Severe abdominal trauma represents a critical subset of injuries, particularly in the aging European population, where the prevalence of preexisting anticoagulant or antiplatelet therapy is increasing. While the impact of such medications on outcomes in traumatic brain injury is well studied, limited data exist regarding their influence in patients with abdominal trauma. This retrospective cohort study used data from the TraumaRegister DGU® between January 2015 and December 2023. Inclusion criteria were patients aged ≥ 50 years with severe blunt abdominal trauma (AIS Abdomen ≥ 3) without relevant head injury (AIS Head ≤ 3) from Austria, Germany, or Switzerland. Patients were grouped according to pre-injury antithrombotic medication (no medication [NM] vs. antithrombotic medication [AM], with subgroups). Statistical analysis included descriptive comparisons, standardized mortality ratios (SMR) using RISC III, and multivariate logistic regression to identify independent predictors of hospital mortality. Of 328,281 patients, 4,069 met inclusion criteria (2,831 NM; 1,238 ATM). Patients in the AM group were older (74.1 vs. 62.3 years) and had higher mortality (25.0

Background/Objectives: The growing elderly population and concomitant increase in physical activity of older adults has led to a growing number of seriously injured elderly patients. The aim of this retrospective cohort study was to investigate the influence of the leading region of injury in severely injured patients on the risk of mortality in different age groups, with focus on elderly patients. Methods: Data from the TraumaRegister DGU® from 2015 to 2020 were analyzed, including severely injured patients admitted to Swiss, German and Austrian trauma centers. Inclusion criteria were a minimum age of 18 years and an Abbreviated Injury Scale (AIS) score of three or higher in at least one of the body regions. Descriptive analysis and odds ratios for mortality derived from multivariable analysis were calculated, stratified by age and leading region of injury. Results: Out of 213,216 patients, 98,481 met the inclusion criteria. Mortality increased from 6.9% in the control group (18-54 years) to a maximum of 35.9% in the 90+ age group. Leading head injuries had a mortality rate of 22%. The odds ratio for the risk of mortality increased with age and reached a maximum value of 17.0 in the 90+ age group. However, the increase in risk of mortality for leading head injury with increasing age was lower than in the other regions, with an OR of 11.7 in the 90+ age group. In contrast, the group with a leading thoracic injury increased to an OR of 22.5, abdomen to an OR of 75.2 and extremities to an OR of 28.7. Conclusions: The risk of mortality from traumatic head injury is less pronounced in elderly people compared to other injury regions. Our data suggests that traditional scoring systems like the AIS might not display nuances of different injury severities in different age groups, especially for head injuries caused by low-energy trauma and therefore should be reevaluated.

Distal humerus fractures in adults are rare but complex injuries, particularly AO type C3 fractures, often involving comminution, instability, and osteoporotic bone. Demographic trends indicate rising incidence, especially among elderly patients, with increasing functional demands challenging modern osteosynthesis. Open reduction and internal fixation (ORIF) with bicolumnar plating remains the preferred reconstructive approach, although complications remain substantial. This study aimed to evaluate trends in fracture complexity, patient demographics, and functional outcomes over five decades, focusing on the most recent cohort (2009–2018, series E) and comparing with historical cohorts (series A–D, 1969–2008). This retrospective analysis included five consecutive 10-year institutional cohorts (series A: n = 43; B: n = 29; C: n = 47; D: n = 58) of 233 patients with 235 supradiacondylar distal humerus fractures (AO type C1–3) treated with ORIF. Functional outcome parameters (Jupiter and Cassebaum Scores) and demographic data were available for all cohorts; additional parameters (range of motion (ROM), QuickDASH Score) were available for series D and E, Mayo Elbow Performance Score (MEPS), Short Form (SF)-36, and strength were assessed specifically in series E (n = 56; follow-up n = 21). Cross-cohort comparisons of categorical variables used chi-square tests; continuous outcomes were summarized descriptively. Historical cohort means served as a basis for comparison, and analysis of variance (ANOVA) with Tukey Honestly Significant Difference (HSD) was applied for within-series analyses. Mean patient age increased to 62.6 (range 19–89, SD ± 18.1) years in series E. The proportion of AO type C3 fractures rose significantly from 11.6

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an increasingly used trauma resuscitation procedure. The purpose of this study is to evaluate the open surgical technique in a cardiac arrest model. Thirty-one fresh cadavers were included in the study. 46 times the open arterial cutdown for the emergency procedure REBOA were performed and evaluated by physicians from a level I. trauma center. For open arterial cutdown time from skin incision to blocking the balloon in averaged 340.6 s (SD: 136.6; range: 178–600) and the balloon was correctly positioned and blocked 37 times (80.4

PURPOSE OF REVIEW:Bleeding complications from pelvic injuries occur after high-energy trauma as well as after low-energy trauma in elderly patients and are the main contributors to mortality. Demographic changes necessitate focussing on both entities and targeted therapies throughout the course of management. RECENT FINDINGS:This article reviews the recent evidence and expertise on bleeding management for haemodynamically unstable patients with pelvic fractures with insights from prehospital care to trends in resuscitation and endovascular techniques and revival of older strategies, to challenges of definitive treatment. It also takes a closer look into pelvic fractures of the elderly and their most recent treatment options. SUMMARY:Bleeding management in pelvic trauma begins prehospitally with targeted transportation, infusion of crystalloids and blood products, and a differentiated use of pelvic binders. In the emergency department, care involves rapid evaluation, massive transfusion protocols and computed tomography (CT) angiography. Resuscitative Endovascular Balloon Occlusion of the Aorta can serve as bridging to diagnostics and bleeding control. Bleeding control management includes mechanical stabilization, preperitoneal pelvic packing or angioembolization. In elderly patients, rigid vessels and anticoagulation contribute to bleeding complications. Selective CT angiography is advised for certain injury patterns and haemodynamic instability. Depending on bleeding localization, selective angioembolization is preferred.

Background Noncompressible truncal hemorrhage is a major contributor to preventable deaths in trauma patients and, despite advances in emergency care, still poses a big challenge. Objectives This study aimed to assess the clinical efficacy of trauma resuscitation care incorporating Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) compared to standard care for managing uncontrolled torso or lower body hemorrhage. Methods This study utilized a target trial design with a matched case-control methodology, emulating randomized 1 : 1 allocation for patients receiving trauma resuscitation care with or without the use of REBOA. The study was conducted at a high-volume trauma center in Southern Austria, including trauma patients treated between January 2019 and October 2023, aged 16 and above, with suspected severe non-compressible torso hemorrhage. The primary outcome was 30-day in-hospital mortality. Secondary outcomes were in-hospital mortality rates at 3, 6, 24 h, and 90 days, need for damage control procedures, time to these procedures, computed tomography (CT) scan rates during resuscitation, complications, length of intensive care and in-hospital stay, and causes of death. Results Median age was 55 [interquartile range (IQR) 42-64] years. Median total injury severity, assessed by Injury Severity Score, was 46.5 (IQR: 43-57). There was no significant difference in 30-day in-hospital mortality between groups [9/22 (41%) vs. 9/22 (41%), odds ratio: 1.00, 95% confidence interval (CI): 0.3-3.36, P > 0.999]. Lower mortality rates within 3, 6, and 24 h were observed in the REBOA group; in a Cox proportional hazards model, hazard ratio (95% CI) for mortality in the REBOA group was 0.87 (0.35-2.15). Timing to damage control procedures did not significantly differ between groups, although patients in the REBOA group underwent significantly more CT scans. Bleeding was cited as the main cause of death less frequently in the REBOA group. Conclusion In severely injured patients presenting with possible major non-compressible torso hemorrhage, a systematically implemented resuscitation strategy including REBOA during the initial hospital phase, is not associated with significant changes in mortality.

Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) may be useful in treating exsanguinating trauma patients. This study seeks to compare rates of success, complications and time required for vascular access between ultrasound-guidance and surgical cut-down for femoral sheath insertion as a prospective observational case control study. Participating clinicians from either trauma surgery or anesthesiology were allocated to surgical cut-down or percutaneous ultrasound-guided puncture on a 1:1 ratio. Time spans to vessel identification, successful puncture, and balloon inflation were recorded. 80 study participants were recruited and allocated to 40 open cut-down approaches and 40 percutaneous ultrasound-guided approaches. REBOA catheter placement was successful in 18/40 cases (45%) using a percutaneous ultrasound guided technique and 33/40 times (83%) using the open cut-down approach (p < 0.001). Median times [in seconds] compared between percutaneous ultrasound-guided puncture and surgical cut-down were 36 (18–73) versus 117(56–213) for vessel visualization (p < 0.001), 136 (97–175) versus 183 (156–219) for vessel puncture (p < 0.001), and 375 (240–600) versus 288 (244–379) for balloon inflation (p = 0.08) overall. Access to femoral vessels for REBOA catheter placement is safer when performed by cut-down and direct visualization but can be performed faster by an ultrasound-guided technique when vessels can be identified clearly and rapidly.

Combined injuries of the pelvic ring and the acetabulum are uncommon. Acute treatment should follow common protocols (ATLS e.g.) for pelvic ring injuries, although mechanical stabilization using pelvic binders or external fixators might be insufficient or even worsen the reduction in some combined fracture patterns. In case of mechanically connected acetabular and pelvic ring injury (MCAPI), surgical treatment might be demanding in lack of clear recommendations concerning the reduction and fixation sequence. A "pelvic ring first" sequence may be the best choice for most MCAPIs, starting with sacrum or SI-joint and symphysis pubis. An "acetabulum first" sequence should be considered in relatively stable posterior ring injuries and acetabulum fractures in younger patients, where a perfect anatomical reduction is feasible. Definitive surgical treatment should be performed as soon as possible depending on concomitant injuries, ideally within 3-7 days. Mechanical understanding of the combined fracture pattern and accurate planning are mandatory for surgical repair.

Background This study aimed at analysing risk factors for development of acute compartment syndrome (ACS) in tibial plateau fractures, and to construct a nomogram predicting ACS-risk. Patients and Methods 243 patients (102 males; mean age: 50.7 [range: 18-85] years) with 253 tibial plateau fractures treated between 2010 and 2019 at a level-1 trauma centre were retrospectively included. Uni- and multivariate logistic regression analysis with odds ratios (OR) were performed to assess variables predicting ACS. Based on the multivariate model, ROC curve, Youden index, and nomogram were constructed. Results ACS developed in 23 patients (9.1%), with risk factors being male gender (OR: 10.606; p<0.001), BMI (OR: 1.084; p = 0.048), polytrauma (OR: 4.085; p = 0.003), and Schatzker type IV-VI fractures (OR: 6.325; p = 0.004). Age, ASA score, diabetes, renal insufficiency, hypertension, smoking or open fracture were not significantly associated with ACS-risk (all p>0.05). In the multivariate analysis, male gender (OR: 7.392; p = 0.002), and Schatzker type IV-VI fractures (OR: 5.533; p = 0.009) remained independent negative ACS-predictors, irrespective of polytrauma (p = 0.081), or BMI (p = 0.194). Area under the ROC curve was 0.840. Youden index revealed a cut-off value of ≥ 18%, upon which patients are at extremely high risk for ACS. Conclusions Particular attention should be paid to male patients with high-energy fractures of the tibial plateau towards any signs of ACS of the affected extremity to initiate early treatment. The compiled nomogram, consisting of four easily quantifiable clinical variables, may be used in clinical practice to individually predict ACS risk. Any risk score ≥ 18% should prompt critical monitoring towards ACS, or even prophylactic fasciotomy during primary surgery.

Introduction Traumatic brain injury (TBI) remains a leading cause of hospital admission and mortality, intracranial hemorrhage (ICH) presents a severe complication. Low complication tolerance in developed countries and risk uncertainty, often cause excessive observation, diagnostics and hospitalization, considered unnecessary and expensive. Risk factors predicting ICH, progression and death in patients hospitalized with mild TBI have not been identified yet. Methods Mild TBI cases indicated for cranial computer tomography (CT) and hospitalization, according to international guidelines, at our Level I Trauma Center between 2008 and 2018 were retrospectively included. Multivariate logistic regression was performed for ICH, progression and mortality predictors. Results 1788 mild TBI adults (female: 44.3%; age at trauma: 58.0 ± 22.7), were included. Skull fracture was diagnosed in 13.8%, ICH in 46.9%, ICH progression in 10.6%. In patients < 35 years with mild TBI, chronic alcohol consumption ( p = 0.004) and skull fracture ( p < 0.001) were significant ICH risk factors, whilst in patients between 35 and 65 years, chronic alcohol consumption ( p < 0.001) and skull fracture ( p < 0.001) revealed as significant ICH predictors. In patients with mild TBI > 65 years, age ( p = 0.009), anticoagulation ( p = 0.007) and neurocranial fracture ( p < 0.001) were significant, independent risk factors for ICH, whilst increased age ( p = 0.01) was a risk factor for mortality following ICH in mild TBI. Late-onset ICH only occurred in mild TBI cases with at least two of these risk factors: age > 65, anticoagulation, neurocranial fracture. Overall hospitalization could have been reduced by 15.8% via newly identified low-risk cases. Conclusions Age, skull fracture and chronic alcohol abuse require vigilant observation. Repeated CT in initially ICH negative cases should only be considered in newly identified high-risk patients. Non-ICH cases aged < 65 years do not gain safety from observation or hospitalization. Recommendations from our data might, without impact on patient safety, reduce costs by unnecessary hospitalization and diagnostics.

Fragestellung Das Schädel-Hirn-Trauma (SHT) des geriatrischen Patienten wird sich in den kommenden Jahren, aufgrund der demographischen Entwicklung in Europa zu einer der größten Herausforderungen für die Traumatologie entwickeln. Gleichzeitig steigt die Inzidenz an Patienten mit gerinnungsaktiven Substanzen. Ziel der Studie war es herauszufinden, ob die Einnahme gerinnungsaktiver Substanzen das Risiko ein schweres SHT zu erleiden erhöht.

Fragestellung Ziel der Studie war es, den Kreuzungspunkt der Arteria radialis und dem Zugangsweg zum volaren Radius nach Henry zu evaluieren.

The purpose of this study was to assess anticoagulant medication as an independent factor influencing the occurrence of a severe traumatic brain injury in geriatric patients. Data were collected from the TraumaRegister DGU® between January 2015 and December 2018. We included patients with an age of ≥65 years with a blunt TBI; an AISHead ≥2 but no other relevant injuries. Patients were divided into five subgroups: no anticoagulant medication, anti-platelet drugs, vitamin K antagonists, direct-oral-anticoagulants, and heparinoids. Separation between moderate TBI (AISHead 2–3) and severe TBI (AISHead ≥ 4) and multivariable regression analysis were performed. The average age of 10,559 included patients was 78.8 years with a mean ISS of 16.8 points and a mortality of 22.9%. The most common cause of injury was a low fall of <3 m with 72.8%. With increasing age, the number of patients without any anticoagulant therapy decreased from 65.9% to 29.9%. The intake of coagulation medication increased mortality significantly. Severe TBI was observed in 51% of patients without medication and ranged from 61 to 67% with anticoagulant drugs. After adjusting for confounding variables, the intake of VKA or DOACs was significantly associated with an increased risk of severe TBI. The use of anticoagulant medication is an independent factor and is associated with an increased severity of TBI depending on the type of medication used.

Fragestellung Schädel-Hirn-Traumata (SHT) sind eine der Hauptursachen für Krankenhauseinweisungen und Mortalität bei Trauma-Patienten. Intrakranielle Blutungen (IKB) stellen eine Komplikation nach SHT dar, besonders in älteren Pateinten besteht dann auch ein erhöhtes Mortalitätsrisiko. Niedrige Komplikationstoleranz in der öffentlichen Wahrnehmung und unklare Risikoeinschätzung führt bei leichtem SHT häufig zu exzessiver Diagnostik und Hospitalisation, welche unnötig und kostspielig ist. Studienziel war die Identifikation von Risikofaktoren für IKB, Voranschreiten der Blutung und Mortalität von Pateinten mit leichtem SHT (1) zur Verbesserung der Risikoeinschätzung und (2) Identifikation von niedrig-Risiko-Gruppen, in welchen eine exzessive Abklärung kontraindiziert scheint.

The aim of this study was to investigate the intersection point of the radial artery (RA) with Henry's approach. Ninety forearms from adult human cadavers which had been embalmed using Thiel's method underwent dissection. Henry's approach was performed alongside the whole length of the forearm, and the RAs course was investigated. Its crossing point with the approach was identified, and the distance from this point to the radial styloid process was determined. In addition, the total radial length (RL) was measured from the radial styloid process to the proximal margin of the radial head. The former measurements were analyzed as proportions with regard to the total RLs. Concerning right radii, the intersection point was, on average, at a proportion of 56.2% of the radius, starting from the tip of the radial styloid process. In left radii, this was located at a mean proportion of 61.2%. In cases of multiply fractured radii, care must be taken at the interval between 40% and 80% to avoid RA lesions during dissection from distal to proximal. Clin. Anat., 33:983–987, 2020. © 2019 Wiley Periodicals, Inc.