Dagmar Vos - Academia.edu (original) (raw)
Papers by Dagmar Vos
European Journal of Trauma and Emergency Surgery
World Journal of Emergency Surgery
Background: Multiple rib fractures are common injuries in both the young and elderly. Rib fractur... more Background: Multiple rib fractures are common injuries in both the young and elderly. Rib fractures account for 10% of all trauma admissions and are seen in up to 39% of patients after thoracic trauma. With morbidity and mortality rates increasing with the number of rib fractures as well as poor quality of life at long-term follow-up, multiple rib fractures pose a serious health hazard. Operative fixation of flail chest is beneficial over nonoperative treatment regarding, among others, pneumonia and both intensive care unit (ICU) and hospital length of stay. With no high-quality evidence on the effects of multiple simple rib fracture treatment, the optimal treatment modality remains unknown. This study sets out to investigate outcome of operative fixation versus nonoperative treatment of multiple simple rib fractures. Methods: The proposed study is a multicenter randomized controlled trial. Patients will be eligible if they have three or more multiple simple rib fractures of which at least one is dislocated over one shaft width or with unbearable pain (visual analog scale (VAS) or numeric rating scale (NRS) > 6). Patients in the intervention group will be treated with open reduction and internal fixation. Pre-and postoperative care equals treatment in the control group. The control group will receive nonoperative treatment, consisting of pain management, bronchodilator inhalers, oxygen support or mechanical ventilation if needed, and pulmonary physical therapy. The primary outcome measure will be occurrence of pneumonia within 30 days after trauma. Secondary outcome measures are the need and duration of mechanical ventilation, thoracic pain and analgesics use, (recovery of) pulmonary function, hospital and ICU length of stay, thoracic injury-related and surgery-related complications and mortality, secondary interventions, quality of life, and cost-effectiveness comprising health care consumption and productivity loss. Follow-up visits will be standardized and daily during hospital admission, at 14 days and 1, 3, 6, and 12 months. Discussion: With favorable results in flail chest patients, operative treatment may also be beneficial in patients with multiple simple rib fractures. The FixCon trial will be the first study to compare clinical, functional, and economic outcome between operative fixation and nonoperative treatment for multiple simple rib fractures.
BMC Emergency Medicine
Background: Rib fractures are common in ageing people after trauma and delirium is a complication... more Background: Rib fractures are common in ageing people after trauma and delirium is a complication often seen in acutely hospitalized elderly patients. For both conditions, elderly have an increased risk for institutionalization, morbidity, and mortality. This study is the first to investigate risk factors of delirium in elderly patients with rib fractures after trauma. Methods: A retrospective chart review was performed on patients ≥65 years admitted with rib fractures after blunt chest wall trauma to the Amphia hospital Breda, the Netherlands, between July 2013 and June 2018. Baseline patient, trauma-and treatment-related characteristics were identified. The main objectives were identification of risk factors of delirium and investigation of the effect of delirium on outcomes after rib fractures. Outcomes were additional complications, length of hospital stay, need for institutionalization and mortality within six months. Results: Forty-seven (24.6%) of 191 patients developed a delirium. Independent risk factors for delirium were increased age, physical impairment (lower KATZ-ADL score), nutritional impairment (higher SNAQ score) and the need for a urinary catheter, with odds ratios of 1.07, 0.78, 1.53 and 8.53 respectively. Overall, more complications were observed in patients with delirium. Median ICU and hospital length of stay were 4 and 7 days respectively, of which the latter was significantly longer for delirious patients (p < 0.001). Significantly more patients with delirium were discharged to a nursing home or rehabilitation institution (p < 0.001). The 6-month mortality in delirious patients was nearly twice as high as in non-delirious patients; however, differences did not reach statistical significance. Conclusion: Delirium in elderly patients with rib fractures is a serious and common complication, with a longer hospital stay and a higher risk of institutionalization as a consequence. Increased awareness for delirium is imperative, most importantly in older patients, in physically or nutritionally impaired patients and in patients in need of a urinary catheter.
BMJ Open
IntroductionThe Emergency Management of Severe Burns (EMSB) referral criteria have been implement... more IntroductionThe Emergency Management of Severe Burns (EMSB) referral criteria have been implemented for optimal triaging of burn patients. Admission to a burn centre is indicated for patients with severe burns or with specific characteristics like older age or comorbidities. Patients not meeting these criteria can also be treated in a hospital without burn centre. Limited information is available about the organisation of care and referral of these patients. The aims of this study are to determine the burn injury characteristics, treatment (costs), quality of life and scar quality of burn patients admitted to a hospital without dedicated burn centre. These data will subsequently be compared with data from patients with<10% total bodysurface area (TBSA) burned who are admitted (or secondarily referred) to a burn centre. If admissions were in agreement with the EMSB, referral criteria will also be determined.Methods and analysisIn this multicentre, prospective, observational study ...
JAMA, Dec 26, 2017
Following clean (class I, not contaminated) surgical procedures, the rate of surgical site infect... more Following clean (class I, not contaminated) surgical procedures, the rate of surgical site infection (SSI) should be less than approximately 2%. However, an infection rate of 12.2% has been reported following removal of orthopedic implants used for treatment of fractures below the knee. To evaluate the effect of a single dose of preoperative antibiotic prophylaxis on the incidence of SSIs following removal of orthopedic implants used for treatment of fractures below the knee. Multicenter, double-blind, randomized clinical trial including 500 patients aged 18 to 75 years with previous surgical treatment for fractures below the knee who were undergoing removal of orthopedic implants from 19 hospitals (17 teaching and 2 academic) in the Netherlands (November 2014-September 2016), with a follow-up of 6 months (final follow-up, March 28, 2017). Exclusion criteria were an active infection or fistula, antibiotic treatment, reimplantation of osteosynthesis material in the same session, alle...
Nederlands Tijdschrift voor Traumatologie
ABSTRACT Proximale femurfracturen hebben in Nederland een hoge incidentie. De operatieve behandel... more ABSTRACT Proximale femurfracturen hebben in Nederland een hoge incidentie. De operatieve behandeling kan bestaan uit stabilisatie van de fractuur met een DHS. Als mogelijke complicatie van deze ingreep kan er een bloeding ontstaan uit de arteria femoralis profunda, enerzijds door het peroperatief ‘doorschieten’ van de boor bij het opboren van de corticalisschroeven, anderzijds doordat de gebruikte schroeven te lang zijn. Deze potentieel ernstige complicatie kan worden voorkomen door met grote voorzichtigheid te boren en door de juiste lengte van corticalisschroeven te kiezen. In dit artikel beschrijven wij twee patiënten bij wie zich deze complicatie pas na enkele dagen presenteerde. Deze late presentatie is vaak kenmerkend voor deze complicatie, en er moet bij klachten van de patiënt aan worden gedacht.
Clinical Interventions in Aging
Background: Delirium in hip fractured patients is a frequent complication. Dementia is an importa... more Background: Delirium in hip fractured patients is a frequent complication. Dementia is an important risk factor for delirium and is common in frail elderly. This study aimed to extend the previous knowledge on risk factors for delirium and the consequences. Special attention was given to patients with dementia and delirium. Methods: This is a retrospective cohort study performed in the Amphia Hospital, Breda, the Netherlands. A full electronic patient file system (Hyperspace Version IU4: Epic, Inc., Verona, WI, USA) was used to assess data between January 2014 and September 2015. All patients presented were aged 70 years with a hip fracture, who underwent surgery with osteosynthesis or arthroplasty. Patients were excluded in case of a pathological or a periprosthetic hip fracture, multiple traumatic injuries, and high-energy trauma. Patient and surgical characteristics were documented. Postoperative outcomes were noted. Delirium was screened using Delirium Observation Screening Scale and dementia was assessed from medical notes. Results: Of a total of 566 included patients, 75% were females. The median age was 84 years (interquartile range: 9). Delirium was observed in 35%. Significant risk factors for delirium were a high American Society of Anesthesiology score, delirium in medical history, functional dependency, preoperative institutionalization, low hemoglobin level, and high amount of blood transfusion. Delirium was correlated with a longer hospital stay (P=0.001), increased association with complications (P0.001), institutionalization (P0.001), and 6-month mortality (P0.001). Patients with dementia (N=168) had a higher delirium rate (57.7%, P0.001) but a shorter hospital stay (P0.001). There was no significant difference in the 6-month mortality between delirious patients with (34.0%) and without dementia (26.3%). Conclusion: Elderly patients with a hip fracture are vulnerable for delirium, especially when the patient has dementia. Patients who underwent an episode of delirium were at increased risk for adverse outcomes.
Nederlands Tijdschrift Voor Traumatologie, Apr 1, 2009
Nederlands tijdschrift voor geneeskunde, Jan 28, 1998
In three women aged 51, 37 and 58 years, with a palpable tumour in the breast, excision and patho... more In three women aged 51, 37 and 58 years, with a palpable tumour in the breast, excision and pathological examination led to the diagnosis of 'phyllodes tumour'. During 3-5 years after radical excision, in one patient followed by radiotherapy, no recurrences were seen. This rare breast tumour with a variable clinical course usually affects women between the ages of 30 and 50. There is often a large tumour and (or) rapid growth. Mammography and ultrasound are unhelpful diagnostically. Cytology is unreliable as the tumour is heterogeneous. Histologically the tumour can be benign, borderline malignant or malignant. Surgical excision with a margin of > or = 1 cm is the therapy of choice. The risk of recurrence after insufficient excision is considerable and histological deterioration can occur. Multiple samples, examination of resection margins and investigation into atypia, mitotic activity and stromal overgrowth are essential for making a prognosis and a treatment plan. In c...
BMC surgery, Jan 6, 2015
In the Netherlands about 18,000 procedures with implant removal are performed annually following ... more In the Netherlands about 18,000 procedures with implant removal are performed annually following open or closed reduction and fixation of fractures, of which 30-80% concern the foot, ankle and lower leg region. For clean surgical procedures, the rate of postoperative wound infections (POWI) should be less than ~2%. However, rates of 10-12% following implant removal have been reported, specifically after foot, ankle and lower leg fractures. Currently, surgeons individually decide if antibiotics prophylaxis is given, since no guideline exists. This leads to undesirable practice variation. The aim of the study is to assess the (cost-)effectiveness of a single intravenous gift of Cefazolin prior to implant removal following surgical fixation of foot, ankle and/or lower leg fractures. This is a double-blind randomized controlled trial in patients scheduled for implant removal following a foot, ankle or lower leg fracture. Primary outcome is a POWI within 30 days after implant removal. Se...
Vascular Disease Management
Nederlands Tijdschrift voor Traumatologie, 2009
... Page 4. 47 Ned Tijdschr Traum 2009 - nr 2 4 Anderson LD, D'Alonzo RT. ... 3 Donovan DJ, ... more ... Page 4. 47 Ned Tijdschr Traum 2009 - nr 2 4 Anderson LD, D'Alonzo RT. ... 3 Donovan DJ, Huynh TV, Purdom EB, ea Osteoradionecrosis of the cervical spine resulting from radiotherapy for primary head and neck malignancies: operative and nonoperative manage-ment. ...
Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology, 2014
Over 75 % of patients presenting with a proximal humerus fracture are 70 years or older. Very lit... more Over 75 % of patients presenting with a proximal humerus fracture are 70 years or older. Very little is known about the outcome after operative treatment of these fractures in very old patients. This study was performed to gain more insight in safety and functional outcome of surgical treatment of proximal humerus fractures in the elderly. In this observational study, we analyzed all operatively treated patients, aged 75 or older, with a proximal humerus fracture between January 2003 and December 2008 in our center. Patient selection was on clinical grounds, based on physical, mental, and social criteria. Complications were evaluated. We used the DASH Questionnaire to investigate functional outcome, pain, and ADL limitations. Sixty-four patients were treated surgically for a displaced proximal fracture of the humerus: 15 two-part, 32 three-part, and 17 four-part fractures. Mean DASH scores were 37.5, 36.9, and 48.6, respectively. Regarding the operative methods, overall good results...
Nederlands Tijdschrift voor Traumatologie, 2010
ABSTRACT In deze retrospectieve studie zijn de resultaten geëvalueerd van de eerste drie jaar chi... more ABSTRACT In deze retrospectieve studie zijn de resultaten geëvalueerd van de eerste drie jaar chirurgische behandeling van proximale humerusfracturen met een hoekstabiele plaatosteosynthese. Tussen 2004 en 2006 werden 40 opeenvolgende patiënten behandeld met een hoekstabiele plaatosteosynthese; 28 patiënten konden worden getraceerd en onderzocht. Evaluatie vond plaats gemiddeld veertig maanden postoperatief. De gemiddelde consolidatietijd was drie maanden. Op de röntgenfoto werd bij drie schouders een avasculaire necrose van de schouderkop gezien, in twee gevallen partieel en in één geval volledig. Bij twee patiënten liet de röntgenfoto protrusie van schroeven door het caput zien. Er werden geen plaatbreuken of secundaire standsafwijkingen waargenomen. De gemiddelde constant-score van de geopereerde arm was 80, de score van de andere arm 95. Zes patiënten werden nogmaals geopereerd in verband met klachten van het osteosynthesemateriaal. Fixatie met hoekstabiele plaatosteosynthese is een goede operatieve behandeling van proximale humerusfracturen. Patiënten kunnen snel mobiliseren, de schouderfunctie op de middellange termijn is goed en de radiologische union-rate is hoog. Het risico op complicaties is klein.
Nederlands Tijdschrift voor Traumatologie, 2013
ABSTRACT Humerusschachtfracturen hebben een lage incidentie en beslaan 1-2% van alle fracturen. D... more ABSTRACT Humerusschachtfracturen hebben een lage incidentie en beslaan 1-2% van alle fracturen. De kans op deze fractuur neemt toe vanaf het 50e levensjaar. Humerusschachtfracturen worden enerzijds veroorzaakt door buiging van of stoot tegen de humerus of ten gevolge van een val op de arm met uitgestrekte elleboog of hand, anderzijds kunnen ook stressfracturen van de humerus ontstaan door repeterende bewegingen of door sterke spiercontracties, zoals bij roeien, speerwerpen en honkbal. Dit zijn vaak spiraalfracturen en die bevinden zich meestal in het distale gedeelte van de humerus. ‘Armpje drukken’ is een sport die veelvuldig op recreatief maar ook op wedstrijdniveau beoefend wordt. Behalve humerusschachtfracturen zijn ook een subscapularis- en proximale bicepspeesruptuur, een tuberculum minusfractuur, avulsiefractuur van de mediale epicondyl, anterieure dislocatie van de elleboog en een olecranonfractuur beschreven als gevolg van armpje drukken. Humerusschachtfracturen ten gevolge van armpje drukken kunnen gepaard gaan met neurovasculair letsel als gevolg van het trauma of de operatie. In de literatuur wordt bij 10-23% van de patiënten zenuwletsel beschreven. De behandeling kan conservatief zijn door middel van een bovenarmgips of sling, of operatief via open reductie en interne fixatie met plaat-schroefosteosynthese of een intramedullaire pen. Wij presenteren drie patiënten met een distale humerusschachtfractuur als gevolg van een wedstrijd armpje drukken. Behalve de biomechanische analyse en de betrokken spiergroepen bespreken we ook de tactiek: Is de aanval de beste verdediging?
Journal of Trauma Management & Outcomes, 2012
Background: The aim of this survey study was to evaluate the current opinion and practice of trau... more Background: The aim of this survey study was to evaluate the current opinion and practice of trauma and orthopaedic surgeons in the Netherlands in the removal of implants after fracture healing. Methods: A web-based questionnaire consisting of 44 items was sent to all active members of the Dutch Trauma Society and Dutch Orthopaedic Trauma Society to determine their habits and opinions about implant removal. Results: Though implant removal is not routinely done in the Netherlands, 89% of the Dutch surgeons agreed that implant removal is a good option in case of pain or functional deficits. Also infection of the implant or bone is one of the main reasons for removing the implant (> 90%), while making money was a motivation for only 1% of the respondents. In case of younger patients (< 40 years of age) only 34% of the surgeons agreed that metal implants should always be removed in this category. Orthopaedic surgeons are more conservative and differ in their opinion about this subject compared to general trauma surgeons (p = 0.002). Though the far majority removes elastic nails in children (95%). Most of the participants (56%) did not agree that leaving implants in is associated with an increased risk of fractures, infections, allergy or malignancy. Yet in case of the risk of fractures, residents all agreed to this statement (100%) whereas staff specialists disagreed for 71% (p < 0.001). According to 62% of the surgeons titanium plates are more difficult to remove than stainless steel, but 47% did not consider them safer to leave in situ compared to stainless steel. The most mentioned postoperative complications were wound infection (37%), unpleasant scarring (24%) and postoperative hemorraghe (19%). Conclusion: This survey indicates that there is no general opinion about implant removal after fracture healing with a lack of policy guidelines in the Netherlands. In case of symptomatic patients a majority of the surgeons removes the implant, but this is not standard practice for every surgeon.
European Journal of Trauma and Emergency Surgery, 2011
European Journal of Trauma and Emergency Surgery, 2009
ABSTRACT Right-sided diaphragm rupture is one of the typical injuries found during a secondary or... more ABSTRACT Right-sided diaphragm rupture is one of the typical injuries found during a secondary or tertiary survey after a major blunt trauma. This is mainly due to the apparently normal aspect of primary X-rays of the thorax. A right-sided diaphragm rupture can cause severe atelectasis of the right lower lobe of the lung, due to a hepatothorax. We present a case of a delayed diagnosis of right-sided diaphragm rupture, which was discovered by accident because of a new trauma. We review the literature on right-sided diaphragm rupture and its treatment.
European Journal of Trauma and Emergency Surgery, 2009
A pseudoaneurysm following a shoulder dislocation is considered rare. We report here a case of an... more A pseudoaneurysm following a shoulder dislocation is considered rare. We report here a case of an 82-yearold man who suffered from vascular and neurological injury due to an axillary pseudoaneurysm following anterior dislocation of the left shoulder. An emerging swelling in the shoulder region was caused by a hematoma and a slowly bleeding pseudoaneurysm in combination with reactive swelling of the soft tissues. Neurological damage occurred due to local compression. A minimally invasive technique was used to treat the pseudoaneurysm. Embolization was initially attempted, but this treatment failed. A stent was subsequently inserted to eliminate the axillary pseudoaneurysm from the circulation. Early imaging and an aggressive endovascular treatment should be considered in all patients suffering from an axillary artery (pseudo)aneurysm.
Clinical Interventions in Aging, 2013
Background: Hip fractures in the elderly population are associated with high morbidity and mortal... more Background: Hip fractures in the elderly population are associated with high morbidity and mortality. However, there is still a lack of information on mortality and loss of independence in extremely elderly people with a hip fracture. Objective: To study functional outcomes and mortality after osteosynthesis of hip fractures in very old patients in our clinic. Patients and methods: Hospital charts of all patients over 90 years old who were operated for a hip fracture between January 2007 and December 2011 were reviewed. Outcome measures were mortality, preoperative and postoperative mobility, and loss of independence. Results: A total of 149 patients were included; 132 (89%) women, median age 93.5±2.45 years. Thirty-six (24%) patients were classified as American Society of Anesthesiologists (ASA) grade 2, 104 (70%) as ASA grade 3, and nine (6%) as ASA grade 4. The Charlson comorbidity index (CCI) score was 2 or less in 115 (77%) patients and 34 (23%) patients scored 3 or more points. Short-term survival was 91% and 77% at 30 days and 3 months, respectively. Long-term survival was 64%, 42%, and 18% at 1, 3, and 5 years after surgery, respectively. Survival was significantly better in patients with lower ASA scores (P=0.005). No significant difference in survival was measured between patients according to CCI score (P=0.13). Fifty-one percent of patients had to be accommodated in an institution with more care following treatment, and 57% were less mobile after osteosynthesis of a hip fracture. Conclusion: Our study shows that short-term mortality rates in very elderly patients with a hip fracture are high and there is no clear predictive value for mortality. ASA classification is the best predictive value for overall mortality. A large proportion of these patients lost their independence after osteosynthesis of a hip fracture.
European Journal of Trauma and Emergency Surgery
World Journal of Emergency Surgery
Background: Multiple rib fractures are common injuries in both the young and elderly. Rib fractur... more Background: Multiple rib fractures are common injuries in both the young and elderly. Rib fractures account for 10% of all trauma admissions and are seen in up to 39% of patients after thoracic trauma. With morbidity and mortality rates increasing with the number of rib fractures as well as poor quality of life at long-term follow-up, multiple rib fractures pose a serious health hazard. Operative fixation of flail chest is beneficial over nonoperative treatment regarding, among others, pneumonia and both intensive care unit (ICU) and hospital length of stay. With no high-quality evidence on the effects of multiple simple rib fracture treatment, the optimal treatment modality remains unknown. This study sets out to investigate outcome of operative fixation versus nonoperative treatment of multiple simple rib fractures. Methods: The proposed study is a multicenter randomized controlled trial. Patients will be eligible if they have three or more multiple simple rib fractures of which at least one is dislocated over one shaft width or with unbearable pain (visual analog scale (VAS) or numeric rating scale (NRS) > 6). Patients in the intervention group will be treated with open reduction and internal fixation. Pre-and postoperative care equals treatment in the control group. The control group will receive nonoperative treatment, consisting of pain management, bronchodilator inhalers, oxygen support or mechanical ventilation if needed, and pulmonary physical therapy. The primary outcome measure will be occurrence of pneumonia within 30 days after trauma. Secondary outcome measures are the need and duration of mechanical ventilation, thoracic pain and analgesics use, (recovery of) pulmonary function, hospital and ICU length of stay, thoracic injury-related and surgery-related complications and mortality, secondary interventions, quality of life, and cost-effectiveness comprising health care consumption and productivity loss. Follow-up visits will be standardized and daily during hospital admission, at 14 days and 1, 3, 6, and 12 months. Discussion: With favorable results in flail chest patients, operative treatment may also be beneficial in patients with multiple simple rib fractures. The FixCon trial will be the first study to compare clinical, functional, and economic outcome between operative fixation and nonoperative treatment for multiple simple rib fractures.
BMC Emergency Medicine
Background: Rib fractures are common in ageing people after trauma and delirium is a complication... more Background: Rib fractures are common in ageing people after trauma and delirium is a complication often seen in acutely hospitalized elderly patients. For both conditions, elderly have an increased risk for institutionalization, morbidity, and mortality. This study is the first to investigate risk factors of delirium in elderly patients with rib fractures after trauma. Methods: A retrospective chart review was performed on patients ≥65 years admitted with rib fractures after blunt chest wall trauma to the Amphia hospital Breda, the Netherlands, between July 2013 and June 2018. Baseline patient, trauma-and treatment-related characteristics were identified. The main objectives were identification of risk factors of delirium and investigation of the effect of delirium on outcomes after rib fractures. Outcomes were additional complications, length of hospital stay, need for institutionalization and mortality within six months. Results: Forty-seven (24.6%) of 191 patients developed a delirium. Independent risk factors for delirium were increased age, physical impairment (lower KATZ-ADL score), nutritional impairment (higher SNAQ score) and the need for a urinary catheter, with odds ratios of 1.07, 0.78, 1.53 and 8.53 respectively. Overall, more complications were observed in patients with delirium. Median ICU and hospital length of stay were 4 and 7 days respectively, of which the latter was significantly longer for delirious patients (p < 0.001). Significantly more patients with delirium were discharged to a nursing home or rehabilitation institution (p < 0.001). The 6-month mortality in delirious patients was nearly twice as high as in non-delirious patients; however, differences did not reach statistical significance. Conclusion: Delirium in elderly patients with rib fractures is a serious and common complication, with a longer hospital stay and a higher risk of institutionalization as a consequence. Increased awareness for delirium is imperative, most importantly in older patients, in physically or nutritionally impaired patients and in patients in need of a urinary catheter.
BMJ Open
IntroductionThe Emergency Management of Severe Burns (EMSB) referral criteria have been implement... more IntroductionThe Emergency Management of Severe Burns (EMSB) referral criteria have been implemented for optimal triaging of burn patients. Admission to a burn centre is indicated for patients with severe burns or with specific characteristics like older age or comorbidities. Patients not meeting these criteria can also be treated in a hospital without burn centre. Limited information is available about the organisation of care and referral of these patients. The aims of this study are to determine the burn injury characteristics, treatment (costs), quality of life and scar quality of burn patients admitted to a hospital without dedicated burn centre. These data will subsequently be compared with data from patients with<10% total bodysurface area (TBSA) burned who are admitted (or secondarily referred) to a burn centre. If admissions were in agreement with the EMSB, referral criteria will also be determined.Methods and analysisIn this multicentre, prospective, observational study ...
JAMA, Dec 26, 2017
Following clean (class I, not contaminated) surgical procedures, the rate of surgical site infect... more Following clean (class I, not contaminated) surgical procedures, the rate of surgical site infection (SSI) should be less than approximately 2%. However, an infection rate of 12.2% has been reported following removal of orthopedic implants used for treatment of fractures below the knee. To evaluate the effect of a single dose of preoperative antibiotic prophylaxis on the incidence of SSIs following removal of orthopedic implants used for treatment of fractures below the knee. Multicenter, double-blind, randomized clinical trial including 500 patients aged 18 to 75 years with previous surgical treatment for fractures below the knee who were undergoing removal of orthopedic implants from 19 hospitals (17 teaching and 2 academic) in the Netherlands (November 2014-September 2016), with a follow-up of 6 months (final follow-up, March 28, 2017). Exclusion criteria were an active infection or fistula, antibiotic treatment, reimplantation of osteosynthesis material in the same session, alle...
Nederlands Tijdschrift voor Traumatologie
ABSTRACT Proximale femurfracturen hebben in Nederland een hoge incidentie. De operatieve behandel... more ABSTRACT Proximale femurfracturen hebben in Nederland een hoge incidentie. De operatieve behandeling kan bestaan uit stabilisatie van de fractuur met een DHS. Als mogelijke complicatie van deze ingreep kan er een bloeding ontstaan uit de arteria femoralis profunda, enerzijds door het peroperatief ‘doorschieten’ van de boor bij het opboren van de corticalisschroeven, anderzijds doordat de gebruikte schroeven te lang zijn. Deze potentieel ernstige complicatie kan worden voorkomen door met grote voorzichtigheid te boren en door de juiste lengte van corticalisschroeven te kiezen. In dit artikel beschrijven wij twee patiënten bij wie zich deze complicatie pas na enkele dagen presenteerde. Deze late presentatie is vaak kenmerkend voor deze complicatie, en er moet bij klachten van de patiënt aan worden gedacht.
Clinical Interventions in Aging
Background: Delirium in hip fractured patients is a frequent complication. Dementia is an importa... more Background: Delirium in hip fractured patients is a frequent complication. Dementia is an important risk factor for delirium and is common in frail elderly. This study aimed to extend the previous knowledge on risk factors for delirium and the consequences. Special attention was given to patients with dementia and delirium. Methods: This is a retrospective cohort study performed in the Amphia Hospital, Breda, the Netherlands. A full electronic patient file system (Hyperspace Version IU4: Epic, Inc., Verona, WI, USA) was used to assess data between January 2014 and September 2015. All patients presented were aged 70 years with a hip fracture, who underwent surgery with osteosynthesis or arthroplasty. Patients were excluded in case of a pathological or a periprosthetic hip fracture, multiple traumatic injuries, and high-energy trauma. Patient and surgical characteristics were documented. Postoperative outcomes were noted. Delirium was screened using Delirium Observation Screening Scale and dementia was assessed from medical notes. Results: Of a total of 566 included patients, 75% were females. The median age was 84 years (interquartile range: 9). Delirium was observed in 35%. Significant risk factors for delirium were a high American Society of Anesthesiology score, delirium in medical history, functional dependency, preoperative institutionalization, low hemoglobin level, and high amount of blood transfusion. Delirium was correlated with a longer hospital stay (P=0.001), increased association with complications (P0.001), institutionalization (P0.001), and 6-month mortality (P0.001). Patients with dementia (N=168) had a higher delirium rate (57.7%, P0.001) but a shorter hospital stay (P0.001). There was no significant difference in the 6-month mortality between delirious patients with (34.0%) and without dementia (26.3%). Conclusion: Elderly patients with a hip fracture are vulnerable for delirium, especially when the patient has dementia. Patients who underwent an episode of delirium were at increased risk for adverse outcomes.
Nederlands Tijdschrift Voor Traumatologie, Apr 1, 2009
Nederlands tijdschrift voor geneeskunde, Jan 28, 1998
In three women aged 51, 37 and 58 years, with a palpable tumour in the breast, excision and patho... more In three women aged 51, 37 and 58 years, with a palpable tumour in the breast, excision and pathological examination led to the diagnosis of 'phyllodes tumour'. During 3-5 years after radical excision, in one patient followed by radiotherapy, no recurrences were seen. This rare breast tumour with a variable clinical course usually affects women between the ages of 30 and 50. There is often a large tumour and (or) rapid growth. Mammography and ultrasound are unhelpful diagnostically. Cytology is unreliable as the tumour is heterogeneous. Histologically the tumour can be benign, borderline malignant or malignant. Surgical excision with a margin of > or = 1 cm is the therapy of choice. The risk of recurrence after insufficient excision is considerable and histological deterioration can occur. Multiple samples, examination of resection margins and investigation into atypia, mitotic activity and stromal overgrowth are essential for making a prognosis and a treatment plan. In c...
BMC surgery, Jan 6, 2015
In the Netherlands about 18,000 procedures with implant removal are performed annually following ... more In the Netherlands about 18,000 procedures with implant removal are performed annually following open or closed reduction and fixation of fractures, of which 30-80% concern the foot, ankle and lower leg region. For clean surgical procedures, the rate of postoperative wound infections (POWI) should be less than ~2%. However, rates of 10-12% following implant removal have been reported, specifically after foot, ankle and lower leg fractures. Currently, surgeons individually decide if antibiotics prophylaxis is given, since no guideline exists. This leads to undesirable practice variation. The aim of the study is to assess the (cost-)effectiveness of a single intravenous gift of Cefazolin prior to implant removal following surgical fixation of foot, ankle and/or lower leg fractures. This is a double-blind randomized controlled trial in patients scheduled for implant removal following a foot, ankle or lower leg fracture. Primary outcome is a POWI within 30 days after implant removal. Se...
Vascular Disease Management
Nederlands Tijdschrift voor Traumatologie, 2009
... Page 4. 47 Ned Tijdschr Traum 2009 - nr 2 4 Anderson LD, D'Alonzo RT. ... 3 Donovan DJ, ... more ... Page 4. 47 Ned Tijdschr Traum 2009 - nr 2 4 Anderson LD, D'Alonzo RT. ... 3 Donovan DJ, Huynh TV, Purdom EB, ea Osteoradionecrosis of the cervical spine resulting from radiotherapy for primary head and neck malignancies: operative and nonoperative manage-ment. ...
Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology, 2014
Over 75 % of patients presenting with a proximal humerus fracture are 70 years or older. Very lit... more Over 75 % of patients presenting with a proximal humerus fracture are 70 years or older. Very little is known about the outcome after operative treatment of these fractures in very old patients. This study was performed to gain more insight in safety and functional outcome of surgical treatment of proximal humerus fractures in the elderly. In this observational study, we analyzed all operatively treated patients, aged 75 or older, with a proximal humerus fracture between January 2003 and December 2008 in our center. Patient selection was on clinical grounds, based on physical, mental, and social criteria. Complications were evaluated. We used the DASH Questionnaire to investigate functional outcome, pain, and ADL limitations. Sixty-four patients were treated surgically for a displaced proximal fracture of the humerus: 15 two-part, 32 three-part, and 17 four-part fractures. Mean DASH scores were 37.5, 36.9, and 48.6, respectively. Regarding the operative methods, overall good results...
Nederlands Tijdschrift voor Traumatologie, 2010
ABSTRACT In deze retrospectieve studie zijn de resultaten geëvalueerd van de eerste drie jaar chi... more ABSTRACT In deze retrospectieve studie zijn de resultaten geëvalueerd van de eerste drie jaar chirurgische behandeling van proximale humerusfracturen met een hoekstabiele plaatosteosynthese. Tussen 2004 en 2006 werden 40 opeenvolgende patiënten behandeld met een hoekstabiele plaatosteosynthese; 28 patiënten konden worden getraceerd en onderzocht. Evaluatie vond plaats gemiddeld veertig maanden postoperatief. De gemiddelde consolidatietijd was drie maanden. Op de röntgenfoto werd bij drie schouders een avasculaire necrose van de schouderkop gezien, in twee gevallen partieel en in één geval volledig. Bij twee patiënten liet de röntgenfoto protrusie van schroeven door het caput zien. Er werden geen plaatbreuken of secundaire standsafwijkingen waargenomen. De gemiddelde constant-score van de geopereerde arm was 80, de score van de andere arm 95. Zes patiënten werden nogmaals geopereerd in verband met klachten van het osteosynthesemateriaal. Fixatie met hoekstabiele plaatosteosynthese is een goede operatieve behandeling van proximale humerusfracturen. Patiënten kunnen snel mobiliseren, de schouderfunctie op de middellange termijn is goed en de radiologische union-rate is hoog. Het risico op complicaties is klein.
Nederlands Tijdschrift voor Traumatologie, 2013
ABSTRACT Humerusschachtfracturen hebben een lage incidentie en beslaan 1-2% van alle fracturen. D... more ABSTRACT Humerusschachtfracturen hebben een lage incidentie en beslaan 1-2% van alle fracturen. De kans op deze fractuur neemt toe vanaf het 50e levensjaar. Humerusschachtfracturen worden enerzijds veroorzaakt door buiging van of stoot tegen de humerus of ten gevolge van een val op de arm met uitgestrekte elleboog of hand, anderzijds kunnen ook stressfracturen van de humerus ontstaan door repeterende bewegingen of door sterke spiercontracties, zoals bij roeien, speerwerpen en honkbal. Dit zijn vaak spiraalfracturen en die bevinden zich meestal in het distale gedeelte van de humerus. ‘Armpje drukken’ is een sport die veelvuldig op recreatief maar ook op wedstrijdniveau beoefend wordt. Behalve humerusschachtfracturen zijn ook een subscapularis- en proximale bicepspeesruptuur, een tuberculum minusfractuur, avulsiefractuur van de mediale epicondyl, anterieure dislocatie van de elleboog en een olecranonfractuur beschreven als gevolg van armpje drukken. Humerusschachtfracturen ten gevolge van armpje drukken kunnen gepaard gaan met neurovasculair letsel als gevolg van het trauma of de operatie. In de literatuur wordt bij 10-23% van de patiënten zenuwletsel beschreven. De behandeling kan conservatief zijn door middel van een bovenarmgips of sling, of operatief via open reductie en interne fixatie met plaat-schroefosteosynthese of een intramedullaire pen. Wij presenteren drie patiënten met een distale humerusschachtfractuur als gevolg van een wedstrijd armpje drukken. Behalve de biomechanische analyse en de betrokken spiergroepen bespreken we ook de tactiek: Is de aanval de beste verdediging?
Journal of Trauma Management & Outcomes, 2012
Background: The aim of this survey study was to evaluate the current opinion and practice of trau... more Background: The aim of this survey study was to evaluate the current opinion and practice of trauma and orthopaedic surgeons in the Netherlands in the removal of implants after fracture healing. Methods: A web-based questionnaire consisting of 44 items was sent to all active members of the Dutch Trauma Society and Dutch Orthopaedic Trauma Society to determine their habits and opinions about implant removal. Results: Though implant removal is not routinely done in the Netherlands, 89% of the Dutch surgeons agreed that implant removal is a good option in case of pain or functional deficits. Also infection of the implant or bone is one of the main reasons for removing the implant (> 90%), while making money was a motivation for only 1% of the respondents. In case of younger patients (< 40 years of age) only 34% of the surgeons agreed that metal implants should always be removed in this category. Orthopaedic surgeons are more conservative and differ in their opinion about this subject compared to general trauma surgeons (p = 0.002). Though the far majority removes elastic nails in children (95%). Most of the participants (56%) did not agree that leaving implants in is associated with an increased risk of fractures, infections, allergy or malignancy. Yet in case of the risk of fractures, residents all agreed to this statement (100%) whereas staff specialists disagreed for 71% (p < 0.001). According to 62% of the surgeons titanium plates are more difficult to remove than stainless steel, but 47% did not consider them safer to leave in situ compared to stainless steel. The most mentioned postoperative complications were wound infection (37%), unpleasant scarring (24%) and postoperative hemorraghe (19%). Conclusion: This survey indicates that there is no general opinion about implant removal after fracture healing with a lack of policy guidelines in the Netherlands. In case of symptomatic patients a majority of the surgeons removes the implant, but this is not standard practice for every surgeon.
European Journal of Trauma and Emergency Surgery, 2011
European Journal of Trauma and Emergency Surgery, 2009
ABSTRACT Right-sided diaphragm rupture is one of the typical injuries found during a secondary or... more ABSTRACT Right-sided diaphragm rupture is one of the typical injuries found during a secondary or tertiary survey after a major blunt trauma. This is mainly due to the apparently normal aspect of primary X-rays of the thorax. A right-sided diaphragm rupture can cause severe atelectasis of the right lower lobe of the lung, due to a hepatothorax. We present a case of a delayed diagnosis of right-sided diaphragm rupture, which was discovered by accident because of a new trauma. We review the literature on right-sided diaphragm rupture and its treatment.
European Journal of Trauma and Emergency Surgery, 2009
A pseudoaneurysm following a shoulder dislocation is considered rare. We report here a case of an... more A pseudoaneurysm following a shoulder dislocation is considered rare. We report here a case of an 82-yearold man who suffered from vascular and neurological injury due to an axillary pseudoaneurysm following anterior dislocation of the left shoulder. An emerging swelling in the shoulder region was caused by a hematoma and a slowly bleeding pseudoaneurysm in combination with reactive swelling of the soft tissues. Neurological damage occurred due to local compression. A minimally invasive technique was used to treat the pseudoaneurysm. Embolization was initially attempted, but this treatment failed. A stent was subsequently inserted to eliminate the axillary pseudoaneurysm from the circulation. Early imaging and an aggressive endovascular treatment should be considered in all patients suffering from an axillary artery (pseudo)aneurysm.
Clinical Interventions in Aging, 2013
Background: Hip fractures in the elderly population are associated with high morbidity and mortal... more Background: Hip fractures in the elderly population are associated with high morbidity and mortality. However, there is still a lack of information on mortality and loss of independence in extremely elderly people with a hip fracture. Objective: To study functional outcomes and mortality after osteosynthesis of hip fractures in very old patients in our clinic. Patients and methods: Hospital charts of all patients over 90 years old who were operated for a hip fracture between January 2007 and December 2011 were reviewed. Outcome measures were mortality, preoperative and postoperative mobility, and loss of independence. Results: A total of 149 patients were included; 132 (89%) women, median age 93.5±2.45 years. Thirty-six (24%) patients were classified as American Society of Anesthesiologists (ASA) grade 2, 104 (70%) as ASA grade 3, and nine (6%) as ASA grade 4. The Charlson comorbidity index (CCI) score was 2 or less in 115 (77%) patients and 34 (23%) patients scored 3 or more points. Short-term survival was 91% and 77% at 30 days and 3 months, respectively. Long-term survival was 64%, 42%, and 18% at 1, 3, and 5 years after surgery, respectively. Survival was significantly better in patients with lower ASA scores (P=0.005). No significant difference in survival was measured between patients according to CCI score (P=0.13). Fifty-one percent of patients had to be accommodated in an institution with more care following treatment, and 57% were less mobile after osteosynthesis of a hip fracture. Conclusion: Our study shows that short-term mortality rates in very elderly patients with a hip fracture are high and there is no clear predictive value for mortality. ASA classification is the best predictive value for overall mortality. A large proportion of these patients lost their independence after osteosynthesis of a hip fracture.