Cardiac injury remains a rare occurrence even to the most experienced trauma surgeon. Despite this rarity, a physician receiving trauma patients with potential injury to the heart must be prepared to lead a rapid and precise assessment, request the relevant diagnostic imaging, and guide a surgical or observation based plan. A high index of suspicion of cardiac injury is vital to avoid missed injuries and preventable fatalities. Knowledge of the differences between blunt and penetrating cardiac trauma is crucial in managing these patients. A paucity of data has prevented evidenced based guidelines, nevertheless large volume centers continue to publish and update their experiences which have led to recommendations on how to evaluated and treat cardiac trauma patients with good outcomes. This paper reviews the literature on cardiac trauma, while focusing on the difference between blunt and penetrating injury, the current recommendations for diagnostic imaging, observation, and certain principles of surgical treatments.

Introduction: Proximal femoral fractures (PFFs) are a major medical event in an elderly's life. The extent of conservative treatment is poorly evaluated in Western health systems. This study retrospectively examines a national cohort of patients older than 65 years with PFFs treated by early surgery (ES) (48h), and conservative treatment (COT) over the past decade (2010 to 2019). Results: The study cohort included 38,841 patients; 18.4% were 65 to 74 years, 41.1% were 75 to 84 years, and 40.5% were older than 85 years; 68.5% were female. ES rose from 68.4% in 2013 to 85% in 2017 (P < 0.0001). COT dropped from 8.2% in 2010 to 5.2% in 2019 (P < 0.0001). Level I trauma centers chose 2.3 times less COT (7.75% in 2010 decreased to 3.37% in 2019) while regional hospitals chose COT only 1.4 times less over the years (P < 0.001). Hospitalization periods differed: 6.3 ± 0.6d for COT, 8.6 ± 0.3d for ES, and 12 ± 0.4d for DS (P < 0.001), and the in-hospital mortality rates were 10.5%, 2%, and 3.6%, respectively (P < 0.0001). One-year mortality rates decreased for ES only (P < 0.001). Discussion: ES rose from 58.1% in 2010 to 84.9% in 2019 (P = 0.00002). COT is diminishing throughout the Israeli health system, from 8.2% in 2010 to 5.2% in 2019. Tertiary hospitals consistently practice less COT than regional hospitals (P < 0.001), probably related to surgeons' and anesthetists' appraisal of the patient's medical status and demand. COT had the shortest hospitalization period but carried the highest in-hospital mortality rates (10.5%). The mild difference in out-of-hospital mortality between the COT and DS groups suggests similar patient characteristics that require additional investigation. In conclusion, more PFFs are treated within 48h with a reduced mortality rate, and the 1-year mortality has improved for ES only. Treatment preferences vary between tertiary and regional hospitals.

Background/Objectives: Proximal femoral fractures (PFFs) are a common worldwide ailment, causing high morbidity and mortality among the elderly, with one-year mortality estimated at 15–30%. This study aimed to identify factors influencing in-hospital patient survival after proximal femoral fracture surgery. Methods: A retrospective cohort study of patients over 65 admitted to an orthopedic surgery department due to a PFF over five years was carried out. Medical records, surgery reports, anesthesia and post-anesthesia care unit sheets, and laboratory archives were reviewed. Results: The study group consisted of 48 patients who died during the first postoperative week, while the control group consisted of 69 patients who were discharged for rehabilitation after a week. The study group was older, less active, and had higher rates of comorbidities. Anesthetic factors, such as the type of anesthesia and admixture of drugs, did not have a significant association with mortality. However, a binary logistic regression showed that age (OR = 1.15, p < 0.001), intraoperative lactate levels (OR = 5.86, p < 0.001), and post-anesthesia care unit (PACU) overnight stays (OR = 17.54, p < 0.001) were significantly associated with early mortality. Conclusions: The study highlights the challenge of identifying PFF patients at risk of early mortality and the need to better understand the decision-making algorithm to create a reliable scale that can predict mortality and adjust treatment. In our study, solid mortality parameters were age and intraoperative lactate levels. The most significant parameter was PACU overnight stay, which represents the anesthesiologist’s soft-skill-based decision that is challenging to scale and reproduce.