Background

On 22 July 2011 Norway was subjected to two terrorist attacks by a right-wing extremist. The first attack was an explosion from a car bomb against the Government Building (GB) in Oslo. The second attack occurred less than two hours later at a summer camp on the island Utøya, outside Oslo, where 600–700 young members of the Labour Party hold their annual summer camp. The car bomb killed 8 people and 69 persons were shot and killed at Utøya. All seriously injured patients came to Oslo University Hospital, Ullevål (OUH).

Introduction

Many patients with displaced intracapsular femoral neck fractures (IFNF) are treated with hemiarthroplasty (HA) which has been shown superior to internal fixation(IF) the first year after injury. Long term results, however, are sparse.

Background: Increased intramedullary pressure in the femoral cavity causes intravasation of bone marrow content to the circulation which may lead to occlusion of pulmonary vessels and cardiorespiratory dysfunction. A one-step reamer-irrigator-aspirator (RIA) technique has been developed to reduce the intramedullary pressure (IMP) during the reaming procedure.

Material and method: In a randomized study in 19 Nor-wegian landrace pigs reamed intramedullary nailing was performed with two different reamer devices. Nine animals were operated with a traditional reamer and ten animals with RIA. One animal in the RIA group was excluded due to a perioperative femoral fracture, and three animals in the traditional group due to a perforation of the distal medial femoral cortex. The intramedullary pressure was registrated with a transducer-tipped pressure monitoring catheter during reaming.

Results: The highest intramedullary pressure during reaming was mean 33 mm Hg in the RIA group and 188 mm Hg in the traditional reamer group. This difference was significant (P < 0.05). Intramedullary pressures recorded before surgery, at the opening of the femoral cavity with an awl, by insertion of a guide wire, at insertion of the intramedullary nail, and ten minutes after nail insertion showed no significant differences between the groups.

Conclusion: The use of a one-step reamer-irrigator-aspirator technique in the pig femur induced less intramedullary pressure increase than the use of a traditional reamer.

Objective: To assess the impact of EPP on physiological parameters in hemodynamically unstable patients with blunt pelvic trauma.

Methods: Of 661 patients treated for pelvic trauma, 18 consecutive patients in shock underwent EPP with the intent to control massive pelvic bleeding. These patients constituted the study population. Data collected from the medical records and the Ullev̊l Trauma Registry included: demographics, fracture classification, additional injuries, blood transfusions, surgical interventions, angiographic procedure, physiological parameters and outcome. An association between continuous variables was calculated using the Spearman correlation coefficient. A comparison between means was calculated using the t-test.

Results: Mean patient age was 44 years (range 16–80). ISS 47 (9–66). 39 % had non-measurable blood pressure at admission. Survival rate within 30 days was 72% (13/18) and correlated inversely to the age of the patient (p=0.038). Only one non-survivor died of exsanguination from multiple bleeding foci. A significant increase in systolic blood pressure (p=0.002) and hemoglobin count (p=0.012) was observed immediately after EPP. Arterial injury was observed in 80% of patients who underwent angiography after EPP.

Conclusions: 30-day survival rate after EPP was 72 %. A significant increase in systolic blood pressure and hemoglobin count was observed immediately after EPP, indicating that EPP as part of a multi-interventional resuscitation protocol may be life-saving in patients with exsanguinating pelvic injury. However, the high rate of arterial injuries seen after EPP indicates that the procedure should be supplemented with angiography once the patient is stabilized for transfer to the angiography suite.

Aims: To describe the clinical characteristics, radiological classiþcation and management of 30 patients with severe pelvic injuries necessitating arterial embolization due to uncontrollable haemorrhage. Patients and methods: A prospective registration of patients admitted to our Level I- trauma hospital with pelvic fractures during a six year- period (1996-2002). Annually 168 patients had pelvic and acetabular fractures. The study group constituted of thirty of these patients where uncontrollable haemorrhage necessitated angiographic embolization of intrapelvic arteries. Results: 21 of the patients were male, on average 36 years old. All patients were subjected to high-energy traumas. Four had open pelvic fractures. One patient died in the initial phase due to multiple injuries. Average ISS score was 43,7. All patients had additional injuries, 50% were multitraumatized. Isolated sacral and acetabular fractures occurred in 5, the rest had pelvic ring injuries, 14 type B- and 11 type C-fractures. Deþnitive orthopaedic treatment was performed in 20 patients. There was a delay of 9 hours from admittance to embolization. Patients received 6,8 units prior to arrival at our unit, 15,4 units prior to embolization, 2 units 24-hours after embolization and 17,0 units from embolization to discharge. A total of 33, 9 units of erytrocytes was transfused at our unit. Time in angiography laboratory was 138 minutes. Branches of the internal iliac artery were affected in 28 patients, the superior gluteal artery being most frequently injured. Embolization was not effective in achieving haemostasis in 3. Conclusions: Pelvic fractures necessitating embolization due to uncontrollable haemorrhage are a result of high energy injuries and associated injuries are common. Arterial injuries associated with unstable pelvic haemorrhage are often due to injuries to branches of the internal iliac artery and early percutaneous embolization of these branches seems to control bleeding effectively.

Aims: The complications and functional long time results after glenohumeral arthrodesis are described. Methods: 22 patients (9 men, 13 women) with a median age of 64 (19 – 75) years were operated with a glenohumoral arthrodesis between 1982 and 2000. The indications for surgery were fracture sequelae (11), severe osteoarthritis (4), deltoid dysfunction (3), failed revision arthroplasty (1), chronic posterior dislocation (1), tuberculosis (1) and gunshot wound (1). Standard AO surgical technique with stable plating was used. 6 patients are dead and 1 refused examination. The remaining 15 patients were examined retrospectively after a mean of 7.8 years. The American Shoulder and Elbow Surgeons (ASES) score and Oxford score were registered and radiographs taken. Results: 8 patients had intermittent or continuous pain with a mean pain score (VAS) of 1.5 (0–8). 1 patient was reoperated after 4 months due to excessive pain and one was operated due to a humeral shaft fracture after 8 months. The implants had been removed in 5 patients and 1 had a lateral clavicle resection after 3 years. No patients had infections, but 1 had reflex sympathetic dystrophy. Radiologically all but two arthrodesis fused, the remaining 2 were painfree. Mean Oxford score was 33 (20 – 49), mean ASES score was 59 (15 – 95). Conclusions: The functional results after glenohumeral arthrodesis are comparable with results reported after shoulder arthroplasty. The he arthrodesis has a wide range of indications and the long time complications related to shoulder prosthesis may be avoided.