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ABSTRACTS

Abstracts

European Congress of Trauma and Emergency Surgery

April 24–26, 2016

Vienna, Austria

Congress President

Prof. Dr. Richard Kdolsky

Vienna, Austria

123

Eur J Trauma Emerg Surg (2016) 42 (Suppl 2):S9–S245

DOI 10.1007/s00068-016-0658-5

European Journal of Trauma and Emergency Surgery

Ofﬁcial Publication of the European Society for Trauma and Emergency Surgery

Abstracts for the 17

European Congress of Trauma and Emergency Surgery

April, 24–26, 2016

Vienna, Austria

Organized by

European Society for Trauma & Emergency Surgery

Austrian Trauma Society

Contents

12 Oral Presentations

110 Posters

231 Author Index

S10

123

Dear Colleagues, dear Friends,

It is a great honor to welcome you to the 17

European Congress of Trauma and Emergency Surgery from April 24–26,

2016 in Vienna, Austria.

‘‘Myths & Truths’’

is the leading theme of this congress.

Colleagues of all national ESTES member societies in Europe as well as from other continents will share their knowledge

and experience during these three days.

Instructional lecture courses, keynote sessions, mini-battles, case presentations and poster sessions will present the state of

the art in emergency and trauma surgery. Distinguished speakers will share their personal experiences in invited lectures at

noon.

Also, in order to intensify the cooperation and understanding within the ESTES community we have prepared several

sessions involving more than one section, e.g.

•Mangled extremity in war, disaster and civil

•Interface between trauma and emergencies

•Cross border rescue

•Interface: prehospital & inhospital

•Nightmare session

…and many more

For the ﬁrst time, an EBSQ trauma exam will be held in Vienna on April, 23rd, 2016.

Furthermore, a Modular Ultra Sound Estes Course (MUSEC) will be offered.

The 17th European congress of Trauma and Emergency Surgery (ECTES) is organised by the European Society for

Trauma and Emergency Surgery (ESTES) in close cooperation with the Austrian Trauma Society.

Vienna – I am sure you know our keywords like Scho

¨nbrunn, Mozart, Apfelstrudel and the Opera. But, you may be certain,

Vienna offers much more and will fascinate you with culture, lifestyle, hundreds of restaurants and lovely places to relax.

‘‘Vienna waits for you’’ – as Billy Joel sang in 1977…

I am glad to be a part of this congress and it will be my pleasure to welcome you to my hometown Vienna!

Prof. Dr. Richard Kdolsky

Congress president

S11

123

Oral Presentations

SPORTS MEDICINE – UPPER EXTREMITY

O001

INJURIES OF THE UPPER EXTREMITY AND PREVENTION

IN EQUINE RELATED SPORTS

M. Bielefeld

, C. Schro¨ter

, A. Schulte-Sutum

, D. Bielefeld

P. Mommsen

, C. Krettek

, C. Zeckey

Unfallchirurgie, Medizinische Hochschule Hannover, Hannover,

Germany,

Medizinische Hochschule Hannover, Hannover, Germany

Introduction: Equine related sports are very popular. In this present

study patients, hurt by horses or during riding, were analysed, to gain

knowledge of injury patterns, mechanisms, circumstances and to

identify groups of risk.

Material and methods: 667 patients injured by horses since 2006,

were analysed regarding epidemiology, initial fettle, based on GCS

and the injury severity, based on the ISS. All injuries were catego-

rized, based on AO classiﬁcations, treatment duration and information

about intensive care. To obtain information about the accident,

patients were surveyed.

Results: Average age was 25 (std.dev. 6 years) and 90 % were

female. 72 % were injured while riding, with an average ISS of 5.7.

33 % suffered from injuries of the upper extremity. 51 % were con-

tusions, mostly affecting hands and shoulder, followed by fractures

with 41 %. 48 % of the upperarm fractures occured distal and were

simple without joint involvement. 70 % of the forearm fractures

occured distal, involving the wrist in 30 % of the cases. 68 % of the

patients wore a helmet. Accidents at courtyards had an average ISS of

10. The average ISS in riding halls was 5.7 and 6.6 on outside courts.

35 % of the accidents occured during jumping. While handling the

horse 79 % wore no protection.

Conclusion: Riders jumping in riding halls bear the highest risk of

getting injured. Handling and riding injuries are equally severe,

although fewer persons wear protection when handling their horse.

Therefore wearing protection at all time is mandatory. Riders need to

be well trained in falling techniques in order to prevent injuries of the

upper extremity.

References: Niedersa

¨chsisches Landesamt fu

¨r Statistik (2006) Die

beliebtesten Sportarten in Niedersachsen. Statistische Monatshefte

Niedersachsen, 10/2006. Busch M, Schro

¨ter C, Schulte-Sutum A,

Bielefeld D, Mommsen P, Krettek C, Zeckey C (2015) Injuries of the

upper extremity and prevention in equine related sports.

Disclosure: No signiﬁcant relationships.

O002

‘‘THE LABRALBRIDGE’’ – A NOVEL TECHNIQUE FOR

ARTHROSCOPIC ANATOMIC KNOTLESS BANKART

REPAIR

R.C. Ostermann

, M. Hofbauer

, P. Platzer

Trauma Surgery, Medical University of Vienna, Vienna, Austria,

Department of Trauma Surgery, Medical University of Vienna,

Vienna, Austria

Introduction: Arthroscopic Bankart repair is widely considered a

mainstay for surgical treatment of anterior shoulder instability.

Traditionally, the displaced capsulolabral complex is restored and

ﬁrmly attached to the glenoid by placing multiple suture anchors

individually from a 5 to 3 o’clock position. Different techniques

utilizing different anchors and materials have been described. How-

ever, these techniques result in a concentrated point load of the

reduced labrum to the glenoid at each suture anchor. Thus, the

remaining tissue between the suture anchors is not ﬁrmly attached to

the bone.

Material and methods: The following technique, developed by the

ﬁrst author, describes a method using the 1.5 mm LabralTape

(Arthrex) in combination with knotless suture anchors (3.5 mm PEEK

PushLock anchors; Arthrex) for hybrid ﬁxation of the labrum. The

LabralTape is utilized to secure the torn labrum to the glenoid

between each suture anchor creating some kind of seal, thus poten-

tially providing a more even pressure distribution.

Results: This technique avoids the direct labral ﬁxation in a hori-

zontal way, thus potentially preventing from interruption of the blood

supply to the labrum and capsule, since the supplying vessels in that

area are running vertical to the rim of the glenoid.

Conclusion: Since tissue to bone healing is what one wants to

achieve, one could expect that this is achieved to a superior grade, if

the tissue was attached to the bone over a larger total length. Since no

suture material is running perpendicular to the newly created capsu-

lolabral bump, the suction cup effect of the labrum might be less

compromised.

References:

Disclosure: Medical advisor for Arthrex

O003

CLINICAL OUTCOME AND PAIN RELIEF AFTER

ARTHROSCOPIC REPAIR OF ISOLATED TYPE II SLAP

LESIONS – THE PROGRESS OVER TIME

S. Bo¨smu¨ller

, T.M. Tiefenboeck

, M. Hofbauer

, A. Bukaty

G. Oberleitner

, W. Huf

, C. Fialka

Trauma Surgery, Medical University of Vienna, Vienna, Austria,

Division of General Anaesthesia and Intensive Care Medicine,

Medical University of Vienna, Vienna, Austria,

University Hospital

St. Poelten, St. Poelten, Austria,

Center For Medical Physics and

Biomedical Engineering, Medical University of Vienna, Vienna,

Austria,

AUVA Trauma Center Meidling, Vienna, Austria

Introduction: Recent literature provides only few prospective studies

addressing the pain component when performing SLAP repairs,

although it is well known that patients complain of pain especially

after reﬁxation of the biceps tendon anchor. The aim was to

prospectively evaluate the chronological sequence of function and

pain after arthroscopic isolated type II SLAP repair.

Material and methods: Outcome measures were assessed using the

Individual Relative Constant Score (CS

indiv

), the American Shoulder

and Elbow Surgeons (ASES) Score, the Visual Analogue Scale

(VAS), and the Short Form 36 (SF-36). Data was collected preoper-

atively as well as 3, 6, 12 and [24 months postoperatively.

Results: Twelve patients with an average age of 33.9 years (range

22.8 to 56.6 years) underwent arthroscopic repair of isolated type II

SLAP lesions. The mean follow-up was 41.9 months (range 36.1 to

48.4 months). Six months after surgery, there was a statistically sig-

niﬁcant improvement of function according to the

indiv

(p =0.004), the ASES Score (p =0.006), and the SF-36

subscale ‘‘physical functioning’’ (p =0.014) and a statistically sig-

niﬁcant decrease of pain according to the VAS (p =0.007) and the

S12

123

SF-36 subscale ‘‘bodily pain’’ (p =0.022) compared to preoperative

levels.

Conclusion: Arthroscopic repair of isolated type II SLAP lesions

utilizing suture anchors leads to a satisfactory functional outcome and

return to pre-injury sports levels. Although this satisfying result is not

reached immediately after surgery, there is a signiﬁcant increase of

function and decrease of pain at six months after surgery. Thus,

6 months after surgery seems to be an appropriate time point for

returning to sports.

References: Andrews JR, Carson WG, Jr., McLeod WD. Glenoid

labrum tears related to the long head of the biceps. Am J Sports Med

1985;13-5:337-41. Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD,

Friedman MJ. SLAP lesions of the shoulder. Arthroscopy 1990;6-

4:274-9. Snyder SJ, Banas MP, Karzel RP. An analysis of 140 inju-

ries to the superior glenoid labrum. J Shoulder Elbow Surg 1995;4-

4:243-8. Provencher MT, McCormick F, Dewing C, McIntire S,

Solomon D. A prospective analysis of 179 type 2 superior labrum

anterior and posterior repairs: outcomes and factors associated with

success and failure. Am J Sports Med 2013;41-4:880-6.

Disclosure: No signiﬁcant relationships.

O004

PLATE FIXATION VERSUS NONOPERATIVE TREATMENT

FOR DISPLACED MIDSHAFT CLAVICULAR FRACTURES:

A RANDOMIZED CONTROLLED TRIAL

S. Woltz

, S.A. Stegeman

, P. Krijnen

, B.A. Van Dijkman

T.P.h. Van Thiel

, N.W.l. Schep

, P.A. De Rijcke

, J.P.M. Fro¨lke

I.B. Schipper

Surgery Traumatology, Leiden University Medical Center, Leiden,

The Netherlands,

Leiden University Medical Center, Leiden, The

Netherlands,

Flevoziekenhuis, Almere, The Netherlands,

Koningin

Beatrix Ziekenhuis, Winterswijk, The Netherlands,

Amsterdam

Medical Center, Amsterdam, The Netherlands,

IJselland Ziekenhuis,

Capelle a/d IIssel, The Netherlands,

Radboud University Medical

Center, Nijmegen, The Netherlands

Introduction: It is still debated whether adult patients with a dis-

placed clavicular fracture are better off with operative treatment. The

aim of this study was to compare patient outcomes and complications

of nonoperative treatment versus plate ﬁxation for displaced, midshaft

clavicular fractures.

Material and methods: In this multicenter, prospective, randomized

controlled trial, patients between eighteen and sixty years old with a

fully displaced, midshaft clavicular fracture were randomized

between nonoperative treatment and open reduction with internal

plate ﬁxation. The outcomes; nonunion, secondary operations, com-

plications, arm function, pain, and quality of life, were recorded at

two and six weeks, three months and one year.

Results: One hundred and sixty patients were randomized. The inci-

dence of nonunion was higher in the nonoperative group (2.4 % vs

21.4 %, p \0.0001), as was the incidence of symptomatic nonunion

(1.2 % vs 12.9 %, p =0.006). After one year, the secondary operation

rate due to complications was 10.7 % in the operative group (27.4 %

including plate removal operations), and 17.1 % in the nonoperative

group. Constant scores did not differ between groups. Shortly after injury,

DASH-scores and physical quality of life scores were better in the

operative group, but these differences ceased to exist beyond six weeks.

Conclusion: Plate ﬁxation signiﬁcantly reduces the incidence of

(symptomatic) nonunion, but imposes a considerable risk of compli-

cations necessitating a reoperation. Plate ﬁxation does not result in a

long term better functional outcome. Nonoperative treatment is a

good option in many patients, whereas early operative treatment can

offer advantages for patients who have physical demands shortly post-

operative or have high pain scores.

References: Stegeman, S.A., et al., Displaced midshaft fractures of

the clavicle: non-operative treatment versus plate ﬁxation (Sleutel-

TRIAL). A multicentre randomised controlled trial. BMC Muscu-

loskelet Disord, 2011. 12:196.

Disclosure: No signiﬁcant relationships.

O005

MINIMAL INVASIVE PLATE OSTEOSYNTHESIS IN

MIDSHAFT CLAVICULAR FRACTURES

P. Kornherr

, K. Wenda

Traumatology, Helios Dr Horst Schmidt Kiniken, Wiesbaden,

Germany,

Helios Dr Horst Schmidt Kiniken, Wiesbaden, Germany

Introduction: From September 2009 on, we treated 121 patients with

clavicular fractures. 85 cases were midshaft clavicular fractures.

Operations were performed in a minimal invasive approach using a

locking plate osteosynthesis. Indication for plate osteosynthesis were

clavicular fractures B1 and higher (AO-Classiﬁcation). This study

evaluates the clinical and radiographic outcome of midshaft clavicular

fractures treated by minimal invasive plate osteosynthesis.

Material and methods: Operation was performed with the patient

lying on a radiolucent operating table in a supine position. For

osteosynthesis we used an anatomical shaped (s-shaped) locking

plate. Reposition of fracture was achieved with the plate attached to

the lateral fragment. The locking plate was positioned lateral-superior

and medial-anterior. All patients were reexamined after one year with

radiographs and functional tests like DASH- and Constant-Score.

Results: All examined cases showed consolidation after one year

except four of them who acquired revision because of cutting out of

the lateral screws in the early postoperative time. In two cases we had

to perform open reposition because adequate reposition could not be

achieved with closed reposition. All patients had a good functional

outcome in DASH- and Constant Score.

Conclusion: Minimal invasive plate osteosynthesis (MIPO) of mid-

shaft clavicular fractures shows to be an effective treatment with a

good functional as well as cosmetic outcome. An approximate repo-

sition of fracture can already be achieved with the patient lying in

supine position. This facilitates the ﬁnal reposition via the minimal

invasive approach. Cosmetic results were better than after conven-

tional approach.

References:

Disclosure: No signiﬁcant relationships.

O006

RAPID PROTOTYPING IN CLAVICLE FRACTURES

REPAIR: CLINICAL STUDY

R.F.m. Van Doremalen

, J.J. Kootstra

, S.H. Van Helden

E.E.g. Hekman

Traumasurgery, Isala, Zwolle, The Netherlands,

Traumasurgery,

Isala Diaconessenhuis, Meppel, The Netherlands,

Biomechanical

Engineering, University of Twente, Enschede, The Netherlands

S13

123

Introduction: During open reduction and internal ﬁxation of a mid-

shaft clavicle fracture it is not uncommon that the osteosynthesis plate

has to be bent perioperatively to ﬁt the curvature of the clavicle. This

takes time and is suboptimal in the sterile environment. To avoid the

need for bending the plate we developed a method where the plate is

preoperatively bent according the curvature of a plastic replica of the

fractured clavicle, created using rapid prototyping. The aim of this

study was to test this method. The hypothesis was that this will

shorten plate handling time and improve surgical workﬂow.

Material and methods: A non-blinded, prospective cohort study was

performed. The control group received conventional operative treat-

ment using standard precontoured clavicle locking plates. The

intervention group received operative treatment by means of descri-

bed method. In both groups four speciﬁc proceedings were timed.

Results: Eight subjects were included in the control group and seven

in the intervention group. A plate handling time reduction of 2:04

minutes (p:0.563) was measured, however this time reduction was

associated with a lengthened average surgery time of 9:22 minutes

(p:0.132). A good integration of the method in the workﬂow of the

surgical team was accomplished.

Conclusion: It is possible to implement this rapid prototyping method

in fracture treatment. No signiﬁcant time reduction can be stated,

however the concept of having a preoperatively contoured plate

available is dearly appreciated by the surgeons. The method would be

more valuable with more complex fracture types.

References: [1] Brown GA, Firoozbakhsh K, DeCoster TA, Reyna JR

Jr, Moneim M., Rapid prototyping: the future of trauma surgery?

J Bone Joint Surg Am. 2003;85-A Suppl 4:49-55. [2] Chung KJ, et al.,

Preshaping plates for minimally invasive ﬁxation of calcaneal frac-

tures using a realsize 3D-printed model as a preoperative and

intraoperative tool. Foot Ankle Int. 2014 Nov;35(11):1231-6. [3]

Jeong HS, Park KJ, Kil KM, Chong S, Eun HJ, Lee TS, Lee JP.,

Minimally invasive plate osteosynthesis using 3D printing for shaft

fractures of clavicles: technical note. Arch Orthop Trauma Surg. 2014

Nov;134(11):1551-5.

Disclosure: No signiﬁcant relationships.

EDUCATION AND TRAINING

O007

REMOTE SURGICAL EDUCATION - CAN SURGICAL

SKILLS BE TAUGHT REMOTELY?

W. English, V. Buckle, O. Trampleasure, A. Jawad, S. Ahmed

Royal London Hospital, Virtual Medics, London, UK

Introduction: Virtual medics is a not for proﬁt organisation that is a

world leader in the ﬁeld of innovating medical and surgical education.

We have developed a programme - ROSE - remote online surgical

education. As a preliminary study we taught a group of students how

to tie and hand reef knot using either face to face or virtual teaching

and then assessed them.

Material and methods: 20 ﬁrst year medical students with no pre-

vious exposure/experience in suturing were enrolled. They were

randomly allocated to one of two group - Pott or Blizzard. The virtual

teaching was a high quality teaching video of the stitch. The Pott

group received only face-to-face teaching for 15 minutes. The Bliz-

zard group received only virtual teaching for 15 minutes. Both groups

were then assessed immediately after, at one week, two weeks and

one month. The Blizzard group had access to the online teaching

materials for the follow up period while the Pott group did not.

Results: The Pott group (face-to-face) all 10 received 100 % on

initial assessment. The Blizzard group (virtual) 2/10 got 50 % and

1/10 got 25 %, 7/10 got 100 % on initial assessment. Follow up

assessment is still pending but we expect a high rate of retention for

those with access to online videos compared to just face-to-face

teaching.

Conclusion: Remote teaching of surgical skills leads to a good

appreciation of technique with good assessment results. We expect

those with access to online resources to have greater retention of skills

compared to face-to-face teaching. More studies are needed.

References:

Disclosure: No signiﬁcant relationships.

O008

SEVERITY, SOCIAL AND EDUCATIONAL PROFILE OF

THE CAREGIVER AND THE CHILD VICTIM OF

UNINTENTIONAL TRAUMA INJURIES. A STUDY

CONDUCTED BY NGO CRIANc¸A SEGURA - SAFE KIDS

BRAZIL

S.C.V. Abib

, A.M. Franc¸o´ia

, R. Waksman

, M.I. Dolci

H.P. Guimara˜es

, F. Moreira

, M. Cezillo

, A.M.G. Ju´nior

Surgery, Federal University of Sa

˜o Paulo, Sa

˜o Paulo, Brazil,

Research, NOG Crianc¸a Segura - Safe Kids Brazil, Sa

˜o Paulo,

Brazil,

Department of Childhood Safety, Brazilian Pediatric Society,

˜o Paulo, Brazil,

Brazilian Consumer Law Association,

PROTESTE, Sa

˜o Paulo, Brazil,

Teaching and Simulation Center,

HCor (CETES-HCor), Sa

˜o Paulo, Brazil,

Statistics, Statistics, Sa

˜o

Paulo, Brazil

Introduction: Safe Kids Brazil, the Pediatric Brazilian Society and

PROTESTE joined to elaborate a questionnaire about non intentional

pediatric injuries, to build a permanent pediatric trauma data bank to

evaluate the social and educational proﬁle of parents and children

with non intentional injuries; its severity and risk factors and the use

and knowledge about prevention.

Material and methods: 4 month observational prospective study

conducted in ﬁve hospitals in the city of Sa

˜o Paulo.

Results: 916 cases in 4 months.

Parents: 83.5 % female, 33.4 years, median schooling (39.6 %) and

income (\R$1244.00) in 57.3 %.

Children: 61.5 % male, 6.4 years; 36 % (1-4 years) and 31 % (5-

9 years); 26.9 % (out of school); peripheric regions (58 %). Incidence

was higher on Sundays. Child’s home (42 %). Alone at the moment

the accident (18.9 %). 59.8 % of parents believe that the accident

could be prevented. Accident types: falls 48.4 %; bicycle/sport

accidents 14.5 %; choking/foreign bodies-7.6 %; pedestrian/colli-

sions-5.9 %. Severity: child age (p \0.001), parent age (p \0.001),

falls (p \0.001), sports (p \0.001), foreign bodies (p =0.043),

pedestrian (p =0.006), penetrating wounds (p =0.018), poisoning

(p =0.005), male parent (p \0.001), child schooling (p \0.001),

central housing (p =0.003).

Conclusion: Most injured children live in peripheric regions, are

male and have 6.4 years of age. A great part of the accidents occurred

inside the child home, but also at school and on the street. Parents

proﬁle is female, aged from 26 to 44 years, medium schooling and

low family wage. Severity criteria were observed in 8.5 % and was

related to falls, sport and bicycle accidents, pedestrian, child

schooling (p =0.015) and male parent. Simple actions could have

prevented such accidents.

S14

123

References: DATASUS: Database of the Uniﬁed Health System.

Brasilia, Ministry of Health, Department of SUS Informatics

(http://w3.datasus.gov.br/datasus/datasus.php, accessed 20th June

2014) Peden M, Oyegbite K, Ozanne-Smith J, Hyder A, Branche C,

Rahman, Rivara F, Bartolomeos K. World Health Organization:

World report on child injury prevention. ISBN 978 92 4 156357 4

(NLM classiﬁ cation: WA 250) World Health Organization 2008.

Grabowski J, Simmons J, Eichelberger M. Preventing Unintentional

Pediatric Injuries at Evacuation Centers. J Trauma 2009;67: S94–

S95. Chandran A, Hyder A, Peek-Asa C. The Global Burden of

Unintentional Injuries and an Agenda for Progress. Epidemiol

Rev 2010;32:110–120.

Disclosure: No signiﬁcant relationships.

O009

CAN WE BALANCE SERVICE PROVISION AND

EMERGENCY GENERAL SURGICAL TRAINING?

A TRAINEES’ PERSPECTIVE

V. Shatkar, P. Leung, D. Mukherjee

Department of Surgery, Queen’s Hospital, Romford, London, UK

Introduction: Emergency general surgery is an upcoming sub-spe-

cialty and training the future specialists can be challenging. A balance

between service provision and training is vital in achieving this goal.

This study is aimed at evaluating emergency surgical training, from a

trainee perspective.

Material and methods: This study was conducted in a busy teaching

Hospital in London, UK. Trainees at different levels of training in

general surgery were involved in the study. A semi-qualitative

questionnaire was used anonymously to explore training issues in

emergency general surgery. Data was collected and a thematic anal-

ysis was done to evaluate the results.

Results: Majority of trainees felt that dedicated surgical assessment

unit and emergency ‘Hot’ clinic, led by a senior surgeon provided

valuable training opportunities. Trainees also felt that a consultant led

emergency surgical theatres, with a dedicated trainee in attendance,

improved emergency general surgery training. A multidisciplinary

team approach (with increased involvement of nurses and allied

professionals) improved service provision, providing more training

opportunities. With protected training sessions, trainees were more

prepared to do on call commitments. Junior trainees found it difﬁcult

to balance service provision with training opportunities, especially

during out-of-hours work.

Conclusion: Dedicated surgical training sessions with senior input

and a departmental setup to deliver training improves emergency

surgical training with high satisfaction rates. More research is needed

to evaluate the speciﬁc surgical procedures and the training processes

to improve surgical training.

References: V. J. Gokani, et al. Deﬁning our destiny: trainee working

group consensus statement on the future of emergency surgery

training in the UK World. J Emerg Surg. 2015; 10: 26.

Disclosure: No signiﬁcant relationships.

O010

THE NEED FOR A CONTINUOUS EDUCATIONAL

PROGRAM: THE RESULTS AFTER 1 YEAR OF CLINICAL

PATHWAY ON ACUTE CALCULUS CHOLECYSTITIS

M. Pisano

, A. Allegri

, M. Ceresoli

, F. Coccolini

, A. Harbi

M. Lotti

, S. Magnone

, R. Manfredi

, G. Montori

, D. Piazzalunga

E. Poiasina

, L. Ansaloni

1st Unit General Surgery Department of Emergency, Papa Giovanni

XXIII, Bergamo, Italy,

Papa Giovanni XXIII Hospital, Bergamo,

Italy

Introduction: Clinical Pathways (CP) have been demonstrated to

improve patient management as well health resources.

Material and methods: the CP, based on EBM, has been developed

according to the Institutional rules. The analysis has been done by

measuring the result indicators provided before the release of the CP.

When comparable, the results were matched to pre-CP observation.

TG13 diagnostic criteria for ACC were used. A questionnaire to test

the acceptance of the CP was administered to surgeons

Results: 134 patients with biliary disease were observed mean age

60.3 yo, 64.4 % males; 65 patients (48.5 %) reached the diagnosis of

ACC: 48 (73.9 %) were admitted at the ﬁrst presentation, 12 were

discharged home but 5 (41.6 %) required a second ED into 72 h and 3

(25 %) were admitted. Among admitted patients (n 51), 29 (57 %)

were operated on at the index admission while the remnant were

discharged home: the 85 % because high risk patients and 15 % for

refusal of the operation. Admission to Surgical Unit correlates with a

higher rate of operation (58.5 %). Among surgical patients we

observed 1 readmission for abdominal pain requiring observation

(IVB Clavien complication). The comparison to pre-CP on ACC

shows signiﬁcant decrease in the rate of delayed operation for patient

admitted to the Surgical Unit, a signiﬁcant decrease in the rate of

controversies among surgeons on preoperative biliary tree clearance

and on surgical timing

Conclusion: Despite some positive results, in our hospital, there is a

strong need for continuous sharing the ACC CP in order to improve

all the aspects of the ACC patient treatment

References: Brooks, Kelli R., et al. ‘‘No need to wait: An analysis of

the timing of cholecystectomy during admission for acute cholecys-

titis using the American College of Surgeons National Surgical

Quality Improvement Program database.’’Journal of Trauma and

Acute Care Surgery 74.1 (2013): 167-174.

Disclosure: No signiﬁcant relationships.

O011

THE TRAINING AND PROVISION OF PERSONAL

PROTECTIVE EQUIPMENT FOR VASCULAR TRAINEES IN

THE UK: A RE-AUDIT INTO IONISING RADIATION

(MEDICAL EXPOSURE) REGULATIONS

C. Dover

, S. Goodyear

S15

123

Trauma and Orthopaedics, University Hospital North Midlands,

Stoke On Trent, UK,

Vascular Surgery, Worcestershire Acute

Hospitals NHS Trust, Worcester, UK

Introduction: The beneﬁts of radiologically-guided interventional

procedures are beyond dispute, but not without risk. There has been

particular concern regarding occupational dose to the lens of the eye.

This study hopes to evaluate the provision of IR(ME)R schooling

amongst vascular trainees, and the availability of personal protective

equipment to those performing endovascular procedures.

Material and methods: Data was gathered via an email survey,

disseminated to all Rouleaux-registered individuals. Have you

received IR(ME)R training? Who provided IRMER training? Do you

have concerns regarding your personal health or safety during IR or

endovascular cases? In 2014, a follow-up questionnaire was per-

formed, which also asked about the availability of personal protective

equipment, including eyewear.

Results: Our research shows that 27.4 % of respondents in the pri-

mary survey had received IR(ME)R accreditation, compared with

36.4 % in the follow-up survey. ‘‘Serious’’ health and safety concerns

were identiﬁed in 58.1 % during the primary survey, compared to a

subsequent 79.5 %, which was signiﬁcant (p =0.0024). Lead coats

were provided by the employer ‘‘often’’ for 72.7 % and thyroid

shields for 54.5 %, whereas protective eyewear was available for only

5.7 %.

Conclusion: These results highlight a considerable lack of compli-

ance with IR(ME)R training among vascular surgical trainees, which

is a departure from existing legislation. Most alarming is the

incomplete provision of PPE for vascular trainees, with the lack of

protective eyewear being a major concern. With the NHS retirement

age now advanced to 68 years and the full scope of national deﬁ-

ciencies in PPE provision unknown, more stringent laws should be

enforced to protect staff and their eyesight.

References:

Disclosure: No signiﬁcant relationships.

O012

QUALITY MANAGEMENT OF ACUTE CARE SURGERY

TRAINING PROGRAM BASED ON PDCA CYCLE

K. Murata

, Y. Otomo

, K. Fushimi

Trauma and Acute Critical Care Medical Center, Tokyo Medical and

Dental University, Tokyo, Japan,

Trauma and Acute Critical Care

Medical Center, Tokyo Medical and Dental University Hospital of

Medicine, Tokyo, Japan,

Quality Management Center, Tokyo

Medical and Dental University, Tokyo, Japan

Introduction: We have no means to evaluate acute care surgery

training program.

Material and methods: Walter A. Shewhart reported that PDCA

cycle is very effective to manage the quality of industrial products.

We have 25 young ACS residents and examined survival rate of

trauma patients who received surgery. and we seek suitable clinical

indicators of education to evaluate and keep our acute care surgery

(ACS) training program based on PDCA cycle.

Results: In surgical trauma patients, total survival rate has no dif-

ference between operators. There was a signiﬁcant difference between

operators, instructors and residents in survival rate of surgical trauma

patients whose probability of survival under 0.5. Instructors saved

100 % of trauma patients, on the other hand, residents saved

0 %(2012), 25.0 %(2013), 42.9 %(2014) of trauma patients.

Conclusion: We try to keep the survival rate of trauma patients

(probability of survival under 0.5) over 0.5 based on PDCA cycle

every year, because it is the important benchmark for residents and

our educational concept. We should monitor speciﬁc clinical indica-

tors to improve our educational performance.

References:

Disclosure: No signiﬁcant relationships.

O013

MASS CATASTROPHE TRAINING IN A CIVIL UNIVERSITY

HOSPITAL, 5 YEARS AFTER START OF POLYTRAUMA

MANAGEMENT

A. Visnakovs

, S. Stabina

, A. Kaminskis

Emergency Department, Riga East Clinical university hospital

Gailezers, Riga, Latvia,

General and Emergency Surgery, Riga East

Clinical university hospital Gailezers, Riga, Latvia

Introduction: Mass casualties can occur in a variety of ways, and

military conﬂicts are considered to be a special type of them. We

present disaster training model designed to conﬁrm the emergency

response of the civil hospital in case of explosion at military bases

located across Latvia with a lot of casualties with severe blast injuries

transferred to the hospital right from the scene.

Material and methods: Training for Mass Casualty in civil univer-

sity hospital.

Results: The legend of training was unknown for Emergency

Department personnel. Totally 28 patients were transferred to Riga

East clinical university hospital Emergency department after explo-

sion in two military bases in Latvia. During the ﬁve hours 21 patient

were delivered with USA military helicopters, 5 patients with military

ambulances of Latvian national armed forces and 2 patients with

Latvian border guard helicopter. All patients were triaged in four

groups: 14 patients had immediate (red) tag, 10 patients with obser-

vation (yellow) tags, 14 patients with wait (green) tags and 2 patients

with non-survivable injury or black tags, 14 of all patients underwent

immediately surgery.

Conclusion: The only way to check the emergency response,

capacity and resources of civil hospital in case of mass casualty is

well-organized and realistic training. Important role in disaster

medicine have the collaboration between military and civilian medics,

communication, pre-hospital care, time of transportation, hospital

readiness and resources.

References:

Disclosure: No signiﬁcant relationships.

O014

BEDSIDE EXTENDED FOCUSED ASSESSMENT

SONOGRAPHY FOR TRAUMA TRAINING FOR

UNDERGRADUATE MEDICAL STUDENTS

F.M. Abu-Zidan

Surgery, College of Medicine, UAE University, Al-Ain, United Arab

Emirates

Introduction: Extended Focused Assessment Sonography for

Trauma (EFAST) is important in evaluating multiple trauma patients.

S16

123

We aim to report our recent experience in bedside teaching of EFAST

for undergraduate medical students.

Material and methods: 101 ﬁfth and sixth year medical students of

the UAE University were trained on performing EFAST on trauma

patients in Al-Ain Hospital during the period of October 2014 to June

2015 by an Acute Care Surgeon having 25-year experience in point-of-

care ultrasound. Bedside Training included a 4-hour round with groups

of 3-6 students each. Training did not affect the patient management,

was performed on stable patients in the ward during the tertiary survey

as an extension of the clinical examination after patients were orally

consented to be examined by the students according to our educational

standards. Training included understanding the basic physics, konbol-

ogy, and artifacts. Students were then trained to perform EFAST on

patients to ﬁnd intra-peritoneal, pleural, and pericardiac ﬂuid; and

pneumothorax in 8 points. An audit structured questionnaire was dis-

tributed to the students after ﬁnishing each session.

Results: The students could quickly grasp the principles of EFAST

and perform it in an efﬁcient organized way in about 5-10 minutes.

Students highly enjoyed the training, thought it should be integrated

in their curriculum, and were enthusiastic in including ultrasound in

their future practice.

Conclusion: Undergraduate medical students can efﬁciently learn

EFAST in the clinical setting which is advised to be included in their

undergraduate curriculum.

References:

Disclosure: No signiﬁcant relationships.

POLITICS

O015

WHY ARE WE SO UNCONSCIOUSLY INSECURE? THE

THREATS PROJECT

R. Faccincani

, M. Carlucci

, G. Monti

, S. Vicini

, C. Morey

M. Massey

, C. Arculeo

, C. Dakin

, R. Dobson

, F. Della Corte

P. Ingrassia

, A. Djalali

, A. Guinet

, I. Ashkenazi

Emergency, Ospedale San Raffaele, Milano, Italy,

Icu, Ospedale

San Raffaele, Milano, Italy,

Iris, Ospedale San Raffaele, Milano,

Italy,

Hanover Associates, London, UK,

Crimedim, Universita

`del

Piemonte Orientale, Novara, Italy,

Disp, INSA de Lyon, Lyon,

France,

HYMC, Hadera, Israel

Introduction: Terrorism against the health sector represents a real

danger. Despite this the perception of the risk and the actions to

increase the resilience of the Health Critical Infrastructures are

lacking. The THREATS Project has the main objective to analyze the

risk, the risk perception and the level of protection of the EU hos-

pitals. Additionally the project aims to develop a set of tools for

conducting risk analysis, evaluating the level of protection and sug-

gesting possible countermeasures.

Material and methods: The ﬁrst 18 months of the project has been

spent analyzing the literature and conducting surveys among the EU

hospital personnel, trying to gain a snapshot the status quo. In the

meanwhile Ospedale San Raffaele, selected as prototype of National

Health Critical Infrastructure, has been studied to assess its risk and

level of protection and to prepare for simulations of terrorist scenarios.

Results: Hospitals are very attractive targets for terrorists. Despite

this protection is far from being adequate. Some of the protection

methodologies implemented by other Critical Infrastructures can

easily be transferred to the Health Sector. OSR processes can be

modeled and the model used for simulate some terrorist

scenarios. Some many scenarios have been selected according with a

risk matrix produced by an internal group of experts. Suggestions

how to increase the hospital protection will hopefully arrive from the

use of a set of tool to risk assess and simulate terrorist scenarios.

Conclusion: THREATS Project suggests a practical way to risk

assess and propose measures to increase the EU hospitals protection

against terrorist attacks.

References: Djalali, A., F. Della Corte, M. Foletti, L. Ragazzoni, A.

Ripoll Gallardo, O. Lupescu, C. Arculeo, G. von Arnim, T. Friedl, M.

Ashkenazi, P. Fischer, B. Hreckovski, A. Khorram-Manesh, R.

Komadina, K. Lechner, C. Patru, F. M. Burkle, Jr., and P. L. Ingras-

sia. 2014. Art of disaster preparedness in European union: a survey on

the health systems. PLoS Curr 6 European Union Terrorism Situation

and Trend Report 2014. European law enforcement agency Ganor B,

and MH Wernli. 2013. Terrorist attacks against hospitals: case stud-

ies. International Institute for Counter-Terrorism Reference manual to

mitigate potential terrorist attacks against buildings. 2011. Federal

Emergency Management Agency

Disclosure: No signiﬁcant relationships.

O016

NARCOTIC OVERPRESCRIBING AND ABUSE

D. Easley, K. Himschoot, S. Kibbe

Medical, White Lattice, Inc, Louisville, USA

Introduction: Narcotic prescriptions are legitimately written for

patients with pain after trauma. In the State of Kentucky the uncon-

trolled use of narcotic prescriptions led to an alarming rise in narcotic

use. Narcotics were also diverted for non-medical use.

Material and methods: To control inappropriate use of narcotics the

State introduced a documentation system - KASPER where all nar-

cotic prescriptions were put in a data base which included patient,

doctor, medication and amount. Physicians were obligated to obtain a

report (KASPER report) prior to prescribing narcotics for patients.

Patterns of inappropriate narcotic prescription writing were detected

by the State and monitored.

Results: The narcotic monitoring system led to a reluctance on the

part of doctors treating injuries to prescribe narcotics outside the

limits mandated by State Law. Short term (month or so) narcotics

were allowed for injuries with drug contracts, narcotics screening

tests and complete examinations required for longer term prescrip-

tions. As narcotics became less available, patients resorted to illegal

drugs including Heroin which was taken nasally or injected. With the

fall in use of medically prescribed narcotics there has been in the

State a concomitant rise in the use of Heroin and the appearance of

HIV and Hepatitis in at-risk patients.

Conclusion: A well meaning attempt to control the use of prescrip-

tion narcotics can have unanticipated late effects. The current plan is

to seek, test, treat and retain at-risk individuals.

References:

Disclosure: No signiﬁcant relationships.

O017

PLASTICS OPERATIVE WORKLOAD IN MAJOR TRAUMA

CENTRES: A NATIONAL PROSPECTIVE SURVEY

K. Young, S.A. Hendrickson, G. Phillips, M.D. Gardiner,

S. Hettiaratchy

S17

123

Major Trauma Centre, St. Mary’s Hospital, Imperial College NHS

Healthcare Trust, London, UK

Introduction: The introduction of the major trauma network in Eng-

land 2012 has resulted in a 63 % improvement in probability of

survival from trauma [1]. However orthoplastic services at major

trauma centers were found to be inadequate by the national peer review

[2]. The impact of the major trauma network on plastic surgery oper-

ative workload has not been quantiﬁed. Such information is essential to

help guide workforce provision and postgraduate training.

Material and methods: A prospective, multicentre study was per-

formed. All major trauma patients, as deﬁned by the Trauma and Audit

Research Network (TARN), presenting to eleven major trauma centers

(MTCs) in England over a set three-month period were identiﬁed.

Operative data were recorded for those requiring plastic surgery.

Results: A total of 2,056 patients were admitted to 11 MTCs within

the study period. 53 % required surgical intervention, of which 242

(22 %) required plastic a surgery procedure. A total of 902 plastic

surgical procedures were performed. Wound debridement accounted

for 27 % and free-ﬂaps for 4 %. The most frequently operated on

body regions were the upper (17 %) and lower (27 %) extremities.

Consultant plastic surgeons performed 26 % of the procedures.

Conclusion: Major trauma is a signiﬁcant yet often unrecognised

aspect of the plastic surgeon’s workload. This data demonstrates that

the plastic surgery skill set is required in this patient population. To

ensure on going quality care, enable workforce planning, and spe-

cialist training needs the important role which plastic surgery plays in

the management of major trauma patients must be acknowledged. On

behalf of POW-MTC collaboration.

References: 1. TARN Press Release. https://www.tarn.ac.uk/Content.

aspx?c=3477. Accessed October 22nd, 2015. 2. National Peer Review

Report: Major Trauma Networks 2013/2014. An overview of the

ﬁndings from the 2013/2014 National Peer Review of Trauma Net-

works in England National Peer Review Programme; 2014.

Disclosure: No signiﬁcant relationships.

O018

PEDIATRIC TRAUMA SCORES – SYSTEMATIC REVIEW

AND NEEDS ASSESSMENT IN LOW-RESOURCE SETTINGS

E. St-Louis

,J.Se´guin

, T. Landry

, D.L. Deckelbaum

, R. Baird

T. Razek

General Surgery, McGill University Health Centre, Montreal, AB,

Canada,

McGill University Health Centre, Montreal, QC, CANADA

Introduction: Trauma is a leading cause of mortality and disability

in children worldwide. The World Health Organization (WHO)

reports that 95 % of all childhood injury deaths occur in Low-Middle

Income Countries (LMIC) (1). Injury scores have been developed to

facilitate trauma stratiﬁcation, clinical decision-making and research.

Trauma registries in LMIC depend on adapted trauma scores that do

not rely on investigations that require unavailable material or human

resources. We sought to review and assess the existing trauma scores

used in pediatric patients. Our objective is to determine their validity,

setting of use, outcome measures and criticisms. We believe there is a

need for further development of a truly adapted trauma score for

pediatric patients in low resource settings.

Material and methods: A systematic review of the literature was

conducted to identify and compare existing injury scores used in

pediatric patients. We constructed a peer-reviewed search strategy in

collaboration with a senior hospital librarian. Multiple databases were

searched, including sources of gray literature. Articles were selected

based on predeﬁned inclusion criteria by 2 reviewers and underwent

qualitative analysis.

Results: All scores identiﬁed are suboptimal for use in Pediatric

patients in low-resource settings based on various factors. An ideal

score should be easy to calculate using point-of care data that is

readily available in resource limited settings, and can be easily

adapted to the speciﬁc physiologic variations of different age groups.

Conclusion: There appears, therefore, to exist a gap in our ability to

simply and reliably estimate injury severity in pediatric patients and

understand their probability of poor outcome

References: 1. Mock C, Abantanga F, Goosen J, Joshipura M, Juil-

lard C. Strengthening care of injured children globally. Bulletin of the

World Health Organization. 2009;87(5):382-9.

Disclosure: No signiﬁcant relationships.

O019

A DECADE OF ADVANCED TRAUMA LIFE SUPPORT

TRAINING IN THE UNITED ARAB EMIRATES: LESSONS

LEARNED

F.M. Abu-Zidan

, S. Gautam

, F. Branicki

Surgery, College of Medicine, UAE University, Al-Ain, United Arab

Emirates,

Surgery, Fujairah Hospital, Fujairah, United Arab

Emirates

Introduction: ATLS is one of the most common courses taught

worldwide. We aim to present the lessons we learned over a decade

from teaching ATLS courses in the United Arab Emirates in educa-

tional, clinical, research, and international collaboration areas.

Material and methods: We have started teaching ATLS in 2004.

More than 2000 doctors have been trained in three centres. More than

85 % were residents and specialists (1). They stand in the ﬁrst line of

managing multiple trauma patients.

Results: Teaching ATLS in UAE was helpful in increasing the

knowledge of our doctors and develop and update their management

plans. It was made obligatory for all doctors who manage trauma

patients in most of our major hospitals to attend this course. Our

ATLS training had a major impact on other countries in our region as

it helped to start ATLS training in Egypt, Syria, India, and Iran.

Furthermore, it helped us to perform high level educational research

and its value using evidence based approach (2).

Conclusion: ATLS courses are very useful for doctors who treat

multiple trauma patients although they may not alone improve trauma

death rates and disability. Our experience supports its use and spread

worldwide.

References: 1. Abu-Zidan FM, Mohammad A, Jamal A, Chetty D,

Gautam SC, van Dyke M, Branicki FJ. Factors affecting success rate

of Advanced Trauma Life Support (ATLS) courses. World J Surg.

2014;38:1405-10. 2. Mohammad A, Branicki F, Abu-Zidan FM.

Educational and clinical impact of Advanced Trauma Life Support

(ATLS) courses: a systematic review. World J Surg. 2014;38:322-9.

Disclosure: No signiﬁcant relationships.

O020

LOSS TO FOLLOW-UP IN ORTHOPAEDIC TRAUMA: FACT

OR FICTION?

B.A. Zelle

, J.S. Somerson

, K.C. Bartush

, J.B. Shroff

, M. Bhandari

S18

123

Orthopaedic Surgery, University of Texas Health Science Center at

San Antonio, San Antonio, TX, USA,

Orthopaedic Surgery,

McMaster University, Hamilton, ON, Canada

Introduction: Patients lost to follow-up (LTFU) contribute to bias in

randomized controlled trials (RCTs). In particular, trauma patients

have been suggested to be at risk for LTFU. The purpose of this study

is to evaluate the LTFU in orthopaedic RCTs. The goal is to identify

risk factors for LTFU. We hypothesize that trials from the orthopaedic

trauma literature have a higher LTFU than other orthopaedic

subspecialties.

Material and methods: A systematic review of orthopaedic RCTs

published from 2008 to 2011 was performed using a hand search of 32

scientiﬁc journals. This included all major orthopaedic journals and

ﬁve leading medical journals. The percentage of LTFU, minimum

follow-up time, orthopaedic subspecialty, publication date, journal

name, country and region of publication, number of enrolled patients,

mean patient age, follow-up strategy and funding type were recorded.

Results: A total of 559 RCTs with 129,370 enrolled subjects were

included in the review. Mean loss to follow-up was 11 %. LTFU in

orthopaedic trauma trials was not signiﬁcantly higher than in other

orthopaedic subspecialties. Studies performed in the United States

had a signiﬁcantly higher rate of LTFU. Studies with a remote follow-

up strategy (telephone or mail) did not show signiﬁcantly better fol-

low-up rates. Minimum follow-up length of three or more years was

signiﬁcantly correlated with greater LTFU.

Conclusion: We reject our hypothesis that RCTs performed in

orthopaedic trauma patients are associated with a higher LTFU than

other orthopaedic subspecialties. Studies performed in the United

States and those with more than three years of minimum follow-up

seem to have signiﬁcantly higher rates of LTFU.

References: 1. Sprague S, Leece P, Bhandari M, et al. Limiting loss

to follow-up in a multicenter randomized trial in orthopedic surgery.

Control Clin Trials. 2003;24:719-725.

2. Zelle BA, Bhandari M, Sanchez AI, et al. Loss of follow-up in

orthopaedic trauma: is 80 % follow-up still acceptable? J Orthop

Trauma. 2013;27:177-181. 3. Somerson JS, Bhandari M, Vaughan

CT, et al. Lack of diversity in orthopaedic trials conducted in the

United States. J Bone Joint Surg Am. 2014;96:e56. 4. Pape H-C, Zelle

B, Lohse R, et al. Evaluation and outcome of patients after poly-

trauma–can patients be recruited for long-term follow-up? Injury.

2006;37:1197-1203.

Disclosure: No signiﬁcant relationships.

O021

THE AUSTRIAN HAND PREVENTION CAMPAIGN

TO AVOID HAND INJURIES

M. Leixnering

, C. Pezzei

, J. Jurkowitsch

, C. Szolarz

S. Quadlbauer

, T. Hausner

Traumatology, AUVA Trauma Hospital Lorenz Bo

¨hler - European

Hand Trauma Center, Vienna, Austria,

AUVA Trauma Hospital

Lorenz Bo

¨hler - European Hand Trauma Center, Vienna, Austria,

Department of Statistics, AUVA Vienna, Vienna, Austria

Introduction: Hand injuries are a frequent occurrence and account in

occupational accidents up to 41 %. The main reasons for hand injuries

are stress, inattention, tiredness and the use of maintained machinery.

So in the last 10 years much affords had been carried out in Europe to

reduce the numbers of hand injuries. In Austria the Austrian Workers

Compensation Board has started in 2014 a prevention campaign to

reduce the numbers of hand injuries during work.

Material and methods: Hand injuries at work had been analysed in

the years 2010 – 2011 in respect of nature of the injury, time of the

injury, sick leave duration, and cause of injury. Furthermore the costs

for each type of hand injury for the AUVA, companies and economy

had been calculated.

Results: At all 632.693 injuries had been treated in hospitals of the

Austrian Workers

´Compensation Board. From these 174.855 involved

hand injuries. Total sick leave of all hand injuries amount in total

474.859 days per year, which means 12.3 days per hand accident. In

26 % of the cases not powered handheld tools, in 25 % (building-)

materials and in 10 % Machines had been the reason for a hand

injury. Hand injuries entail annual costs of 309 Million €years.

Average costs per hand accident was 7.778 €per patient.

Conclusion: Hand injuries are very common and account for up to

41 % of all injuries and they cause annual costs in Austria by 309

Million €. So the last decade much affords have been done to reduce

hand injuries.

References:

Disclosure: No signiﬁcant relationships.

O022

PREVENTION STRATEGIES AND COST ANALYSIS OF

COMPLEX HAND INJURIES

S. Quadlbauer

, C. Pezzei

, J. Jurkowitsch

, C. Szolarz

, T. Hausner

M. Leixnering

Traumatology, AUVA Trauma Hospital Lorenz Bo

¨hler - European

Hand Trauma Center, Vienna, Austria,

Department of Statistics,

AUVA Vienna, Vienna, Austria

Introduction: Complex hand injuries are very rare and occur with an

incidence of 5.74 in 100.00 inhabitants per year. Calculated costs in

the United States are 38.000 $ per patient. Complex hand injuries

often lead to a reduction of hand function and posttraumatic psy-

chological restriction.

Material and methods: All complex hand injuries in the years 2010 -

2011, that had been treated in hospitals of the Austrian Workers’

Compensation Board (AUVA) had been analyzed in respect of the

time of the accident, age, profession and object causing the injury. A

complex hand injury had been deﬁned as an injury with a combination

of at least two injuries: fracture/dislocation fracture, vascular injury,

nerve injury, tendon injury, gunshot injury and amputation.

Results: From 174.855 treated hand injuries 814 (0.5 %) had been

complex hand injuries. Fifth-eight % of all work-related complex hand

injuries had been between 26 and 50 years of age. Forty-two % of the

patients had been in the construction and metalworking industries. The

calculated lifetime costs per complex hand injury were 110.846 €per

case. A combination of three injuries showed in mean signiﬁcant higher

total lifetime costs and sick leave than a combination of two injuries.

Conclusion: Complex hand injuries are very rare with 0.5 % of all

hand injuries. All hand injuries lead to 309 Million €costs per year

for the AUVA. Therefore 0.5 % of all hand injuries causes 4,2 % of

all work related lifetime costs.

References:

Disclosure: No signiﬁcant relationships.

S19

123

GERIATRICS

O023

OUTCOME OF POLYTRAUMATIZED GERIATRIC

PATIENTS IN A LEVEL ONE TRAUMA CENTER

M. Hofbauer

, M. Winnisch

, T. Tiefenbo¨ck

,J.Jo¨stl

, S. Hajdu

Department of Trauma Surgery, Medical University of Vienna,

Vienna, Austria,

Trauma Surgery, Medical University of Vienna,

Vienna, Austria

Introduction: According to aging and more active older population

an increase of geriatric trauma patients need to be expected. The

geriatric polytrauma patient present with a poorer functional outcome

and increased mortality compared to a younger patient collective.

Thus the aim of this study was to evaluate factors inﬂuencing out-

come and survival in a geriatric polytraumatized collective.

Material and methods: Included were all patients over the age of 64

with a minimum ISS C16 who were treated between January 1992

und January 2014. Descriptive analysis of all evaluated data was

performed focusing on injury mechanism, GCS-, ISS-, AIS-, GOS-

score and clinical outcome.

Results: 82 patients with a mean age of 74.8 ±8.64 matched our

inclusion criteria. Patient group consisted of 47 men (57.3 %) and 35

women (42.7 %) aged between 65 and 97 years. Injury pattern was in

37.8 % of the patients (N =31) a fall, followed by trafﬁc accidents as

pedestrian (36.6 %; N =30), other trafﬁc accidents (19.6 %;

N=16) and other accidents (6 %; N =5). The following parts were

injured: Head (92.7 %; N =76), thorax (78 %; N =64), extremities

(57.3 %; N =47) and abdomen (28 %; N =23).31 patients (38 %)

died of disease with a mean ISS of 37.8 ±15.5. 62 % of the patients

(N =51) a median GOS of 4 could be reached after treatment.

Conclusion: The geriatric polytrauma is a rare disease mostly with

severe and combined injuries with a high morbidity and mortality.

Although the ﬁeld of geriatric trauma is still in its infancy, research on

this topic is ongoing to develop advanced management strategies and

improve outcome.

References: 1. Aldrian S, Nau T, Koenig F, Vecsei V. Geriatric

polytrauma. Wien Klin Wochenschr. 2005;117:145-149. 2. Trunkey

DD, Cahn RM, Lenfesty B, Mullins R. Management of the geriatric

trauma patient at risk of death: therapy withdrawal decision mak-

ing. Arch Surg. 2000;135:34-38. 3. Lonner JH, Koval KJ. Polytrauma

in the elderly. Clin Orthop Relat Res. 1995;136-143.

Disclosure: No signiﬁcant relationships.

O024

INJURY PATTERNS, CAUSES AND OUTCOMES OF

GERIATRIC MULTITRAUMA PATIENTS – AN ANALYSES

OF TRAUMA REGISTRIES

R. De Vries, M. El Moumni, I.H.F. Reininga, K.W. Wendt

Trauma Surgery, University Medical Center Groningen, Groningen,

The Netherlands

Introduction: Due to the growth of the elderly population and their

improved mobility the multitrauma patient tends to be nowadays

more often an elder. The aim of this study is to compare demo-

graphics, injury patterns, causes and outcomes in these two groups of

multitrauma patients.

Material and methods: Our study includes all Dutch multitrauma

(ISS C16) patients between 2008-2012 extracted from the Dutch

trauma registry (LTR) and was completed with data from the UMCG.

We compared the younger (Group A: 18-59 years) and elder (Group

B: C60 years) multitrauma patient. Main outcomes were: injury

severity, trauma cause, injury patterns, ICU characteristics and

mortality.

Results: This analysis included 11.297 multitrauma patients. The

elderly represented 43.9 % of the multitrauma population. The

younger group have a worse Glasgow coma scale (A: GCS =3:

21.4 %, B: 14.4 %). Trauma cause in elderly was more likely to be a

bicycle accident (A: 11.9 %; B: 27.1 %) or fall [3 meters (A:

11.7 %; B: 30.9 %). Serious head injury is more often seen in elderly

(A: 43.4 %; B: 64.3 %) and associated with a lesser chance of

recovering with low disability after sustaining traumatic brain injury

(A: 72.4 %; B: 46.7 %). The elderly have a higher chance of devel-

oping multi organ failure (A: 30.9 %; B: 38.8 %) or sepsis (A:

24.8 %; B: 32.7 %) during ICU admission and have an overall dou-

bled mortality risk (A: 10.6 %; B: 21.9 %).

Conclusion: Elderly are more often involved in multitrauma.

Although injury severity does not differ between groups, they are at

an increased risk of dying compared to their younger counterparts

while sustaining less high energy accidents.

References: Aldrian, S. et al. (2005). Lonner, J. H. & Koval, K. J.

(1995). Giannoudis, P. V., et al. (2009). Fro

¨hlich, M. et al. (2014).

Baker, S. P. et al. (1974). Copes, W. S. et al. (1988). Jennett, B. &

Bond, M. (1975). Brockamp, T. et al. (2012). Wafaisade,

A. et al. (2011). Butcher, N. & Balogh, Z. J. (2009). Clement, N.

D.et al. (2010). Probst, C. et al. (2009). Baker, S. P. & Harvey, A. H.

(1985). Susman, M. et al. (2002). Haring, R. S. et al. (2015).

Disclosure: No signiﬁcant relationships.

O025

DOES THE FIRST HOSPITAL PROVIDING CARE

DETERMINE THE OUTCOME OF GERIATRIC TRAUMA

PATIENS?

M. Fro¨hlich

, R. Lefering

, P. Koenen

, A. Driessen

, B. Bouillon

A. Wafaisade

Department of Trauma and Orthopedic Surgery, University of

Witten, Herdecke, Cologne-Merheim Medical Center (cmmc),

Cologne Merheim Medical Center, Cologne, Germany,

Institute for

Research in Operative Medicine (IFOM) University of Witten,

Herdecke, Cologne, Germany

Introduction: In a constantly aging society, the higher degree of

activity among the elderly also increases the risk of severe injuries.

Due to presumably higher number of pre-existing conditions and

reduced physiological reserves optimized and more intense diagnos-

tics and therapy than with comparable injured younger patients may

be required. The present study aims to determine whether geriatric

patients beneﬁt from immediate treatment in higher-level trauma

centers.

Material and methods: Over a period of ﬁve years (2009 - 2013)

datasets of 54 784 patients from the TraumaRegister DGU



were

analysed. Included were patients [16 years with an ISS C9, who

were admitted to an intensive care unit. We compared the outcome of

patients \65 vs. C65 years, with regard to the primary care level

treated.

Results: During the observation period, the proportion of

patients [65 years increased from 25.1 % to 31.2 %. The percentage

S20

123

of older patients treated was higher in Level III (38.4 %) than in

higher ranked trauma centers. Injury severity (ISS 17.7 Level III vs.

23.4 Level I) and the rate of severe head injuries (AIS-Head C3:

30.0 % in Level III vs. 60.7 % in Level I) increased accordingly.

Independent of the supply stage, the observed mortality matches the

expected according to RISCII (Level III 18.5 %vs. 17.5 %; Level I

30.7 %vs. 28.1 %).

Conclusion: The allocation of elderly patients to the different levels

of care follows predominantly the entity and severity of injury.

However, patients [65 years are mostly treated in local and regional

centers compared to younger patients. Nevertheless, the standardized

mortality ratio indicates a good quality of care in all health care

levels.

References:

Disclosure: No signiﬁcant relationships.

O026

GERIATRIC POLYTRAUMA PATIENTS WITH SEVERE

PELVIC FRACTURES: COMPARISON WITH YOUNGER

ADULT PATIENTS

S. Kanezaki, M. Miyazaki, N. Notani, H. Tsumura

Orthopedic Surgery, Oita University Hospital, Yufu, Japan

Introduction: The elderly patients complicated with polytrauma and

severe pelvic fractures are presumed to present with extremely

severe conditions [1-4]. The aims of this study are to describe the

clinical features of these patients in comparison with younger adult

patients.

Material and methods: This is a retrospective cohort study at a

single institution. Patients with pelvic AIS score of 3 or more, and

with at least 2 body lesions of AIS score of 3 or more were included.

Fifteen patients older than 65 years (group G) and 13 of younger

adults (group A) were identiﬁed. We compared the data of two groups

and evaluated factors related to severity that is deﬁned as receiving

massive transfusion (MT) and/or death.

Results: Mean age was 75 ±7/38 ±11 (group G/A). Mean injury

severity score was similar in two groups. Differences among two

groups in systolic blood pressure, heart rate, shock index, Hb level,

PT-INR, and base deﬁcit were not signiﬁcant. Two patients in

group G and 1 in group A died. Over two third of group G

demanded MT. The number of patients receiving MT was signif-

icantly greater in the group G. In group G, hypotension, anemia,

coagulopathy, base deﬁcit [2, extravasation on CT scan were

predictors for severity. In group A, shock index [1showedrela-

tionship with severity.

Conclusion: Two-thirds of geriatric polytrauma patients with pelvic

fractures demanded MT, and it showed a signiﬁcant difference from

younger adult patients. The severity of these patients could be pre-

dicted by hypotension, abnormality in a blood test, and extravasation

on CT scan.

References: 1. D Matewski, et al, Analysis of management of

patients with multiple injuries of the locomotor system, Int Orthop,

32:753-758, 2015 2. DP O’Brien, et al, Pelvic fracture in the elderly is

associated with increased mortality, Surgery, 132:710-715, 2002 3.

A Matityahu, et al, Survivorship and severe complications are worse

for octogenarians and elderly patients with pelvis fractures as com-

pared to adults: Data from the National Trauma Data Bank, J Osteop,

475739, 2012 4. PV Giannoudis, et al, Severe and multiple trauma in

older patients; incidence and mortality, Injury, 40:362-367, 2009

Disclosure: No signiﬁcant relationships.

O027

DIABETES AND MORTALITY IN ORTHOGERIATRIC

NECK OF FEMUR FRACTURE PATIENTS

O.S. Thein, K. Dasari, E.L.J. Hirons

Trauma and Orthopaedics, Sandwell General Hospital, West

Bromwich, UK

Introduction: Diabetes has become an increasingly common co-

morbidity [1]. Orthogeriatric neck of femur fracture patients more

commonly present with this co-morbidity. Diabetic patients are

thought to pose a higher risk of post-operative mortality and mor-

bidity due to diabetic control. There is little previous literature

detailing this [2]. We aimed to assess relative mortality of all operated

orthogeriatric diabetic neck of femur fracture patients for an ortho-

paedic centre in Birmingham, UK.

Material and methods: 6 months of operations identiﬁed 43 diabetic

patients (mean age 78.9). Diabetic control (HbA1

) and comorbidities

(generally classiﬁed to cardiovascular, respiratory, vascular, neurol-

ogy, gastrointestinal, renal, ophthalmological, and malignancies) were

recorded. Mortality from the operation was recorded at 30 days, 3, 6

and 12 months.

Results: 30-day mortality rates were equal between non-diabetic and

diabetic patients (9.3 %), but above national average (8.2 %) [3].

1-year mortality was higher in the non-diabetic population (30.2 %

vs. 11.6 %). No signiﬁcant difference between number of co-mor-

bidities or age of patients. There was a signiﬁcant difference in renal

function (creatinine) between diabetic and non-diabetic deaths (mean

non-diabetic 88, diabetic 115, p =0.007). Type of prosthesis had no

impact. Diabetic patients who died had a signiﬁcantly higher age than

those who survived (mean alive 76.2, dead 91.3, p =0.027). There

was no signiﬁcant difference in co-morbidities (p =0.656),

HbA1

(p =0.123), or renal function (p =0.193).

Conclusion: We evaluated the perception that diabetes increases

post-operative mortality in an orthogeriatric neck of femur fracture

population. Diabetic patients are not at higher risk of mortality, but

elderly diabetics have a higher mortality risk than their younger

diabetic counterparts.

References: 1. Diabetes: Facts and Stats May 2015, Diabetes UK,

https://www.diabetes.org.uk/Documents/Position%20statements/Facts

%20and%20stats%20June%202015.pdf. 2. ‘Mortality after hip frac-

ture in diabetic patients’, 2011, Karakaya J, Exp Clin Endocrinol

Diabetes, 119(7):P 414-8 3. UK National Hip Fracture Database 2013,

Royal College of Physicians

Disclosure: No signiﬁcant relationships.

O028

THE BURDEN OF INFECTION IN POLYTRAUMATIZED

GERIATRIC TRAUMA PATIENTS

C.D. Weber

, C. Herren

, R. Pfeifer

, K. Horst

, F. Hildebrand

M. Knobe

, H. Pape

Orthopedic Trauma, RWTH Aachen University Hospital, Aachen,

Germany,

Orthopaedic Trauma Surgery, RWTH Aachen University

Hospital, Aachen, Germany

Introduction: Infectious complications in multiply injured patients

are common and have major impact on survival and patient outcomes.

S21

123

Especially in the subgroup of geriatric trauma victims, little is known

about the drivers for infectious complications. The objective of this

study was to characterize the burden of all-cause infections in the

severely injured elderly.

Material and methods: Cohort study of consecutive geriatric trauma

patients. Setting: Level-I Trauma Center. Elderly trauma victims

([60 yrs) with ICU admission following resuscitation were included.

Data collection (1-12/2013) included patient demographics, comor-

bidities, injury mechanisms/characteristics (AIS; ISS, NISS), baseline

physiology, objective score systems (e.g. SAPS II) and therapeutic

interventions (e.g. vasopressor use, antibiotic coverage, organ

replacement therapy). Infections loci were documented according to

CDC/ACS: Bacteremia, respiratory, urinary tract, vascular catheter

line, wound and surgical site infection. Furthermore, microbiological

ﬁndings and resistograms were evaluated. Statistical analyses were

performed with SPSS statistics (IBM, Version 21).

Results: There were no signiﬁcant differences in age (mean

75.6 ±9.2 years; p =0.12), sex, injury severity (mean ISS

23.9 ±9.3; p =0.33) and objective scores (SAPSII) between

patients who developed infection (39 %, n =14) and those who did

not (61 %, 22). There were 9 respiratory, 5 bloodstream, 2 SSI, and 2

urinary tract infections. A high number of ‘‘exotic’’ or resistant

pathogens, and polybacterial infections (mean 3.0 ±1.7) were iden-

tiﬁed. ICU stay was prolonged in septic patients (5 vs. 17.5 days,

p=0.001). Regression analysis identiﬁed hemodynamic instability at

ER admission as major independent risk factor for infectious com-

plications (OR 20.8, 95 %-CI: 1.03-420.21).

Conclusion: Infectious complications occur frequently in elderly

trauma patients and must be considered as major burden for patients

and society.

References: 1. Keel M, Trentz O. Pathophysiology of polytrauma.

Injury 2005. 2. Horan TC et al. CDC/NHSN surveillance deﬁnition of

heath-care associated infection and criteria for speciﬁc typed of

infections in the acute care setting. Am J Infect Control 2008 3.

O’Keefe et al. Ventilator-associated pneumonia: bacteremia and death

after traumatic injury. J Trauma Acute Care Surg 2012 4. Waifaisade

A, Lefering et al. Epidemiology and risk factors for sepsis after

multiple trauma. Crit Care Med 2011 5. Cole E et al. Coagulation

system changes associated with susceptibility to infection in trauma

patients. J Trauma Acute Care Surg 2013

Disclosure: No signiﬁcant relationships.

O029

BACTERIURIA AND URINARY TRACT INFECTION

ASSOCIATED WITH PROXIMAL FEMUR FRACTURES

M. Tomazˇevic

, G. Makovec

, A. Fischinger

, M. Cimerman

M. Veselko

Department of Traumatology, University Medical Centre Ljubljana,

Ljubljana, Slovenia,

University Medical Center Ljubljana, Ljubljana,

Slovenia

Introduction: Increasing number of orthogeriatric patients with

proximal femur fracture makes co-managed care more important for

the outcome than fracture treatment alone. Source of major compli-

cations are infections associated with diminished immune response

system in geriatric population. Infections are associated with in-hos-

pital delirium. One of the most frequent is urinary tract infection. Do

we have to wait and treat urinary tract infection or is it better to treat

bacteriuria during the perioperative period?

Material and methods: 20 consecutive patients with proximal femur

fracture were included in the study. At the time of admission urine

was taken for analysis. If there were nitrates, leukocytes or bacteria in

basic urine analysis, urine was sent for further microbiological anal-

ysis and immediate treatment with Sulfametoksazol/Trimetoprim was

initiated. Incidence of further delirium and infections was analyzed.

Results: 10 % of patients had no bacteriuria at the time of the

admission. With 25 % of patients there were nitrites and numerus

bacteria present at the time of admission. Later microbiological

testing was positive with these patients. In 65 % of patients there was

either small amount of bacteria or leucocytes present in these

microbiology was positive in 54 %. Post-operative delirium devel-

oped in 15 % of patients. Urosepsis developed in one patient without

bacteriuria at the time of admission. No surgical site infections or

symptomatic infection was present where antibiotic treatment was

initiated.

Conclusion: Early treatment of bacteriuria and urinary tract infection

may reduce the level of post-operative delirium. New guidelines for

treatment of bacteriuria with orthogeriatric patients may be needed to

reduce post-operative delirium and infection-rate.

References: 1. David TS, Vrahas MS. Perioperative lower urinary

tract infections and deep sepsis in patients undergoing total joint

arthroplasty. J Am Acad Orthop Surg. 2000 Feb;8(1):66–74. 2. Tsuda

Y, Yasunaga H, et al. Association between dementia and postopera-

tive complications after hip fracture surgery in the elderly: analysis of

87,654 patients using a national administrative database. Arch Orthop

Trauma Surg. 2015 Nov;135(11):1511–7. 3. Rajamanickam A, Noor

S, Usmani A. Should an asymptomatic patient with an abnormal

urinalysis (bacteriuria or pyuria) be treated with antibiotics prior to

major joint replacement surgery? Cleve Clin J Med. 2007 Sep;74

Suppl 1:S17–8.

Disclosure: No signiﬁcant relationships.

INNOVATIONS

O030

APOSEC TREATMENT IMPROVES OUTCOME

FOLLOWING TRAUMA & HAEMORRHAGE IN RATS

C. Penzenstadler

, M. Ashmwe

, A. Bahrami

, A. Klotz

M. Jafarmadar

, M.M. Kasiri

, H.J. Ankersmit

, H. Redl

S. Bahrami

Ludwig Boltzmann Institute for Experimental and Clinical

Traumatology, Vienna, Austria,

Department of Thoracic Surgery,

Medical University Vienna, Vienna, Austria,

Ludwig Boltzmann

Institute for Experimental and Clinical Traumatology, Ludwig

Boltzmann Institute for Experimental and Clinical Traumatology,

Vienna, Austria

Introduction: Trauma & hemorrhage (TH) is a leading cause of

death worldwide and is often associated with general inﬂammatory

response, cell and organ injury. Recent preclinical studies have shown

that APOSEC, a newly developed compound, exerts cytoprotective

and/or immune modulating effects [1]. We evaluated the therapeutic

potential of APOSEC in a TH model in rats.

Material and methods: Anesthetized rats were subjected to TH and

a resuscitation protocol mimicking pre-hospital setting with a

restrictive reperfusion phase (30 ml/kg/h, MAP maintained at

50-55 mmHg for 40 min) followed by an adequate reperfusion phase

(75 ml/kg/h over 60 min, MAP to baseline). Animals received either

APOSEC or vehicle intravenously 20 minutes after onset of

S22

123

reperfusion. Blood samples were taken at baseline, end of resuscita-

tion (EOR), 24 and 48 h after shock and survival was followed for

28 days.

Results: APOSEC treatment modulated the immune response

reﬂected in IL-10 (decrease by 26 % at EOR) compared to vehicle

group (p \0.01). Changes in IL-6 and MCP-1 were not different

between groups. APOSEC attenuated apoptosis reﬂected by plasma

histone release up to 24 h (p \0.003). Cell injury assessed by lactate

dehydrogenase was 40 % decreased by APOSEC treatment 24 h post

shock (p \0.05). HTS-induced liver injury determined by plasma

alanine aminotransferase was 1.6 and 1.5 fold higher in vehicle

compared to APOSEC group at EOR and 24 h respectively. The

28-day mortality (25 %) was prevented by APOSEC treatment

(100 % survival).

Conclusion: Here we show for the ﬁrst time that APOSEC supple-

mented resuscitation ameliorates the TH-related inﬂammation,

apoptosis, cell and organ injury, and prevents TH-induced long term

mortality in rats.

References: 1. Lichtenauer M, Mildner M, Hoetzenecker K, Zim-

mermann M, Podesser BK, Sipos W, Bere

´nyi E, Dworschak M,

Tschachler E, Gyo

¨ngyo

¨si M, Ankersmit HJ. Secretome of apoptotic

peripheral blood cells (APOSEC) confers cytoprotection to car-

diomyocytes and inhibits tissue remodelling after acute myocardial

infarction: a preclinical study. Basic Res Cardiol. 2011

Nov;106(6):1283-97. doi:10.1007/s00395-011-0224-6

Disclosure: No signiﬁcant relationships.

O031

THERAPEUTIC HYPOTHERMIA AND ITS EFFECT ON

SYSTEMIC AND LOCAL INFLAMMATION - RESULTS

FROM A PORCINE MODEL OF COMBINED TRAUMA

K. Horst

, D. Eschbach

, R. Pfeifer

, M. Sassen

, T. Steinfeldt

H. Wulf

, N. Vogt

, M. Frink

, S. Rucholtz

, H. Pape

, F. Hildebrand

Orthopedic Trauma, RWTH Aachen University Hospital, Aachen,

Germany,

Department of Hand, Traumatology and Reconstructive

Surgery, University Hospital Marburg, Marburg,

Germany,

Department of Anesthesiology, University Hospital

Marburg, Marburg, Germany,

Neurosurgery, University Hospital

Gießen, Gießen, Germany

Introduction: Background: Therapeutic hypothermia has been

shown to have beneﬁcial effects after trauma by altering the early

post-traumatic inﬂammatory reaction. However, little is known about

the impact of induced hypothermia in long term application and on

local inﬂammatory response. We therefore investigated the kinetics of

systemic and local inﬂammation in the late posttraumatic phase after

induction of therapeutic hypothermia in an established porcine

polytrauma model.

Material and methods: Male pigs (35 ±5 kg) were subjected to

multiple trauma consisting of extremity fracture, unilateral lung

contusion, liver laceration and pressure-controlled hemorrhagic shock

(MAP\30 ±5 mmHg for 90 min). After resuscitation, hypothermia

(33 C) was induced for a period of 12 h (HT-T group) with subse-

quent re-warming. Systemic and local (fracture hematoma) cytokine

levels and alarmins were measured.

Results: Severe signs of shock occurred in both trauma groups.

Systemic pro-inﬂammatory parameters also increased. Pro- and anti-

inﬂammatory mediator concentrations were signiﬁcantly increased in

fracture hematoma compared to systemic values. In the HT-T group,

signiﬁcantly prolonged increased concentrations of both systemic and

local pro-inﬂammatory mediators were observed compared to the

normothermic group.

Conclusion: Therapeutic hypothermia seems to affect long-term

inﬂammatory response after trauma and thus might reduce the well-

described protective effects on organ and immune function observed

in the early phase after induction of hypothermia. Moreover, the

immunologic milieu of fracture hematoma seems to be affected.

Future studies must investigate effects of therapeutic hypothermia in

the multiple injured and should focus on depth and duration of

application.

References: Shock. 2013 Oct;40(4):247-73. doi:10.1097/SHK.0b013

e3182a3cd74. Combined hemorrhage/trauma models in pigs-current

state and future perspectives. Hildebrand F, andruszkow H, Huber-

Lang M, Pape HC, van Griensven M. Induced hypothermia reduces

the hepatic inﬂammatory response in a swine multiple trauma model.

Fro

¨hlich M, Hildebrand F, Weuster M, Mommsen P, Mohr J, Witte I,

Raeven P, Ruchholtz S, Flohe

´S, van Griensven M, Pape HC, Pfeifer

R. J Trauma Acute Care Surg. 2014 Jun;76(6):1425-32. doi:

10.1097/TA.0000000000000224.

Disclosure: No signiﬁcant relationships.

O032

NON-INVASIVE, INDIVIDUAL-SPECIFIC, REAL-TIME

TRENDING OF SIGNIFICANT HUMAN BLOOD LOSS

S.L. Moulton

, J. Mulligan

, M.A. Santoro

, K. Bui

, G.Z. Grudic

D. Macleod

Surgery, University of Colorado, School of Medicine, Aurora, CO,

USA,

Flashback Technologies, Inc., Boulder, CO,

USA,

Anesthesiology, Duke University, School of Medicine,

Durham, NC, USA

Introduction: Humans are able to compensate for signiﬁcant blood

loss with little change in traditional vital signs, limiting early detec-

tion and intervention. We hypothesized that an algorithm, which

monitors subtle compensatory changes in pulse oximetry waveforms

(PPG) caused by acute changes in central volume, would accurately

differentiate asymptomatic and symptomatic humans who are bled.

Material and methods: Men/women, 18-55 years, underwent step-

wise (*333 ml aliquot) removal of 20 % blood volume (males

15 ml/kg; females 13 ml/kg). PPG waveforms were processed in real-

time by a computational algorithm that calculated each subject’s

compensatory reserve index (CRI). CRI is a physiological measure of

compensation related to changes in central volume. A CRI of ‘‘1’’

represents supine normovolemia and ‘‘0’’ represents the circulatory

volume at which hemodynamic decompensation will occur; values

between 1 and 0 are estimates of the proportion of reserve remaining

(e.g. CRI =0.5 implies 50 % compensatory reserve remaining before

decompensation). Withdrawn blood was re-infused at the end of each

experiment.

Results: 42 subjects (24 men/18 women). 3 had corrupted data. 32

subjects achieved maximum blood loss volume and were never

symptomatic: baseline CRI =0.9 +/-0.07 and lowest CRI =0.6 +/-

0.17 at maximum blood loss. 7 subjects became symptomatic and

collapsed (SBP \80): baseline CRI =0.9 +/-0.08 and lowest

CRI =0.15 +/-0.08 at maximum blood loss. The symptomatic sub-

jects were rescued with saline/stored blood. Statistics (alpha 0.05

range) for CRI sampled in asymptomatic versus symptomatic subjects

at baseline and maximum blood loss.

Conclusion: The Compensatory Reserve Index (CRI) exploits

information present in the PPG waveform to trend individual-speciﬁc,

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123

real-time compensatory changes associated with acute blood loss

from normovolemia to collapse.

References: 1. VA Convertino, J Mulligan, GZ Grudic, SL Moulton.

J Appl Phys 2013;115(8): 1196-1202. 2. SL Moulton, J Mulligan, GZ

Grudic, VA Convertino. J Trauma Acute Care Surg 2013;75:1053-

1059. 3. VA Convertino, JT Howard, C Hinojosa-Laborde, S Cardin,

P Batchelder, J Mulligan, GZ Grudic, SL Moulton, DB MacLeod.

Shock 2015;44 Suppl 1:27-32.

Disclosure: SL Moulton: Ownership, equity, IP, Consultant, board of

directors at Flashback Technologies, Inc. J Mulligan: Ownership,,

equity, IP at Flashback Technologies, Inc. GZ Grudic: Ownership,

equity, IP, board of directors at Flashback Technologies, Inc.

O033

THE IL-33/ST2 PATHWAY IN POLYTRAUMATIZED

PATIENTS AND ITS POTENTIAL ROLE AS NOVEL

BIOMARKER

T. Haider, E. Simader, T. Heinz, S. Hajdu, L.L. Negrin

Department of Trauma Surgery, Medical University of Vienna,

Vienna, Austria

Introduction: Severe injuries are associated with profound systemic

implications on the immune response, which increases susceptibility

to acute respiratory distress syndrome and infections. The interleukin-

1 receptor family member soluble ST2 (sST2) is secreted by lung

tissue and binds to interleukin-33 (IL-33), thereby acting as a ‘‘decoy

receptor’’ counteracting its pro-inﬂammatory potential. With this

study we sought to investigate the potential involvement of this

pathway in immunosuppression and pulmonary complications

observed after severe injuries.

Material and methods: Therefore, we included polytraumatized

patients admitted to our level I trauma center in this study. Blood

withdrawals were performed at admission and 24 to 48 hours later and

levels of IL-33 and sST2 were evaluated using ELISA technique.

Results: Our study population consists of 130 patients with a mean

injury severity score (ISS) of 32. ARDS was present in 42 patients

(32.1 %), while pulmonary infections manifestedin 41 patients (31.3 %).

ARDS was associated with higher IL-33 serum levels on both time points

(1:5.65 vs. 8.15 pg/ml, p \0.01; 2:3.38 vs. 5.42 p \0.01). In patients

suffering from pulmonary infections plasma levels of sST2 were sig-

niﬁcantly increased at the 2

measurement (2083.38 vs. 4569.78,

p\0.01). Soluble ST2 was elevated at the follow-up measurement

(2580.51 vs. 16015.21 pg/ml, p \0.05) in non-surviving patients.

Conclusion: Our data suggest involvement of the IL-33/ST2-pathway

in pulmonary complications commonly seen after severe injuries.

Here presented results indicate the potential utility of IL-33 and sST2

as a biomarker for mortality and pulmonary complications in these

patients.

References:

Disclosure: No signiﬁcant relationships.

O034

SERUM TROPONIN IN PATIENTS WITH TRAUMATIC

BRAIN INJURIES: IMPLICATIONS AND OUTCOMES

A. El-Menyar

, H. Al-Thani

, H. Abdelrahman

, R. Peralta

M. Ellabib

Clinical Research, Trauma Surgery, Hamad General Hospital &

Weill Cornell Medical College, Doha, Qatar,

Trauma Surgery,

Hamad General Hospital, Doha, Qatar

Introduction: We aimed to study the implications of serum Troponin

and outcomes in traumatic brain injury (TBI) patients in the absence

of cardiac injury.

Material and methods: A retrospective analysis was conducted for

TBI patients admitted between 2010-2014. Patients were divided into

2 groups according to the serum Troponin (Group 1; nega-

tive vs Group 2; positive).

Results: Over the study period, we identiﬁed 805 TBI patients with a

median age of 28 years. MVCs were the main injury mechanism in

group 2 (51.8 % vs 38 %, p =0.01). Ejection from the car was fre-

quent in group 2 (p =0.005). Age and chest AIS were comparable in

the 2 groups. Admission blood pressure and GCS were lesser in group

2(p=0.001). Mean ISS (28 ±10 vs 21 ±9), head AIS (4.04 ±1.1

vs 3.7 ±1.0) were greater in group 2(p =0.001). Skull fracture,

brain edema and diffuse axonal injury were signiﬁcantly more

prevalent in group 2. Brain contusion, and subdural and extradural

hematoma, subarachnoid and interventricular hemorrhage were

comparable in the 2 groups. Pneumonia and sepsis rates were higher

in group 2 (p =0.001). Median ventilatory days, hospital and ICU

length of stay were prolonged in group 2 (p =0.001 for all). Overall

mortality was 24 % with a higher proportion in group 2 (36 % vs

11 %, p =0.001). On multivariate analysis, positive troponin was

independent predictor for mortality (OR 2.71; 95 %CI 1.77-4.14)

after adjusting for ISS, GCS and head AIS.

Conclusion: TBI patients with positive serum troponin has a 3-fold

increase in mortality and prolonged hospitalization in the absence of

traumatic cardiac injury. The implications of positive troponin among

TBI need further assessment.

References: Salim A, Hadjizacharia P, Brown C, et al: Signiﬁcance

of troponin elevation after severe traumatic brain injury. J Trauma.

2008 Jan;64(1):46-52

Disclosure: No signiﬁcant relationships.

O035

FEMALE PATIENTS HAVE LOWER EARLY SYSTEMIC IL-6

LEVELS AND LESS SIRS AND SEPSIS AFTER MAJOR

TRAUMA

K. Mo¨rs

, O. Braun

, B. Relja

, I. Marzi

Unfall-, Hand- Und Wiederherstellungschirurgie, Uniklinik

Frankfurt, Frankfurt, Germany,

Unfall-, Hand- Und

Wiederherstellungschirurgie, Universita

¨tsklinikum Frankfurt,

Frankfurt, Germany

Introduction: Gender inﬂuences the outcome and recovery of

severely injured trauma patients (TP). Female sex is associated with

lower rates of systemic inﬂammatory response syndrome (SIRS),

sepsis and single and/or multiple organ failure (MOF). Here, we

analyzed the inﬂuence of gender on systemic Interleukin (IL)-6 levels

and outcome in TP.

Material and methods: Upon admittance to emergency department

(ED), 343 TP with injury severity scores (ISS) C16 were included

and grouped to male vs. female. Injury severity, vital signs, physio-

logical parameters, length of intensive care unit (ICU) and in-hospital

stay, SIRS, sepsis, pneumonia, acute respiratory distress syndrome

(ARDS) single- and/or MOF and in-hospital mortality were analyzed.

S24

123

Systemic IL-6 levels during the ﬁrst 10 post-injury days were deter-

mined. P-value \0.05 was considered statistically signiﬁcant.

Results: Eighty-six female and 257 male TP comparable in age and

ISS were included. Abbreviated Injury Scale (AIS) C3 of chest and

abdominal body regions were signiﬁcantly more prevalent in male vs.

female TP (Chest: 51.02 % vs. 36.05 %, Abdomen: 19.84 % vs.

10.47 %, p \0.05). Female TP had signiﬁcantly lower SIRS and

sepsis rates (SIRS: 53.31 % vs. 40.70 %, p \0.05; Sepsis: 19.46 %

vs. 6.98 %, p \0.05). On post-injury days 1 and 2 IL-6 was signif-

icantly increased in male TP (d1: 363.9 ±72.58 vs.

163.7 ±25.98 pg/ml; d2: 194.3 ±31.38 vs. 114.3 ±17.81 pg/ml,

p\0.05). There were no further signiﬁcant gender-based differences

in IL-6 levels during the later post-injury course.

Conclusion: This study indicates that early increased systemic IL-6

levels may contribute to higher susceptibility for SIRS and sepsis

development in male compared to female TP.

References:

Disclosure: No signiﬁcant relationships.

O036

MIGHT EXOGENOUS LEPTIN SERVE AS THERAPEUTIC

AGENT FOR THE TREATMENT OF SEPTIC

TRAUMATIZED PATIENTS?

L.L. Negrin

, A. Jahn

, M. Van Griensven

Trauma Surgery, Medical University of Vienna, Vienna,

Austria,

Trauma Lab, Klinikum rechts der Isar, Munich, Germany

Introduction: 10 % of multiple injured develop sepsis during their

hospital stay, 18.2 % of them die. The objective of our study was to

evaluate the impact of exogenous leptin, related to the presence of IL-

6, in an animal model that simulated the processes referring to trauma

patients.

Material and methods: Following the same scheme 69 wild type

and 63 IL-6-/-mice were evaluated separately in three models each

subdivided into three groups, the 2Hit-model (ﬁrst hit: standardized

closed fracture using a blunt guillotine, hemorrhage by orbital plexus

puncturing; second hit: cecal ligitation and puncture two days later),

the 1Hit-model (ﬁrst hit and laparotomy) and the Sham-model (la-

parotomy). In the three models equivalent tests series were

performed, applying recombinant leptin in two different doses to the

Leptin2-groups (5 lg/g body weight) and the Leptin1-groups (2.5 lg/

g body weight), respectively, whereas a saline solution was admin-

istered to the Vehicle-groups. All animals were exsanguinated by

direct cardiac puncture six days after the test started.

Results: Our test series revealed a dose-dependent immunomodula-

tory effect of exogenous leptin by inﬂuencing the immunologic

pathways corresponding to patient’s medical condition. Whereas the

lethality rate of sepsis signiﬁcantly decreased in wild type mice

(2HitVehicle-group: 36.4 %, 2HitLeptin1-group: 25 %, 2HitLeptin2-

group: 0 %), it increased in IL-6 knockout mice (53.8 %, 83.4 %,

100 %).

Conclusion: Preventive leptin administration to trauma patients

seems to have no negative impact on their medical condition. Leptin

might be a therapeutic agent for the prevention or treatment of sepsis

after initial trauma.

References:

Disclosure: No signiﬁcant relationships.

O037

TARGETED ANTIOXIDANT TREATMENT WITH

MITOCHONDRIAL ROS-SCAVENGERS SKQ1 AND

MITOTEMPO IS DETRIMENTAL IN THE MOUSE

ABDOMINAL SEPSIS

P. Rademann, A. Weidinger, S. Drechsler, A. Klotz, M. Jafarmadar,

J. Zipperle, A. Hacobian, S. Dumitrescu, S. Bahrami, A. Kotzlov,

M. Osuchowski

Auva Research Center, Ludwig Boltzmann Institute for Clinical and

Experimental Traumatology, Vienna, Austria

Introduction: Altered mitochondrial function by excessive produc-

tion of reactive oxygen species (ROS) has been considered an

important factor in pathogenesis of organ failure in sepsis. We

investigated effects of two speciﬁc mitochondria-targeted antioxi-

dants (SkQ1: lipophilic; MitoTEMPO: hydrophilic) on outcome,

inﬂammatory response and organ homeostasis in a mouse model of

cecal ligation and puncture (CLP) sepsis.

Material and methods: 3-month old female CD-1 mice (n =90)

were subjected to moderate-severity CLP, and treated intraperi-

toneally with SkQ1 (5 nmol/kg), MitoTEMPO (50 nmol/kg) or

saline at 1 h, 12 h, 24 h, 36 h, 48 h post-CLP. We assessed 28-day

survival, and circulating parameters over 0 h-72 h post-CLP.

Additional SkQ1/saline-treated CLP mice (n =24) were sacriﬁced

within the ﬁrst 48 h for peritoneal lavage ﬂuid (PLF) and spleen

characterization.

Results: SkQ1 exacerbated mortality by 29 % (to 67 %; p =0.04)

and MitoTEMPO by 15 % (to 53 %; p =0.24). CLP induced a

systemic protracted cytokine release (IL-1b,-5,-6,-10,-12p70,

CXCL-1, MCP-1, MIP-1a,IFN-c,TNFa) and deregulation of

organ function (urea, ALT, LDH, glucose), but antioxidant treat-

ment failed to further modify them. Similar was true for CLP-

induced lymphopenia/neutrophilia and NO-release in the blood.

Dying CLP mice had approximately 100-fold more CFUs in the

spleen than survivors, but this effect was not SkQ1-related. In PLF,

macrophage (CD11b+/F4/80+) and granulocyte (Ly6G+) counts

and intra-/extracellular ROS release were similar, irrespectively of

the SkQ1 treatment.

Conclusion: This CLP study shows that even reﬁned, target-tailored

antioxidant treatment is detrimental rather than beneﬁcial. It is sug-

gestive that the negative role of mitochondrial ROS as the

contributory factor to MODS is overestimated, at least in the young

mice in acute CLP peritonitis.

References:

Disclosure: No signiﬁcant relationships.

CHEST INJURIES

O038

POPULATION–BASED INVESTIGATION OF TRAUMATIC

VASCULAR INJURIES IN ESTONIA: 353 CONSECUTIVE

CASES ANALYSED

I. Soosaar

, S. Saar

, A. Lomp

, J. Laos

, M. Laht

, V. Mihnovits

R. Shalkauskas

,M.Va¨li

, T. Lustenberger

, U. Lepner

, L. Kukk

J. Starkopf

, P. Talving

S25

123

Department of Surgery, North Estonia Medical Center, Tallinn,

Estonia,

University of Tartu, Tartu/ESTONIA,

Tartu University

Hospital, Tartu, Estonia,

Department of Pathological Anatomy and

Forensic Medicine, University of Tartu, Tartu, Estonia,

Unfall-,

Hand- Und Wiederherstellungschirurgie, Uniklinik Frankfurt,

Frankfurt, Germany

Introduction: The epidemiology of vascular trauma in Estonia is

unknown. Thus, the objective of this study was to evaluate the pop-

ulation-based incidence and outcomes of traumatic vascular injuries

in Estonia.

Material and methods: After IRB, consecutive autopsy reports from

the national department of forensic medicine and trauma admissions

to trauma centers between 1/2009 and 12/2013 in Estonia were

queried for vascular injuries per ICD-10. Data accrued included

demographics, injury proﬁle, hospital admission data, surgical inter-

ventions, and in-hospital outcomes. Primary outcome was population-

based vascular injury related mortality. Secondary outcomes were

surgical interventions, complications per Clavien-Dindo, hospital

length of stay (HLOS), and in-hospital mortality for admitted cases.

Results: During the 5-year study period, 353 autopsies and hospital

admissions met the inclusion criteria. The overall mean incidence of

vascular injuries was 5.4/100,000 annually. 75.9 % of patients were

male and 43.6 % suffered penetrating trauma. Most frequently injured

vessel was the aorta at 43.6 %. A total of 27.8 % (n =98) of patients

survived to hospital admission and 79.6 % of these patients required

surgical interventions. Primary repair, ligation and graft repair was

deployed in 41.0 %, 33.3 % and 12.8 %, respectively. Mean HLOS

was 15.9 ±26.8 days. In-hospital mortality was 11.2 % in hospital

admissions. Overall population-based mortality was 75.4 %

(n =266).

Conclusion: The population-based mean annual incidence of vascu-

lar injuries is 5.4/100,000 in Estonia. The overall vascular injury

related mortality was 75.4 %. Current study contributes data to

national and regional trauma epidemiology.

References:

Disclosure: No signiﬁcant relationships.

O039

NEEDLE THORACOSTOMY FOR TENSION

PNEUMOTHORAX: IS THERE A POINT?

N. Owens

, P.P. Healy

, M. Quirke

, G.A. Bass

, B.J. Monroe

Department of Surgery, Connolly Hospital, Dublin,

Ireland,

Department of Surgery, Royal College of Surgeons in

Ireland, Dublin, Ireland,

Department of Emergency Medicine,

Memorial Hermann, Houston, TX, USA

Introduction: Tension pneumothorax (TPT) is a signiﬁcant cause of

potentially-preventable mortality following trauma, occurring in up to

5.4 % of pre-hospital trauma patients [1]. Decompression by needle

thoracostomy (DNT) remains widely-advocated, most notably by the

most recent ATLS guidelines [2], but is associated with iatrogenic

morbidity and a reported failure rate of 38 % [3]. Given its contro-

versial role, we performed a systematic review of the published

literature relevant to DNT for TPT.

Material and methods: We searched CENTRAL, MEDLINE,

EMBASE, and trial registries from inception to August 2015,

including any randomised controlled trials(RCTs) or observational

studies in which the effectiveness and safety of DNT to treat tension

or simple pneumothorax was evaluated or compared with any other

intervention. Study selection, qualitative assessment using GRADE

methodology [4] and extraction of relevant data were performed

independently by the review authors, with disagreements resolved by

an additional review author.

Results: 47 papers were included in this review - 7 case series, 32

cohort studies, 8 case reports and no RCTs. Overall, the quality of

evidence was low, ranging from moderate to very low. The quoted

effectiveness of DNT ranged from 40.7 % - 85.3 %. The existing

literature describes several complications following DNT, including

failure to reach the pleural space, catheter dislodgement, lumen

obstruction, and tissue/vessel injury.

Conclusion: Evidence quality is poor with regard to the effectiveness

of DNT. Continued use of this procedure as a ﬁrst-line intervention

may delay deﬁnitive treatment and lead to increased patient mortality.

In the absence of prospective RCTs reporting adverse events, expert

consensus is needed in this ﬁeld.

References: 1. Coats TJ, Wilson AW. Pre-hospital management of

patients with severe thoracic injury. Injury 1995;2:581–5. 2. Ameri-

can College of Surgeons Committee on Trauma. ATLS Advanced

Trauma Life Support for Doctors - Student Course Manual : Ninth

Edition. ISBN 1880696029. 3. Barton ED et al. Prehospital needle

aspiration and tube thoracostomy in trauma victims: a six-year

experience with aeromedical crews. J Emerg Med 1995;13:155–63. 4.

Kirwan AJ et al. The Eastern Association of the Surgery of Trauma

approach to practice management guideline development using

Grading of Recommendations, Assessment, Development, and Eval-

uation (GRADE) methodology. J Trauma Acute Care Surg. 2012

Nov;73(5 Suppl 4):S283-7.

Disclosure: No signiﬁcant relationships.

O040

RESUSCITATIVE ENDOVASCULAR OCCLUSION OF THE

AORTA IMPROVED IN-HOSPITAL MORTALITY OF

SURGICALLY TREATED TORSO TRAUMA PATIENTS

WITH NON-COMPRESSIVE HEMORRHAGE IN

COMPARISON OF AORTIC CROSS CLAMP –A

INSTRUMENTAL VARIABLE ANALYSIS

A. Shiraishi, M. Yagi, Y. Otomo

Trauma and Acute Critical Care Medical Center, Tokyo Medical and

Dental University Hospital of Medicine, Tokyo, Japan

Introduction: Resuscitative endovascular occlusion of the aorta

(REBOA) is expected as an alternative to aortic cross clamp (ACC) in

recent years, however clinical evidences have largely lacked [1].

Material and methods: This study included adult torso trauma

subjects who underwent surgery after undergoing REBOA or ACC

from subjects of the Japan Trauma Databank. Subjects with out-of-

hospital cardiac arrest or subjects who underwent both procedures

were excluded. A linear regression analysis adjusted for the proba-

bility of death based on the Trauma Injury Severity Score estimated

differences in mortality between subjects with REBOA or ACC. Two-

stage least square (2SLS) of instrumental variable method [2] which

enabled to adjust for even unmeasured confounders demonstrated

sensitivity analysis for the result of adjusted linear regression

analysis.

Results: Out of a total of 644 subjects eligible to the selection cri-

teria, 279 (60.8 %) of 459 subjects underwent REBOA and 152

(82.2 %) of 185 subjects underwent ACC died during hospitalization,

respectively. An adjusted linear regression analysis estimated that

difference in in-hospital mortality was lower in subjects with REBOA

S26

123

(-14.6 %, 95 %CI [-22.2, -6.9], P \0.001). We found that number

of REBOA use per institute per year was appropriate as an instru-

mental variable. Sensitivity analysis on 2SLS did not altered the result

and estimated non-signiﬁcantly lower in-hospital mortality in subjects

with REBOA (-29.8 %, 95 %CI [-77.2, 17.5], P =0.216).

Conclusion: This study showed that mortality of surgically treated

torso trauma patients with non-compressive hemorrhage was better in

association with REBOA than ACC and warranted further prospective

studies to test efﬁcacy and feasibility of REBOA in those trauma

population.

References: 1.Bifﬂ WL, Fox CJ, Moore EE. The role of REBOA in

the control of exsanguinating torso hemorrhage. J Trauma Acute Care

Surg 78:1054–1058;2015 2. Imbens G, Angrist J. Identiﬁcation and

estimation of local average treatment effects. Econometrica

62:467–476;1994

Disclosure: No signiﬁcant relationships.

O041

EMERGENCY DEPARTMENT THORACOTOMY IN

A WESTERN EUROPEAN LEVEL 1 TRAUMA CENTER

A. Piccinini

, S. Di Saverio

, L. Di Donato

, A. Biscardi

A. Birindelli

, M. Mandrioli

, D. Beghelli

, S. Villani

, S.N. Forti

Parri

, K. Kawamukai

, G. Tugnoli

Trauma Unit, Ospedale Maggiore, Bologna, Italy,

Thoracic

Surgery, Ospedale Maggiore, Bologna, Italy

Introduction: According to literature ED thoracotomy is an

unquestionable procedure in the treatment of a selected group of

patients with penetrating or blunt trauma. Currently EDT is indicated

in penetrating (with or without vital signs or in case of witnessed

arrest in ED) or rarely in blunt trauma, due to low survival and poor

neurological outcomes. In case of arrest before arrival to ED, CPR has

to be executed for less than 15 minutes in penetrating wounds and 10

minutes in blunt ones.

Material and methods: In our institution 17 EDT were performed

from 2011 till 2015. Among them 14 (82 %) were due to blunt

trauma, and 3 (18 %) to penetrating ones. Road trafﬁc accidents

appear to be the most common process involved (9 cases), followed

by 5 falls. Regarding penetrating trauma, we approached 2 stab

wounds and one gunshot. 5 EDT were executed in the ED, while 12

patients were addressed directly to the OR.

Results: Our results show that most of the patients were male (88 %)

and a mean age of 42 years old. Five patients survived (29 %) without

neurological outcomes; in particular 67 % of penetrating trauma and

21 % of blunt injuries.

Conclusion: From this observational study we can understand the

critical value of EDT in penetrating trauma. Even if poorer survival

rates are reported in blunt trauma, in our trauma center an aggressive

approach is dedicated to them. We trust in the value of this lifesaving

procedure if promptly performed, demonstrated by our encouraging

results.

References: Pendulum knife on a stabbed heart. Di Saverio S,

Kawamukai K, Biscardi A, Boaron M, Tugnoli G.Emerg Med J. 2014

Jan;31(1):29. Working Group, Ad Hoc Subcommittee on Outcomes,

American College of Surgeons. Committee on Trauma. Practice

management guidelines for emergency department thoracotomy.

Working Group, Ad Hoc Subcommittee on Outcomes, American

College of Surgeons-Committee on Trauma. J Am Coll Surg.

2001;193(3):303-9. Western Trauma Association critical decisions in

trauma: resuscitative thoracotomy. Burlew CC, Moore EE, Moore

FA, Coimbra R, McIntyre RC Jr, Davis JW, Sperry J, Bifﬂ WL.J

Trauma Acute Care Surg. 2012 Dec;73(6):1359-63.

Disclosure: No signiﬁcant relationships.

O042

SURGICAL STABILIZATION OF COMBINED FLAIL CHEST

INJURIES AND CLAVIULA FRACTURE – A CASE SERIES

OF COSTOCLAVICULAR INJURIES

A. Langenbach, S. Krinner, S. Grupp, F.F. Hennig, S. Schulz-Drost

Orthopedic and Trauma, University Hospital Erlangen, Erlangen,

Germany

Introduction: Flail chest injuries after blunt trauma to the thorax

Show a high morbidity and mortality rate. Especially when serial rib

fractures are combined with fractures of the ipsilateral clavicula a

good functional outcome might be endangered . In this special case

the framework of the shoulder and the chest lost its stability so

muscular imbalance and a loss of function can occur.

Material and methods: 10 patients with ﬂail chest injury combined

with a fracture of the clavicula, were surgical stabilized by addressing

the ribs and the Clavicula. Locked plate Fixation was performed

through limited surgical approaches to the ribs under general anaes-

thesia. Patients were followed up after 2, 6 and 12 weeks.

Results: All patients showed severe chest wall deformity due to

severely displaced fractures of the ribs and the clavicle. They were

suffering from pain and restriction of respiratory movements. The

chest wall could be restored to normal shape in all cases. The healing

was uneventful in all cases. Plates showed a high patients conve-

nience. Fractures of the clavicle and the second rib were managed

through an innovative clavipectoral approach. Fractures involving the

anterolateral chest wall were managed through an anterolateral

Approach and those involving posterior ribs through an inter-

spinoscapular Approach. Since the limited approaches were

performed in muscle sparing technique there was no loss of muscular

function of the shoulder.

Conclusion: Stabilizing of combined costoclavicular fractures

restores the function and the shape of the chest wall and the shoulder.

It reduces the morbidity after complex ﬂail chest injuries. Conser-

vative Treatment of severely displaced fractures may not be a

sufﬁcient strategy,

References:

Disclosure: The Senior author has Consultant Agreement with

DePuySynthes. He also joins the Thoracic expert Group of the AO

Foundation. The other authors are not involved in any COI

O043

SURGICAL TREATMENT OF ASSOCIATED THORACIC

TRAUMA AND SHOULDER GIRDLE FRACTURES

V. Kusturov

, A. Kusturova

Institute of Emergency Medicine, Chisinau, Moldova,

Orthopedics

and Traumatology, State Medical and Pharmaceutical University

‘‘Nicolae Testemitanu’’, Chisinau, Moldova

Introduction: Multiple chest injuries associated with fractures of the

ribs and shoulder girdle are shockogenic traumas due to multifocal

S27

123

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