity of symptoms, varying data quality caused by different spatio-temporal resolutions, and the inherent noise associated with image and signal acquisition. The purpose of this article is to review current advances in developing artificial intelligence-based decision support systems for the diagnosis, severity assessment, and long-term prognosis of TBI complications. Full article

(This article belongs to the Special Issue Diagnosis and Management in Trauma Surgery)

10 pages, 245 KiB

Open AccessReview

Rational Usage of Fracture Imaging in Children and Adolescents

by Ralf Kraus and Klaus Dresing

Diagnostics 2023, 13(3), 538; https://doi.org/10.3390/diagnostics13030538 - 1 Feb 2023

Cited by 7 | Viewed by 2054

Abstract

In this paper, authors introduce the basic prerequisite for rational, targeted, and above all, child-oriented diagnosis of fractures and dislocations in children and adolescents is in-depth prior knowledge of the special features of trauma in the growth age group. This review summarizes the [...] Read more.

In this paper, authors introduce the basic prerequisite for rational, targeted, and above all, child-oriented diagnosis of fractures and dislocations in children and adolescents is in-depth prior knowledge of the special features of trauma in the growth age group. This review summarizes the authors’ many years of experience and the state of the current pediatric traumatology literature. It aims to provide recommendations for rational, child-specific diagnostics appropriate to the child, especially for the area of extremity injuries in the growth age. The plain radiograph remains the indispensable standard in diagnosing fractures and dislocations of the musculoskeletal system in childhood and adolescence. Plain radiographs in two planes are the norm, but in certain situations, one plane is sufficient. X-rays of the opposite side in acute diagnostics are obsolete. Images to show consolidation after conservative treatment is rarely necessary. Before metal removal, however, they are indispensable. The upcoming diagnostical tool in pediatric trauma is ultrasound. More and more studies show that in elected injuries and using standardized protocols, fracture ultrasound is as accurate as plain radiographs to detect and control osseous and articular injuries. In acute trauma, CT scans have only a few indications, especially in epiphyseal fractures in adolescents, such as transitional fractures of the distal tibia or coronal shear fractures of the distal humerus. CT protocols must be adapted to children and adolescents to minimize radiation exposure. MRI has no indication in the detection or understanding of acute fractures in infants and children. It has its place in articular injuries of the knee and shoulder to show damage to ligaments, cartilage, and other soft tissues. Furthermore, MRI is useful in cases of remaining pain after trauma without radiological proof of a fracture and in the visualization of premature closure of growth plates after trauma to plan therapy. Several everyday examples of rational diagnostic workflows, as the authors recommend them, are mentioned. The necessity of radiation protection must be taken into consideration. Full article

(This article belongs to the Special Issue Diagnosis and Management in Trauma Surgery)

Other

Jump to: Research, Review

9 pages, 15488 KiB

Open AccessViewpoint

Ultrasonographic Measurement of Torsional Side Difference in Proximal Humerus Fractures and Humeral Shaft Fractures: Theoretical Background with Technical Notes for Clinical Implementation

by Jan-Niklas Menzel, Dafang Zhang, Christian Krettek, Nael Hawi and Sam Razaeian

Diagnostics 2022, 12(12), 3110; https://doi.org/10.3390/diagnostics12123110 - 9 Dec 2022

Cited by 3 | Viewed by 2431

Abstract

Both nonoperative and operative treatment of proximal humerus fractures (PHF) and humeral shaft fractures can result in torsional side differences. Several measurement methods are available to determine torsional malalignment. While conventional X-ray or computed tomography would entail additional radiation exposure for the patient, [...] Read more.

Both nonoperative and operative treatment of proximal humerus fractures (PHF) and humeral shaft fractures can result in torsional side differences. Several measurement methods are available to determine torsional malalignment. While conventional X-ray or computed tomography would entail additional radiation exposure for the patient, and while magnetic resonance imaging might be associated with higher costs and is not suitable in cases of surgically treated fractures due to metal-induced artifacts, the sonographic measurement of humeral torsion represents a readily available and quickly performable measurement method without radiation exposure. Both fully sonographic procedures and sonographically assisted procedures have been described in the literature for this purpose. To date, however, its application in the case of trauma patients, for example those with healed PHF and humeral shaft fractures, is not reported. This viewpoint article aims to provide a concise summary of the literature concerning ultrasonographic indirect measurements of humeral torsional side differences, with technical notes for clinical implementation in case of healed proximal humerus fractures and humeral shaft fractures. Full article

(This article belongs to the Special Issue Diagnosis and Management in Trauma Surgery)

► Show Figures

Figure 1

5 pages, 909 KiB

Open AccessInteresting Images

Combined Disruption of the Thoracic Spine and Costal Arch Fracture: An Indicator of a Severe Chest Trauma

by Stefan Schulz-Drost, Stephan Kloesel, Jan Carsten Kühling, Axel Ekkernkamp and Mustafa Sinan Bakir

Diagnostics 2022, 12(9), 2206; https://doi.org/10.3390/diagnostics12092206 - 12 Sep 2022

Viewed by 2195

Abstract

Blunt high-energy chest trauma is often associated with thoracic and abdominal organ injuries. Literature for a hyperextension-distraction mechanism resulting in a costal arch fracture combined with a thoracic spine fracture is sparse. A 65-year-old male suffered a fall from a height of six [...] Read more.

Blunt high-energy chest trauma is often associated with thoracic and abdominal organ injuries. Literature for a hyperextension-distraction mechanism resulting in a costal arch fracture combined with a thoracic spine fracture is sparse. A 65-year-old male suffered a fall from a height of six meters. Initial X-ray of the chest shows left-sided high-riding diaphragm and CT scan proves anterior cartilage fracture, posterolateral serial rib fractures, traumatic intercostal pulmonary hernia, avulsion of the diaphragm, and 7th thoracic vertebral fracture. An exploratory thoracotomy was performed and the rupture of the diaphragm, creating a two-cavity injury, had been re-fixed, the pulmonary hernia was closed, and locking plate osteosyntheses of the fractured ribs including the costal arch were performed. We generally recommend surgical therapy of the thorax to restore stability in this severe injury entity. The spine was fixed dorsally using a screw-rod system. In conclusion, this thoracovertebral injury entity is associated with high overall injury severity and life-threatening thoracoabdominal injuries. Since two-cavity traumata and particularly diaphragmatic injuries are often diagnosed delayed, injuries to the costal arch can act as an indicator of severe trauma. They should be detected through clinical examination and assessment of the trauma CT in the soft tissue window. Full article

(This article belongs to the Special Issue Diagnosis and Management in Trauma Surgery)

► Show Figures

Figure 1

Journal Menu

Journal Browser

Diagnosis and Management in Trauma Surgery

Share This Special Issue

Special Issue Editor

Special Issue Information

Keywords

Benefits of Publishing in a Special Issue

Published Papers (15 papers)

Research

Review

Other

Further Information

Guidelines

MDPI Initiatives

Follow MDPI