Successful non-surgical management of pleuroparenchymal fistula following cervical intraspinal empyema

Pulmonary infections are life-threatening complications in patients with spinal cord injuries. In particular, paraplegic patients are at risk if they are ventilator-dependent. This case history refers to a spinal cord injury with a complete sensorimotor tetraplegia below C2 caused by a septic scattering of an intraspinal empyema at C2-C5 and T3-T4. A right-sided purulent pneumonia led to a complex lung infection with the formation of a pleuroparenchymal fistula. The manuscript describes successful, considerate, non-surgical management with shortterm separate lung ventilation. Treatment aimed to achieve the best possible result without additional harm. A variety of surgical and conservative strategies for the treatment of pleuroparenchymal fistula (PPF) have been described with different degrees of success. We detail the non-surgical management of a persistent PPF with temporary separate lung ventilation (SLV) via a double-lumen tube (DLT) in combination with talc pleurodesis as an approach in patients who are unable to undergo surgical treatment

Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study

Background Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. Methods This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. Results Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI − 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI − 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. Conclusions Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021)

Langzeitergebnisse nach konservativer und operativer Therapie von traumatischen Kniegelenksluxationen

Ziel der Untersuchung war die Bestimmung von Langzeitergebnissen von Patienten mit traumatischen Kniegelenksluxationen nach erfolgter konservativer und operativer Therapie. Nach einem Follow-up von 10,9 Jahren wurden 38 Patienten mit 39 Kniegelenksluxationen nachuntersucht. Patienten mit operativer Ligamentversorgung zeigten im Verlauf eine signifikant bessere Flexion als Patienten mit konservativer Therapie der Ligamente (p ≤ 0,033) und im Trend auch bessere Ergebnisse in den Scores allerdings ohne Erreichen des notwendigen Signifikanzniveaus. Die langfristigen Ergebnisse zeigten eine zufriedenstellende Kniefunktion mit körperlichen Einschränkungen in der gesundheitsbezogenen Lebensqualität. Unabhängig von der gewählten Therapieform kam es häufig zur Ausbildung eines reduzierten Bewegungsausmaßes sowie zu einer posttraumatischen Arthrose des betroffenen Kniegelenkes

Blunt Pancreatic Injury in Major Trauma: Decision-Making between Nonoperative and Operative Treatment

Blunt trauma injuries to the pancreas are rare but are associated with significant overall mortality and a high complication rate. Motor vehicle collisions are the leading cause of blunt pancreatic trauma, followed by falls, and sports injuries. We discuss the decision-making process used during the clinical courses of 3 patients with life-threatening blunt pancreatic injuries caused by traumatic falls. We also discuss the utility of the American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS), which provides a system for grading pancreatic trauma. Retrospectively, the cases reviewed were classified as AAST-OIS grade II, III, and IV in each one patient. Although the nonoperative approach was initially preferred, surgery was required in each case due to pseudocyst formation, pancreatic necrosis, and posttraumatic pancreatitis. In each case, complete healing was achieved through exploratory laparotomy with extensive lavage and placement of abdominal drains for several weeks postoperatively. These cases show that nonoperative management of pancreatic ductal trauma results in poor outcomes when initial therapy is less than optimal

Long-term results after traumatic knee joint dislocations

Traumatic knee joint dislocations belong to the most serious injuries of the lower extremity with a high rate of neurovascular injuries, soft tissue injuries and compartment syndromes. The aim of the study was to determine the long-term results of patients with traumatic knee joint dislocations after conservative and operative treatment of the ligaments. In addition, differences between the two therapies were investigated and what kind of incidents and complications occurred. All patients with traumatic knee joint dislocation were included over a time period of 25 years (1990 to 2014). 119 patients with 121 traumatic knee joint dislocations were hospitalized during this time. A conservative treatment of the ligaments was performed in 48 knee joint dislocations (39.7%) and an operative treatment in 73 injuries (60.3%). After an average follow-up of 10.9 ± 6.7 years, 38 patients with 39 knee joint dislocations were examined. Significance was set to p &lt; 0.05. Patients with operative ligament care showed significantly better flexion compared to patients with conservative treatment of the ligaments (p &lt; 0.033). A median of 76 points (range 34 - 100 points) was achieved in the Lysholm score. 56.2 points (range 45.3 - 71.1 points) were achieved in the SF-36 mental health score and 43.7 points (range 21.2 - 59.6 points) in the SF-36 physical heatlh score. The subjective part of the IKDC 2000 showed a median score of 60.9 points (range 32.1 - 97.7 points). Patients with operative ligament care showed better results in the scores, however, without achieving any significance.Posttraumatic arthrosis was found in 47% of all radiologically-re-examined patients in the Kellgren-Lawrence score. The long-term results showed a satisfactory knee function with physical limitations in the health-related quality of life. However, a reduced range of motion as well as a posttraumatic osteoarthritis of the affected knee joint often appeared, which was independent of the therapy strategy. Patients with operative ligament care showed better results in the scores without any significane, but achieved a significantly better flexion than patients with conservative treatment of the ligaments. </jats:sec

Differences between primary and secondary osteosynthesis for fractures of the lower limb with acute compartment syndrome

To analyze the differences between primary and secondary osteosynthesis for fractures of the lower limb with acute compartment syndrome (ACS). From our trauma database, we indentified a total number of 107 patients with 126 fractures of AO/OTA type 41 to 44 and 120 ACS from January 01, 2001 to December 31, 2015 who were treated with primary or secondary osteosynthesis after compartment incision. 71 patients with 77 fractures of AO/OTA classification type 41 to 44 suffering ACS received primary osteosynthesis after compartment incision (POCI) and were compared to 36 patients with 49 fractures of AO/OTA type 41 to 44 and ACS, who were treated by secondary osteosynthesis after compartment incision (SOCI). Patients with POCI showed a significantly shorter length of stay in the hospital with significantly less necessary surgeries for definitive treatment of the fractures and the soft tissue closure than SOCI patients (p &lt; 0,001). The overall rate of infections in both groups were 13% without any difference between POCI and SOCI. The POCI of AO/OTA fractures type 41 to 44 with ACS is a safe and effective procedure for unilateral und single fractures of the lower limb without an increasing infection rate. </jats:sec