Polytrauma and concomitant hemorrhagic shock can lead to intestinal damage and subsequent multiple organ dysfunction syndrome. The intestinal fatty acid-binding protein (I-FABP) is expressed in the intestine and appears quickly in the circulation after intestinal epithelial cell damage. This porcine animal study investigates the I-FABP dynamics in plasma and urine after polytrauma. Furthermore, it evaluates to what extent I-FABP can also act as a marker of intestinal damage in a porcine polytrauma model. Eight pigs (Sus scrofa) were subjected to polytrauma which consisted of lung contusion, tibial fracture, liver laceration, and hemorrhagic shock followed by blood and fluid resuscitation and fracture fixation with an external fixator. Eight sham animals were identically instrumented but not injured. Afterwards, intensive care treatment including mechanical ventilation for 72 h followed. I-FABP levels in blood and urine were determined by ELISA. In addition, immunohistological staining for I-FABP, active caspase-3 and myeloperoxidase were performed after 72 h. Plasma and urine I-FABP levels were significantly increased shortly after trauma. I-FABP expression in intestinal tissue showed significantly lower expression in polytraumatized animals vs. sham. Caspase-3 and myeloperoxidase expression in the immunohistological examination were significantly higher in the jejunum and ileum of polytraumatized animals compared to sham animals. This study confirms a loss of intestinal barrier after polytrauma which is indicated by increased I-FABP levels in plasma and urine as well as decreased I-FABP levels in immunohistological staining of the intestine.

Background: The Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) are widely used to assess trauma patients. In this study, the interobserver variability of the injury severity assessment for severely injured patients was analyzed based on different injured anatomical regions, and the various demographic backgrounds of the observers. Methods: A standardized questionnaire was presented to surgical experts and participants of clinical polytrauma courses. It contained medical information and initial X-rays/CT-scans of 10 cases of severely injured patients. Participants estimated the severity of each injury based on the AIS. Interobserver variability for the AIS, ISS, and New Injury Severity Score (NISS) was calculated by employing the statistical method of Krippendorff's α coefficient. Results: Overall, 54 participants were included. The major contributing medical specialties were orthopedic trauma surgery (N = 36, 67%) and general surgery (N = 13, 24%). The measured interobserver variability in the assessment of the overall injury severity was high (α _ISS: 0.33 / α _NISS: 0.23). Moreover, there were differences in the interobserver variability of the maximum AIS (MAIS) depending on the anatomical region: α_{head and neck}: 0.06, α_thorax: 0.45, α_abdomen: 0.27 and α_extremities: 0.55. Conclusions: Interobserver agreement concerning injury severity assessment appears to be low among clinicians. We also noted marked differences in variability according to injury anatomy. The study shows that the assessment of injury severity is also highly variable between experts in the field. This implies the need for appropriate education to improve the accuracy of trauma evaluation in the respective trauma registries.

Background: The management of lateral compression type 1 (LC-1) pelvic fractures remains controversial. Posterior fixation alone has traditionally been practiced without clearly defined indications for supplementary anterior stabilization. Direct comparative evidence between posterior-only and combined anterior–posterior fixation remains scarce. This study evaluated whether institutional criteria reliably identify patients who benefit from additional percutaneous anterior fixation. Methods: A retrospective cohort study was conducted at a level I trauma center and included adults with LC-1 fractures treated exclusively by percutaneous fixation. Combined anterior–posterior fixation was performed when predominant anterior pain and radiographic compromise indicated instability. Primary outcomes were pain trajectory (Numeric Rating Scale), inpatient opioid use, physiotherapy clearance, and ward mobility. Results: Thirty-seven patients were analyzed (combined = 14; posterior-only = 23). Preoperative pain was higher in the combined group (median 7 vs. 6; median difference 1 [95% CI 0 to 2]; p = 0.0036). Postoperatively, pain scores were lower in the combined group at 1–6 weeks (median difference −1 [95% CI −2 to 0]; p < 0.05). Opioid consumption was reduced (193 mg vs. 312 mg; median difference −200 mg [95% CI −280 to −120]; p < 0.001), and physiotherapy clearance occurred earlier (4 vs. 7 days; median difference −3 [95% CI −5 to −1]; p = 0.020). Conclusion: Our current indications to perform combined fixation were associated with favorable early outcomes in pain control and physiotherapy clearance among patients with LC-1 fractures showing anterior compromise. These results support a selective combined approach, though interpretation must remain cautious given the small retrospective cohort. Further prospective studies are warranted to validate these findings and refine patient selection.

Background/Objectives: The GCS is widely used to assess a patient’s level of consciousness after trauma. Although not a diagnostic tool for traumatic brain injury (TBI), prehospital clinicians frequently rely on GCS findings—along with pupil exam, mechanism of injury, and clinical presentation, to estimate the likelihood that TBI may be present before imaging is available. However, the GCS has known limitations and fails to identify a significant proportion of TBI patients. This study aimed to evaluate the association between GCS scores and the presence of TBI, and whether additional clinical variables improve its discriminatory value. Methods: This retrospective cohort study analyzed data from trauma patients registered in the TraumaRegister DGU^® between 2015 and 2017. TBI was defined as a head injury with an Abbreviated Injury Scale (AISHead) score of ≥2. Inclusion criteria consisted of trauma team activations with a maximum AIS ≥ 3 and/or the need for intensive care. Prognostic values were assessed using multivariable logistic regression analysis. Results: 40,216 patients were included of which 17,205 (42.8%) were diagnosed with TBI and 23,011 (57.2%) were non-TBI patients. In the TBI group, 36.4% (n = 6216) presented with an initial GCS of 15 prehospitally. 17.8% (n = 3059) of TBI patients had anisocoric or bilaterally dilated pupils, 22.1% (n = 3799) had sluggish or fixed light reactivity and 17% (n = 2934) had no motoric response in Eppendorf-Cologne Scale (ECS) motor component. GCS score by itself showed better TBI prediction value than pupil size or reactivity or motor component alone. Nevertheless, substantial misclassification was observed when using GCS alone: 25.7% of patients with a normal GCS (15) had TBI (AIS Head ≥ 2), while 19.1% of patients with GCS 3 had no TBI. In the non-TBI group, 2.7% (n = 622) had a GCS of 3, 2.9% (n = 685) had anisocoric or bilaterally dilated pupils, 4.2% (n = 960) had sluggish or fixed light reactivity and 3.3% (n = 751) had no motoric response. Even at the lowest GCS score of 3, 19.1% of patients did not have TBI, while a normal GCS of 15 still included 25.7% of patients with TBI. Conclusions: The expanded model combining GCS with pupillary assessment and the ECS motor component demonstrated superior performance in prehospital TBI detection compared with the GCS alone. Implementing an extended GCS incorporating pupillary and ECS assessment may facilitate earlier recognition of TBI and support timely triage decisions; however, potential effects on patient outcomes require confirmation in prospective studies.

Purpose: To compare early postoperative results for the management of acetabular fractures using open reduction and internal fixation versus acute total hip replacement with a cementless modular cup in patients older than 55 years. Methods: This was a retrospective cohort study conducted at a Level I trauma center between April 2019 and March 2024, including 36 consecutive patients aged ≥ 55 years with displaced acetabular fractures treated by a single senior pelvic surgeon using open reduction and internal fixation ( n = 20), stand-alone total hip replacement ( n = 9), or a planned two-stage combined hip procedure ( n = 7). The primary outcome included Harris Hip Score at 6 months, Secondary outcomes included postoperative complications, unplanned reoperation, and radiographic implant assessment. Results: At six months, both replacement groups showed significantly better functional outcomes (mean Harris hip scores of 83 and 82) compared to the fixation-only group (mean score of 57; p < 0.001). All reoperations (4/20) occurred in the fixation group, while no reoperation was required in the replacement groups. Radiographic evaluation confirmed stable implant fixation in all arthroplasty cases, without signs of loosening or dislocation. Conclusion: According to our treatment algorithm, acute total hip replacement using a modular revision cup with an iliac peg, with or without plate osteosynthesis, offers the advantage of early full weight-bearing and promising functional outcomes in the management of complex acetabular fractures. These results support the integration of acute total hip replacement into structured decision-making protocols especially for elderly patients.

Background: Pelvic ring fractures (PRF) in polytraumatized patients can have a substantial impact on both short- and long-term outcomes. This study aimed to compare the outcomes of combined anterior–posterior (AP) stabilization versus posterior-only (PO) fixation for unstable PRFs in polytraumatized patients. Methods: This retrospective, cross-sectional cohort study included adult polytraumatized patients with AO/OTA type B and C pelvic ring injuries treated at a Level I trauma centre between 2010 and 2023. Patients were assigned to one of two groups according to the definitive pelvic stabilization strategy: posterior-only (PO) fixation or combined anterior–posterior (AP) stabilization. The primary outcomes were functional recovery and quality of life, assessed using the Pelvic Outcome Score and the EuroQol EQ-5D-5L. Secondary outcomes included complication rates, quality of radiographic fracture reduction, time to mobilization, length of hospital stay, and pain at discharge. Results: A total of 158 patients were included in the study; most were male ( n = 102, 64.6%), with a median age of 42 years. Fifty-eight patients (36.7%) completed the cross-sectional follow-up assessment after a median follow-up of four years. Overall, 31.0% ( n = 49) underwent definitive posterior-only (PO) stabilization, whereas 69.0% ( n = 109) underwent combined anterior–posterior (AP) stabilization according to the institutional treatment protocol. AO/OTA type C injuries were significantly more common in the AP group. No significant differences were observed between the AP and PO groups with respect to length of hospital stay, complication rates, time to mobilization, functional outcomes, or quality of life. AP stabilization was associated with superior radiographic fracture reduction, particularly of the anterior pelvic ring, but this did not translate into improved long-term outcomes. PO fixation was associated with lower pain scores at follow-up (median VAS, 2 vs. 4; p < 0.05), particularly among patients with AO/OTA type B injuries. Conclusions: Both AP and PO stabilization, when selected according to the institutional treatment protocol, yielded comparable functional outcomes and complication rates in polytraumatized patients with unstable pelvic ring fractures. The choice of stabilization strategy should be individualized based on pelvic injury morphology, patient physiology, and overall trauma burden within the framework of Early Appropriate Care principles. Further prospective studies are needed to validate these findings and identify factors influencing long-term recovery.