Objectives We carried out a retrospective cohort study to differentiate geriatric odontoid fractures into stable and unstable and correlated it with fracture fusion rates. Results are based on the literature and on our own experience. The authors propose that the simple Anderson and D’Alonzo classification may not be sufficient for geriatric patients. Methods There were 89 patients ≥ 65 years who presented at our institution with type II and III odontoid fractures from 2003 until 2017 and were included in this study. Each patient was categorized with CT scans to evaluate the type of fracture, fracture gap (mm), fracture angulation (°), fracture displacement (mm) and direction (ventral, dorsal). Fractures were categorized as stable [SF] or unstable [UF] distinguished by the parameters of its angulation (< / > 11°) and displacement (< / > 5 mm) with a follow-up time of 6 months. SFs were treated with a semi-rigid immobilization for 6 weeks, UFs surgically—preferably with a C1–C2 posterior fusion. Results The classification into SFs and UFs was significant for its angulation (P = 0.0006) and displacement (P < 0.0001). SF group (n = 57): A primary stable union was observed in 35, a stable non-union in 10, and an unstable non-union in 8 patients of which 4 were treated with a C1/2 fixation. The overall consolidation rate was 79%. UF group (n = 32): A posterior C1–C2 fusion was carried out in 23 patients, a C0 onto C4 stabilization in 7 and an anterior odontoid screw fixation in 2. The union rate was 100%. Twenty-one type II SFs (91%) consolidated with a nonoperative management (P < 0.001). A primary non-union occurred more often in type II than in type III fractures (P = 0.0023). There was no significant difference in the 30-day overall case fatality (P = 0.3786). Conclusion To separate dens fractures into SFs and UFs is feasible. For SFs, semi-rigid immobilization provides a high consolidation rate. Stable non-unions are acceptable, and the authors suggest a posterior transarticular C1–C2 fixation as the preferred surgical treatment for UFs. Level of evidence Level III.

Purpose The aim of this study was to analyze the injury patterns and clinical course of a winter sport dominated by blunt renal trauma collective. Methods Blunt renal trauma cases (N = 106) treated in a Level 1 Trauma Center in Austria were analyzed. Results We encountered 12.3% grade 1, 10.4% grade 2, 32.1% grade 3, 38.7% grade 4 and 6.6% grade 5 renal traumata classified according to the American Association for the Surgery of Trauma (AAST). The mechanisms of injury (MOI) did not have an influence on the frequency of HG trauma (i.e., grade 4 and 5). No concomitant injuries (CIs) were found in 57.9% of patients. The number of patients without CIs was significantly higher in the sports associated trauma group compared to other MOIs (p < 0.01). In 94.3% the primary treatment was a non-operative management (NOM) including 56.6% conservative, 34.0% endourological, and 3.8% interventional therapies. A follow-up computed tomography (FU-CT) was performed in 81.1%, 3.3 days after trauma. After FU-CT, the primary therapy was changed in 11.4% of cases (grade ≥ 3). Comparing the Hb loss between the patients with grade 3 and 4 kidney trauma with and without revision surgery, we find a significantly increased Hb loss within the first 96 h after the trauma in the group with a needed change of therapy (p < 0.0001). The overall rate of nephrectomy (primary or secondary) was 9.4%. Independent predictors of nephrectomy were HG trauma (p < 0.01), age (p < 0.05), and sex (p < 0.05). The probability of nephrectomy was lower with (winter) sports-associated trauma (p < 0.1). Conclusions Sports-associated blunt renal trauma is more likely to occur isolated, and has a lower risk of severe outcomes, compared to other trauma mechanisms. NOM can successfully be performed in over 90% of all trauma grades.

Zusammenfassung Hintergrund/Ziele Vergleich der präklinischen Behandlungsmodalitäten und Interventionsschemata für schwer traumatisierte Patienten mit vergleichbaren Verletzungsmustern zwischen Österreich und Deutschland. Patienten und Methoden Diese Analyse basiert auf Daten aus dem TraumaRegister DGU®. Die Daten umfassten schwer verletzte Traumapatienten mit einem Injury Severity Score (ISS) ≥ 16, einem Alter ≥ 16 Jahre und primärer Aufnahme in ein österreichisches (n = 4186) oder deutsches (n = 41.484) Level I Trauma Center (TC) von 2008 bis 2017. Untersuchte Endpunkte umfassten präklinische Zeiten und durchgeführte Eingriffe bis zur endgültigen Krankenhauseinweisung. Ergebnisse Die kumulierte Zeit für den Transport vom Unfallort zum Krankenhaus unterschied sich nicht signifikant zwischen den Ländern (62 min in AUT, 65 min in GER). Insgesamt wurden 53 % aller Traumapatienten in AUT mit einem Hubschrauber ins Krankenhaus transportiert, verglichen mit 37 % in GER (p < 0,001). Die Intubationsrate – 48 % in beiden Ländern, die Anzahl platzierter Thoraxdrainagen (5,7 % GER, 4,9 % AUT) und die Häufigkeit der verabreichten Katecholamine (13,4 % GER, 12,3 % AUT) waren vergleichbar (Φ = 0,00). Die hämodynamische Instabilität (systolischer Blutdruck (BP) ≤ 90 mmHg) bei Ankunft im TC war in AUT höher (20,6 % vs. 14,7 % bei GER; p < 0,001). In AUT wurden im Median 500 ml Flüssigkeit verabreicht, während in GER 1000 ml infundiert wurden (p < 0,001). Die demografischen Daten der Patienten zeigten keinen Zusammenhang (Φ = 0,00) zwischen beiden Ländern, und die Mehrheit der Patienten erlitt ein stumpfes Trauma (96 %). ASA-Score von 3–4 betrug 16,8 % in Deutschland (GER) gegenüber 11,9 % in Österreich (AUT). Fazit In AUT wurden deutlich mehr Helikopter-EMS-Transporte (HEMS) durchgeführt. Die Autoren schlagen vor, eine internationale Richtlinie zu implementieren, um das HEMS-System explizit nur für Traumapatienten a) für die Rettung/Versorgung von verunfallten oder in lebensbedrohlichen Situationen befindlichen Personen, b) für den Transport von Notfallpatienten mit ISS > 16, c) für den Transport von Rettungs- oder Bergungspersonal in schwer zugängliche Regionen oder d) für den Transport von Arzneimitteln, insbesondere Blutprodukten, Organtransplantaten oder Medizinprodukten einzusetzen. Graphic abstract