Medizinische Universität Graz - Research portal
Selected Publication:
Ulle, A.
SEVERE FOOT AND ANKLE INJURIES IN MVA’S AS PART OF THE POLYTRAUMA MANAGEMENT AND THE POSSIBILITIES OF THEIR PREVENTION
A retrospective analysis/study of cases including the patients’ outcome with the data from the TraumaRegister DGU®
Humanmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2022. pp.
- Authors Med Uni Graz:
- Advisor:
- Eibinger Nicolas
- Seibert Franz
- Altmetrics:
- Abstract:
- Introduction: ‘Treat first what kills first’ is a fundamental principle of the polytrauma management. However, there are also injuries that are not be initially life threatening but can be overlooked in this stressful setting. If such injuries remain undetected for a long time, they can worsen the patient’s outcome and lead to long term impairment. Methods: This study includes all patients treated at the Level I Trauma Center at the University Medical Center of Graz between 2016 and 2019 and included in the TraumaRegister DGU®. All patients had to have sustained a polytrauma in the course of a traffic accident (mechanism of injury: car/truck, motorcycle, cyclist or pedestrian) and a severe foot or ankle injury had to be diagnosed. Primary overlooked foot injuries were discovered and diagnosed at different later points in time. Patient’s outcome, presence of a TBI, the ISS, GCS, and at least one AIS code from the Abbreviated Injury Scale© were included. All data were collected from MEDOCS and the TraumaRegister DGU® at the Department of Orthopaedics and Traumatology at the University Medical Center of Graz and were stored in a Microsoft-Excel® document for subsequent analysis with IBM-SPSS 27®. Differences and correlations with a p value of < .05 were considered statistically significant. Results: The sample consisted of 40 men (69%) and 18 females (31%), totaling 58 patients with a mean age of 46 years (SD = 20 years). The mean scores of the ISS were 29.98 (SD = 12.93), of the GCS 12.38 (SD = 3.63) and of the RTS 7.18 (SD = 0.64). Most of the patients had been in a car accident (55%), followed by motorcycle accidents. Most primary overlooked injuries could be found in patients who had been in a car accident and were male. 78% of detected severe foot and ankle injuries could be diagnosed during the so-called primary survey in the emergency trauma room, but of primary overlooked injuries 16% remained undetected during the primary survey. The number of patients who recovered well was the same as those who died (7%), but most patients were slightly handicapped (47%) or were in a persistent vegetative state (40%). In 28 cases (48%) patients also sustained a TBI. Because of the small sample size, most analyses were descriptive, but small differences were found. Conclusion: Since overlooked injuries still play a major role in polytrauma patients and can have a significant impact on their outcome, adequate imaging, patient history taking, evaluation of symptoms, and detailed knowledge of the anatomy and mechanisms of injury are required. Documentation is key and should be done carefully. Patients with a TBI require good monitoring. Even if a foot injury has already been diagnosed, it is important to keep in mind that a more complex pattern of injury may not have been recognized.