Faculty Bibliography

INTRODUCTION/BACKGROUND:Pediatric polytrauma remains a major cause of morbidity and mortality worldwide. Owing to age-specific anatomical and physiological characteristics, children are particularly vulnerable to traumatic brain injury (TBI), which frequently represents the most severe component of polytrauma. This study aimed to evaluate injury mechanisms, injury patterns, treatment strategies, complications, and outcomes in pediatric polytrauma patients treated at a tertiary trauma center. METHODS:A retrospective single-center cohort study was conducted including pediatric patients (< 18 years) with polytrauma, meaning with an Injury Severity Score (ISS) ≥ 16, treated at the University Hospital Bonn between 2023 and 2025. Demographic data, injury mechanisms, injury patterns, ISS, Maximum Abbreviated Injury Scale (MAIS) scores, surgical interventions, intensive care unit (ICU) treatment, complications, and discharge outcomes were analyzed. Correlations between head MAIS, ISS, age, and length of hospital stay were assessed using Spearman's rank correlation coefficient, while differences in ISS between injury mechanisms were evaluated using the Kruskal-Wallis test. RESULTS:Thirty-two pediatric patients were included. The median age was 13.5 years (range 2-17 years), and 50% were female. Traffic accidents were the predominant mechanism of injury (75%), followed by falls from heights greater than 3 m (12.5%). Head trauma was the most common injury pattern, including skull fractures (34.4%), subarachnoid hemorrhage (28.1%), subdural hematoma (25.0%), and epidural hematoma (9.4%). Thoracic, abdominal, pelvic, and extremity injuries were also frequently observed. Fifteen patients (46.9%) required surgical intervention. The median ICU stay was 3 days (range 0-69 days). Complications occurred in five patients (15.6%) and included meningitis, aseptic bone necrosis, epidural rebleeding, soft tissue infection, and pulmonary complications. No in-hospital mortality was observed. Most patients (84.4%) were discharged directly home, while 6.3% required inpatient rehabilitation and 9.4% were transferred to another hospital. No significant correlations were found between head MAIS and length of hospital stay (ρ = 0.28, p = 0.127), head MAIS and ISS (ρ = 0.07, p = 0.714), ISS and hospitalization duration (ρ = 0.10, p = 0.581), or age and head MAIS (ρ = 0.03, p = 0.883). CONCLUSION/CONCLUSIONS:TBI represented the predominant injury burden and was associated with the most complex clinical courses. Despite the severity of injuries, outcomes were generally favorable, characterized by low complication rates, absence of in-hospital mortality, and a high proportion of patients discharged home. These findings emphasize the importance of specialized multidisciplinary trauma care, neurosurgical expertise, and pediatric intensive care management in severely injured children. Larger multicenter studies with long-term follow-up are warranted to further identify predictors of outcome and optimize pediatric polytrauma care.

This study evaluates whether a proline-rich P6 peptide provides added benefit to a cross-linked hyaluronic acid (HA) hydrogel after partial lateral meniscectomy-associated osteoarthritis-like change in sheep. The corrected four-group framework includes Intact no-surgery/no-injection reference knees (n = 7) and 16 surgically injured knees from eight sheep assigned to Mnx (meniscectomy only, n = 4), Mnx + HA (n = 6), or Mnx + HA + P6 (n = 6). Mnx + HA and Mnx + HA + P6 knees received intra-articular injections at Weeks 0, 1, 2, and 4. Osteochondral tissues were evaluated at Week 12 by microCT, H&E scoring, and histochemical/immunohistochemical image analysis. Endpoint-specific animal- or knee-level models were used, with sheep identity included as a random effect when estimable. HA-based treatment was associated with favorable trabecular microCT patterns after meniscectomy. However, the primary Mnx + HA + P6 versus Mnx + HA contrast was not significant for percent trabecular bone volume/BV/TV (+1.52 percentage points; 95% CI -2.22 to 5.26; p = 0.427). Histology and IHC/histochemical findings showed selected exploratory tissue-pattern signals, including collagen-associated matrix staining, but did not establish consistent peptide-specific superiority. These findings support cross-linked HA as an intra-articular biomaterial platform while defining requirements for confirmatory HA-peptide hydrogel studies.

BACKGROUND:Patients with traumatic brain injury (TBI) occupy an important place in intensive care units (ICUs) with high morbidity and mortality rates. The aim of this study was to determine the parameters predictive of mortality as the primary outcome and the distribution of these parameters as a secondary outcome in patients admitted to the ICU with TBI. METHODS:After ethics committee approval and informed consent of the patient's relatives, TBI patients over 18 years of age treated in the anesthesia and reanimation ICU of our hospital between 2021 and 2023 were retrospectively included in our cohort study. The association and distribution of 18 different parameters, including demographic and clinical characteristics of TBI patients at ICU admission, with mortality were compared. Univariate and multivariate analyses were used to estimate the odds ratio for mortality. RESULTS:Of the 194 patients included in the study, 80.4% were male, the mean age was 39.1±19.8 years, and the mortality rate was 35,1%. When comparing patients in 2 groups as survivor and non-survivor, patients in non-survivor group had a significantly lower mean Glasgow Coma Scale (GCS) score (5.7±3.1 vs. 10.1±3.1, p<0.001), revised trauma score (RTS) (5.25±2.1 vs. 10.6±2.7), the rate of surgery (33.8% vs. 53.2%, p<0.01), and the rate of epidural hematoma (EDH) (33.8% vs. 53.2%, p<0.01). The mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score (29 vs. 13, p<0.001), the estimated mortality rate based on the mean APACHE II score (55% vs. 12%, p<0.001), the stress index (SI), (62.3±29.5 vs. 42.4±19.2, p<0.001), the rate of intracerebral hematoma/hemorrhage (ICH) (52.9% vs. 30.2%, p<0.01), the rate of skull fracture (80.9% vs. 24.6%, p<0.01), and the rate of intubation (94.1% vs. 60.3%, p<0.01) were found to be higher in non-survivor group. In multivariate analysis, the significant independent predictors of mortality were high APACHE II score (OR: 1.292 [1.192-1.400, p<0.001]), high SI (OR: 0.820 [0.699-0.921], p<0.001), and the presence of concomitant skull fracture (OR: 4.982 [1.894-13.103], p<0.001). CONCLUSION/CONCLUSIONS:our study, high APACHE II score, high SI, presence of skull fracture, low GCS score, low RTS, intubation, and presence of ICH were associated with high mortality, while operability and presence of EDH were associated with low mortality. Therefore, we believe that these parameters should be prioritized when following TBH cases to initiate treatment earlier and prevent high mortality.

BackgroundSkull fractures are a common heterogenous finding in patients with traumatic brain injury (TBI). Their clinical significance, particularly of displaced and nondisplaced fractures, remains a topic of debate. This study aims to compare injury severity and clinical outcomes between patients with and without skull fractures.MethodsA retrospective study of prospectively triaged adult trauma patients with blunt TBI and radiographic evidence of intracranial hemorrhage (ICH) or skull fracture was performed. Patients were grouped based on the presence or absence of skull fracture. Multivariable logistic regression was used to identify independent predictors of mortality and radiographic progression.ResultsA total of 2543 patients were included in the analysis. Skull fractures were present in 24.6% (n = 626) of the population. Skull fractures were associated with increased incidence of midline shift and all ICH subtypes, SAH being the most prevalent. Skull fracture patients were more likely to have radiographic progression on CT head (CTH) and require neurosurgical intervention. Median hospital and ICU LOS were longer in skull fracture patients. Mortality was significantly higher in patients with skull fractures. Skull fractures were an independent predictor of radiographic progression, but not mortality. Displaced skull fractures had more severe outcomes than nondisplaced fractures; however, nondisplaced fractures had more severe outcomes than no fractures.ConclusionSkull fractures are associated with more severe patterns of intracranial injury, greater need for neurosurgical intervention, and higher mortality in patients with blunt TBI. This underscores the role of skull fractures as a clinically meaningful marker of injury severity and support continued caution in triage and management.

BACKGROUND/UNASSIGNED:This study aims to evaluate the effectiveness of a new method using a silicone barrier (SB) device for temporary abdominal closure (TAC) in trauma patients with an open abdomen (OA). MATERIALS AND METHODS/UNASSIGNED:This retrospective single-center study included trauma patients in whom the abdominal fascia was left open and covered with an SB (case group) or an organ bag (OB; control group) between 21 June 2020 and 21 April 2021. Demographic features, mortality rate, hospital and intensive care unit (ICU) length of stay, duration of intubation, and rates of successful abdominal closure during the index hospital admission were compared. RESULTS/UNASSIGNED:= 0.621). ICU and hospital lengths of stay and mortality rates were similar between the groups. CONCLUSION/UNASSIGNED:The SB demonstrated comparable short-term outcomes to the OB. Although no statistically significant differences were observed, the SB appears to be a feasible TAC option, particularly in resource-limited settings. Larger prospective studies are needed to confirm these preliminary findings.

BACKGROUND:Hand-intensive surgical tasks expose the thumb and surrounding musculature to repetitive mechanical loading. Instrument design may influence the distribution of forces across the hand, yet quantitative data characterizing these loads during routine orthopedic procedures remain limited. This study quantified fingertip forces and thenar pressure during simulated meniscectomy using a pituitary rongeur and Ferris-Smith forceps. METHODS:Orthopedic residents performed simulated meniscectomy on a porcine knee model while wearing TekScan pressure sensors. Each participant used both a pituitary rongeur and Ferris-Smith forceps. The rongeur employs a pistol-grip mechanism producing thenar loading, whereas the forceps use a pincer-style grip emphasizing distal thumb-index finger motion. The TekScan Grip System quantified force distribution across the fingers, thumb tip, and thenar region. RESULTS:Thirteen residents completed 4 meniscectomies each. The use of the pituitary rongeur resulted in significantly higher mean forces in the fingers (50.10 ± 6.22 N vs 30.62 ± 5.69 N) and thenar region (40.69 ± 11.99 N vs 3.34 ± 1.39 N) compared with forceps. Thumb-tip forces were similar between instruments (7.66 ± 3.85 N for rongeur vs 10.59 ± 3.15 N for forceps). Linear regression revealed no significant associations between demographic variables and force measurements, except for thumb-tip force during forceps use. CONCLUSION/CONCLUSIONS:Instrument design significantly affects hand force distribution during meniscectomy. The rongeur imposes substantially greater mechanical demands on the fingers and thenar region, whereas forceps rely primarily on distal thumb-index finger motion. Repetitive rongeur use may contribute to cumulative hand and thumb carpometacarpal strain in surgeons.

PURPOSE/UNASSIGNED:Meniscal repair failure is a significant clinical concern, but existing literature treats it as a single outcome without differentiating timing. Early and late failures may represent mechanistically distinct phenomena; identifying their differential predictors could improve risk stratification and postoperative monitoring. METHODS/UNASSIGNED:A retrospective cohort study used a national database to identify patients undergoing arthroscopic meniscal repair, including both isolated repairs and repairs performed with concomitant anterior cruciate ligament reconstruction, classified into early failure (reoperation <365 days, approximating the conventional period of meniscal healing), late failure (≥365 days) or no failure. Cause-specific Cox proportional hazards regression identified independent predictors of each failure type separately. RESULTS/UNASSIGNED: < 0.05). CONCLUSION/UNASSIGNED:Early and late meniscal repair failures are distinct clinical phenotypes with differing risk factors and reoperation patterns. Early failure appears driven by mechanical and technical factors; late failure is more strongly associated with degenerative joint disease and host biology. These findings may inform individualised monitoring and risk stratification strategies. LEVEL OF EVIDENCE/UNASSIGNED:Level III, retrospective cohort study.

IMPORTANCE/UNASSIGNED:Anemia is a prevalent condition among patients with traumatic brain injury (TBI); however, the optimal hemoglobin (Hb) threshold to initiate red blood cell transfusion (RBCT) is not well defined. OBJECTIVE/UNASSIGNED:To assess which of 2 different Hb thresholds for guiding RBCT in patients with anemia and TBI is associated with a more favorable neurological outcome. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This was a preplanned secondary analysis of the Transfusion Strategies in Acute Brain Injured Patients multicentric randomized clinical trial, conducted in 72 intensive care units across 22 countries between September 1, 2017, and December 31, 2022. Follow-up was completed June 30, 2023. Only patients with TBI were included in the present analysis, conducted from February to May 2025. INTERVENTIONS/UNASSIGNED:Liberal (transfusion at Hb <9 g/dL [to convert to g/L, multiply by 10.0]) vs restrictive (transfusion at Hb <7 g/dL) RBCT strategy over a maximum of 28 days. MAIN OUTCOME AND MEASURES/UNASSIGNED:The primary outcome was the occurrence of unfavorable neurological outcome, defined as a Glasgow Outcome Scale Extended score of 1 to 5 (overall range, 1-8, with higher scores indicating more favorable outcome) at 180 days. In addition, 14 prespecified serious adverse events, including infection and cerebral ischemia, were assessed. Data were analyzed using both the intention-to-treat and per-protocol principles. RESULTS/UNASSIGNED:Of 486 patients who presented with TBI (mean [SD] age, 46.8 [17.6] years; 347 [71.4%] male), 475 were included in the primary outcome analysis: 236 were randomized to the liberal transfusion strategy group and 239 to the restrictive transfusion strategy group. Both groups had similar baseline characteristics. In total, 534 RBCTs were administered in the liberal transfusion strategy group, compared with 246 RBCTs in the restrictive group. At 180 days after randomization, 138 patients (58.5%) in the liberal group had unfavorable neurological outcome compared with 161 patients (67.4%) in the restrictive group (relative risk [RR], 0.86 [95% CI, 0.75-1.00]; P = .047; fragility index = 1). There were no significant differences in the occurrence of secondary outcomes (eg, 28-day mortality: 42 of 240 [17.5%] vs 51 of 244 [20.9%]; RR, 0.84 [95% CI, 0.58-1.21]; P = .34) or serious adverse events (eg, RR, 1.13 [95% CI, 0.88-1.43]; P = .34 for infection and RR, 0.87 [95% CI, 0.40-1.90]; P = .72 for cerebral ischemia). After adjustment for several confounders, being randomized to the liberal group was associated with a lower observed probability of unfavorable neurological outcome (odds ratio, 0.60 [95% CI, 0.38-0.94]; P = .03). CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this secondary analysis of a multicenter randomized clinical trial, a liberal RBCT strategy was associated with a lower risk than a restrictive RBCT strategy of unfavorable neurological outcome at 180 days among patients with TBI. These findings should be interpreted with caution in light of the inherent uncertainty of the estimate. TRIAL REGISTRATION/UNASSIGNED:ClinicalTrials.gov Identifier: NCT02968654.

PURPOSE/UNASSIGNED:To evaluate the effects of medial open-wedge high tibial osteotomy (MOWHTO) combined with arthroscopic partial meniscectomy (APM) on spatiotemporal gait parameters and plantar pressure distribution in patients with varus knee osteoarthritis (KOA). METHODS/UNASSIGNED:A prospective study was conducted including 25 patients with medial compartment KOA who underwent MOWHTO combined with APM and 25 healthy controls. Gait parameters and plantar pressure were recorded preoperatively and 4 months postoperatively using the Zebris FDM pressure platform. Radiographic parameters-including the femorotibial angle (FTA), medial proximal tibial angle (MPTA), weight-bearing line ratio (WBLR), and tibial plafond inclination (TPI)-as well as clinical scores (VAS, HSS, WOMAC, and Lysholm) were assessed. RESULTS/UNASSIGNED:Postoperative radiographic parameters and clinical scores significantly improved (P < 0.001). Stride length (P < 0.05), gait velocity, and affected-limb stance duration (P < 0.01) increased. COP path length (P < 0.001) and gait temporal symmetry indices (P < 0.01) decreased. Radiographic correction correlated with plantar-pressure variables (P < 0.05). Medial forefoot (M1) and medial heel (HM) contact time and peak pressure also increased (P < 0.05). CONCLUSION/UNASSIGNED:MOWHTO combined with APM was associated with improvements in lower-limb alignment, gait performance, plantar-pressure distribution, and gait symmetry during the short-term postoperative period.

BACKGROUND:The Dead Sea is a hypersaline lake with unique mineral concentrations. Ingestion and aspiration of its water can lead to severe electrolyte imbalances and chemical pneumonitis. OBJECTIVES/OBJECTIVE:To evaluate imaging findings from Dead Sea near-drowning victims and to correlate these findings with clinical outcomes. METHODS:We conducted a retrospective study of patients (age > 18 years) admitted to a tertiary medical center between 2004 and 2024 following Dead Sea near-drowning. Imaging studies were categorized by a radiology expert into normal, interstitial changes, unilateral consolidation, or bilateral consolidation. Clinical outcomes, including mortality and intensive care unit (ICU) admission, were analyzed across the groups. RESULTS:Of the 150 patients identified, 68.7% (n=103) had normal chest X-rays. Abnormal findings included bilateral consolidation 12.7% (n=19), unilateral consolidation 9.3% (n=14), and interstitial changes 9.3% (n=14). Patients with bilateral consolidation had significantly higher peak serum magnesium (median 10.5 vs. 3.1 mg/dl in the normal group; P < 0.001) and peak calcium (median 13.1 vs. 10.3 mg/dl; P < 0.001). Bilateral consolidation was a strong predictor of severity: 26.3% in-hospital mortality rate compared to 1% in the group with normal X-rays (P < 0.001). ICU admission was required for 78.9% of patients with bilateral consolidation and 71.4% with interstitial changes (P < 0.001). CONCLUSIONS:Radiologic findings in Dead Sea near-drownings are predictive of clinical trajectory. Bilateral alveolar consolidation is an indication of massive mineral aspiration, severe hypermagnesemia, and high mortality. Early imaging is essential for risk stratification and for determining the level of care required.