Survivors of a major trauma experience a range of difficulties in relation to the reduction in physical, psychosocial, and cognitive functions, which can result in a reduced health-related quality of life. This study aims to explore lived experiences of major trauma survivors in the German healthcare system. Semi-structured exploratory interviews were performed with nine major trauma survivors (18-55 years; Injury Severity Score ≥16). For exploratory analyses, an artificial intelligence-based coding software was used. Further, results were clustered by using the International Classification of Functioning, Disability and Health framework (ICF). Communication was one of the major topics concerning amongst others diverting opinions between different healthcare disciplines and a general lack of information. The participants showed a high demand for a contact person. Furthermore, social support was essential during recovery for those interviewed. Social network was not only important as emotional and physical support but also for overcoming of gaps in the healthcare system. The support by employers and colleagues seemed to be beneficial for our participants in relation to returning to work. Further, psychological consequences of trauma, and that mobility is a key factor for quality of life, self-efficacy and return to work were discussed. The qualitative analyses highlight several topics such as communication, burden of sickness, support systems that the participants mentioned as important along their journey through the German healthcare system during recovery. Through the ICF model the interplay of certain components that influenced the outcome of the major trauma survivors was visualized. These results might offer a deepened understanding of modifiable components of a patient pathway in recovery process such as improvements of patient communication, provision of a contact person and others.

Background/Objectives: The aim was to investigate diagnostic, treatment and preventive options to establish an overview of the existing evidence on hemorrhage in pelvic fractures in older adults. Methods: A systematic review was conducted. Due to the rarity of this complication, only case reports and series with individuals older than 55 years with a pelvic ring fracture that is caused by a low-energy trauma or no apparent trauma, along with hemorrhage, were eligible. A search was performed on four databases. The CARE checklist was used to investigate the reporting integrity of the included studies. Analysis was performed narratively, and this study was registered on the Open Science Framework. Results: 21 patients from 19 studies were included (17 females and 4 males) with an average age of 82.1 years. The 21 patients suffered a total of 29 fractures. Pubic ramus fractures were present in 48.3% of all fractures. In 42.9%, an active hemorrhage was reported. Arterial vessels were injured in direct anatomical relationship to the fracture. Abdominal pain and hemorrhagic instability were the main red flag symptoms reported. Active arterial hemorrhage was diagnosed by CT with angiogram and treated by embolization with or without additional surgery. Conclusions: Clinically relevant hemorrhage in pelvic fractures due to low-energy trauma is rare. However, these fractures, combined with clinically relevant hemorrhage, account for an increased mortality and morbidity in elderly people. This systematic review was able to create a clinical decision tree for hemorrhage in ramus pubic fractures.

Das Ausmaß von Schuss- und Explosionsverletzungen wird häufig unterschätzt, insbesondere wenn sie – wie in Deutschland – selten vorkommen und die Erfahrung mit ihnen begrenzt ist. Ziel dieses Beitrags ist es, die Charakteristika von Schuss- und Explosionsverletzungen darzulegen – inklusive der Notfalldiagnostik – und eine initiale chirurgische Behandlung vorzustellen. The severity and extent of gunshot and blast injuries are often misjudged due to a lack of specialist knowledge. The aim of this article is to outline the characteristics of gunshot and blast injuries, including emergency diagnostics and initial surgical treatment. Due to multiple high-energy penetrating injuries, barotrauma, or blunt trauma, affected patients are usually polytraumatized, with multiple organ damage and an average Injury Severity Score (ISS) of > 36. In addition to the complexity of the wounds, they are characteristically severely contaminated. After pre-hospital treatment, life-threatening injuries and conditions should be identified and initially treated in the trauma room phase. The procedure should be based on a standardized, internal hospital emergency medical and emergency surgical algorithm. Damage control surgery can then be used to treat acutely life-threatening complications of gunshot and blast injuries in order to prevent the fatal triad and the occurrence of further early complications. Examples of interventions include debridement and decontamination, fracture stabilization (external fixators and splints), surgical decompression (skull, thorax, compartment syndromes) and surgical hemostasis. Article published online: 21 November 2024 © 2024. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Background/Objectives: Blood lactate concentration is often used to assess systemic hypoperfusion, tissue hypoxia, and sepsis in trauma patients and serves as a prognostic indicator and marker of response to therapy. Point-of-care (POC) devices provide rapid lactate measurements with a single drop of blood. In this study, lactate values from whole blood, measured with two POC devices, Abbott i-STAT^® and the Nova Biomedical Lactate (LA) Plus™ meter, are compared. Methods: An observational analysis of 760 blood samples from four preclinical trauma animal models was performed. Lactate was measured simultaneously with two POC devices (i-STAT^® and the Lactate Plus™ meter). The evaluation in the form of a Bland–Altman diagram showed the agreement of the tests. Results: The Spearman correlation was 0.9180 (95% CI 0.9056 to 0.9288) for i-STAT^® vs. the LA Plus™ meter. Both tests showed a significant increase in lactate after injury (p < 0.05). The i-STAT^® showed a small bias compared to the LA Plus™ meter (−0.0227 ± 0.4542 with 95% limits of agreement from −0.09129 to 0.8675). The LA Plus™ meter showed slightly higher values overall (0.0227 mmol/L), but the i-STAT^® showed higher results at lactate levels above 2.5 mmol/L. Conclusions: The observed similarity in performance between the two devices suggests that both are capable of reliably measuring lactate levels in a trauma situation. The LA Plus™ meter provides fast results with only one drop of blood. This study supports the prehospital use of POC devices.

Acute extremity compartment syndrome (CS) is a serious medical complication triggered by factors such as trauma, vascular injury, or prolonged compression, resulting in elevated intracompartmental pressure (ICP) and tissue ischemia. Diagnosis remains challenging, mainly relying on the subjective evaluation of clinical symptoms. Different animal models have been used to study pathophysiology and evaluate diagnostic and therapeutic approaches. The aim of this review is to summarize and compare different animal CS models to provide insight for the development of more authentic and clinically relevant CS model. A comprehensive search of two databases was conducted. English-language animal studies focusing on CS were included. Human studies, non-acute extremity CS, and review papers were excluded. Data extraction and analysis focused on animal species, CS models, and clinically relevant assessment methods of CS. After screening, 90 studies met the inclusion criteria. Small animal (n=36, 40%) and canine models (n=31, 34.4%) were the most used animal species. A fluid infusion model (n=48, 53.3%) was the predominant induction method, followed by the ischemia-reperfusion (n=29, 32.2%) and the internal/external mechanical pressure models. Five studies used a combination CS model to achieve a more comprehensive representation of the clinical pathophysiology. Various diagnostic modalities were employed; ICP measurement (n=74, 82.2%) and evaluation of tissue oxygenation (n=10, 11.1%) were the most frequent device-based assessments. Biomarkers assessing muscle cell damage (n=15, 16.7%), antioxidant status (n=18, 20%) and inflammation (n=16, 17.8%) were analyzed as well as physical examination (n=12, 13.3%) and neuromuscular testing (n=10, 11.1%). There are a variety of validated animal species models, which can be considered depending on the research objectives. This review helps researchers evaluate model strengths and drawbacks before deciding on an experimental design.

Purpose: This systematic review analyzes the patterns and distribution of blast injuries from landmine explosions, UXOs and terror attacks including suicide bombing, in civilians and military personnel. Methods: A search was conducted in two databases on 26. March 2025 for observational studies reporting blast injuries in civilian and military populations of all ages. Studies were clustered by explosion typ. A narrative data synthesis was performed. The JBI tool for case series was used. PROSPERO: CRD42023391736. Results: 126 studies were included in the overall systematic review. 45 studies on terror & suicide bombings and 12 studies on landmines & UXOs are analyzed in the present paper. Studies on landmines from 1980 to 2006 included 13,270 individuals (age: 24.0 years (Range 8.2 years – 32.2 years); mainly male (88.9%)) in post-conflict low- and middle-income countries. Lower extremity injuries including amputations were most frequent, followed by eye injuries. Studies on terrorist attacks with a total of 12,518 mainly civilian victims (average age: 33,1 years; 61.6% males) reported on incidents in post-conflict regions and high-income cities mainly from the early 2000s. The injury pattern was multidimensional, with extremity injuries most frequent (28%-30%), including fractures, lacerations, and traumatic amputations (18%-20%). Conclusion: This Systematic Review Part 2 on landmines and terror attacks found that extremity injuries, including traumatic amputations, are the most frequent and dominate injury. However, the injury pattern varies depending on the explosion mechanism. Landmines primarily cause lower extremity injuries, as well as eye injuries. Terror and suicide explosions exhibit multidimensional injury pattern depending on the distance and location of the explosion.